Numerous authors have documented clinical success in loading threaded implants at the time of implant placement when carefully controlled surgical and restorative protocols are followed. This clinical series documents the application of immediate loading techniques to fixed mandibular restorations in 27 patients who were edentulous or had non-restorable mandibular dentitions. Eighteen patients had complete conventional maxillary dentures, while 9 had natural or fixed prosthetic maxillary dentitions. Twelve different restorative dentists provided prosthetic support for these patients and used 4 different restoration types: laboratory- or office-processed, with cement or screw retention. Five to 8 threaded implants were placed in each patient. One hundred sixty-one of the 186 implants that were placed by the authors were loaded immediately using fixed provisional restorations of the various designs. More than 99% (160/161) of the immediately loaded implants and 99.5% (185/186) of all implants were clinically integrated and radiographically successful at the time of final evaluation for restoration fabrication. After final implant evaluation, no additional implant losses occurred, indicating an implant survival rate of nearly 100% over a mean of 25.0 months (range 13 to 41 months) following implant placement. While a strong preference for cement-retained restorations was apparent, all prostheses showed similar success. The data and the experience described in this report indicate that immediate loading with fixed restorations using appropriate surgical and restorative techniques can be a predictable technique for rehabilitation of the completely edentulous mandible.