It is not without some frequency that we encounter ankylosed primary teeth in the adolescent patient. Extraction of the ankylosed primary tooth and space preservation is the most frequently recommended treatment. It would make sense that, after removal, the erupting permanent teeth would preserve the alveolar bone both vertically and horizontally as they emerge into the arch. But what about the case where there is no permanent tooth successor? Does the alveolar bone continue to develop as normal growth continues, or does it atrophy? In this article, Dr. David M. Sarver explores a few cases and proposes treatment options for you to consider.