The clinical report describes an immediate implant placement after atraumatic extraction of a maxillary first molar procedure, mentioning specific requirements to achieve this surgical step. The tooth was extracted with minimum trauma to adjacent tissues, then a flap was raised to immediately place an implant in the site of the removed molar. Three months after extraction, a peri-implant keratinized gingiva augmentation was indicated to ameliorate the implant function and guarantee its long-term health. During a two-year –follow-up, no clinical or radiographic complications were exhibited. A minimized bone reduction was observed around the implant and osseointegration was satisfactory. The maxillary molar replacement with an immediate implant is a reliable treatment option offering the advantages of a reduced bone loss, shorter treatment duration and a facilitated procedure. However, this remains a meticulous intervention where particular guidelines should be respected. Further intervention may be needed as soft tissue grafting to enhance the result.