Treatment options for severely misaligned teeth with advanced bone loss are limited. We report the management of a case of advanced periodontitis in a labially placed extruded maxillary canine. A 24 years old male reported to the periodontal clinic to preserve his mobile and misaligned upper left lateral incisor. Clinical and radiographic examination revealed advanced attachment loss with bone resorption around the affected tooth. The decision was taken to reconstruct the lost periodontal tissues in coordination with orthodontic intervention to align the tooth in a functionally esthetic position. At the end of the combined periodontal and orthodontic treatment, the tooth was preserved and was well-aligned in the arch; the patient was satisfied with the treatment outcome. It can be concluded that severely misaligned teeth with advanced bone loss can be salvaged with a combined and meticulously planned Periodontal Orthodontic treatment approach.