The appearance and long-term stability of peri-implant bone, mucosa, and gingiva determine the success of implant-supported prostheses from both the esthetic and functional standpoints. Any surgical or prosthetic technique that takes into consideration only some variables, or that only intervenes in a limited phase of treatment, is a potential source of a partially successful and/or unpredictable clinical outcome. This article describes the underlying principles and surgical-prosthetic procedures of a systematic regenerative approach, edentulous site enhancement (ESE). The goal of this approach is to improve the anatomy of edentulous sites. Applied to implant dentistry, this approach enables peri-implant tissue to be managed predictably, optimizing the functional and esthetic result of restorations with regard to treatment time, number of surgical stages, long-term prognosis, and incidence of complications. The principles underlying the ESE approach, which are independent of any specific implant system, are applicable in the majority of clinical situations, regardless of the esthetic requirements.