Purpose: This study evaluated the effect of the level of the prosthetic construction on the marginal bone stability around extra-short implants (≤ 6.5 mm in length) supporting a fixed prosthesis. Materials and Methods: This retrospective study was performed at a private dental clinic. The patient charts were reviewed to select those who had an extra-short implant (≤ 6.5 mm in length) supporting a fixed prosthesis. A transmucosal abutment (transepithelial Multi-Im, BTI Biotechnology Institute) was used in those implants that were restored at the gingival level. Otherwise, the implants were restored at the platform level. Demographic data and implant-related and prosthesis-related variables were obtained. Results: Thirty-three extra-short implants in 17 patients were assessed. The patients' mean age was 61 ± 12 years at the time of surgery. The prosthetic reconstruction was done at the platform level in 18 implants and at the gingival level (via transmucosal abutment) in 15 implants. Considering the use or not of a transmucosal abutment, there were no statistically significant differences in all studied variables except bone stability. The extra-short implants that were restored at the platform level experienced more crestal bone loss (P = .024). Conclusion: The extra-short implant restoration at the gingival level would increase the stability of the marginal bone. Keywords: dental prosthesis, fixed prosthesis, implant survival, marginal bone loss, short dental implants