Alveolar ridge deficiency following tooth extraction, trauma, periodontal disease, and long-term edentulism presents a major challenge in implant rehabilitation. Adequate bone volume is essential for ideal implant positioning, long-term osseointegration, esthetic success, and functional stability. Autogenous bone grafting continues to be regarded as the gold standard in ridge augmentation because of its osteogenic, osteoinductive, and osteoconductive properties. However, contemporary regenerative dentistry has introduced multiple evidence-based approaches that improve the predictability of horizontal and vertical ridge reconstruction while reducing morbidity and graft resorption. This review discusses the biologic basis of alveolar ridge resorption and critically evaluates current decision-making principles in horizontal and vertical ridge augmentation. Various reconstructive modalities including guided bone regeneration, autogenous block grafting, shell techniques, titanium mesh-assisted augmentation, distraction osteogenesis, and biologically enhanced regenerative procedures are analyzed with emphasis on clinical indications, advantages, limitations, and evidence-based outcomes. Horizontal ridge augmentation procedures generally demonstrate greater predictability and lower complication rates compared with vertical reconstruction, which remains surgically demanding because of limited vascularity, soft tissue tension, and graft instability. Recent evidence supports the use of combination grafting protocols involving autogenous bone and slowly resorbing biomaterials to enhance dimensional stability and reduce postoperative resorption. Digital technologies including cone-beam computed tomography, CAD/CAM-guided reconstruction, and customized titanium meshes have further improved surgical precision and treatment outcomes. Successful alveolar ridge reconstruction depends on careful defect analysis, individualized treatment planning, biologic principles, and meticulous soft tissue management. Contemporary evidence indicates that autogenous ridge augmentation remains the most reliable option for complex alveolar reconstruction despite ongoing advances in biomaterials and tissue engineering.