In 61 patients, 61 consecutive implants were placed immediately after extraction of one anterior or premolar maxillary tooth. One of 3 surgical approaches based on rotated full (RPF) or rotated split (RSPF) palatal flaps, with and without the use of barrier membranes to enable primary soft tissue closure, was applied. A bovine bone mineral graft was used in all cases. At the time of implant placement, the distance between the most apicobuccal alveolar crestal bone and the coronal aspect of the implant body was measured; this was measured again at second-stage surgery. All implants appeared clinically stable. The buccal crestal bone gain was statistically significant for all groups (RPF = 2 mm, RSPF = 1.6 mm, RSPF with membrane = 3.7 mm) (P .001). Analysis of covariance showed a significant covariant for preoperative measurements; however, this was not significant between groups. Keywords: alveolar process, endosseous dental implantation, oral mucosa, oral surgical procedures