Background: Optimal aesthetic implant restoration is a combination of a visually pleasing prosthesis and adequate surrounding peri-implant soft tissue architecture. This study describes the influence of the residual buccal bone thickness (BBT), measured at the time of implant placement, on the soft tissue maturation during three years of follow-up. Methods: Seventy-eight implants were enrolled in the present study. The BBT was assessed at the surgical stage and each case assigned to Group 1 (BBT values ≤0.5 mm), Group 2 (BBT values >0.5 and <1.5 mm), or Group 3 (BBT values ≥1.5 mm). Only native bone and healed sites were included. The tooth height (TH), based on the distance between the buccal free gingival margin at the zenith level and the crown incisal edge, according to the main axis of the tooth, was monitored at one, two, and three years from the final prosthodontic rehabilitation to determine any occurrence of recession or coronal repositioning of the gums over time. A Pearson Two-Tailed test was applied and the significance level set at p ≤ 0.05. Results: For BBT values ≤0.5 mm, the buccal gum at three years showed an average recession of 1.22 ± 0.41 mm. For BBT values >0.5 and <1.5 mm, the buccal gum also showed recession of 0.64 ± 0.29 mm. In contrast, for BBT values ≥1.5 mm, the buccal gum showed coronal growth of 0.77 ± 0.22 mm. The differences between the groups were significant (p ≤ 0.01) at all times. Conclusion: The BBT at the time of implant placement was found to affect the buccal gingival margin stability over three years of observation.