Aim: To assess the effect of connective tissue grafting on the mid-buccal mucosal level (MBML) of immediately placed and provisionalized single implants in the maxillofacial aesthetic zone. Materials and methods: Sixty patients with a failing tooth were provided with an immediately placed and provisionalized implant. During implant placement, patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). Follow-up visits were at one (T1) and twelve months (T12) after final crown placement. The primary outcome measure was any change in MBML compared to the pre-operative situation. In addition, gingival biotype, aesthetics (using the Pink Esthetic Score–White Esthetic Score), marginal bone level, soft tissue peri-implant parameters and patient satisfaction were assessed. Results: The mean MBML change at T12 was −0.5 ± 1.1 mm in the control group and 0.1 ± 0.8 mm in the test group (p =.03). No significant differences regarding other outcome variables were observed, neither was gingival biotype associated with a gain or loss in MBML. Conclusions: This one-year study shows that connective tissue grafting in single, immediately placed and provisionalized implants leads to less recession of the peri-implant soft tissue at the mid-buccal aspect, irrespective of the gingival biotype (www.trialregister.nl: TC3815).