A case is presented of a ‘dilacerated’ central incisor whose apex perforated the labial alveolus following orthodontic traction subsequent to its surgical exposure, which then necessitated endodontic treatment and an apicoectomy. The literature is reviewed regarding the aetiology and terminology of this complication and the implications for informed consent in such cases are discussed. Clinical Relevance: This article will clearly differentiate between the two types of incisor root deflections that may occur during development. That is, those with true incisor palatal root dilacerations and those with pseudo-dilacerations which are actually incisors with vestibular root angulations. The surgical and orthodontic recovery of an unerupted central incisor with a vestibular root angulation is outlined, in particular the management of the manifestation of one of the risks associated with this procedure, namely that of inducing an alveolar fenestration with the apex of the tooth during the process.