To save or remove an ailing implant is multifactorial, it has become one of the more controversial topics in the field of dental implantology. Various factors are at play to save implants that may be healthy yet esthetically compromised. Any eventual decision regarding the retention or removal of an ailing implant must be balanced with the desires of the patient, who has already invested a significant amount of pain, time and, finances to initially place and restore the implant. Techniques to save implants in the esthetic zone that particularly present with mid facial recession defects will be presented as well as new restorative solutions to manage poor implant angulation.