Treatment of severe crowding and cross bite

A 35-year-old adult patient presented with severe crowding in both the maxillary and mandibular dental arches. Following comprehensive clinical and radiographic evaluation, a non-conventional extraction approach was adopted. Severe crowding and crossbite are usually treated with metal or clear fixed braces, sometimes combined with tooth extraction, jaw expansion, or elastics to align teeth and correct the bite. Instead of the typical extraction of four first premolars, treatment involved the extraction of the lower third molars and one mandibular incisor.

This alternative plan aimed to manage the crowding while preserving overall arch integrity and supporting favorable facial aesthetics. Arch expansion was employed in both the maxillary and mandibular arches to relieve crowding, enhance arch form, and improve overall facial proportions.

The active orthodontic treatment phase lasted approximately 24 months, resulting in a well-aligned dentition with improved arch shape and volume, as well as enhanced facial harmony.