The present study was conducted to investigate whether a different implant neck design could affect survival rate and peri-implant tissue health in a cohort of disease-free partially edentulous patients in the molar-premolar region. The investigation was conducted on 122 dental implants inserted in 97 patients divided into two groups: Group A (rough wide-neck implants) vs. Group B (rough reduced-neck implants). All patients were monitored through clinical and radiological checkups. Survival rate, probing depth, and marginal bone loss were assessed at 12- and 24-month follow-ups. Patients assigned to Group A received 59 implants, while patients assigned to Group B 63. Dental implants were placed by following a delayed loading protocol, and cemented metal-ceramic crowns were delivered to the patients. The survival rates for both Group A and B were acceptable and similar at the two-year follow-up (96.61% vs. 95.82%). Probing depth and marginal bone loss tended to increase over time ( : t = 12 vs. t = 24 months) in both groups of patients. Probing depth ( = 0.015) and bone loss ( = 0.001) were significantly lower in Group A (3.01 vs. 3.23 mm and .92 vs. 1.06 mm; Group A vs. Group B). Within the limitations of the present study, patients with rough wide-neck implants showed less marginal bone loss and minor probing depth, as compared to rough reduced-neck implants placed in the molar-premolar region. These results might be further replicated through longer-term trials, as well as comparisons between more collar configurations (e.g., straight vs. reduced vs. wide collars).