Implant site development is performed at the time of extraction as well as during implant placement to prevent ridge resorption as well as to augment ridge width and height for better implant placement and final aesthetic appearance. Bone grafting, either horizontally or vertically, is often needed to facilitate an ideal anatomical and prosthetic position implant placement. Currently, there are many techniques available for horizontal and vertical bone augmentation; these include but are not limited to socket augmentation, immediate implant placement, guided bone regeneration (i.e. sandwich bone augmentation and modified sandwich bone augmentation), block graft and others. This presentation will discuss these approaches. The “decision tree” that can assist clinicians choose the most predictable procedure for horizontal and vertical bone augmentation will be presented and discussed. In addition, recent advancements in these areas such as custom made blocks will also be presented.