Purpose: The purpose of this study was to evaluate radiographic bone levels adjacent to implants placed in fresh extraction sockets (ESs) and immediately loaded with a fixed full-arch provisional restoration compared to bone levels adjacent to implants placed in native bone (NB) under the same restorative conditions. Materials and Methods: Patients with a hopeless maxillary and/or mandibular dentition had their remaining teeth extracted and 6 to 8 implants placed and restored within 72 hours. Radiographs were obtained at time 0, 3 to 6 months, and annually for 5 years. The radiographs were digitized, and the bone level changes were measured using a computer-assisted method. Results: A total of 139 implants, 42 ES and 97 NB, placed in 17 patients were evaluated. The overall results indicated that for all implants (ES + NB), 0.60 ± 0.71 mm of bone was lost after 6 months; 1.17 ± 0.59 mm of bone was lost after 18 months; 0.87 ± 0.76 mm bone was lost after 36 months; and 1.35 ± 0.42 mm of bone was lost after 60 months. When stratifying for NB versus ES implants, it was found that for NB implants, 0.75 ± 0.21 mm of bone was lost after 6 months; 1.31 ± 0.91 mm of bone was lost after 12 months; 1.07 ± 0.21 mm of bone was lost after 36 months; and 1.45 ± 0.49 mm of bone was lost after 54 months. For ES implants, 0.14 ± 0.33 mm of bone was lost after 6 months; 1.02 ± 0.27 mm of bone was lost after 12 months; 0.86 ± 0.42 mm of bone was lost after 36 months; and 1.30 ± 0.48 mm of bone was lost after 54 months. Conclusion: The combination of ES and NB implants can be immediately loaded with a fixed full-arch prosthesis and remain stable for greater than 5 years. The bone loss adjacent to these implants is similar to that seen surrounding those placed and restored using traditional protocols. Keywords: bone loss, dental implants, extraction sockets, immediate loading, immediate placement, radiographic analysis, radiographic bone levels