Purpose: To study the outcome of implant placement in fresh extraction sockets with simultaneous use of particulate bone graft material. Materials and Methods: Patients referred to the maxillofacial surgery clinic for extraction and implant therapy were included in the study. A consecutive series of patients suitable for immediate placement in combination with extraction was subjected to implant surgery. Patients with ongoing inflammatory, exacerbating processes were not included. The space between implants and sockets was filled with autologous bone graft material. A two-stage surgical procedure was planned to optimize marginal bone healing. All patients were to be followed clinically and radiologically for 2 years according to a standard protocol. Results: Forty implants were placed in fresh extraction sockets in 26 patients (nine women and 17 men) with an average age of 60 years (range, 19 to 76 years). The most frequent site for implant placement was the anterior maxilla. Autologous bone graft material was used in all cases to fill the space between the implant and the socket borders. All implants were osseointegrated at the time of abutment connection. No complications were observed. Radiographic examination showed only slight marginal bone reduction of 0.13 mm mesially and 0.19 mm distally. Conclusion: Implants can be placed successfully in fresh extraction sockets using autologous bone graft material to fill the gap between implant and labial bone through a submerged surgical technique. This technique demonstrated acceptable clinical and radiographic outcomes over a 2-year period in 26 patients with 40 implants. Int J Oral Maxillofac Implants 2009;24: 282–288