Purpose: In the present cohort study, overdentures with a combined root and implant support were evaluated and compared with either exclusively root- or implant-supported overdentures. Results of a 2-year follow-up period are reported, namely survival of implants, root copings, and prostheses, plus prosthetic complications, maintenance service, and patient satisfaction. Materials and Methods: Fourteen patients were selected for the combined overdenture therapy and were compared with 2 patient groups in which either roots or implants provided overdenture support. Altogether, 14, 17, and 15 patients (in groups 1, 2, and 3, respectively) were matched with regard to age, sex, treatment time, and observation period. The mean age was around 67 years. Periodontal parameters were recorded, radiographs were taken, and all complications and failures were registered during the entire observation time. The patients answered a 9-item questionnaire by means of a visual analogue scale (VAS). Results: One implant failed and 1 tooth root was removed following longitudinal root fracture. Periodontal/peri-implant parameters gave evidence of good oral hygiene for roots and implants, and slight crestal bone resorption was measured for both. Technical complications and service performed were significantly higher in the first year (P .04) in all 3 groups and significantly higher in the tooth root group (P .03). The results of the VAS indicated significantly lower scores for satisfaction, speaking ability, wearing comfort, and denture stability with combined or exclusive root support (P .05 and .02, respectively). Initial costs of overdentures with combined or root support were 10% lower than for implant overdentures. Conclusion: The concept of combined root and implant support can be integrated into treatment planning and overdenture design for patients with a highly reduced dentition