Purpose: This prospective clinical study evaluated the performance of 290 tapered, anodic oxidized (TiUnite) titanium implants placed in compromised bone in a consecutive series of 126 patients. Materials and Methods: Inclusion criteria were: (1) a need for dental implants in either a single-tooth or partially edentulous segment, (2) sufficient medical fitness to undergo the procedure, (3) enough bone to enable placement of a 10-mm or longer implant, and (4) compromised bone, as judged by computerized tomography and confirmed by clinical findings, in at least one implant site. Implants were placed and left unloaded for at least 6 months (mean 9.9 ± 3.9 months) before placement of the first provisional prosthesis and followed for at least 3 years after loading. Marginal bone was measured by an independent radiologist. Results: A second-stage uncovering was required for approximately half the implants. Failure of osseointegration was observed for only two implants; all other implants provided the intended prosthetic support during the entire observation period. The overall implant survival rate after 3 years of loading was 99.3%. The average mean changes in the marginal bone level showed stability (–2.70 mm, –2.67 mm, and –2.74 mm at 1, 2, and 3 years postloading, respectively). Conclusions: Using a modified surgical technique that minimized the osteotomy dimensions, tapered implants with an oxidized surface proved to be a predictable support for fixed prostheses in both grafted and ungrafted compromised bone. Marginal bone levels were stable throughout at least 3 years of follow-up. Int J Oral Maxillofac Implants 2009;24:325–334