Initial situation
- Narrowing of the upper and lower jaws causing crowding and misalignment of multiple teeth
- Some teeth tilted or rotated around their axis
- Midline of the smile shifted
- Smile asymmetry and tilt of the occlusal plane
The decision
Treatment was carried out with braces, in collaboration with a partner clinic, to address the crowding, tooth rotations, midline shift, and occlusal plane tilt together as a single treatment plan.
The result
The combined treatment resolved the severe crowding and corrected the misaligned teeth, producing a straighter, more symmetrical smile with the midline and occlusal plane brought into better alignment.
Severe crowding linked to narrow jaws often involves rotation, midline shift, and occlusal plane tilt together, and treating them as a coordinated plan supports a fully resolved outcome.
About skeletal expansion & MARPE
This case highlights how narrow jaw arches can drive several interconnected problems at once — crowding, tooth rotation, midline shift, and occlusal plane tilt. Rather than treating each finding in isolation, a coordinated fixed appliance approach addressed the arches as a whole. Collaborating with a partner clinic on this case also illustrates how multidisciplinary coordination can support comprehensive correction of complex crowding presentations.
Questions clinicians ask
Why does jaw narrowing cause tooth rotation?
When the arches are too narrow to accommodate all the teeth, individual teeth can tip or rotate around their axis as they compete for space, contributing to crowding.
How is a midline shift corrected alongside crowding?
Resolving crowding and arch width often naturally repositions the midline, though specific mechanics may also be used to fine-tune its position during treatment.
Why was this case treated in collaboration with another clinic?
Complex crowding cases can benefit from multidisciplinary input, and this case was managed together with a partner clinic to support a comprehensive result.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
