ABD EL- AZIZ, N. FABD . EL-BARBARI, A. REL-BARBARI, A. MELARAB, A. E2022-07-042022-07-042022-06https://doi.org/10.23805/JO.2022.14.8http://repository.msa.edu.eg/xmlui/handle/123456789/4975Aim It is not easy to maintain natural aesthetic appearance of implant-supported restorations in the esthetic zone. Immediate dental implant is a predictable solution in terms of decreased patient morbidity, in addition to the fact that it acts as socket preservation. The aim of the present study was to evaluate the esthetic outcome and stability of gingival tissue and crestal bone level over immediate implants using connective tissue graft (CTG). Materials and methods 16 patients with a single non-restorable tooth in the aesthetic zone were randomly assigned to either receiving immediate implant alone or immediate implant with CTG with a six-month follow-up. Tissue biotype, width of keratinized tissue (WKT), crestal bone level (CBL) were measured at baseline and after 6 months, Pink Esthetic Score (PES) was measured at 8 months in addition to patient satisfaction. Results Immediate implant with CTG had a statistically significant higher effect on PES (P=0.004), WKT (P=0.001) and tissue biotype (p=0.002) outcomes; while a statistically non-significant difference was found in CBL (P=0.619). No difference was found between groups with respect to patient satisfaction. Conclusion Immediate implant in combination with CTG showed better aesthetics with natural appearance resembling natural teeth. PES, tissue biotype and WKT were significantly higher with CTG compared with immediate implant alone. CBL was more preserved when using CTG with immediate implants.en-USImmediate dental implantConnective tissue graftPink Esthetic Score.Tissue biotypeKeratinized tissue widthCrestal Bone LevelArticlehttps://doi.org/10.23805/JO.2022.14.8