Purpose: Immediate loading has become a widely reported practice in implant dentistry. The aim of this study is to report on the 10-year clinical and radiographic outcomes of an immediate-loading treatment protocol that included flapless surgery. Materials and Methods: Forty-six patients were treated with 97 immediately loaded Mk IV implants (Nobel Biocare) with machined surface in the maxilla. Presurgically, a three-dimensional model of each patient's soft tissue and underlying alveolar bone anatomy was created and a surgical template was fabricated. A circular mucotome was used to punch out a 5-mm hole in the mucosa to avoid flap elevation. Control examinations were performed on the day of surgery and at 1, 2, 3, 6, 8, and 10 years after surgery. Results: All prepared implant sites had intact buccal and lingual bone walls. The prefabricated provisional restorations showed excellent fit. Nine implants failed within 8 weeks of loading, resulting in a cumulative survival rate of 91% after 10 years of loading. The survival rates were 94% for implants supporting partial prostheses and 81% for implants supporting single restorations. Average marginal bone resorption was 1 mm during the first year, 0.4 mm during the second year, and 0.1 mm during the third year and after 10 years. Conclusions: The unchanged survival rate and the low average bone loss after 10 years confirm the feasibility of an immediate loading treatment protocol in the maxilla that included flapless surgery. Keywords: dental implants, flapless surgery, immediate loading, machined surfaces, poor bone quality