A single tooth restoration in the anterior maxilla is the most challenging restorative procedure in dentistry.  The challenge is significantly compounded when the restoration is an implant supported crown. Although osseointegration is a very predictable event, placing and restoring an implant that meets the criteria of esthetic success is the most complex implant procedure for the surgeon and the restorative dentist. The trend of immediately placing implants in the anterior maxilla after extractions have proved successful.  Kemppainen et al. (1) reported a 99% success rate using one and two stage implants. Other studies have recommended one stage implants and immediate load with success in specific situations(2).  In my practice, I have been placing provisional restorations on implants at the time of insertion for several years.  Most of the implants that I placed following that protocol were in the lateral and central positions, however, implants in the upper and lower bicuspid regions were also successfully provisionalized at the time of surgery. Making and placing the immediate provisional restoration in my office allows me to properly control the soft tissue drape and ensure a successful final restoration.