Mesiodens are the most common supernumerary teeth seen associated with trauma. A survey has found 23% cases of mesiodens causing delay in eruption of the permanent teeth.13 In 28-63% of cases mesiodensis noted to cause ectopic eruption, displacement or rotation of a permanent central incisor.15-18 Trauma to the primary maxillary central incisor is highly associated with developmental disturbances of the permanent tooth germ, owing to its palatal and superior position to the apex of the root of the primary tooth.11,12 Dilaceration is a rare condition seen in permanent maxillary incisors because they are more prone to trauma and due to their close proximity, and represents only 3% of the total injuries to the developing teeth. Teeth with dilacerated crown may either erupt with buccal or lingual displacement or remain impacted.11 In a situation such as this, a mesiodens in a favorable position could be considered to replace a permanent missing tooth. Most literature available describes the need for early recognition of the mesiodens and its extraction, to avoid displacement, developmental anomalies or delay in eruption of the associated permanent tooth.15,16 Early extraction of a supernumerary or mesiodens in the mixed dentition is recommended, to allow for optimal yet minimal treatment for the permanent successor. However, in the event of a malformed, impacted permanent successor, similar to our situation, all efforts should be taken to analyze and identify the path of eruption and location of the impacted mesiodens relative to the adjacent structures, and development of an appropriate treatment plan evolved to preserve and guide it to the desired position. Once a mesiodens have been diagnosed, the clinician must decide on early treatment to minimize further sequelae.5,19