Severe damage to the periodontium requires stabilization and restoration of masticatory function. This case report examines the therapeutic planning process for a patient with generalized periodontitis (stage IV, grade C). The main dilemma in this case was whether periodontally compromised natural teeth should be retained during the full-mouth rehabilitation or extracted. Retention of natural teeth usually is associated with better oral health-related quality of life. This article presents challenging treatment considerations and describes why extraction of periodontally compromised natural teeth is sometimes a viable treatment option.