It is suggested that encroachment of the implant-abutment interface (IAI) to the existing tooth (< 1.5mm), negatively affects bone levels. As bone is the foundation for soft tissue, changes in bone levels may influence the overall esthetic outcome. The first part of this thesis details a study on 44 dental implants placed in 38 patients. Peri-apical radiographs and dental photographs were evaluated at 1 and 4 year/s to assess interproximal bone levels and pink esthetics. Current data assessed failed to indicate a relationship between IAI - tooth distances and bone changes at 4 years. Data suggest that there is no correlation between proximity of dental implant to adjacent tooth and interproximal soft tissue fill. Data also suggest that crestal bony changes following immediate dental implant placement do not have any relationship with soft tissue esthetics. Further investigations are necessary to examine soft and hard tissue architecture and their influence on esthetics. The second part of this paper consists of a comprehensive review discussing the multi-factorial nature of dental implant esthetics.