A histological and ultrastructural study was carried out on the spongy bone response to smooth titanium oral implant surfaces. The samples obtained both from monkeys and from patients at various times from the implant insertion revealed that the bone-implant integration developed through different morphological aspects. The implant surface appeared in contact with medullary lacunae, as well as with osteoid tissue or directly with bone matrix. The complementary ultrastructural techniques employed have shown that the medullary lacunae appeared as wide and flattened cisternae delimited by a continuous single layer of flattened cells forming a thin lamina adhering to the implant and an endosteal lamina facing the bone surface. For their position and flattened shape we named them peri-implant medullary cisternae. The presence of blood vessels, reticular cells and myeloid cells in their lumen suggested that these peri-implant medullary cisternae were functional sites of new bone formation.