“I’m afraid your case is too complex for me to treat.” “You’ll probably need jaw surgery.” “I’m not sure anyone can fix this.” If you’ve heard these discouraging words from a general dentist, you’ll know the sinking feeling that accompanies them. You came seeking help, only to be told your orthodontic problems are beyond reach.
Here’s what you need to understand: complex orthodontic cases exist, certainly, but the definition of “too complex” depends entirely on the training and expertise of the clinician you’re consulting. At The London Smile Clinic in London’s West End, Dr Pratik Sharma—a GDC-registered Specialist in Orthodontics and Consultant at the Royal London Hospital—treats precisely these challenging cases every day. His specialist training, hospital experience, and role teaching other orthodontic specialists mean he regularly achieves results that general dentists might consider impossible.
In this guide, we’ll explore what makes an orthodontic case “complex,” why specialist expertise makes a critical difference, and what treatment options exist even for severe crowding, significant gaps, and challenging bite problems.
Understanding “Complex” Orthodontic Cases
Not all orthodontic treatments are equal in difficulty. Mild crowding or minor spacing can often be addressed by a general dentist with some orthodontic training. However, certain situations require the advanced diagnostic skills, comprehensive training, and extensive experience that only a Specialist Orthodontist possesses.
Cases typically classified as complex include:
- Severe crowding: When there’s significant lack of space and teeth are severely overlapped or rotated
- Large gaps or missing teeth: Spaces requiring careful management or interdisciplinary treatment involving implants or bridges
- Significant bite problems: Severe overbites (where upper teeth excessively overlap the lower), underbites (where lower teeth sit in front of upper teeth), or crossbites (where teeth meet incorrectly side-to-side)
- Impacted teeth: Teeth that haven’t erupted properly, particularly canines buried in the jawbone
- Asymmetries: When the jaw or teeth are significantly uneven from side to side
- Previous failed orthodontics: Cases where prior treatment didn’t achieve the desired result or has relapsed
- Combined skeletal and dental issues: Where the jaw relationship is significantly disproportionate, sometimes requiring surgical intervention
These situations demand not just technical skill but diagnostic expertise to identify the underlying cause of the problem and create a treatment plan that addresses the root issue, not just the visible symptoms.
Why Specialist Training Makes the Critical Difference
In the United Kingdom, the title “Specialist Orthodontist” is a protected designation regulated by the General Dental Council (GDC). To achieve this status, a dentist must complete a minimum of three years of full-time, intensive postgraduate training in orthodontics at an approved institution, followed by examination and registration on the GDC Specialist List.
Dr Pratik Sharma completed precisely this rigorous pathway. After graduating with distinction from Guy’s Dental Hospital, he undertook a three-year specialist training programme at The Royal London Hospital, earning a Master of Science in Orthodontics with distinction for his research. This isn’t simply an academic credential—it represents thousands of hours of supervised clinical experience treating the full spectrum of orthodontic complexity.
The specialist training difference includes:
- In-depth understanding of craniofacial growth and development: Specialists understand how the jaws and face grow, enabling them to predict long-term outcomes and create treatment plans that work with the body’s natural development
- Advanced biomechanics expertise: The physics of tooth movement is complex. Specialists are trained in the precise forces and directions required to move teeth safely and effectively, even in challenging situations
- Comprehensive diagnostic skills: Specialists can identify subtle problems that might be missed by a general practitioner, such as underlying skeletal discrepancies or airway issues
- Experience with the full range of treatment modalities: From simple removable appliances to complex fixed braces to surgical orthodontics, specialists have hands-on training in all approaches
This depth of training explains why a general dentist might deem a case “too complex” whilst a specialist views it as entirely manageable. It’s not about having better intentions—it’s about having fundamentally different tools, knowledge, and experience.
Dr Sharma’s Unique Position: Where Hospital Expertise Meets Private Practice
What sets Dr Pratik Sharma apart, even amongst specialist orthodontists, is his dual role. He divides his time between The London Smile Clinic and his position as a Consultant and Senior Clinical Lecturer in Orthodontics at the Royal London Hospital, one of the UK’s leading teaching hospitals.
In his hospital capacity, Dr Sharma treats the most challenging cases referred from across the region. These include patients with severe skeletal discrepancies requiring collaborative treatment with oral surgeons, individuals with congenital conditions affecting facial development, and complex cases that have failed previous treatment attempts. This constant exposure to orthodontic complexity keeps his diagnostic skills razor-sharp and his treatment approaches at the cutting edge of the profession.
Crucially, Dr Sharma also teaches. He’s responsible for training undergraduate dental students and supervising the specialist registrars who are themselves training to become consultant orthodontists. When you’re teaching the teachers, it’s a powerful validation of your expertise. As Dr Sharma himself notes, his approach is “patient-centred,” taking time to listen to individual needs and develop personalised treatment plans based on the latest research and clinical evidence.
His contributions to orthodontic research have been recognised with prestigious awards, including the B.F. and Helen E. Dewel Award from the American Journal of Orthodontics and Dentofacial Orthopaedics and the British Orthodontic Society’s Chapman Prize. These aren’t participation trophies—they’re peer recognition from the international orthodontic community that his work represents the highest standard of clinical research.
Treatment Approaches for Severe Crowding
Severe crowding—where teeth are significantly overlapped, twisted, or erupting out of position due to lack of space—is one of the most common “complex” presentations. Many patients assume that severe crowding automatically means extractions or invasive procedures, but modern orthodontic techniques offer sophisticated alternatives.
Treatment options Dr Sharma may consider include:
- Strategic expansion: Using advanced appliances to carefully widen the dental arches, creating space without removing teeth
- Interproximal reduction (IPR): Gently reshaping the sides of teeth to create small amounts of space throughout the arch
- Distalization techniques: Moving back teeth further back to create space for front teeth to align
- Selective extractions: When necessary, removing specific teeth strategically to enable optimal alignment and facial aesthetics
- Sequential treatment approaches: Sometimes combining early-phase expansion with later-phase alignment for optimal results
The key is accurate diagnosis. Dr Sharma uses comprehensive records—including detailed photographs, X-rays, and 3D imaging—to understand not just where the teeth are now, but why they’ve ended up in that position and what the most stable long-term solution will be. This diagnostic rigour, honed through years of hospital work with complex cases, ensures that treatment addresses the root cause rather than simply masking symptoms.
Patients at The London Smile Clinic benefit from Dr Sharma’s extensive experience with all modern orthodontic systems. Whether the optimal solution involves Invisalign with advanced attachments, lingual braces for invisible treatment, or traditional fixed braces with contemporary techniques, he has the expertise to deliver results.
Solutions for Significant Bite Problems
Bite problems—malocclusions in clinical terminology—range from mild discrepancies that are purely aesthetic to severe functional issues that affect chewing, speech, jaw health, and facial proportions. These are among the most challenging orthodontic situations to treat successfully.
The three primary bite problems include:
- Overbite (Class II malocclusion): The upper teeth and jaw sit significantly forward of the lower teeth. In severe cases, the upper teeth may completely cover the lower front teeth, sometimes causing the lower teeth to bite into the roof of the mouth.
- Underbite (Class III malocclusion): The lower teeth and jaw sit forward of the upper teeth, creating a “bulldog” appearance. This can cause significant wear on teeth and affect self-confidence.
- Crossbite: Teeth meet incorrectly from side to side, where upper teeth bite inside lower teeth (rather than outside, as they should). This can cause asymmetrical jaw growth, excessive wear, and TMJ problems.
Treating these conditions requires understanding the skeletal relationship between the upper and lower jaws, not just the position of the teeth. Dr Sharma’s hospital experience is invaluable here. At the Royal London Hospital, he works closely with oral and maxillofacial surgeons on cases where jaw surgery is required to correct severe skeletal discrepancies.
However, many bite problems that might appear “surgical” can actually be treated orthodontically alone with specialist expertise. Through a combination of modern biomechanics, contemporary appliances, and strategic treatment planning, Dr Sharma can often achieve remarkable improvements without surgery. When surgery is genuinely necessary, his established relationships with leading oral surgeons ensure seamless collaborative care.
The Interdisciplinary Approach: When Multiple Specialists Collaborate
Some complex orthodontic cases require input from multiple dental specialists working in concert. This is where practising within a comprehensive clinic like The London Smile Clinic provides significant advantages.
Consider a patient who has severe crowding, several missing teeth, and wants a beautiful final result. This might require:
- Orthodontic space management by Dr Sharma to create appropriate gaps for replacement teeth
- Dental implant placement by Dr Zaki Kanaan, the clinic’s implant surgeon who holds a Master’s degree in implant treatment
- Final cosmetic refinement by Dr Tim Bradstock-Smith or Dr Michelle Sayour
Dr Sharma is experienced in this type of interdisciplinary treatment planning. His role involves carefully orchestrating the tooth movements to create ideal spaces in precisely the right positions, at the right time, to enable the implant surgeon to work effectively. This requires communication, precision, and a comprehensive understanding of the complete treatment timeline.
Similarly, some orthodontic cases may benefit from gum recontouring, tooth reshaping, or other cosmetic enhancements after tooth alignment is complete. Having all these specialists under one roof at The London Smile Clinic means your treatment is coordinated seamlessly, with all practitioners working towards a unified final outcome.
What to Expect During Your Specialist Consultation
If you’ve been told your case is complex or if you’ve struggled to find a clinician willing to take on your orthodontic challenges, your consultation with Dr Sharma will be markedly different from previous experiences.
Your specialist assessment includes:
- Comprehensive diagnostic records: Detailed photographs from multiple angles, X-rays (including cephalometric analysis to assess jaw relationships), and potentially 3D CBCT scans for complex cases
- Thorough clinical examination: Assessment of your bite, jaw function, facial proportions, airway, and overall oral health
- Honest discussion of complexity: Dr Sharma will explain what makes your case challenging and why specialist expertise is required
- Exploration of treatment options: You’ll learn about different approaches, their benefits and limitations, and the likely timeframes involved
- Realistic expectation setting: You’ll understand what can be achieved, what compromises might be necessary, and what the treatment journey will involve
- Transparent cost discussion: Complex cases require honest conversation about investment, and you’ll receive clear information about fees
The goal of this consultation isn’t to convince you to proceed—it’s to provide you with accurate information so you can make an informed decision about your care. Dr Sharma’s patient-centred approach means he takes time to listen to your concerns, understand your priorities, and answer your questions thoroughly.
Your Complex Case Deserves Specialist Expertise
The London Smile Clinic has successfully completed over 25,000 smile straightening cases since its founding in 1999. Within that substantial number are countless patients who arrived feeling discouraged, having been told their orthodontic problems were beyond solution. Under the care of Dr Pratik Sharma, many of these “impossible” cases have been transformed.
Whether you’re facing severe crowding, significant bite problems, missing teeth requiring interdisciplinary care, or simply uncertainty about whether your situation can be improved, specialist consultation provides clarity and, often, hope. Dr Sharma’s credentials as a GDC-registered Specialist in Orthodontics, his role as a hospital consultant treating the most complex cases, and his position teaching the next generation of specialists provide unmatched reassurance that you’re consulting with a true authority in the field.
Complex doesn’t mean impossible—it simply means you need the right expertise.
Don’t give up on your smile because you’ve been told your case is too challenging. Book a specialist consultation with Dr Pratik Sharma at The London Smile Clinic today. Call the West End practice or visit the website to discover what advanced orthodontic expertise can achieve, even in the most demanding situations.
