Hard and Soft Tissue Changes After Immediate Implant Placement Using Connective Tissue Graft With and Without Bone Grafting in the Esthetic Zone

Inclusion Criteria: * Patient-related criteria: * Adults at or above the age of 18. * Non-restorable maxillary anterior or premolar tooth requiring extraction and needed an implant placing therapy. * The failing tooth will have adjacent and opposing natural teeth. * Sufficient mesial-distal and interocclusal space for placement of the implant and definitive restoration. * Able to tolerate surgical periodontal procedures. * Full mouth plaque and bleeding scores less than 20%. * Compliance with the maintenance program. * Provide informed consent. * Accepts the one-year follow-up period. Teeth related criteria: * Intact thick biotype gingival tissue with at least 2mm band of keratinized tissue. * Intact socket wall before the extraction, buccal bone thickness ≤1mm assessed by CBCT. * Sufficient apical bone to place an immediate implant with minimum primary stability of 30Ncm Exclusion Criteria: * Patients diagnosed with periodontal diseases. * Current or previous smokers. * Pregnant and lactating females. * Patients with medical conditions that would compromise the surgical procedures; uncontrolled diabetes mellitus, taking IV Bis-phosphonates for treatment of osteoporosis. * Patients with active infection related at the site of implant/bone graft placement. * Patients with parafunctional habits