This prospective clinical study involved 20 patients in whom implants were immediately placed in extraction sockets. Residual bone defects were grafted, and the buccal bone plate was overcontoured with a xenogeneic bone substitute and covered by a collagen membrane. One year after implant placement, CBCT images were acquired to evaluate buccal bone, and implant stability was analyzed through resonance frequency analysis. Results showed that buccal bone covered the rough surface of all implants 1 year after implantation. Hard tissues responded more favorably in the flapless group. No correlation was found between initial bone defects and bone dimensions in the follow-up exam.