Patient was noticing that her front tooth was shifting. In addition, she was developing a “black triangle”. Normally there is a pink triangle of gum tissue between teeth called a papilla. When there is a decrease/loss in bone support, the papilla shrinks and a black triangle results. Her bone loss was such that the adjacent tooth was beginning to become compromised. With an eye to the future, we did not want her to end up losing two teeth. So we planned to prophylactically extract the “bad” tooth so that it would not continue to bring/drag down the bone on its neighboring tooth. In addition, we sought to understand why someone with good hygiene would experience bone loss considering that poor hygiene is the typical cause for bone loss. In her case her occlusion was not ideal in that her lower tooth was enacting trauma on the upper tooth and banging into it. The bone was the weaker link and it was “giving”. After seeing an orthodontist to address the occlusion/bite issue, she then saw a periodontist for the extraction and an implant placement. And then, finally, we restored her implant with a crown. This case reflects the long term planning and coordination with specialists needed to achieve an excellent result.