A peripheral ossifying fibroma (POF) presents similarly to other soft tissue reactive lesions, such as pyogenic granuloma or peripheral giant cell granuloma, and yet the pathogenesis of POFs remains undetermined. Surgical excision is the standard of care for a POF, but given their propensity to present in the esthetic area and likelihood for recurrence, these lesions must be addressed with careful technique to prevent mucogingival defects. To the best of the authors' knowledge, this is the first report to show that complete excision of a recurrent POF followed by a pouch recipient bed preparation for simultaneous soft tissue augmentation, and this technique may prove to be a novel and predictable approach to successfully treat such cases.A 57-year-old female presented with a firm, sessile, painless, broad-based, gingival mass between the maxillary central and lateral incisors. It was excised conservatively and allowed to heal by secondary intention. A histopathologic diagnosis of POF was made, but after 12 months, the mass recurred. Subsequent excision of the recurrent lesion was performed by removing the free gingival margin and surrounding tissues. All gingival and periosteal tissues involved were removed aggressively in addition to thorough root planing. Peripheral undermining of the marginal tissue was performed to create a pouch, preparing a recipient site for simultaneous soft tissue augmentation. Palatal connective tissue was harvested and sutured into the recipient site such that the tissue defect was filled, and the exposed root remained completely covered after 48 months.Aggressive surgical excision with simultaneous soft tissue augmentation may successfully resolve the pathologic process and ensure esthetic success in cases of recurrent POFs.