Retaining a periodontal hopeless tooth has always been in controversy regarding its effect on the surrounding periodontal structures or the cost effectiveness on its treatment attempt. Considering patients anticipation to retain his/her tooth for fear of extraction and aesthetics as well as monetary/ insurance troubles, non-surgical and surgical approach could be attempted to retain a hopeless tooth that would be indicated for extraction and replacement by implants. With various advancements in grafting materials and surgical techniques, the article discusses clinical and radiological considerations as well as treatment modalites in order to retain a hopeless periodontal tooth which could be an economic alternative to an implant.