Existe uma maneira de criar ou atualizar um índice do MongoDB?

Olhando para o driver Eu implementei um CreateOrUpdateIndex método de extensão que compara os documentos de índice bruto e se as opções de índice foram alteradas, o índice é substituído (desde que o nome do índice permaneça o mesmo):

public static WriteConcernResult CreateOrUpdateIndex(
    this MongoCollection mongoCollection,
    IMongoIndexKeys keys,
    IMongoIndexOptions options = null)
{
    if (mongoCollection.IndexExists(keys))
    {
        var indexDocument = mongoCollection.GenerateIndexDocument(keys, options);
        if (!mongoCollection.GetIndexes().RawDocuments.Any(indexDocument.Equals))
        {
            mongoCollection.DropIndex(keys);
        }
    }

    return mongoCollection.CreateIndex(keys, options);
}

Gerando o documento de índice bruto:

public static BsonDocument GenerateIndexDocument(this MongoCollection mongoCollection, IMongoIndexKeys keys, IMongoIndexOptions options)
{
    var optionsDocument = options.ToBsonDocument();
    var keysDocument = keys.ToBsonDocument();
    var indexDocument = new BsonDocument
    {
        { "ns", mongoCollection.FullName },
        { "name", GenerateIndexName(keysDocument, optionsDocument) },
        { "key", keysDocument }
    };
    if (optionsDocument != null)
    {
        indexDocument.Merge(optionsDocument);
    }

    return indexDocument;
}

public static string GenerateIndexName(IEnumerable<BsonElement> keys, BsonDocument options)
{
    const string name = "name";
    if (options != null && options.Contains(name)) return options[name].AsString;

    return string.Join("_", keys.Select(element =>
    {
        var value = "x";
        switch (element.Value.BsonType)
        {
            case BsonType.Int32: value = ((BsonInt32)element.Value).Value.ToString(); break;
            case BsonType.Int64: value = ((BsonInt64)element.Value).Value.ToString(); break;
            case BsonType.Double: value = ((BsonDouble)element.Value).Value.ToString(); break;
            case BsonType.String: value = ((BsonString)element.Value).Value; break;
        }
        return string.Format("{0}_{1}", element.Name, value.Replace(' ', '_'));
    }));
}