Abstract Aim: The aim of this study was to compare the esthetic outcome of single implants placed in fresh extraction sockets with that of fully healed sites of the anterior maxilla. Materials and methods: This retrospective study was based on data from patients treated with single-tooth Morse taper connection implants placed in fresh extraction sockets and in fully healed sites of the anterior maxilla. Only single implant treatments were considered with both neighboring teeth present. Additional prerequisites for immediate implant treatment were intact socket walls and a thick gingival biotype. The esthetic outcome was objectively rated using the pink esthetic/white esthetic score (PES/WES). The Mann-Whitney test was used to compare the PES and WES scores between the two groups. Results: Twenty-two patients received an immediate implant and 18 patients had conventional implant surgery. The mean follow-up was 31.09 months (SD 5.57; range 24-46) and 34.44 months (SD 7.10; range 24-48) for immediate and conventionally inserted implants, respectively. No implants were lost. All implants fulfilled the success criteria. The mean PES/WES was 14.50 (SD 2.52; range 9-19) and 15.61 (SD 3.20; range 8-20) for immediately and conventionally placed implants, respectively. Immediate implants had a mean PES of 7.45 (SD 1.62; range 4-10) and a mean WES of 7.04 (SD 1.29; range 5-10). Conventional implants had a mean PES of 7.83 (SD 1.58; range 4-10) and a mean WES of 7.77 (SD 1.66; range 4-10). The difference between the two groups was not significant.Conclusions: Immediate and conventional single implant treatment yielded comparable esthetic outcomes.