Attempts to save natural teeth have created numerous restorative, endodontic, and periodontal techniques. It has always been considered the treatment of choice to save teeth whenever possible, and extreme efforts to save teeth are often considered because of the poor treatment alternatives for replacing them. Today osseointegration provides a predictable means of replacing teeth; therefore, retaining questionable teeth may not be as necessary as in the past. This article reviews situations in which the selective extraction of compromised natural teeth or even healthy natural teeth is considered because of alternative treatment options utilizing osseointegrated implants.