A very rare case of bilateral supernumerary teeth in the maxillary canine region and its management through a 3-step-conservative approach and 5-year-follow up is presented in this report. A 7-year-old Caucasian boy presented with 2 erupted supernumerary primary maxillary canines (53s and 63s) and two unerupted supernumerary permanent maxillary canines (13s and 23s). The treatment was carried out in three steps. In the first step, we removed teeth 53s and 63s. As the second step, early removal of teeth 53 and 63 and cementation of a space maintenance appliance (Nance's arch) were performed. In the third step, teeth 13s and 23s were removed, and the Nance's arch was maintained until the complete eruption of teeth 13 and 23. The management of this case with a proper treatment plan enabled us to solve the problem without complex procedures. (J Oral Sci 51, 145-150, 2009)