The aim of this randomized controlled trial (RCT) was to evaluate whether placement of a soft tissue graft substitute (STGS) could decrease peri-implant tissue shrinkage at immediate postextractive implants. Twenty patients with one missing tooth between two adjacent healthy teeth in esthetic areas and at least 4 mm of bone apical to the tooth apex were randomly allocated (after tooth extraction) to receive (n = 10; test group) or not receive (n = 10; control group) a subepithelial buccal STGS. Implants were inserted with a torque of at least 30 Ncm, and sites were grafted with a cancellous particulate allograft. All patients were restored with nonoccluding immediate provisional screw-retained crowns, replaced after 6 months by definitive metal-ceramic crowns. One year after loading, no dropouts, crown or implant failure, or complications occurred. No statistically significant difference or trends in volume shrinkage, esthetics, peri-implant marginal bone loss, and keratinized mucosa heights between the two groups were observed. Acknowledging that the sample size was small, no clinical benefit could be observed for the use of a STGS in immediate postextractive implants.