Objectives: The purpose of this study was to evaluate horizontal zero-dimensional changes of the buccal alveolar plate using cone-beam CT (CBCT) following maxillary premolar single immediate implant placement into fresh extraction socket. A novel intra-socket grafting technique (IGT) was used for placing graft material into the implant–socket gap to minimise the resorptive process. Methods: A 58-year-old woman in good general health required extraction of a maxillary first premolar (1.4) due to fracture, with extraction and immediate implant placement. Her soft tissues were healthy with good thickness and normal periodontium. Extraction involved minimal trauma to the bone and soft tissue. The osteotomy was prepared towards the palatal plate. A decision was made to fill the gap between the internal surface of the labial socket wall and the implant surface before installing the implant by IGT, with bovine-derived particulate grafting material (Bio-OssTM) to support the buccal bony contour. The TE-SLA 4 implant (diameter 4.8 mm, length 10mm) was inserted in the implant bed in a slightly palatal position and primary stability was achieved. The implant shoulder was placed about 3mm apical of the gingival margin. A resorbable collagen membrane (Bio-GideTM) was applied and sutured. Four months after placement, a screw-retained provisional crown was attached to the implant, which was then restored with a cement-retained metal-ceramic crown. CBCT was performed six months after implant surgery and compared with pre-extraction images using imaging software (OnDemand3DTM) to superimpose scan data for evaluation of crestal preservation. Results: Healing was uneventful and the implant site was clinically stable and inflammation-free throughout follow-up. The aesthetic outcome was stable and pleasing. Periapical radiography at the one-year showed a well-integrated implant with stable crestal bone level. CBCT scans taken six months after surgery showed good integration of the graft in the bed and the implant surface, and complete radiographic healing. The scan data revealed preservation of buccal alveolar bone thickness in coronal, middle and apical points after six months, and that using bovine derived-xenograft material to fill the implant–alveolar gap preserved buccal alveolar thickness on the coronal aspect and at the midfacial level, where the buccal width plate is often constricted. Conclusion: Within the limitation of this study, the IGT procedure was associated with horizontal bone stability of the buccal alveolar plate following maxillary premolar single immediate implant placement. The case met the following criteria: i) intact buccal bony plate before and after tooth extraction with an intact periodontium; ii) flapless immediate implant placement procedure; iii) grafting of the implant–socket gap using a bovine-derived bone substitute; iv) placement of the implant towards the palatine bone wall, with adequate primary stability. When these requirements are met, immediate implant placement in fresh extraction socket provides predictable aesthetic outcomes and stable peri-implant tissues. CBCT data clearly demonstrated the preservation of buccal alveolar bone.