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To compare the long-term clinical and radiographic outcomes between immediate loading (IL) and conventional loading of implants placed immediately in fresh extraction sockets.Demographic data, implant details, and periapical radiographs of patients were collected. The long-term marginal bone level remodeling and implant survival rate were calculated.Twenty-one patients (mean age 52.55 ± 14.61 years) with 35 implants immediately inserted into postextraction sites (22 immediate loaded and 13 delayed loaded) were analyzed. The mean follow-up duration was 6 years (range 2–11 years). The implant cumulative survival rate was 96.5%. At the longest follow-up, the mean crestal bone level averaged 0.144 ± 0.705 for IL and 0.161 ± 0.877 for delayed loading, respectively. The mean implant aesthetic score was 7.IL does not negatively influence the long-term prognosis of implants inserted into fresh extraction sockets.