Purpose: This study was conducted to evaluate the influence of fluoride-treated, titanium dioxide grit-blasted implant surfaces on marginal bone levels through radiography at 3 years after functional loading and to determine whether a correlation exists between primary stability and marginal bone levels of implants. Materials and Methods: Edentulous patients who sought two-implant-retained mandibular overdentures and were available for follow-up were included. Each patient received two implants in the mandible; one implant received fluoride treatment and the other did not. To determine primary stability of the dental implants, resonance frequency analysis was performed at the time of implant placement. Panoramic radiographs were obtained preoperatively, at the time of overdenture connection, and at 6-month and 1- , 2-, and 3-year follow-up examinations. Results: Fifty-two edentulous patients with a mean age of 58 years (range, 40 to 70 years) were enrolled. All implants survived the observation period. No statistically significant differences were observed in the marginal bone levels of implants with and without fluoride treatment at 6 months and 1, 2, and 3 years (P > .05). No significant relationship was found between marginal bone levels and the recorded resonance frequency analysis values of the implants. Conclusions: Fluoride treatment of titanium dioxide grit-blasted implants was not effective in preventing marginal bone loss, and primary stability did not affect marginal bone loss around implants placed in anterior mandibles. Keywords: dental implant surface, fluoride treatment, grit blasting, marginal bone loss, resonance frequency analysis, titanium dioxide grit blasting