Although every effort is made to place dental implants in a proper position, the restorative dentist does not always succeed. Historically, treatment options for poorly placed implants included removing the implant or leaving it "sleeping." Recent modifications of an existing technique, the segmental osteotomy, may offer hope in these situations by rendering many of these "hopeless" implants salvageable. This paper presents lessons learned from a series of cases in which segmental osteotomies were performed to improve the esthetic outcome of implant malpositioning. Two clinical cases (one successful, one failed) utilizing segmental osteotomy to surgically correct malposed implants are presented with a review of the literature associated with the technique. With adherence to proper case selection and detailed surgical protocol, segmental osteotomy is a viable treatment option to correct misaligned dental implants.