Objectives: The aims of this retrospective study were to evaluate the survival rate of a series of immediate implants after 3 years of follow-up and to study the relationship between survival and indication for tooth extraction. Study design: A retrospective study of patients treated with immediate implants between January 2003 and Dec - ember 2008 was carried out. All patients receiving at least one post-extraction implant and a minimum follow-up of 5 years were included. Results: After 60 months, 30 immediate implants had been lost in 17 patients, yielding a total implant success rate of 93.8%. None of the implants placed failed after the extraction of included canines (100% success rate). In 20 failed implants the reason for extraction had been severe periodontal disease (91.8% SR), in 4 endodontic failure (88.6%SR), in 3 unrestorable caries (95.9% SR), in 1 untreatable fracture (95.2% SR) and in 2 improvement of prosthetic design (98.1% SR). No statistically significant influence was found between immediate implant failure and the reason for tooth extraction ( p =0.11). Conclusions: The use of immediate implants is a successful alternative to replace missing teeth for severe perio - dontal disease, periapical pathology or by decay or untreatable fractures. Some reasons, such as periodontal disease itself is associated with a success rate significantly below the overall average. Similarly, the prosthetic design is associated with a better prognosis than all other reasons.