With tooth loss, there is increased bone loss of the alveolus. In some cases alveolar bone loss can be severe. Severe bone loss may cause difficulty for patients wearing a conventional prosthesis or being restored with dental implants. Severe alveolar bone loss can result in malnutrition, poor self-esteem, multiple dental visits for failed prosthesis, and jaw fracture. In many cases, patients with loss of alveolar bone height or width may require reconstructive procedures. Vertical ridge augmentation remains a challenge in the reconstruction of the atrophic maxilla and mandible. The main problem arises from the need to expand the soft-tissue envelope and achieve the proper bony architecture. Techniques that have been developed to solve or circumvent this problem include onlay bone grafting with particulate bone graft, block bone graft, barrier techniques with permanent or resorbable membranes, distraction osteogenesis, vascularized ridge splitting techniques, sinus lifts, nerve repositioning techniques, short implants, and angled implants. All of these techniques have advantages and disadvantages. This article focuses on augmentation procedures using titanium mesh, which acts as a barrier and physical support of the soft tissue over the bone graft. © 2010.