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by Dr. SreeThe thinking beyond your smile.Specialist Orthodontist · Dubai
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COMPLEX ORTHODONTIC CASES · DUBAI

A complex bite.
Clear next steps.

Narrow arches. Jaw discrepancies. Facial-height imbalance. Midline shifts. Gum display. Deep or open bites. Impacted teeth. Lip trapping. Each needs a defined movement strategy.

Dr. Srinivasa Rao Bogavilli, MDS
Dr. Srinivasa Rao BogavilliMDS · Specialist Orthodontist · DubaiSince 2010 · 3,000+ completed cases
Explore a bite concern

A CLOSER LOOK AT THE FINDINGS

Open the concern.
See what I review.

Explore the clinical questions and a related record. Choosing a topic does not diagnose your own bite.

01Narrow arches and crossbite
Top-view conceptual MARPE schematic with a central expansion mechanism and palatal anchorage, with outward arrows across the upper jaw.
MARPE uses skeletal anchorage for selected transverse problems.

Arch width and a possible bite shift

I distinguish a dental crossbite from a transverse jaw discrepancy and assess arch form, periodontal support and skeletal maturity. Expansion, MARPE assessment or a surgical expansion opinion may be appropriate for different findings.

02Class II and Class III jaw relationships
Three side-view schematics comparing a coordinated jaw relationship, a relatively retrusive lower jaw and a relatively prominent lower jaw.
A bite concern may involve the teeth, the jaws, or both.

Dental correction, growth or skeletal assessment

The review separates tooth position from the underlying jaw discrepancy. Growth guidance, orthodontic camouflage and combined orthodontic–surgical care have different indications. Facial priorities and the safe limits of tooth movement guide the discussion.

03Lower facial height and chin prominence
Side-profile diagram marking soft-tissue lower facial height from the base of the nose to the lowest point of the chin.
The distance from the nose base to the lowest point of the chin.
Profile illustration locating chin projection and the curve between the lower lip and chin.
Projection and the lip–chin curve are related, but different.

Vertical control is part of the diagnosis

Excessive or reduced lower facial height, a weak-looking chin or a prominent chin may accompany a vertical or sagittal bite discrepancy. I assess facial proportions, incisor display and jaw rotation before choosing intrusion, other tooth movements or a broader assessment.

04Dental and facial midline discrepancies
Facial and upper dental midlines shown separately, with the dental marker at the contact between the upper central incisors.
Compare the facial midline with the actual centre between the upper front teeth.

Find which structures are out of line

A shifted dental midline may reflect unequal spaces, tooth positions, a functional bite shift or skeletal asymmetry. I identify the source before choosing asymmetric mechanics, anchorage or a multidisciplinary approach.

05Gummy smile
Four possible contributors to gum display: tooth position with lower-lip coverage of the upper incisal edges, upper-lip movement, gum coverage and vertical jaw pattern.
Gum display can relate to tooth position, lip movement, gum coverage or jaw height.

Identify the source of excessive gum display

Tooth over-eruption, incisor position, deep bite, lip activity, gum coverage and vertical skeletal proportions can contribute differently. TAD-supported intrusion may address a dental component; other causes may need periodontal or surgical care.

06Severe deep bite or open bite
Prominent deep bite with upper front teeth covering most of the visible lower incisor crowns.
In a deep bite, the upper front teeth overlap too much of the lower front teeth vertically.
Front-tooth schematic with a visible vertical gap between the upper and lower incisors when the back teeth meet.
The back teeth may meet while the front teeth do not.

Choose the right vertical movements

Deep-bite planning considers tooth overlap, wear, incisor display and which teeth should move vertically. Open-bite planning also reviews habits and the skeletal pattern. In selected open bites, molar intrusion can permit mandibular autorotation. Retention and relapse risk need specific discussion.

07Impacted teeth and unusual eruption
Upper canine schematic showing a tooth within the gum above a space, an assessed movement path and adjacent tooth roots.
Check the position, space and neighbouring roots before traction.

Coordinate the path into the arch

An impacted canine or another unerupted tooth may need imaging, space creation and coordinated surgical exposure and orthodontic traction. Its position, neighboring roots, oral health and the risks of movement determine whether that pathway is appropriate.

08Large overjet and lower-lip trapping
Pronounced horizontal overjet with the lower lip visibly positioned behind the upper incisors and in front of the lower incisors.
Prominent upper front teeth can trap the lower lip in the space behind them.

Review the teeth, lips and jaw relationship

Prominent upper front teeth can trap the lower lip and affect comfortable lip closure. I assess incisor inclination, root position, available space, growth and facial support. A useful plan explains how the overjet and lip relationship will be managed together.

THE RELATED CLINICAL RECORDS

Review the recorded treatment.

These are individual records for the clinical concerns above. Open a record for the original treatment facts.

Case 20 · Gummy smile and complete deep bite

Case 06 · Narrow upper arch and crossbite

Case 01 · Class III profile correction

Case 04 · Midline shift and overjet

BIOMECHANICS AND RETREATMENT

Explain the mechanics behind the correction.

Complex care requires a plan for how the roots, bite and facial relationships will be managed.

01

Crown and root control

Tooth cutaway showing the crown, root and supporting bone, with a curved arrow indicating controlled inclination.
A straight-looking crown does not reveal the whole root position.
How I plan this

An aligned-looking crown is only part of the result. Root inclination and the tooth’s position within supporting bone affect the safe movement and the final bite.

02

Anchorage and vertical mechanics

Schematic temporary anchorage screw in supporting bone, connected to a tooth by an orthodontic force element.
A temporary anchorage device can provide an additional point of support.
How I plan this

TADs can support selected movements such as intrusion, distalization or asymmetric space closure. The purpose is specific control, with an explanation of alternatives and risks.

03

Relapse and unfinished correction

Review pathway linking previous records, current findings and retention history to a revised orthodontic plan.
Bring the earlier records, treatment history and retainer history.
How I plan this

I review the original diagnosis, current bite, tooth positions, periodontal health and retention history. A second opinion should explain the findings before proposing retreatment.

BRING THE STORY SO FAR

A second opinion
starts with your questions.

Bring what you already have. The review can identify which further records, if any, are needed.

  1. 01

    Your main concern

    What still bothers you, what you are considering and what you would like explained.

  2. 02

    Previous information

    The treatment plan, photographs, scans or radiographs already available to you.

  3. 03

    The proposed next step

    Options, reasonable limits, responsibilities, fees and how the result would be maintained.

SEE THE RELATIONSHIP

Symptoms deserve a separate assessment.

Tell me about jaw pain, locking or restricted movement.

Side-view jaw-joint schematic locating the joint near the ear and separating symptom assessment from orthodontic tooth alignment.
Pain, locking or restricted movement should be discussed.

Jaw-joint or muscle symptoms may need coordinated assessment. Orthodontics is not presented as a guaranteed treatment for TMD.

BEFORE YOU DECIDE

Your questions.
Clearer next steps.

Further patient information
What makes an orthodontic case complex?

Examples include a skeletal jaw discrepancy, severe vertical bite problem, impacted tooth, narrow arches, facial or dental asymmetry, significant lip trapping, relapse or a need to coordinate orthodontics with restorative or surgical care. The difficulty depends on the combined findings.

Why does root control matter if the teeth look straight?

The visible crown can move differently from the root. Root inclination, periodontal support and the position of the tooth within bone affect which movements are safe and how the bite is finished. A review should consider more than a front-view photograph.

Can a complex case be treated without jaw surgery?

Some can be managed with orthodontic mechanics, growth-related treatment or camouflage. Others have skeletal discrepancies beyond the limits of tooth movement. The assessment should explain what each option can achieve for the bite and face.

Can I request a second opinion while treatment is continuing?

Yes. Bring the current treatment plan and any records you already have, along with the question you want answered. A review can discuss the diagnosis, progress, proposed mechanics and reasonable alternatives. Acceptance of a transfer needs its own assessment.

Does changing the bite cure TMJ pain?

Orthodontics should not be promised as a cure for temporomandibular disorders. Jaw-joint and muscle symptoms need their own assessment and may require coordinated care.

What happens after retreatment?

Finishing includes the bite, root positioning when relevant and a retention plan. Relapse risk and ongoing retainer responsibilities should be discussed for the individual situation.

Face & smile planning

Facial balance, chin, lips and smile planning.

Braces

Fixed appliances and how treatment is planned.

Smile transformations

Recorded clinical cases with their context.

YOUR NEXT STEP

Bring your questions.
Start with a conversation.

Meet Dr. Sree at Anytime Dental Clinic in Dubai. Choose your preferred location and tell the appointment team what you would like assessed.

Call +971 58 596 3637 ↗
Request a consultation in Al Rigga

Please confirm Dr. Sree’s availability, the appointment time and the consultation fee before attending.

A RECORDED TEEN TREATMENT DECISION

Teen crowding treated with a non-extraction plan.

For this 13-year-old female patient, Dr. Sree created space through TAD-supported posterior distalization. The initial and final records show the front, both sides and both arches.

Explore the teen non-extraction TAD case ↗

Consult Dr. Sree in Dubai

Please confirm Dr. Sree’s availability, appointment time and consultation fee before travelling.

Anytime Dental Clinic – Al Rigga
Office 835, 8th Floor, Al Ghurair Office Tower
Al Ghurair Centre, Entrance 3, Al Rigga, Deira, Dubai
Branch address and directions
Dr. Sree appointments: 058 596 3637
Anytime Dental Clinic – Barsha Heights
Unit 903, 9th Floor, Al Shafar Tower 1
Barsha Heights (Tecom), Dubai
Branch address and directions
Dr. Sree appointments: 058 596 3637
Dr. Sree · MDS · Specialist Orthodontist · Dubai

General patient information. Treatment choices depend on an individual clinical assessment. Clinical records illustrate individual care.

CLINICAL CASE RECORD

    One patient’s recorded care. A similar concern does not imply the same treatment, duration or outcome.

    Discuss a similar concern

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    Al RiggaAnytime Dental Clinic
    Al Ghurair Centre, Deira    WhatsApp for Al Rigga     Barsha HeightsAnytime Dental Clinic
    Al Shafar Tower 1, Tecom    WhatsApp for Barsha Heights

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