Purpose: To assess clinical performance of bar-retained implant overdentures (IOs) with distally placed ERA attachments on four implants, and patient satisfaction after a followup period of 5 years in a convenience selection of 15 patients. Materials and Methods: Bar-retained IOs with distally placed ERA attachments were placed and clinically monitored. Encountered complications during a 5-year follow-up period were recorded; and a modified OHIP-14 questionnaire was used to assess patient satisfaction. Results: Implant and restoration survival rates of 97.5% and 100%, respectively, were recorded. The most common maintenance requirement was the replacement of ERA retentive elements. A high degree of patient satisfaction was reported. Conclusions: The proposed IO design is a reliable clinical treatment protocol associated with a high degree of patient satisfaction and minor prosthetic complications.