The purpose of this clinical study was to compare peri-implant crestal bone levels between misfitting (overhanging/open margin) cement-retained implant single crowns (SCs) vs accurately fitted implant SCs. Seventeen subjects were divided into two groups: test group (misfitting crowns, n = 10) and control group (accurately fitted crowns, n = 7). Crestal bone level changes were assessed using digital software. The average differences in mean bone loss within and between the two groups were statistically significant. Cement-retained implant SCs with marginal misfit resulted in more crestal bone loss than accurately fitted crowns after a mean of 3 years in function.