This case report presents a 24-year-old female with Class III skeletal pattern, anterior cross-bite, retroclined upper incisors with missing teeth (23, 26, 46). Upper dental midline was shifted to left for 3.5 mm due to early missing of tooth 23. Maxillary sinus pneumatization was noted at both sides.

Our treatment goal was to correct upper dental midline and anterior crossbite. On the other hand, the patient requested to close all of the extraction space and solve the problem of poor prognostic tooth 36. Therefore, we extracted tooth 14 for crowding relief and midline correction. Interdental screw was used to protract teeth 24-27 and substitute 23-26. In the lower arch, tooth 36 and 46 extraction space were planned to be closed to create positive overjet.

After treatment, posterior teeth protraction was achieved at quadrant two even with maxillary sinus pneumatization. The upper occlusal plane was maintained, although asymmetric teeth movement was planned. The profile was improved.

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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.