This case report of a patient with a central incisor with rapid destruction of periodontal tissues associated with pathologic tooth migration illustrates the esthetic and functional reconstruction of a severely compromised tooth. An interdisciplinary approach, including resolution of the infection and regenerative periodontal surgery followed by orthodontic tooth movement, transformed a hopeless tooth with high mobility, attachment loss approaching the apex, and a Miller Class IV recession into a clinically healthy tooth. Treatment planning for periodontally involved anterior teeth with pathologic migration should consider a multidisciplinary approach for preservation of the natural dentition.