The concept of 10 keys for successful esthetic-zone single immediate implants is an evidenced-based summary for the treatment planning and replacement of a hopeless tooth in the maxillary anterior sextant. It includes two treatment-planning, five surgical, and three prosthetic keys. These keys are aimed at minimizing soft- and hard-tissue complications to achieve an optimal long-term esthetic implant restoration. Based on the 10 keys, which were described in a prior publication and are reiterated herein, the management of an immediate implant in the esthetic zone is considered a complex SAC procedure (SAC = straightforward, advanced, and complex). The present article highlights the importance of connective tissue grafting as part of the 10 keys and its role in biotype conversion and esthetic success that endures.