Purpose: To clinically evaluate immediate implant placement with simultaneous intentional retention of the buccal aspect of the root and to report longitudinal data on survival of implants placed with the use of this novel technique. Materials and Methods: A retrospective case series of implants placed with the root-membrane technique in the maxillary anterior region of adult patients was conducted. Clinical and radiographic analysis was performed to assess implant success and to evaluate the survival of the retained root fragment based on predetermined criteria. A Kaplan-Meier method analysis was used to estimate the 5-year success rate of implants placed with this technique. Results: Data from 46 patients (median follow-up time, 40 months; range, 24 to 60 months) were evaluated. Each patient contributed one implant site in this study. All implants successfully maintained osseointegration at the end of the follow-up period for a 100% cumulative survival rate, based on clinical and radiographic criteria. Radiographic examination revealed good crestal bone stability with mean crestal bone loss on the mesial and distal aspects of the implants estimated to be 0.18 ± 0.09 mm and 0.21 ± 0.09 mm, respectively. The only complication noted in this patient cohort was apical root resorption of a single retained root fragment that did not interfere with the osseointegration of the implant. Conclusion: The intentional retention of the buccal aspect of the root with its periodontal apparatus during immediate implant placement can lead to predictable and sustainable osseointegration of implants placed in the maxillary anterior region of healthy adults. Keywords: alveolar bone preservation, dental implant, dentin fragment, esthetics, immediate implant placement, root retention