Nowadays, with technological advances in implantology and knowledge of healing patterns after tooth extraction, rehabilitations of patients with immediate esthetic needs, with adequate success rates and favorable esthetic outcomes, are a reality. However, case selection criteria should be followed to ensure high-quality functional and esthetic results and a good prognosis, particularly in patients with unfavorable gingival phenotype. This report describes a three-year clinical and cone beam computed tomography followup of post extraction immediate dental implant placement in the aesthetic region (teeth #11 and #21), provisionalization using the crown of the freshly extracted natural teeth, subsequent rehabilitation and threeyear follow-up. Results are compared with findings reported in recent studies, and the ideal treatment to maintain gingival architecture is discussed.