This case report describes the placement of a large-diameter implant at the time of a maxillary molar extraction in conjunction with a simultaneous oroantral communication (OAC) repair and an intraosteotomy lift and the 5-year postloading follow-up. Literature exists supporting the efficacy of immediate implant placement using both conventional and modified insertion techniques. However, no reports detail the repair of an OAC concomitantly with immediate implant insertion. The OAC was repaired by first placing multiple layers of a collagen matrix through the socket, followed by grafting with a mixture of freeze-dried demineralized bone and calcium sulfate, simultaneous obliteration and reshaping of the socket using implant shape-specific osteotomes, and immediate placement of a Frialait-2 6.5-mm-diameter implant. No flap elevation was performed and no membranes were placed. A radiograph taken 5 year after loading showed a stable implant in conjunction with a new maxillary sinus bony floor.