Purpose: The goal of this multicenter prospective clinical trial was to compare clinical outcome and post-treatment care and patient satisfaction with different implant systems used for mandibular overdenture treatment during a 6-year follow-up period. Patients and Methods: A total of 87 edentulous patients with a severely resorbed mandible (bone height, 8 to 15 mm) received treatment involving either 2 Intra Mobiele Zylinder implants (IMZ group, n = 41) (Friedrichsfeld AG, Mannheim, Germany), 2 Brånemark implants (Brå group, n = 17) (Nobel Biocare AB, Gothenburg, Sweden) or a Transmandibular Implant (TMI; Krijnen Medical, Beesd, The Netherlands) (TMI group, n = 29). The evaluation involved clinical parameters, radiographs, surgical and prosthetic post-treatment care, clinical implant performance (CIP scale), and patient satisfaction. Results: After 6 years, there was a significant difference in the mean plaque index: the mean plaque index of the TMI group was significantly higher than that of the IMZ and Brå groups. Other clinical parameters showed no significant differences. The implant survival rate of 97.5% was noted in the IMZ group, 97.1% in the Brå group, and 72.0% in the TMI group. The CIP scale were significantly worse for the TMI group. Conclusion: It was concluded that the IMZ and the Brånemark implant systems have a better survival rate and clinical implant performance than the TMI system. Based on these data, these systems should be the choice for the edentulous mandible with a height between 8 and 15 mm. © 2001 American Association of Oral and Maxillofacial Surgeons.