First: You have great looking teeth!! Congratulations!Finding: Midline is off by 1/2 a tooth to the patient's right. Why?1. Skeletal base/skeletal growth asymmetry. The jaws can grow disproportionately, meaning one side can grow more than another, causing a shift of the midline towards the side that grows less. 2. Early tooth loss.As a child, there may have been a tooth that was lost prematurely, or may have never developed, subsequently the new adult teeth will erupt into the empty space, causing a shift to the affected side. 3. Tooth size discrepancy.More difficult to judge from the photo... the size (width) of the two central incisors don't match, the central incisor on the patient's left (tooth #9) looks smaller than the right( #8). Notice edges of the teeth, the V-shaped space formed by the curved proximal surfaces of adjacent teeth is known as the embrasure. The embrasures on the patient's left are larger than on the right.Potential solutions:Orthodontics: Can partially, or fully correct midline, Depending on radiographic analysis (cephalometric and CBCT). Interproximal stripping (IPS) is selective adjustment of the tooth surfaces in between each tooth. By creating space in between selective teeth (in essence creating a gap) the orthodontist can move the teeth towards the empty spaces, minimizing or fully correcting the midline problem.Orthognathic surgery: Involves significant double jaw surgery, most likely is done in tandem with a 2nd round of braces...Depending on radiographic analysis (cephalometric and CBCT) . 3-dimensional imaging would also more than likely show that you have a deviated septum and or nasal tubernate, due to limited space on the patient's right (Consult an ENT for further evaluation)Restorative: Ceramic Veneers or Crowns can move the midline, PARTIALLY, to the patient's left, by approximately 1-2 mm. You would still have a shift to the right by about 2-4 mm, although it would be less than current position. Remember, as always, Get a consultation with your local friendly prosthodontist specialist for a comprehensive evaluation.Hope that helps!Dr. Ace