Purpose: This is a follow-up of an earlier 1-year prospective study on implant success rates and the peri-implant response after immediate placement and provisionalization of single implants in the esthetic zone. The effects of gingival biotype on the peri-implant tissues were also evaluated. Materials and Methods: Thirty-five patients were evaluated clinically and radiographically at presurgical examination (T0), immediately after immediate implant placement and provisionalization (T1), 1 year after implant surgery (T2), and the latest follow-up appointment (T3). Data were analyzed using t tests and repeated-measures analysis of variance at the significance level of α = .05. Results: After a mean follow-up time of 4 years (range, 2 to 8.2 years), all implants remained in function. At T3, the mean mesial and distal marginal bone level changes were significantly greater than those observed at T2. At T3, the mean mesial and distal papilla level changes were significantly smaller than those observed at T2, whereas the mean facial gingival level change was significantly greater than that observed at T2. Sites with a thick gingival biotype exhibited significantly smaller changes in facial gingival levels than sites with a thin gingival biotype at both T2 and T3. Conclusions: Favorable implant success rates and peri-implant tissue responses can be achieved with this procedure. While the results suggest the possibility of spontaneous papilla regeneration over time following this procedure, continuing recession of the facial gingival tissue was also observed. The effect of gingival biotype on peri-implant tissue response seemed to be limited only to facial gingival recession and did not influence interproximal papilla or proximal marginal bone levels. Keywords: dental implants, esthetics, gingival biotype, gingival recession, immediate implant placement, immediate loading, immediate provisionalization, papilla, single tooth replacement