BackgroundWhen a dental implant is discovered to be failing, the implant must be removed, resulting in a defect. Immediate reconstruction of the defect using an autogenous composite tuberosity graft has been reported following the removal of a single implant. Ridge reconstruction after the removal of more than one failing dental implant poses an even greater challenge, given the substantial loss of hard and soft tissue. To the author's knowledge, this is the first report to describe the use of an autogenous composite tuberosity graft for the reconstruction of hard and soft tissue for multiple sites. Methods and ResultsThree patients with failing implants and ridge defects received a composite tuberosity graft comprising the bone, periosteum, connective tissue, and epithelium of the maxillary tuberosity for simultaneous hard and soft tissue reconstruction. Bone from the maxillary tuberosity was positioned between the bony borders of the defect or fixed buccally to augment the ridge. Smaller bone pieces from the tuberosity were used to fill the gaps. The soft tissue portion of the graft was allowed to heal spontaneously, thus eliminating the need for further surgery to increase keratinized gingiva and vestibular depth. All sites recovered uneventfully, and the ridge dimensions were re-established. ConclusionFor patients with sufficient tuberosity bone volume, using a one-piece composite tuberosity bone graft appears to be a promising approach for rebuilding the ridge in a single surgery. Key pointsWhy are these cases new information? Large hard and soft tissue defects are reconstructed immediately after the removal of one or more failed implants.Keratinized gingival width and vestibular depth are improved.What are the keys to the successful management of these cases? Cone-beam computed tomography for tuberosity and defect evaluationCareful handling of tuberosity boneProper graft shapingComposite tuberosity graft fixationFixed provisional prosthesis for grafted area protectionWhat are the key limitations to the success of these cases? Unavailability of tuberosityA technique-sensitive approach