In order to maintain esthetics immediately after maxillary anterior tooth extraction, immediate implant placement and provisionalization (IIPP) is one of the current options for implant reconstruction. However, esthetic outcome after IIPP is depended on proper condition of the preexisting tissue. This clinical report introduces the strategy of apical surgery and guided tissue/bone regeneration before tooth extraction to improve the preexisting tissue condition. It could not only achieve the patient's esthetic demand, but also prevent the risk factors for IIPP.