Objective To investigate the effect of immediate implantation combined with customized provisional restoration on aesthetic effect and peri-implant bone resorption in patients with tooth loss in the anterior aesthetic zone. Methods A total of 66 patients with tooth loss in the anterior aesthetic zone admitted to the Department of Geriatric Stomatology, Afffliated Stomatological Hospital of Xuzhou Medical University from January 2022 to January 2025 were selected as the research subjects. According to the random number table method, they were divided into group A and group B, with 33 patients in each group. Group A received conventional delayed implant restoration, and group B received immediate implantation combined with customized provisional restoration. The aesthetic effect, oral health-related quality of life, peri-implant bone resorption, restoration satisfaction and implant survival rate were compared between the two groups. Results At 6 months after restoration, the scores of PES and WES in group B were higher than those in group A (P<0.05). At 6 months after restoration, the OHIP-14 score of group B was lower than that of group A (P<0.05). At 6 months after restoration, the peri-implant bone resorption in group B was less than that in group A (P<0.05). The restoration satisfaction rate of group B (93.94%) was higher than that of group A (75.76%) (P<0.05). There was no statistically signiffcant difference in implant survival rate between the two groups (P>0.05). Conclusion For patients with tooth loss in the anterior aesthetic zone, immediate implantation combined with customized provisional restoration can improve soft tissue contour and prosthetic aesthetic effect, reduce peri-implant bone resorption, and elevate oral health-related quality of life and patient satisfaction, without affecting implant survival rate.