Immediate dental implants were placed directly into extraction sites of the four failing maxillary incisors. Careful treatment planning, attention to detail and three dimensional implant placement are essential for optimum results. Bone and connective tissue grafting was carried out at the same time directly through extraction sockets. Crowns were placed on the 4 implants and two natural canines. The superb overall aesthetics and maintenance of the gingival architecture are clearly seen at the 2 year follow up.