Purpose: The sequence of observations presented is intended to alert the dental profession to complications that may occur when teeth and implants co-exist and subtle adult craniofacial growth occurs. Materials and Methods: The authors' observations of partially edentulous implant restorations with more than 20 years of follow-up included some observed changes relative to patients' remaining teeth and jaw structures. These changes, which were not easily explained and appeared to be random deviations from expected implantrestorative stability, conformed with research findings of craniofacial growth continuing into adulthood. The authors identified several distinct areas in which such adult craniofacial growth could potentially influence the relationship of implant restorations to the remaining teeth and jaw structure. Results: Potential esthetic, occlusal, and periodontal ramifications of continued adult craniofacial growth were found to include changes in occlusion, opened contact as a result of teeth migration, and changes in anterior esthetic results. The latter may include labialization of the anterior implant restoration and a progressive discrepancy of the cervical gingival margin of the implant restoration relative to the adjacent teeth. Cases are presented showing poor sequellae of treatment due to growth occurring after the assumption was made that a stable jaw dimension had been reached. While continued adult craniofacial growth sufficient to cause clinical problems is not common, it is also presently not predictable. Conclusion: When changes in tooth position relative to implant restorations secondary to long-term adult growth occur, they can cause problems that are difficult or even impossible to correct. Future research will ideally enable identification of patients at risk for developing such problems. Keywords: implant, growth, esthetics, occlusion, maintenance, complication