Objective : This study was established to compare the prevalence of peri-implant biological complications for edentulous patients receiving screw retained fixed restorations and telescopic removable prostheses.Material and Methods : This study was a randomized clinical trial (RCT), which used cone beam computed tomography imaging and flapless surgical technique to place four implants in each arch, and compare the peri-implant biological complications. Each patient received eight implants (four in each arch) and was restored at the end of the study with either a telescopic or a screw-retained prosthesis . The primary outcome was Crestal bone loss measured in ( mm) Using Digora digital imaging, and followed up at 6, 12 and 18 months from day of loading.Results: For the telescopic removable overdenture group, the day of loading compared to 6 months showed the lowest mean crestal bone loss value (0.27±0.19) .There was significant increase at p≤0.001.Day of loading compared to 18 months showed mean crestal bone loss value of (1.70±0.52) which significantly increased at p≤0.001.For the screw retained restoration group, the day of loading compared to 6 months showed the lowest mean crestal bone loss value (0.46±0.29) There was significant increase at p≤0.001. Day of loading compared to 18 months showed mean crestal bone loss value of (0.87±0.64) which was significantly increased at p≤0.001.Conclusions: The type of implant retained prosthesis installed for the patient is a crucial factor in the progression of peri-implant disease. The use of radiographic parameters is a meaningful evaluation of peri-implant disease.