The design and development of today's dental implants has been an evolving process based on scientific research, clinician input, and manufacturer ingenuity. Newer tapered implants with aggressive thread designs allow for placement at greater torque values than in the past, with high levels of initial stability even in situations with low-density or compromised bone. Modern implants are designed for patient cases involving extraction, immediate placement, and immediate load, as well as cases with less-than-ideal bone volume and quality. Contemporary implant body and platform design strongly considers minimizing bone trauma and crestal bone loss while maintaining gingival architecture. Even the most advanced implant design, however, can only function well when the implant is placed in healthy surrounding bone. Current thought leans toward the notion that implant bed preparation is as important as the implant itself. This article discusses the rationale behind the influence of these modern-day factors in immediate loading and aims to assist clinicians in decision making regarding appropriate selection of implants, instrumentation, and clinical procedures.