Diagnosis and implant treatment planning in cases where hopeless teeth need to be extracted and immediately replaced with implants are more difficult and challenging than a standard multistage approach. Software and CAD/CAM technologies are becoming increasingly common to help clinicians in their practices. They use data from CT scans of the patient and of a radiographic guide for virtual implant treatment planning on a computer and the successive production of a surgical template, which will facilitate surgery and enable fabrication of a prosthesis to be delivered immediately. These procedures, however, are well-established only for patients who are already edentulous in the area to be treated; they are difficult to apply to a patient whose desire is to keep the hopeless dentition until the day of implant surgery to avoid having to wear a removable partial or complete denture. This article describes the advantages and the technique for fabrication of a novel 2-piece radiographic guide that, in conjunction with CAD/CAM technology, will help clinicians in the diagnosis and implant treatment planning of patients who want to retain their teeth until surgery. (Quintessence Int 2009;40:773–781)