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INTRODUCTION Whether immediate provisionalization can preserve facial tissue contour remains undetermined. The goal of this 12-month randomized controlled clinical trial was to compare 3-dimensional (3D) ridge changes after immediate implant placement with and without immediate provisionalization. METHODS Forty participants with an unrestorable maxillary anterior or premolar tooth were randomized to receive either a provisional crown (test) or standard healing abutment (control) after immediate implant placement. In each participant, three digital models taken before implant surgery, final crown delivery (4-month) and final follow-up (12-month) were registered to analyze linear deviation in 3D and volume changes of ridge contour at the implant site. RESULTS The mean value of mid-facial linear 3D spatial resorption ranged from 0.1 to 0.7 mm. Significant difference of linear changes of facial contour was noted over time and not between the groups. Facial volume changes at 12 months remained significantly higher in the control group than in the test group (17.4 vs. 11.9%, P = 0.04). CONCLUSION Linear changes of facial soft-tissue resorption at immediately placed implants were independent of immediate provisionalization. However, immediate provisionalization showed better volume preservation at the esthetic concern area (mid-facial margin and 2 to 6mm above) at the final 12-month follow-up. This article is protected by copyright. All rights reserved.