The success of osseous healing around dental implants has allowed for an increased emphasis on soft tissue healing and esthetic results. However, there is limited information profiling the long-term healing of the soft tissues following prosthesis placement. The purpose of this study was to assess the long-term changes in the position of the facial soft tissue margins following restoration of a one-stage implant system. One hundred and six one-stage ITI implants were evaluated in 39 patients. Implants were placed in maxillary and mandibular anterior regions. Clinical assessment of the soft tissues on the midfacial aspect of the implants was performed over a 2-year period, at 3 and 6 month intervals, following placement of the final restoration. A total of 63 implants were placed as multiple units in the mandible, 23 as single units in the maxilla, and 20 as multiple units in the maxilla. There were no implant failures over this time period. Overall, on the facial aspect of 61% of the 106 implants there was 1 mm or more of soft tissue recession, whereas 19% of the implants showed 1 mm or more of gain in soft tissue height. There was a significantly (P < 0.01) greater number of implants showing a gain in soft tissue levels in the mandibular implants compared with the maxillary implants. Of the 39 patients assessed, 24 showed a loss and five showed a gain of 1 mm or more of the soft tissue levels around the implants. Overall, there was a significant decrease in the mean levels of tissue height of 0.6 mm within the first 6 months, with relatively little change afterward. However, in evaluating only patients showing a loss in tissue height around one or more implants, the mean loss in tissue height was 1.6 mm after 24 months. These results suggest that the potential for significant changes in soft tissue levels after completion of restorative therapy need to be considered for implant therapy in esthetic areas.