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Background: Dengue fever is reemerging on the island of Martinique and is a serious threat for the human population. During dengue epidemics, adult Aedes aegypti control with pyrethroid space sprays is implemented in order to rapidly reduce transmission. Unfortunately, vector control programs are facing operational challenges with the emergence of pyrethroid resistant Ae. aegypti populations. Methodology/Principal Findings: To assess the impact of pyrethroid resistance on the efficacy of treatments, applications of deltamethrin and natural pyrethrins were performed with vehicle-mounted thermal foggers in 9 localities of Martinique, where Ae. aegypti populations are strongly resistant to pyrethroids. Efficacy was assessed by monitoring mortality rates of naturally resistant and laboratory susceptible mosquitoes placed in sentinel cages. Before, during and after spraying, larval and adult densities were estimated. Results showed high mortality rates of susceptible sentinel mosquitoes treated with deltamethrin while resistant mosquitoes exhibited very low mortality. There was no reduction of either larval or adult Ae. aegypti population densities after treatments. Conclusions/Significance: This is the first documented evidence that pyrethroid resistance impedes dengue vector control using pyrethroid-based treatments. These results emphasize the need for alternative tools and strategies for dengue control programs. Author Summary: The mosquito Aedes aegypti is the major vector of the Dengue virus in human populations and is responsible of serious outbreaks worldwide. In most countries, vector control is implemented by the use of insecticides to reduce mosquito populations. During epidemics, insecticides of the pyrethroid family (blocking the voltage gated sodium channel protein in the nerve sheath) are used by space spraying with vehicle mounted thermal foggers to kill adult mosquitoes. Unfortunately some populations of Ae. aegypti have become resistant to these insecticides, leading to operational challenges for public health services. In Martinique (French West Indies), resistance to pyrethroids was detected in the 1990s. The present study assessed the impact of this resistance on the efficacy of vector control operations in 9 localities of Martinique. Here we showed that the resistance strongly reduces the efficacy of pyrethroid-based treatments, thus emphasizing the urgent need for alternative insecticides or tools to reduce dengue transmission. [ABSTRACT FROM AUTHOR]