Initial situation
- Crossbite in the area of the fourth teeth
- Narrow upper jaw
- Crowding in both upper and lower arches
The decision
The treatment plan addressed the posterior crossbite, narrow maxilla, and bilateral crowding over a course of just over 20 months, resulting in a wide, even smile.
A stable, wide smile can be achieved through orthodontic tooth movement alone, without altering tooth shape.
The result
Treatment took just over 20 months and produced a wide, even smile that the patient was satisfied with. Orthodontic treatment does not change the shape of the teeth, so a size discrepancy between the upper central incisors would require veneers if the patient chooses to address it.
Correcting a narrow maxilla and posterior crossbite alongside crowding can produce a wide, stable smile, though residual tooth-shape discrepancies fall outside the scope of orthodontic movement.
About skeletal expansion & MARPE
A narrow maxilla with a posterior crossbite commonly presents together with crowding in both arches, since limited arch width restricts space for all the teeth. Addressing the transverse discrepancy as part of the overall plan allows the crowding to resolve without extraction in many cases. This case also illustrates an important distinction for patients: orthodontic treatment repositions teeth but does not reshape them, so shape or size asymmetries may require restorative follow-up.
Questions clinicians ask
What was the main transverse finding in this case?
The patient presented with a crossbite in the area of the fourth teeth and a narrow upper jaw.
How long did treatment take?
Treatment took just over 20 months.
Why might the upper central incisors still look slightly different in size after treatment?
Orthodontic treatment moves teeth but does not change their shape, so a size difference between the upper central incisors can only be corrected with veneers if the patient chooses that option later.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
