This paper presents ultrasonic surgery (ie, Piezosurgery) as a new, relevant, and predictable method for performing atraumatic tooth extraction and subsequent implant site preparation. Forty noninfected teeth or roots were extracted in 23 patients and replaced immediately with implants. Extraction consisted of cutting the fibers of the periodontal ligament with vibrating tips of up to 10 mm in depth; the teeth or roots were mobilized afterward with an elevator. All teeth/roots were removed without fracture. Implant osteotomies were performed using conical tips of increasing diameters. During implant placement, notching of the apical third of the palatal wall or the interradicular bridge was performed without complication due to uncontrolled movements of the instrument. After a mean healing period of 2.4 months, all implants were osseointegrated and have been successfully loaded for at least 12 months. By implementing Piezosurgery, extraction can be atraumatic and implant placement can be predictable and undemanding compared to the use of burs, which can lead to instruments slipping during the procedure.