The placement of implants immediately after tooth extraction has proven to be a predictable treatment strategy with a very high success rate. Nevertheless, the success of this surgery involves strict clinical criteria. A description is provided of a clinical orientation and scientific point of view based on our experience and available evidence of when and how to perform this procedure in the esthetic area.

We consider the clinical criterai in relation to: 1. indications; 2. tooth extraction; 3. soft-tissue management; 4. implant placement technique; 5. the critical distance and gap filling; and 6. immediate versus delayed restoration.

These key factors, including a flapless procedure, presence of an intact buccal bone wall, absence of soft-tissue defects, gap filling to counteract the tissue changes after tooth extraction and immediate restoration when possible, should be considered to achieve good esthetic results.