Initial situation
- Narrow upper and lower jaws
- Crowding and tooth displacement
- Several teeth tilted
- Displaced smile midline from tooth shifting and tilting
- Noticeable smile asymmetry
The decision
The treatment plan addressed the narrow upper and lower arches with the Damon Q2 self-ligating bracket system, targeting arch development, resolution of crowding, and correction of the displaced midline and tilted teeth.
Correcting arch width and tooth position together can restore both midline symmetry and smile balance.
The result
Full correction was achieved in 12 months of active treatment, with resolved crowding, realigned teeth, and a corrected midline.
Bilateral arch constriction with secondary tooth tilting and midline shift can be resolved efficiently with a self-ligating bracket system when treatment is planned around arch development.
About skeletal expansion & MARPE
Narrow upper and lower arches often present with secondary effects, including crowding, axial tipping, and midline discrepancy, that extend beyond the transverse dimension itself. Staged assessment of arch width, tooth position, and midline relationship helps clinicians sequence treatment so that expansion and alignment goals are met together. This case reflects a broader principle in transverse diagnostics: correcting arch form frequently resolves several dependent problems at once.
Questions clinicians ask
What caused the midline shift in this case?
The midline shift resulted from tooth shifting and tilting associated with narrow upper and lower arches and the resulting crowding.
Which appliance system was used?
The Damon Q2 self-ligating bracket system was used to manage arch development and alignment.
How long did treatment take?
This case was completed in 12 months, though treatment duration is always individualized based on the initial presentation.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
