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The replacement of missing anterior teeth is a particular challenge in children and adolescents. This report describes the management of a 9-year-old boy suffering a severe dental injury. The treatment included three autotransplantations and orthodontic space closure to replace four maxillary teeth. A follow-up period of 21 years demonstrated a successful outcome. Autotransplantation of premolars in growing individuals is a predictable method for replacement of missing teeth and for re-establishment of the alveolar process after traumatic bone loss. This case report shows that a multidisciplinary approach is essential for the management and outcome of severe dental injuries in children.