Initial situation
- Narrowing of the jaws
- Upper lateral incisors misaligned
- Dental arch asymmetry
- Excessive gum display when smiling
- Misaligned central line
The decision
This case is presented as a before-and-after outcome. As with other cases in this practice, the treatment plan followed a standard staged assessment addressing arch narrowing, lateral incisor position, and midline discrepancy together.
The result
The patient finished treatment with a wide, open, and symmetrical smile, with the lateral incisors realigned, the arch asymmetry resolved, and the central line restored.
Correcting arch width alongside lateral incisor position and midline discrepancy can resolve multiple related findings within a single coordinated treatment plan.
About skeletal expansion & MARPE
This case reflects how narrow arches, misaligned lateral incisors, and midline discrepancy frequently occur together rather than as isolated findings. Evaluating arch width as part of the overall diagnostic picture, alongside individual tooth position and midline alignment, allows a staged treatment plan to address the underlying cause. Correcting the transverse dimension in this way supports a more complete and stable improvement in smile symmetry.
Questions clinicians ask
Why do narrow arches often coincide with midline shift?
When arch width is insufficient, teeth can shift or crowd unevenly, which frequently displaces the midline as well as individual teeth like the lateral incisors.
How was arch asymmetry addressed in this case?
Arch asymmetry was resolved as part of the overall staged treatment plan, alongside correction of the lateral incisor position and midline.
Is gum display connected to arch width?
Gum display can have several contributing factors, and when it appears with arch narrowing, it is often considered together with the rest of the diagnostic picture during planning.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
