Localized severe chronic periodontitis is often seen in middle-aged patients, particularly when plaque control for malaligned teeth is not satisfactory. While orthodontic treatment can realign such teeth with reduced periodontal support, esthetics may be compromised by gingival recession due to preexisting bone loss and resolution of inflammation after periodontal treatment. This clinical report describes how a malaligned maxillary lateral incisor with severe periodontitis was replaced by an immediately placed implant and implant-supported crown with a good esthetic outcome.