Purpose: To compare the effectiveness of immediately loaded total prostheses supported by implants with a roughened surface versus implants with a machined/turned surface. Materials and methods: Fifty edentulous or to-be-rendered edentulous patients requiring an implant-supported cross-arch prosthesis, were randomised either to receive four to eight implants with a roughened surface (25 patients) or with a machined/turned surface (25 patients). Provisional metal-reinforced acrylic prostheses were delivered 48 h after implant placement. Provisional prostheses were replaced after 4 months, by definitive screw-retained metal-resin cross-arch restorations. Outcome measures were prosthesis and implant failures, any complications and peri-implant marginal bone level changes. Patients were followed 1 year after loading. Results: One year after loading no patient dropped out. No prosthesis failed, but two machined implants were found to be mobile at definitive impression taking in 1 patient (Fisher's exact test: P = 0.312; difference in proportions = 4%; 95% Cl: -10 to 18). No complications occurred. Both groups presented a significant peri-implant marginal bone loss at 1 year after loading (P 0.0001), -0.64 ± 0.20 mm for rough implants and -0.68 ± 0.23 mm for turned implants, respectively, with no statistically significant differences between the two groups (P = 0.482; mean difference = 0.04 mm; 95% Cl: -0.17 to 0.25). Conclusions: Up to 1 year after immediate loading, both implant surfaces provided good and similar results, however, the only two implants which failed early in the same patient had a machined surface. These preliminary results must be confirmed by larger trials with longer follow-ups. Keywords: full edentulism, immediately loaded machined dental implants, roughened dental implants