Initial situation
- Midline of the upper and lower incisors did not match
- Disrupted smile arc
- Narrow dental arches
- Crowding in both upper and lower teeth
The decision
The treatment plan expanded the narrow dental arches to eliminate crowding, then used the resulting space and alignment to restore the midline and the smile arc.
Restoring arch width can resolve midline and smile arc problems that appear unrelated to the transverse dimension at first glance.
The result
Over 22 months, the dental arches were expanded, crowding was eliminated, the midline was restored, and the smile arc was restored.
Midline and smile arc discrepancies that accompany narrow, crowded arches can often be resolved together through arch expansion rather than isolated tooth movement.
About skeletal expansion & MARPE
A midline discrepancy and a disrupted smile arc frequently trace back to narrow, crowded dental arches rather than an isolated anterior problem. Expanding the arches to eliminate crowding creates the conditions needed to reposition the midline and re-establish a proper smile arc. This case illustrates how transverse assessment early in treatment planning can explain findings that initially appear unrelated to arch width.
Questions clinicians ask
What caused the midline mismatch in this case?
The midline mismatch was linked to narrow, crowded dental arches rather than an isolated anterior problem.
How was the crowding addressed?
The narrow dental arches were expanded to eliminate the crowding in both the upper and lower teeth.
How long did treatment take?
This case was completed in 22 months.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
