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Orthodontics/Midline discrepancy after two years of braces



My daughter had narrow upper jaw, class III malocclusion, crowding, and posterior open bite. After two years of braces all the problems seem fixed. My daughter is happy with the way she bites.

The only problem left before removing the braces is a midline discrepancy, about 2 mm. The upper jaw is aligned with the middle of the nose but the lower jaw is not.

The orthodontist asked my daughter to wear the elastics in a certain position and warned her to stop if the jaws shift the other way. After a few nights she couldn't bite properly so she stopped using the elastics. She went back to the office and notified the orthodontist about the problem. After 30 sec he said that her bite and smile are beautiful and she should not wear any elastics until next week when he plans to remove the braces. He did not address the midline discrepancy.

Is this reasonable after two years of treatment?
Thank you very much,

Hi Tania,

Thank you for an interesting question....namely  midline discrepancies. My goodness, in looking at your initial problem list prior to treatment, I do hope you fully realize how difficult a case you present to your orthodontist. Class III  cases are very challenging as they often present a very difficult to manage skeletal architecture. A posterior open bite is also no picnic to treat.  Posterior and anterior open bites are each very difficult to resolve.
Tania, if your orthodontist has successfully wrestled with each of the initial problems and resolved  them, the fact that a small midline discrepancy exists s NOT a major issue which I would be that concerned about.  

Remember, you are very likely dealing with skeletal asymmetries and other imbalances. The small midline effect which you describe may be due to yet another skeletal issue. It may also be the necessary side effect of correcting a far more profound issue such as the open bite.

There have actually been studies in the orthodontic scientific and clinical literature to suggest that midline discrepancies  up to 4 mm may in fact not be noticeable by the lay person. What your Orthodontist may be attempting to perform by the elastics is a repositioning of the jaw. However, if the lower jaw itself is asymmetrical, pushing one side further back into the condylar fossa. What is being attempted while noble  in purpose, may in fact be overkill. Ask you orthodontist if he or she feels that the current result, with the 2mm midline shift, represents an acceptable result given the overwhelming initial problem list. I think the answer will be yes.  Tania, I think at this point you should thank your doctor for the results you do have, and wear the retainers as instructed to keep what you have from relapsing.

I hope that this answer will be well received.I am sharing with you what is realistic. Although I am not able to actually see the results in person, I have every reason to believe that your treatment and the current result is very likely excellent. Please write again if you have any other concerns.

Paul Supan, DDS, MA. MPH


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Paul Supan, DDS, MA, MPH


First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites and are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.


Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

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BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

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