الفهرس 
Title
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Abstract
This study was performed to investigate tissue alteration following immediate implant placement, 16 Maxi-Z two piece implants were placed in 16 patients with teeth indicated for extraction in the area of maxillary premolar teeth. All the patients were free from systemic diseases and non-smokers Each patient received proper oral hygiene instructions and a full mouth scaling and root planning.Cone Beam Computed Tomography (CBCT) was taken to evaluate the area of extraction. The preoperative radiographs were used to confirm the diagnosis and estimate the implant length. All Patients were thoroughly informed of the immediate placement protocol and all the risks associated with this procedure and signed up the consent form.The procedures started by the administration of a local anesthetic, followed by careful atraumatic tooth extraction using elevator and the forceps to deliver the tooth out. After extraction, the integrity of the buccal plate of bone checked using an osteotomy probe through the fresh extraction socket as intact buccal plate of bone was considered crucial.The extracted roots measured in buccolingual and mesiodistal dimension at the middle third using a periodontal probe and the readings were averaged, this helped to choose the correct implant diameter.The length of the implant obtained from the cone beam computed tomography