Purpose The aim of the present study was to evaluate whether there was a difference between machined and TiO2‐blasted implants regarding survival rate and marginal bone loss during a 5‐year observation period.Materials and Methods A total of 133 implants (Astra Tech Dental Implants; Astra Tech AB, Mölndal, Sweden) were placed in 50 patients at 6 centers in 4 Scandinavian countries. Forty‐eight implants were installed in the maxilla and 85 implants in the mandible. A randomization and a stratification were done, so that each fixed partial prosthesis was supported by at least 1 machined and 1 TiO2‐blasted implant. The implant‐supported fixed partial prostheses (ISFPP) were fabricated within 2 months after postoperative healing. A total of 52 ISFPP (17 maxillary, 35 mandibular) were inserted. The patients were clinically examined once a year for 5 years. At the annual follow‐up, biological as well as technical complications were recorded.Results Of the 133 implants placed, 3 were reported as failed after 5 years of follow‐up, resulting in an overall cumulative survival rate of 97.6%. The cumulative implant survival rates were 100% for the TiO2‐blasted implants and 95.1% for the machined implants. No significant difference in survival was, however, found between the machined and TiO2‐blasted implants after 5 years. The mean marginal bone loss in the maxilla was 0.21 ± 0.83 mm (SD) for the machined implants and 0.51 ± 1.11 mm (SD) for the TiO2‐blasted implants during the 5‐year observation period. In the mandible, the mean marginal loss was 0.22 ± 1.13 mm for the machined implants and 0.52 ± 1.07 mm for the TiO2‐blasted implants from baseline to the 5‐year examination. No significant difference in marginal bone loss between the 2 surface groups was found during the 5‐year observation period.Conclusions The present study shows good 5‐year results with small ISFPP in the mandible, as well as in the maxilla. No significant differences were found in failure rate and marginal bone loss around implants with a machined rather than a TiO2‐blasted surface.