Purpose: When encountering a buccal bone defect during implant placement, guided bone regeneration (GBR) is a well-accepted method for bone reconstruction. However, it is still unclear if the esthetic and patient-reported outcomes are comparable to implants placed in native bone. The purpose of this prospective trial was to compare implants placed with a GBR procedure for a small (≤ 4 mm) buccal defect with implants placed completely in native bone (control). Materials and Methods: Patients were allocated to the GBR group or control group during implant placement in the esthetic zone. Implants were placed after at least 12 weeks of healing of the extraction sockets. A buccal bone defect of ≤ 4 mm resulted in allocation to the GBR group. Follow-up was performed until 12 months after loading. Outcome measurements were as follows: esthetic scores, patient-reported outcome measurements, implant survival and complications, clinical indices, and radiographic measurements. Results: In total, 45 patients were included, of which 23 underwent a GBR procedure after implant placement, and in 22 patients no GBR was necessary. No significant differences in esthetic outcomes were seen between the two groups. At the final follow-up, a mean pink esthetic score (PES) of 7.8 (SD: 1.5) was seen for the GBR group and 8.4 (SD: 1.4) for the control group. Regarding the white esthetic score (WES), a mean of 9.1 (SD: 1.0) was found for both groups. Patients of both groups were equally satisfied with their mucosa and crown. A mean visual analog score (VAS) for the soft tissues of 8.6 (SD: 1.0) in the GBR group and 8.8 (SD: 0.9) for the control group was noted. A mean VAS of 9.2 (SD: 0.8) was noted for the crown in the GBR group and 8.6 (SD: 2.0) in the control group. Implant survival was 100%, and there were no significant differences in complications, plaque/bleeding/ gingiva indices, width of attached mucosa, and marginal bone loss. Conclusion: Implants placed in the esthetic zone with GBR or complete native bone coverage showed successful esthetic outcomes and satisfied patients with predictable clinical and radiographic parameters after more than 1 year of loading. Within the limits of this study, GBR for a small buccal bone defect seems to be a reliable technique with good esthetics and patientreported outcomes. Keywords: esthetics, guided bone regeneration, patient-reported outcomes, prospective controlled clinical trial