Purpose: To evaluate the effect of placement of single implants in the esthetic zone of the maxilla in preserved alveolar ridges, compared with nonpreserved alveolar ridges, on the change in midlabial mucosal level, esthetics, marginal bone level, and patient satisfaction. Materials and Methods: Patients with a failing single tooth, and demonstrating a large vertical defect (≥ 5 mm) of the labial wall of the extraction socket, were pre-augmented with a mixture of autologous bone and anorganic bovine bone. A mucosal graft sealed the pocket. After 4 months, a single implant was placed in the preserved alveolar ridge (test group; n = 20). The results were compared with those from patients who had one missing tooth and were treated with placement of an implant in a nonpreserved alveolar ridge, whereby the connective tissue graft was combined with the placement of the implant (control group; n = 20). Changes in midlabial mucosal level were scored on intraoral images. Intraoral radiographs were made to assess marginal bone level changes after definitive crown placement (1 month [T1], 12 [T12] months). The pink esthetic score/white esthetic score at T12 was used to determine esthetics. Patient satisfaction was assessed before treatment (Tpre), and at T1 and T12. Results: The mean midlabial mucosal level changes were 0.07 ± 0.29 mm and -0.15 ± 0.23 mm at T1 and T12 for the control and test groups, respectively (P = .01). No significant changes were observed for the other outcome variables. Conclusion: Single implant treatment in a preserved alveolar ridge and nonpreserved alveolar ridge is accompanied by clinically nonrelevant changes in the midlabial mucosal level. Changes in marginal bone level, esthetics, and patient satisfaction were comparable between the groups. Keywords: alveolar ridge augmentation, connective tissue grafting, esthetics, single-tooth implants