Purpose: The placement of immediate implants has become a routine treatment modality for the replacement of missing teeth. The aim of the present study was to evaluate dimensional changes of hard tissues following tooth extraction, implant bed preparation, and the subsequent integration of titanium implants placed immediately or following an 8-week healing period. Materials and Methods: All mandibular premolars were extracted and used as experimental sites in five beagle dogs. The left quadrant was used to compare the healing of alveolar bone following regular tooth extraction or surgical implant bed preparation. The right quadrant was used to compare immediate with delayed implant placement (3.3 mm, Bone Level SLActive, Roxolid, Straumann) after an 8-week healing period. All samples were assessed histologically for new bone area/total area (BATA), bone-to-implant contact (BIC), and bone height changes from the buccal and lingual midlines. Results: Implant bed preparation led to significantly lower BATA values and bone height loss compared with regular extraction sockets (-2.46 mm vs -1.44 mm, respectively; P = .0007). Placement of immediate implants demonstrated buccal and lingual bone height loss of 1.51 mm and 0.91 mm, respectively, whereas only 0.12 mm and 0.12 mm of bone height loss was observed during delayed implant placement. A significantly higher BIC was observed for implants placed immediately compared with delayed placement (52% vs 35%, P .05). Conclusion: Implant bed preparation further increased dimensional changes when compared with routine extraction sockets. Although immediate implant placement produced better BIC than did delayed placement, a significantly higher bone height loss at both the buccal and lingual midlines was reported. Further investigation is underway to minimize dimensional changes following immediate implant placement. Keywords: bone-to-implant contact, dental implants, extraction sockets, immediate implants, osseointegration