At the turn of the twentieth century, periodontal regeneration has gain much attention due to its ability to restore the lost periodontium once was thought difficult to regain. In doing so, periodontal regenerative therapy has even contributed to the retention of severe periodontally involved hopeless teeth. However, this treatment modality had soon met great resistance by the emergence and steady growth of dental implant which claimed to have the ability to replace poor diseased natural roots with a better future. It is the purpose of this paper, from the therapeutic perspective of a clinical periodontal practitioner, to develop a judging principle utilizing cross matching of prognosis and strategic value of the severely involved teeth with periodontitis to determine the optimal choice for periodontal regeneration or dental implant. In addition, the clinical significance and limitation of various periodontal regenerative procedures will also be discussed in terms of quality and quantity. Careful evaluation must be exercised as a periodontist providing the best capability in preserving natural dentition for the maximum benefit of the patient.