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To evaluate the factors associated with long-term implant survival in a large cohort of patients in regular follow-up until data collection.The study population consisted of 475 patients who were referred to a private clinic limited to Periodontics and Implantology between November 1995 and July 2006. Data were collected from patient files with regards to smoking habits, periodontal condition, diabetes mellitus, implant survival, and time when implant failure occurred. Patients were divided into those who participated in a supportive periodontal program in the clinic and those who only attended the annual free-of-charge implant examination.A total of 1626 implants were placed with a follow-up ranging from 1 to 114 months (average 30.82 ± 28.26 months). Overall, 77 (4.7%) implants were lost in 58 (12.2%) patients after a mean period of 24.71 ± 25.84 months. More than one-half of the patients (246; 51.7%) participated in a structured supportive periodontal program in the clinic, and 229 (48.3%) only attended to the annual free-of-charge implant examination. Smoking and attendance in a regular supportive periodontal program were statistically associated with implant survival. Patients with (treated) moderate-to-advanced chronic periodontal disease demonstrated higher implant failure rates but, this difference did not reach statistical significance. Diabetes mellitus was not related to implant survival in this patient cohort.Smoking and attendance in a regular supportive periodontal program were found to be strongly related to implant survival. Special attention should be given to continuous periodontal supportive programs to implant patients.