The management of patients with Stage IV periodontitis requires a comprehensive interdisciplinary approach in which periodontal therapy, orthodontics, prosthodontics and implant dentistry are integrated into a single treatment pathway. According to the EFP S3 Clinical Practice Guidelines, dental implants should not be regarded as an early substitute for periodontally compromised teeth, but rather as a rehabilitative option to be considered only after successful periodontal disease control and a thorough reassessment of tooth prognosis. We will critically examine the role of dental implants in ortho–perio treatment, with particular emphasis on implant timing, clinical indications and integration with orthodontic therapy, based on the latest scientific data. Contemporary evidence demonstrates that many severely compromised teeth can be successfully retained when periodontal inflammation is controlled and patients comply with supportive periodontal care. Within this framework, orthodontic treatment plays a pivotal role. Implant therapy should be planned only after completion of active periodontal treatment, comprehensive reassessment of the prognosis of the remaining dentition, and completion of orthodontic therapy, except in selected cases where skeletal anchorage is indicated. Patients with a history of periodontitis remain at increased risk of biological complications, highlighting the importance of rigorous risk-factor control and structured supportive periodontal maintenance. Appropriate implant timing, careful patient selection, and close collaboration among the periodontist, orthodontist, implant surgeon and prosthodontist are key determinants of successful rehabilitation. Contemporary treatment planning should be both biologically and prosthetically driven, prioritising the preservation of maintainable natural teeth while reserving implant placement for situations in which it represents the most rational and sustainable therapeutic solution. Current evidence supports the concept that implant therapy is an essential, yet not predominant, component of interdisciplinary ortho–perio treatment. Successful rehabilitation depends not on the number of implants placed, but on their appropriate integration within a comprehensive treatment strategy aimed at achieving periodontal stability, functional rehabilitation and long-term maintenance of clinical outcomes.