Sixty‐six ITI implants placed in the mandible of 33 edentulous elderly patients (mean age: 69 years) were observed longitudinally for 5 years. The implants served as overdenture anchorage either by means of a connecting bar or single spherical attachments. During the study period, 2 implants failed (one because of a peri‐implant lesion and one because of a fracture) and had to be removed. At the beginning of the study, all implants were osseointegrated and had successfully been in function for 335 months. Oral hygiene practices and the peri‐implant mucosal status were assessed according to the criteria of conventional periodontal parameters. Approximately 50% of the implants had been installed into lining mucosa and hence were to surrounded by keratinized mucosa. The peri‐implant mucosal tissue was maintained healthy during the whole observation period, and no or only minimal loss of attachment was observed. The probing depths averaged approximately 3 mm. At the end of the study, orthopantomographic radiographs were obtained from all patients to assess the peri‐implant bony structures. Small local angular bony defects were detected on 16 implants (22%) in 12 patients. Slightly increased probing depths were observed when angular bony defects were present. Loss of attachment was significantly less frequent when the implants had been placed following a prolonged period of edentulousness (<5 years). This study demonstrated that advanced age, reduced dexterity of elderly patients and environmental conditions of overdentures do not represent a 1 higher risk for the development of peri‐impl