Aim: Significant delay in tooth eruption may be observed in many orthodontic patients. This delay may lead to complications, such as devitalization, ankylosis, external root resorption, injury to the adjacent teeth, and mucogingival problems. These complications may result in prolonged treatment time, esthetic deformities, damage to the periodontal tissues, and tooth loss. This report investigates the special considerations needed in treating such cases. Methods: Combined orthodontic and surgical treatment can be used in managing teeth exhibiting significant delay in eruption. Results: A high rate of success can be achieved in terms of esthetics, occlusion, and periodontal health. Conclusion: Nontraumatic surgery, adequate control of gingival inflammation, and use of minimal orthodontic forces may ensure a higher percentage of success and prevention of problems associated with teeth exhibiting significant delay in eruption. World J Orthod 2004;5:224–229.