Aim: to evaluate how adding vancomycin to the xenograft in the infected socket affects bone preservation during immediate implant placement. Background: Proper dental implant placement is crucial for successful osseointegration, as the resultant tiny gaps between the implant and bone can affect implant stability. These gaps are better filled with xenografts, which are easy to handle, widely available, and provide an osteoconductive framework that supports better implant outcomes. It’s also important to prevent nearby infections, since the infected socket can damage both soft and hard tissues, raising the risk of peri-implantitis and further implant failure. Applying locally delivered antibiotics during placement can help protect and manage against early infections. Patients and methods: Twenty patients with mandibular extraction sockets participated in the study divided into two groups: 10 patients received a xenograft mixed with vancomycin (Group I), and 10 patients received a xenograft alone (Group II). Implant stability was assessed clinically at baseline and at 6 months only, while CBCT scans were used to monitor crestal bone loss and bone density at baseline, 6 months, and 9 months. Post-surgical complications were also monitored throughout the study period. Results: Group I showed a significant increase in stability over Group II over time, with less marginal bone loss. While baseline bone density was slightly higher in Group I, the difference became significant by 6 months and stayed that way at 9 months. Group II also improved; gains were consistently greater in Group I. Moreover, there is no significant difference between the studied groups regarding the incidence of complications such as infection, swelling, and edema. Conclusion: The results highlight the impact of local delivery of vancomycin plus xenograft (Group I) compared with xenograft alone (Group II), with a greatly promising effect on stability, bone density, and limiting marginal bone loss in dental implants. However, further well-designed studies with large sample sizes and adequate follow-up periods are necessary.