Abstract :Early diagnosis and extraction is the best treatment option for the mesiodens to prevent further complications. But in most cases, mesiodens is not diagnosed at correct time and leads to various complications such as ectopic eruption of permanent central incisor. In such cases also, treatment is extraction of mesiodens and orthodontic alignment of ectopically erupted tooth. Treatment should always be planned taking various factors into consideration such as main objective for the treatment, radiographic and clinical evaluation, treatment outcome, financial condition of the patient and patient’s preferences. We should think of all treatment alternatives while planning treatment and must take final decision with patient’s involvement. This case report presents a case of intentional retention of fully erupted mesiodens as an esthetic substitute for malpostioned maxillary central incisor emphasizing the importance of patient preferences and treatment needs in treatment planning.