Guided bone regeneration has been shown to be a successful technique to increase the ridge width for dental implant placement. However, in cases of severe or localized horizontal bone deficiencies, achieving sufficient soft tissue mobilization to ensure primary wound closure over the augmented area can be difficult. This article describes a buccal periosteal pocket flap proposed to overcome these challenges. The flap design results in a periosteal pocket, which allows filling of bone-grafting material while facilitating primary tension-free soft tissue closure by splitting of the mucosa. The flap gives stability to the augmented volume within the pocket. Ridge widths of five patients consecutively treated with this technique were recorded before and 24 weeks after augmentation. Results from these cases showed a mean 389% ± 301% gain in bone width (range, 50% to 1,420%) when the periosteal pocket flap design was used. Data obtained from this study suggest that the periosteal pocket flap design could be a predictable alternative flap approach for correction of severe or localized horizontal bone deficiencies.