Background <p>Inverted impaction of anterior teeth with crown-root dilaceration is a rare and clinically challenging developmental anomaly. When orthodontic traction or autotransplantation fails to achieve satisfactory outcomes, extraction followed by implant restoration becomes the preferred treatment option. This approach, however, involves multiple challenges, including the extraction of the inverted impacted tooth, bone defect repair, and aesthetic reconstruction of the anterior dentition.</p> Case presentation <p>This single-case report details the treatment process of a 17-year-old patient with a severely dilacerated (approximately 90° crown-root angulation) and inverted impacted maxillary central incisor. The treatment involved extraction, alveolar ridge preservation using a tenting technique to address substantial labial bone deficiency, delayed implant placement, and prosthetic rehabilitation, with a 4-year follow-up. Although a complication related to tenting screw exposure occurred, it was successfully managed, yielding satisfactory functional and aesthetic outcomes.</p> Conclusions <p>This 4-year follow-up case demonstrates that alveolar ridge preservation utilizing the tenting technique represents a viable strategy for managing severely dilacerated and impacted anterior teeth. The case highlights the value of multidisciplinary planning, staged bone augmentation, and prosthetically guided soft tissue conditioning in achieving long-term functional and aesthetic success.</p>