Four cases have been presented involving malpositioned premolars and molars that were brought into the arch. From the cases presented, it appears that aggressive surgical intervention to redirect ectopic premolars creates significant secondary problems. Interference with the bone surrounding the ectopic tooth may compromise the adjacent teeth and bone level. Pressure against the root of the impacted tooth may cause resorption. If the buccal or labial plate is removed, orthodontic movement will be impeded. Specific biochemical changes in bone are induced by the application of orthodontic forces. In these cases, creating space with coiled spring appliances resulted in remarkable reorientation and proper eruption of ectopic, impacted teeth. When surgical intervention is required in cases involving ectopic teeth, close collaboration between orthodontist and oral and maxillofacial surgeon is imperative to achieve successful results without negative sequelae.