Orthodontic extrusion (OE) is an orthodontic tooth movement in a coronal direction to modify the tooth position and/or induce changes on the surrounding bone and soft tissue with a therapeutic purpose. Evidence emanating from clinical reports and case series studies indicates that OE is a predictable treatment option to manage a variety of clinical situations. Common indications include traction of impacted teeth, exposure of teeth presenting structural damage to facilitate restorative therapy, treatment of periodontal bony and papillary defects, and implant site development. Unfortunately, there is a paucity of established protocols and guidelines for its application in clinical practice. Controversy exists in regard to the definition of rapid and slow OE, use of circumferential supracrestal fiberotomy, and tooth stabilization protocols during and upon completion of orthodontic movement. This article provides a concise perspective on the topic of OE by discussing key biologic principles and technical aspects that are translated into guidelines for the management of different clinical scenarios.