Initial situation
- Tooth crowding
- Oral hygiene difficulties related to crowding
- ENT-related problems
- Skeletal narrowing of the upper jaw
The decision
Given the skeletal narrowing of the upper jaw alongside crowding, hygiene difficulties, and ENT-related findings, the treatment plan combined a MARPE appliance for skeletal expansion with the Damon Q2 bracket system for comprehensive alignment.
Combining MARPE-driven skeletal expansion with a low-friction bracket system can address both transverse deficiency and crowding in one coordinated plan.
The result
The result met the treatment goals set for the patient, with the skeletal narrowing, crowding, and related hygiene concerns resolved through the combined MARPE and Damon Q2 approach.
When skeletal narrowing, crowding, and airway-related ENT findings coexist, combining skeletal expansion with a comprehensive bracket system can address multiple contributing factors in one treatment plan.
About skeletal expansion & MARPE
This case combined MARPE for skeletal expansion of a narrow maxilla with the Damon Q2 bracket system for comprehensive alignment. Clinicians managing similar presentations, where crowding coexists with hygiene difficulties and ENT-related findings, typically evaluate transverse skeletal dimension early, since resolving arch width can simplify subsequent alignment and support better oral hygiene access.
Questions clinicians ask
Why combine MARPE with a bracket system in this case?
MARPE addressed the underlying skeletal narrowing of the upper jaw, while the Damon Q2 bracket system provided comprehensive alignment of the crowded teeth.
How does skeletal narrowing relate to hygiene difficulties?
A narrow upper jaw can contribute to crowding, which in turn makes effective brushing and flossing more difficult and increases hygiene-related risk.
Why might ENT findings factor into the decision to use MARPE?
MARPE produces skeletal expansion of the maxilla, which can also support nasal airway volume, making it a relevant consideration when ENT-related breathing issues are present alongside a narrow arch.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
