Hard and soft tissue alveolar ridge deformities occur following the extraction of teeth, creating functional and esthetic tooth replacement challenges, especially in the maxillary anterior smile zone. A surgical technique using a rotated palatal flap for ridge preservation is discussed that, whether combined with conventional fixed dentures or implant treatment for tooth replacement, provides the possibility for greatly improved esthetics. This technique, used in combination with or in preparation for implant treatment, allows for preservation of the alveolar bone height and width for improved implant size and placement options. In addition, preservation and enhancement of the soft tissue at the extraction site provides for soft tissue contours adjacent to the definitive restoration that vary little from those of the original natural tooth. Combined with conventional fixed dentures, use of this technique creates a template of the labial and interproximal sulcus of the extracted tooth, allowing for the molding of an ovate pontic replacement tooth. This results in vastly improved restorative emergence profiles with minimal or no change in the height of the labial gingival margin and the form and height of the interproximal papillae with adjacent teeth.