OBJECTIVE: Immediate Tooth Replacement Therapy (ITRT) has become popular due to its ability to reduce treatment time and provide immediate esthetic results. However, long-term challenges, such as mid-facial recession and labial bone resorption, have been reported. Anatomic temporary cylinders (ATC), which allow for efficient fabrication of provisional transitional restorations in the esthetic zone, were designed to mimic the natural emergence profile and guide mucosal tissue healing. This study examines the effect of ATCs on the fabrication of provisional restorations compared to conventional non-anatomic temporary cylinders (CTCs) in terms of peri-implant mucosal preservation and stability in patients undergoing ITRT using the dual-zone grafting technique. MATERIALS AND METHODS: Parameters evaluated were peri-implant mucosal tissue thickness (PIMTT), Pink Esthetic Score (PES), and radiographic outcomes, including labial plate dimension (LPD). RESULTS: The use of ATCs resulted in a statistically significant increase in PIMTT compared to CTCs, suggesting better preservation of peri-implant mucosal architecture. Additionally, the ATC group exhibited a positive change in LPD, although this difference was not clinically significant. CONCLUSIONS: The findings indicate that ATCs may offer advantages in maintaining peri-implant mucosal stability, contributing to the esthetic and functional outcomes of implant-supported restorations. Further long-term studies are needed to validate these preliminary results. CLINICAL SIGNIFICANCE: The use of anatomic temporary cylinders (ATC) in immediate tooth replacement therapy (ITRT) demonstrated improved peri-implant mucosal tissue thickness, suggesting enhanced maintenance of peri-implant mucosal architecture. This can contribute to healthier and more esthetic outcomes while potentially reducing the risk of complications such as mid-facial recession.