In its simplest terms, an esthetic complication in implant therapy is defined as the failure to deliver an inconspicuous functional dental replacement in an area of high esthetic concern, as defined by the patient. Although the course of action required to deliver a natural appearing implant restoration may, in certain instances, be simple, a series of surgical and prosthetic procedures methodically sequenced and closely coordinated is most commonly required for the bulk of patients who desire esthetic dental implant replacements for failing or missing dentition. A smaller set of patient’s present with advanced complexity case scenarios that require multiple treatment modalities and the use of camouflage techniques in order to achieve an acceptable, albeit less than perfect, esthetic outcome. Despite all the advancements in procedures and technologies related to dental implant therapy, achieving predictable esthetic results remains the greatest challenge and a significant source of frustration in implant dentistry. Nevertheless, cumulative clinical experience and current scientific knowledge provide the basis to prevent the majority of esthetic implant complications that is occurring. Therefore, it is imperative that clinicians involved in esthetic implant therapy not only fully grasp the factors known to contribute to complications but should posses in-depth knowledge of the treatment modalities, surgical approaches, and prosthetic techniques required to prevent esthetic complications.