Peri-implant bone remodeling occurs in all osseointegrated implants and can be defined as an adaptive process of bone around the implant in response to functional loading. This retrospective study evaluated the marginal bone remodeling around dental implants with external hexagonal connections in function for more than 10 years. The sample consisted of 17 implants placed in the posterior region of the mandible to replace one or several teeth. For all cases, the initial periapical radiograph was assessed together with a subsequent follow-up periapical radiograph. Image analysis was performed using ImageJ software to establish the initial bone measurements and subsequent bone loss. The data were statistically analyzed using paired t test at a significance level of 5%. There was significant bone remodeling when the baseline and follow-up were compared (P .001). The mean values of peri-implant bone remodeling on the mesial aspect were 0.90 ± 0.63 mm vertically and 1.17 ± 0.60 mm horizontally. The distal aspect of the implants showed 1.01 ± 0.82 mm and 1.06 ± 0.75 mm of marginal bone remodeling vertically and horizontally, respectively. Within the limitations of this study, marginal bone remodeling was visible, and bone levels around the external hexagon implants remain stable after 10 years of function.