Introduction The results of immediate implant placement, with a flapless approach, graft of the residual gap and immediate tooth replacement (FIITR) has been extensively reviewed, showing efficacy in terms of the preservation of the alveolar ridge and good implant survival. However, very little information exists on the clinical results of the immediate implants in total or partial absence of the vestibular bone plate (FIITR-AC). 421Objective Analyse retrospectively the success and aesthetic outcomes of 60 consecutive cases of FIITR-AC with a follow-up of 1 to 7 years, evaluated by means of the Albrektsson criteria (Ac), interproximal bone level changes (IPBLC) and the Pink Esthetic Score (PES). 257Material and methods 59 consecutive patients received a FIITR-AC in the anterior region (60 implants), from 2008 to early 2015, were included in the study. Surgery was performed by only one experienced surgeon (AS) with the help of a surgical microscope and microsurgical instruments. All patients were undergoing periodontal maintenance therapy. Special care was taken during the tooth extraction to preserve as much of the cortical plate as possible, after the flapless placement of the implant, an autogenous tunnel soft tissue graft was made to cover internally the bone dehiscence defect, and a deproteinized bovine bone mineral graft was made in the remaining gap. After achieving adequate implant stability, impressions were taken and a lab-made screw-retained provisional prosthesis was fabricated and delivered to the patient within the following 2 hours.Success (Ac), IPBLC (calibrated periapical digital radiographs), and aesthetic aspects compared to the contralateral tooth (PES) were evaluated. Results 40 implants supported single tooth restorations, while 20 were splinted in multiple-implant supported prosthesis. One of the cases (operated in 1988) failed (1.7%) after 1 month of healing. Interproximal peri-implant bone levels (IPBL) remained stable during the years of follow up (mean 0.7 mm single vs 0.26 mm splinted). The success rate was 98.3% (95%cr= 91.1-99.7%). Good aesthetic results were observed, with even significant better aesthetic outcomes in the single tooth implants than in the contralateral teeth (PES: 12.4 vs 10.7, p=0.002), both at the level of the global PES and its components. 78.3% of the cases (95% cr= 62.8-88.6) showed no buccal soft tissue marginal recession (PES=2), while 21.6% showed a PES of 1 (less than 2 mm). Evaluation was made by a calibrated examiner (AP, Kappa> 0.70). 813Conclusions With the limitations of a retrospective study, it has been observed that FIITR-AC may be a reliable option of treatment for alveoli with partial loss of the buccal plate when adequate implant stability may be obtained, showing a good success rate, the stability of IPBL and good aesthetic results in comparison with contralateral teeth.