Restoration of failing multiple adjacent anterior teeth with dental implants has presented an esthetic challenge. It is commonly accepted that placement of adjacent implants into edentulous sites in the esthetic zone leads to compromised soft tissue esthetics, especially when related to the creation of the inter-implant papillae. On the basis of this it is generally accepted that multiple adjacent implant placement should be avoided in the esthetic zone. However, in this regard, there may be a significant advantage to one-stage immediate implant placement in adjacent sites with respect to maintenance of the interdental (inter-implant) gingival architecture. This is illustrated by a report of ten cases with a 2 to 7 year follow-up. The results presented in this paper highlight the importance of case selection and the need for improved understanding of the biologic response to the placement of implants and their components in different situations. Clearly there are some differences in the remodeling response to implants placed in healed ridges compared with implants placed into extraction sockets. The tissue biotype and labial tissue thickness are also factors that may play a significant role, especially with regard to maintaining the labial tissue contours and esthetics, which further accentuates the need for careful case selection. The diverse nature of the cases illustrated in this paper, all treated by the author in his private practice, would seem to suggest that this approach is a valuable alternative for restoration of failing teeth in the anterior maxilla.