Introduction <p>Immediate implant placement with flap elevation and guided bone regeneration in Type II sockets often leads to midfacial gingival recession and compromised esthetics. To address these limitations, vestibular socket therapy (VST) has been proposed as an alternative technique. Our objective is to compare vestibular socket therapy using pericardium membrane versus conventional flap and guided bone regeneration (GBR) for immediate implant placement in type II sockets regarding bone and soft-tissue outcomes.</p> Materials and methods <p>Twenty patients with Type II sockets were divided into two equal groups. Group-I: received immediate implant placement through a vestibular incision with pericardium membrane placement; the defect was grafted with a mixture of allograft and xenograft. Group-II: received immediate implant placement with conventional open-flap surgery using the same membrane and grafting materials. Radiographic evaluation of labial bone was performed at 3 and 6 months using CBCT assessments. Volumetric analyses of buccal soft-tissue contours were recorded preoperatively and at 6 months. Clinical assessment of pink esthetic score (PES) and modified sulcus bleeding index (mSBI) also were performed at 6 months.</p> Results <p>Both groups showed statistically significant increases in buccal bone thickness and height from baseline to 3 and 6 months. Volumetric change and mSBI values demonstrated no statistically significant differences between groups (<i>p</i> &gt; 0.05). Mean PES was significantly higher in the study group (12.78 ± 0.83) compared to controls (11.56 ± 1.24) (<i>p</i> = 0.03).</p> Conclusions <p>Pericardium membrane with VST offers a promising approach for immediate implant placement in type-II sockets, achieving predictable bone regeneration and better esthetic outcomes, as reflected by higher PES.</p> Trial registration <p>Retrospectively registered at ClinicalTrials.gov (NCT07337837) (13/1/2026).</p>