Tooth loss due to trauma or periodontal disease is often associated with extensive deficiencies of the supporting hard and soft tissues and atrophy of the alveolar ridges. The functional and esthetic predictability of an implant-supported prosthetic restoration in patients with extensive tissue augmentation is guarded, even when lost tissues were restored at an early stage by local ridge augmentation. The prosthetic reconstruction of major tissue defects is especially difficult, as lost structures of the alveolar ridge must be replaced by the restoration, which is expected to provide optimal function and esthetics, yet allow for optimal oral hygiene. This article presents prosthetic solutions for replacing missing hard and soft tissues with implant-supported fixed and removable restorations in cases of severe tissue deficiencies. Keywords: atrophy of alveolar ridge, implants, implant-supported restorations, treatment options