Purpose: The aim of the present study was to analyze the possible impact of clinical status, presence and severity of inflammation, and loading on nitric oxide (NO) metabolism around mandibular dental implants. Materials and Methods: A total of 34 implants in 17 patients, loaded either early (EL) or after a delay (DL), were classified according to the presence and severity of clinical inflammation in the peri-implant sites. Clinical parameters were recorded, peri-implant sulcular fluid (PISF) samples were obtained, and PISF nitrite levels were spectrophotometrically determined. Clinical measurements and nitrite analysis were repeated at 1, 3, 6, and 9 months postloading at available sites. Results: Compared to noninflamed sites, inflamed sites demonstrated higher mean total nitrite levels (P = .032) that tended to increase with the severity of inflammation at both EL and DL implants. At noninflamed sites, EL implants provided significantly higher PISF volume than DL implants (P = .001). At noninflamed sites, EL implants revealed higher total nitrite levels; on the contrary, at inflamed sites, DL implants revealed higher total nitrite levels. In general, nitrite levels demonstrated a pattern of decrease followed by an increase during follow-up. Discussion: Increased NO production with the presence and the severity of inflammation supports the contribution of NO in the peri-implant inflammatory process. Loading is also likely to have an impact on NO metabolism, which suggests a role for NO in remodeling and adaptation of bone around dental implants. Conclusion: Besides the presence of inflammation, the severity of inflammation and loading also seem to have an impact on NO metabolism around dental implants. (50 references)