Restoration of the mandibular compromised ridge requires various treatment modalities. The simplest approach often is to extend the denture base adequately for proper use of all available supporting tissues. If the patient is incapable of wearing a conventional denture, the surgical approach becomes necessary. Surgical avenues include vestibular extension procedures that increase vestibular depth and augmentation procedures, which include (1) overlay grafts of rib or the crest of the ilium, (2) osteotomy grafts to include the visor osteotomy and the interpositional bone graft, (3) alloplastic grafts of which hydroxyapatite augmentation is the most common, and (4) various types of implants to restore the compromised ridge. The ultimate goal, regardless of the treatment modality chosen, is to restore the patient to a level of masticatory function.