Purpose The present pilot study was designed to fill this gap in the literature, hypothesizing a possible correlation between lack of accuracy in implant placement and deterioration of peri-implant hard and soft tissue health. Methods a total of 5 male and female patients were enrolled. Patients underwent computer-guided implant surgery and full arch immediate load between 2013 and 2014. After a follow-up of 5 years, all patients treated with the computer-guided implant placement technique and undergoing evaluation of the accuracy of computer-guided implant placement by postoperative CBCT were recalled for a clinical-radiographic evaluation of peri-implant health status. Accuracy of implant placement was then related to peri-implant hard and soft tissue health variables such as marginal bone resorption, amount of keratinized tissue, recession and plaque and bleeding. Results: Mean linear deviation was 0.57 ± 0.23 mm at implant head and 0.69 ± 0.26 mm at implant apex, while mean angular deviation of the long axis was 2.88° ± 1.22°. A mean MBL of 1.16 ± 0.94 mm and 2.01 ± 1.76 mm was observed after 1 and 5 years of follow-up, respectively. At 5 years, mean PPD was 4.09 ± 1.44 mm, 66.6% of the evaluated implants showed BOP, KM was < 2 mm in 48.4% of cases, REC ≥ 1 mm was assessed in 45.4% of the included implants, plaque accumulation occurred in 66.6% of cases. A negative correlation was observed between bucco-palatal/lingual linear inaccuracy and MBL, PPD, BOP and KM. Conclusions: with the limit of a pilot study, it can be observed that the accuracy of computer-guided implant surgery as described here, obtained satisfactory results. A reduction in accuracy leading to the placement of an implant in an excessively vestibular position may be the cause of peri-implant hard and soft tissue suffering in terms of marginal bone resorption, amount of keratinized mucosa and bleeding on probing.