To assess the 5‐year effects of grafting connective tissue while undertaking single immediate implant placement and provisionalization at the mid‐buccal mucosa level (MBML). Secondary outcomes were buccal bone wall thickness (BBT), marginal bone level (MBL) and patient satisfaction.

Sixty patients with a single failing tooth in the maxillary anterior region were provided with an immediately placed and provisionalized implant. At implant placement, the patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). The alveolar socket classification was mainly Type 2A. Data were collected before removing the failing tooth (T₀), and at 1 (T₁), 12 (T₁₂) and 60 (T₆₀) months after final crown placement. The primary outcome was the change in MBML compared with the pre‐operative situation. Additionally, the change in BBT, MBL, aesthetics (using the Pink Aesthetic Score–White Aesthetic Score), soft‐tissue peri‐implant parameters and patient satisfaction were assessed.

At the 5‐year follow‐up, 27 patients could be analysed from each group. In each group, one implant was lost during the osseointegration period, within 3 months of placement, resulting in an implant survival rate of 96.7% in both groups. MBML change at T₆₀ was −0.6 (−1.1 to –0.1) mm in the control group and 0.1 (−0.4 to 0.5) mm in the test group (p = .008). BBT and MBL, aesthetics, soft‐tissue peri‐implant parameters and patient satisfaction showed stable results and satisfied patients, without clinically relevant differences between the groups.

This 5‐year follow‐up study shows that grafting connective tissue when replacing a single failing tooth with immediately placed and provisionalized implant results in favourable peri‐implant tissues and fewer MBML changes.