The use of immediate placement and loading protocols in implant dentistry has increased during the past several years. However, limited information related to the response of the osseous architecture has been reported. The purpose of this study was to evaluate the fate of the buccal alveolar plate with cone beam computed tomography (CBCT) following lingualized placement of implants into fresh extraction sockets using a flapless surgical approach and immediate nonocclusal loading. A total of 14 patients who required extraction of a single maxillary incisor were selected for this study. CBCT was performed preextraction, at the time of implant placement, and 6 months following implant surgery. The results of this study indicate that resorption of the buccal alveolar plate was not significant. It was therefore concluded that with strict patient selection and appropriate technique, predictable healing can be achieved with lingualized implant placement into fresh extraction sockets and immediate loading. (Int J Periodontics Restorative Dent 2014;34:61-68. doi: 10.11607/prd.1807)