Purpose: This 15-year prospective study evaluated the success rate and preservation of the gingival margin of single implants placed in a flapless procedure loaded immediately after extraction or after a healing period. Materials and Methods: Immediate flapless implant placement was performed in patients who fulfilled specified inclusion criteria. Implants were either immediately restored with a provisional crown or left unloaded (received healing abutment only). Impant success and gingival margin levels were evaluated after implant placement and after 1 to 15 years. Results: A total of 305 healthy nonsmoking subjects (90 men, 215 women) were treated with 430 immediate implants during a 15-year period (December 1994 to December 2009) and monitored for 1 to 15 years. Two hundred seventy-five implants received an immediate provisional crown, and 155 received a healing abutment. The implant survival rate was 93.03% (± 3.74%). The immediate provisional helped to maintain the original gingival margin, although the implant survival rate was higher for implants that were not immediately restored (96.78%) than for the implants that were immediately restored with a provisional (90.9%). Conclusions: This 15-year prospective study showed a favorable implant success rate related to the flapless immediate implant placement protocol with healing abutment placement or an immediate provisional crown to replace a single missing tooth.