Initial situation
- Severe dental crowding
- Significant space deficiency
- Scissor bite in the area of the second molars
The decision
Treatment used the Damon bracket system over 26 months, with active use of interproximal enamel reduction (IPR) to create the space needed to align the crowded teeth without extraction.
Active IPR made it possible to resolve severe crowding without extraction while still achieving a balanced result.
The result
The final result after debonding was aesthetic, balanced, and stable, with the surrounding tissues adapting well and the smile appearing natural.
Severe crowding does not always require extraction; active, well-managed IPR can create sufficient space while preserving arch form and tissue health.
About skeletal expansion & MARPE
This case is primarily about space management rather than transverse skeletal expansion, though both approaches address the same underlying constraint of insufficient arch space. Deciding between extraction, IPR, and expansion depends on a full diagnostic picture, including arch width, tooth size, and the severity of crowding. In cases like this, clinicians typically weigh how much space is truly needed against the biologic limits of enamel reduction before ruling extraction in or out.
Questions clinicians ask
Why choose IPR instead of extraction for severe crowding?
IPR can create meaningful space while preserving all the teeth, and it may be selected when the total space deficiency falls within safe reduction limits.
What is a scissor bite and why does it matter?
A scissor bite occurs when posterior teeth do not properly overlap, which can affect chewing function and needs to be corrected as part of the overall bite correction.
How much space can IPR typically provide?
The amount varies by tooth and case, and clinicians generally follow established limits per contact point to protect enamel and periodontal health.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
