Orthodontic treatment is planned on an individual, case-by-case basis after thoroughly considering the patient's overall facial and dental characteristics, the expected duration of treatment, costs, patient preferences, and the orthodontist's experience. This article reports the treatment of a patient with a maxillary premolar-molar transposition in the permanent dentition that was successfully managed with orthodontic treatment. A girl, aged 10 years 2 months, came for treatment with an ectopic maxillary left premolar. Radiographic analysis indicated a developing complete transposition of the maxillary left premolar. The patient was treated with extraction of the deciduous molar and surgical exposure and ligation of the premolar. Eruption was properly guided, and the correct order of the 2 teeth was restored in the arch. This challenging treatment approach is described in detail, including the mechanics used to align the ectopic premolar. Early treatment can, in many cases, prevent a molar-premolar transposition.