To assess the esthetic and functional outcome, as well as the volume maintenance, of autogenous block grafts placed in anterior sextants of thin periodontal biotype subjects over a long-term period.Fifteen consecutive patients were followed up yearly for an average of 40 months after autogenous block grafting. Preoperative and postoperative cone beam computed tomographic scans were analyzed to evaluate bone volume maintenance around the implants placed in the grafted sites. Clinical parameters (mucosal recession and implant transparency through the soft tissue) were assessed at prosthesis delivery and follow-up to evaluate the esthetic outcome. Digital photographs were used to confirm clinical outcomes.The average augmentation per site was 2.2 times the initial buccolingual (BL) width, and 97% of the augmented width was maintained after 3.3 years. The difference between preaugmentation and postaugmentation BL width, 3.3 versus 7.4 mm, was statistically significant (P < .0001; CI 95%: 3.4 to 4.9 mm). There was a lack of implant transparency or mucosal recession around the implants in all 15 patients after an average of 40 months.Autogenous block grafting seems to be a predictable treatment modality to reconstruct alveolar ridge defects in the long term. A thin periodontal biotype did not seem to affect the volume of transplanted bone for the population studied.