Purpose: The present study is designed to evaluate the marginal bone loss after immediate implant placement in mandibular molar region with autogenous versus synthetic hydroxyapatite graft. Materials and Methods: Twenty-four adult patients with an mandibular molar is indicated for extraction were included in this study. Patients were divided into 2 groups: group I, received immediate implants augmented with autogenous bone graft and group II, received immediate implants augmented with synthetic hydroxyapatite graft. Implant success, plaque index PI, and bleeding index BI, and marginal bone loss MBL were evaluated. Results: All the implants were successfully osseointegrated over 18 months. The results of the present study showed that at 18 months the mean values of MBL were 1.15±0.14 in group I, 1.20±0.14 in group II, there were no statistical differences between the test and control group regarding, BI, PI, and MBL through follow- up periods. Conclusion: Autogenous and synthetic Hydroxyapatite graft could be used effectively with immediate placement of dental implants into Fresh Extraction sockets in mandibular molar region.