Purpose: To evaluate the feasibility of a commercially available immediate root analog implant system Replicate (Natural Dental Implants). Materials and Methods: Five consecutive patients in need of an implant in the premolar region were recruited for this pilot study. Following clinical examination, a cone beam computed tomography scan was made and the dental impressions digitized. On the basis of the superimposition of these datasets, a three-dimensional (3D) envelope was created for the selected tooth. Subsequently, the tooth root at the prospective implant site was segmented to create a 3D surface, and the obtained mesh data were used as the basis for designing a single-piece root analog implant within the 3D envelope. The designed root analog implant was fabricated using a five-axis computer-aided manufacturing machine. The root analog implants were inserted following flapless minimally invasive root extraction. Following 3 months of uninterrupted healing, definitive restorations were fabricated. Peri-implant clinical and radiographic measurements were obtained up to 12 months follow-up. Results: All patients functioned well following 12 months of functional loading. Within one patient, one of the two root analog implants failed early. Peri-implant clinical and radiographic measurements demonstrated a stable situation after 12 months of functional loading. Conclusion: A novel digital approach for immediately restoring single teeth using root analog implants was introduced. In the future, long-term evaluation of the root analog implant technique is necessary to evaluate the success and survival of implants that were inserted using this technique. Schlagwörter: CAD/CAM, CBCT, custom implants, digital dentistry, 3D planning