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Purpose. To evaluate the 3-year clinical and radiographic outcomes of partially edentulous patients treated with immediately loaded tilted implants, combined with angulated screw channel (ASC) zirconia abutments. Materials and methods. Any patient requiring an implant-supported fixed dental prosthesis for the rehabilitation of the atrophic posterior maxilla and refusing guided bone reconstruction was considered eligible for this study. Two to three immediately loaded flapless implants, combined with immediately placed ASC abutments were placed for each patients. Six months after implant placement/loading a definitive prosthesis was placed. Outcomes were: prosthesis and implant failures, complications, and peri-implant bone level changes. Outcomes were recorded at implant placement/loading and yearly up to 3-year later. Results. Twenty-three anodized implants and ASC zirconia abutments were placed in 10 consecutive participants (mean age 57.2 years) with severe atrophy of the posterior maxilla, by using computer-guided template-assisted surgery. The mean follow-up period was 38.2 months. No patients dropped out. The prosthesis and implant cumulative survival rate was 100%. No biologic or technical complications were experienced during the entire follow-up. Mean marginal bone levels were 0.29±0.34 mm at implant placement and loading, 0.37±0.32 mm at the 1-year follow-up (difference 0.08±0.11 mm; p=0.002), 0.38±0.33 mm at the 2-year follow-up (difference between the 1- and 2-year follow-up 0.02±0.08 mm; p=0.295), and 0.50±0.42 mm at the 3-year follow-up (difference from implant place-ment 0.22±0.22 mm; p=0.000). Conclusions. Guided surgery and immediate loading of ASC zirconia abutment is an effective and reliable treatment option for the treatment of the partially edentulous posterior atrophic maxilla. Further RCT studies are needed to better understand the gold standard approach in such patients. [ABSTRACT FROM AUTHOR]