Purpose: The aim of this retrospective study was to examine the peri-implant tissue status at immediately provisionalized anterior maxillary implants 12 to 30 months following tooth replacement. Materials and Methods: This is a retrospective study of 43 microthreaded, TiO2 grit-blasted implants placed in healed ridges and immediate extraction sockets to restore maxillary anterior and premolar teeth in 28 patients. The cortical bone position relative to the implant reference point was evaluated at implant placement and 6 to 30 months following restoration. Radiographs were assessed using 73 magnification. The distance from the reference point to the cortical bone was measured to ± 0.1 mm. The relationship of the peri-implant mucosa to the incisal edge of the definitive prosthesis was recorded. Results: Four implants in 3 individuals failed during the first 6 weeks following placement and provisional loading. Cortical bone adaptation from the time of implant placement up to 30 months following restoration ranged from 0.0 mm to 1.5 mm (average, 0.33 ± 0.40 mm mesially and 0.28 ± 0.37 mm distally). The mean radiographic measurements from the interproximal crestal bone to the contact point were 4.53 ± -0.91 mm (mesial) and 4.06 ± 0.98. Maintenance and growth of papilla was observed in this group of immediate provisionalized single-tooth implants. Definitive abutment or abutment screw loosening was not observed. Discussion: The linear clinical and radiographic measures of peri-implant tissue responses suggest that proper implant placement is followed by supracrestal biological width formation along the abutment and preservation of toothlike tissue contours. This may influence buccal peri-implant tissue dimensions. Conclusions: Generalized maintenance of crestal bone and the increased soft tissue dimension with maintenance of peri-implant papilla were identified as expected outcomes for immediate loading/provisionalization of microthreaded, TiO2 grit-blasted implants. Control of peri-implant tissues can be achieved to provide predictable and esthetic treatment for anterior tooth replacement using dental implants. (Case Series)