This study was carried out to clinically evaluate the flapless transmucosal approach for placement of immediately loaded implants in smokers versus implant placement using the conventional surgical technique. Twenty self-tapping implant (OsteoCare’s Maxi-Z one piece implant) implants were placed in twenty patients in the area of premolar region.Twenty smoker patients (11 females and 9 males with a mean age of 32years) were participated in this study and where divided into two groups. The first group (Group A) comprised ten patients where the conventional surgical implant procedure using a flap will be performed using standard surgical procedure that involves; reflection of a mucoperiosteal flap, osteotomy site preparation and then placement of the sterile implant into the prepared site while the second group. (Group B) comprised ten patients who received implants in healed bony sites which were placed through a free hand transmucosal flapless technique and followed by immediate loading with temporary acrylic crowns for 3-4 months then replaced with porcelain fused to metal final restorations.The results revealed an overall survival rate of 100% for both groups. In group (A) the overall mean bone loss was 0.58mm and 0.78mm after 3 months and 6 months respectively, while in group (B) the overall mean bone loss was 0.53mm and 0.69mmafter 3 months and 6 months respectively. There was no statistically significant difference in the means of crestal bone resorption between the two groups at the three months and six month’s evaluation.Regarding the bone density changes around the implants in group (A) the overall mean bone density was 87.60, 75.63 and 76.13 immediately post-operative, 3months and 6 months respectively. While in group (B) the overall mean bone density was 89.98, 74.80 and 76.18 immediately post-operative, 3months and 6 months respectively.Immediately post-operative, the bone density at group B (Flapless) showed statistically significantly higher value than at group A (Flap). While After 3 months, the bone density at the group A(conventional flap) showed statistically significantly higher value than at group B.Yet, after 6 months, there was no statistically significant difference between means bone density between both groups.The average Periotest M values for group (A) was -2.04 as measured immediately after implant placement and the value was -2.77 after 6 months. While for group (B) the mean value was -1.70 as measured immediately after implant placement and the value was -2.85 after 6 months. There was no statistically significant difference in the means of PeriotestM values between the two groups immediately post-operative and at the six months evaluation. The present study showed that the free hand flapless transmucosal immediate implant placement and loading using the tapered Maxi Z one-piece implants is a highly successful treatment in smokers and the prognosis depends on proper treatment planning and case selection.