This retrospective study assessed the prevalence of dental implant-related perforations of adjacent anatomical structures using cone-beam computed tomography (CBCT). Retrospective assessments of CBCT scans of dental implants were evaluated for the presence of relevant anatomical structure perforations. The data collection included demographic and implant information. The implants were further categorized according to the implants’ type, location, length, diameter, mesial and distal spacing, thread exposure, and the presence or absence of a radiographic guide. Univariate and bivariate analyses were conducted to assess the prevalence of dental implant-related anatomical perforations and to evaluate their distribution across several factors. A total of 441 implants met the inclusion criteria; 14.5% were associated with anatomical structure perforation. The inferior alveolar canal was most frequently perforated, followed by the maxillary sinus. Around half of the implants had cortical plate perforations (210 implants; 47%). Perforation of adjacent anatomical structures was more prevalent posteriorly than anteriorly (P=0.03). Mesial and distal spacing were significantly inadequate when the adjacent structure was an implant rather than a tooth (P<.0001). Dental implant-related anatomical perforations are relatively prevalent and occur more frequently posteriorly than anteriorly. This study alerts dental practitioners to avoid these perforations and emphasizes the importance of presurgical planning using CBCT and implant planning software to achieve the desired clinical outcome.