Purpose: The purpose of this study was to retrospectively compare long-term outcomes for immediately loaded tilted and axial implants placed in the posterior region of the edentulous maxillary arch. Materials and Methods: Data obtained from a 5-year prospective study designed to assess clinical outcomes following immediate loading of implants with screw-retained fixed restorations in the edentulous maxillary arch were retrospectively reviewed. Where insufficient alveolar bone was available for axial placement of the posteriormost implant on each side of the arch, tilted placement was employed. Implant survival and marginal bone level changes for these tilted and axial posterior implants were compared. Results: Fifty-one subjects received 64 tilted and 38 axial posterior implants. Forty subjects with 53 tilted and 34 axial posterior implants returned for follow-up after 5 years. Five tilted and seven axial implants failed, representing an 89% and 86% survival proportion, respectively. The mean marginal bone loss was 0.79 (SD: 1.42) mm for tilted implants and 0.14 (SD: 0.34) mm for axial implants. The differences in survival proportions and marginal bone loss between axial and tilted implants were not statistically significant. Conclusion: Predictable long-term implant rehabilitation may be achieved in the edentulous maxillary arch using posterior tilted implants in combination with immediate loading. Keywords: dental arch, dental implants, immediate dental implant loading, maxilla