Managing patient demands for highly esthetic and functional periodontal reconstructive outcomes is a major challenge in Dentistry. Esthetics in the anterior esthetic zone is a particularly important area for the delivery of highly predictable regenerative therapies. Optimized existing and emerging surgical techniques such as guided tissue regeneration (GTR), periodontal tissue engineering by means of growth factors, and modified and simplified papilla preservation techniques, provide innovative solutions to address high level patient esthetic requirements. This presentation will highlight reconstructive approaches as well as discuss the importance of careful pre-surgical treatment planning necessary to avoid postoperative esthetic failures. In addition, the presentation will emphasize the importance of the multidisciplinary approach, including periodontal, prosthetic, orthodontic and surgical parameters.