Initial situation
- Crossbite
- Pronounced skeletal narrowing
- Crowded teeth
- Poor oral hygiene
- Parental concern about nasal breathing and nighttime snoring
The patient was brought in by parents for a routine checkup, prompted by concerns about difficulty breathing through the nose and snoring at night.
The decision
The treatment plan addressed the skeletal narrowing, crossbite, and crowding together, timed to take advantage of the patient's growth stage. This case is discussed in full as part of the practice's continuing education course on maxillary skeletal expansion (MARPE), which covers the diagnostic and planning approach used.
Catching skeletal narrowing at the peak of growth allows a single coordinated plan to resolve problems that become harder to treat later.
The result
Treatment took 20 months and produced a stable, well-aligned result. A follow-up three years after completion confirmed the correction had held, with the patient's continued growth visible in the comparison photos.
Identifying skeletal transverse problems while a patient is still growing widens the range of treatment options and supports a more stable long-term outcome.
About skeletal expansion & MARPE
This case centers on skeletal transverse narrowing identified and treated during a period of active growth. Timing treatment to the growth window is a key variable in transverse diagnostics, since skeletal correction becomes more limited once growth slows. The case is discussed in the practice's MARPE course as an example of staged assessment that weighs airway, arch width, and crowding together rather than treating each finding in isolation.
Questions clinicians ask
Why does timing matter for skeletal crossbite correction in growing patients?
Treating skeletal narrowing while growth potential remains active allows changes that become more limited once skeletal maturity is reached, often simplifying the overall treatment plan.
Can nasal breathing and snoring be related to a narrow maxilla?
A narrow maxilla can be associated with nasal airway concerns in some patients, which is one reason transverse assessment is often included in a broader diagnostic workup.
How is long-term stability evaluated in cases like this?
Clinicians typically re-examine the case years after debonding to confirm that the corrected arch form, alignment, and bite relationship have remained stable.
Learn the decision-making behind cases like this
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
