The relationship between attachment loss and occlusal trauma has been debated for many years. When a patient presents with advanced periodontal disease, a decision has to be made on whether the teeth can be saved or extracted. In this treatment example, the decision process in therapeutic planning for a patient with stage IV periodontal disease is discussed. The main dilemma is whether the patient should receive a prosthodontic reconstruction supported by osseointegrated implants or by periodontally compromised natural teeth. It is assumed that implants do better than teeth over the long term based on firm documentation in the literature, but this article describes why a periodontal prosthesis is still a viable treatment option.