Purpose: The peri-implant bone and mucosa architecture contribute to the health and esthetics of singletooth dental implants. The implant-tooth distance (ITD) has been regarded as a key determinant of their outcomes. This study was conducted to determine the relationship between ITD and peri-implant bone, mucosa, and pink esthetic scores (PES) for anterior single-tooth implants. Materials and Methods: For 44 dental implants with a microthread conical abutment interface design placed in 38 participants, periapical radiographs and photographs were evaluated at 1 and 4 years to assess interproximal bone levels and PES. Results: Mean mesial and distal marginal bone level change over 4 years was 0.20 ± 1.00 mm and 0.20 ± 0.74 mm, respectively. In this cohort, there was no relationship between ITD and interproximal bone changes or papilla fill at 4 years; however, marginal bone changes influenced PES score-the smaller the ITD, the lower the PES (P .001). Alone, ITD did not influence marginal bone levels or papilla in this cohort. Conclusion: These results imply a complex relationship between ITD, marginal bone levels, and PES scores for single-tooth implants. Keywords: implant-tooth distance, marginal bone loss, pink esthetic score, single tooth dental implant