Treatment of Class II malocclusion with tooth movement through the maxillary sinus

This case report describes the successful extraction treatment of a Class II malocclusion with excessive maxillary sinus pneumatization. A 20-year-old man sought treatment with the major complaint of protrusive mouth and anterior teeth. He was diagnosed with a skeletal Class II relationship and protrusion of the maxilla. The clinical examination showed a severe Class II molar relationship with excessive overjet and deep overbite. Panoramic radiograph showed obvious maxillary sinus pneumatization bilaterally. Three premolars and one deciduous molar were extracted, and spaces were used to correct molar relationship and retract maxillary incisors. Light forces and low speed movement were applied to overcome the challenge of moving teeth through the maxillary sinus wall. Balanced facial esthetic and stable occlusion were obtained posttreatment with a notable bone formation of the maxillary sinus wall. This result highlights the possibility of tooth movement through cortical floor with bone remodeling and no obvious complications.