Initial situation
- Disrupted smile arc
- Narrow maxilla
- Severe crowding in the upper arch
- Inward displacement of lateral incisors
- Canine rotation
- Axial rotation of central incisors
- Inward tipping of molars
The decision
The treatment plan used the Damon Q2 bracket system to expand the upper jaw, create space for the crowded teeth, and restore the smile arc through comprehensive alignment of the upper arch.
Expanding the maxilla and aligning the arch together can restore the smile arc without adjunctive cosmetic procedures.
The result
After 23 months of treatment, the maxilla was expanded, the crowded teeth were aligned, and the smile arc was restored. Lip position at smile also changed as a direct result of the orthodontic movement, without any cosmetic intervention.
Severe crowding with a narrow maxilla and rotated anterior teeth can be resolved through arch expansion and alignment alone, with visible improvement in lip and smile esthetics.
About skeletal expansion & MARPE
A narrow maxilla frequently underlies severe anterior crowding, canine rotation, and a flattened smile arc, since the arch lacks the width to accommodate the teeth in proper axial position. Addressing the transverse deficiency as part of the overall plan, rather than treating the crowding in isolation, allows the smile arc and soft tissue drape to improve alongside tooth alignment. This case reflects the broader value of assessing arch width before finalizing a crowding treatment plan.
Questions clinicians ask
What caused the disrupted smile arc in this case?
The disrupted smile arc resulted from a narrow maxilla and severe crowding, which caused inward displacement, rotation, and tipping of several upper teeth.
Did the patient have any cosmetic procedures?
No, the changes to lip position and smile appearance were achieved solely through orthodontic treatment.
What appliance system was used?
The Damon Q2 self-ligating bracket system was used for expansion and alignment.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
