Soft and Hard Tissue Grafting in Immediate Implant Therapy: A Narrative Review

<i>Background and Objectives:</i> Immediate implant placement in the esthetic zone presents challenges in maintaining peri-implant tissues due to post-extraction remodeling. Bone grafting has been proposed to support tissue preservation and improve esthetic outcomes. This article reviews the role of grafting in clinical studies and case reports. <i>Materials and Methods:</i> A literature search on PubMed and Google Scholar identified studies focusing on immediate implant placement with grafting. The search strategy included articles from 2012 to 2025, in English, from peer-reviewed journals. <i>Results</i>: Implant survival is possible without grafting in ideal cases, but grafting is often essential in patients with thin biotypes or esthetic demands. Technique and material selection are critical. The socket shield technique shows promise in preserving buccal tissues despite its complexity. Case reports demonstrated stable soft tissues and favorable esthetic outcomes. <i>Conclusions</i>: Grafting should be tailored to the clinical situation. While not always necessary, it is often crucial in compromised sites to ensure long-term esthetic success. Current literature supports predictable outcomes with appropriate grafting protocols.