Maxillary protraction in patients with unilateral cleft lip and palate : Evaluation of soft and hard tissues using the Alt-RAMEC protocol.

Abstract

The aim of this study was to evaluate the hard and soft tissue effects and differences of the Alt-RAMEC protocol to the facemask and conventional facemask protocols in patients with unilateral cleft lip and palate. This prospective study was carried out with 30patients with unilateral cleft lip and palate with skeletal and dental classIII malocclusions who were referred to a university department of orthodontics. The patients were evaluated with the cervical vertebral maturation method and divided into two groups, each consisting of 15patients. The patients in groupI (mean age 10.00 ± 0.73 years) were treated according to conventional facemask protocol, and the patients in groupII (mean age 10.07 ± 2.43 years) were treated according to the Alt-RAMEC protocol before facemask application. Lateral cephalometric radiographs were evaluated by using the Dolphin Imaging Software version 11.7. The skeletal, dentoalveolar and soft tissue differences and treatment times were evaluated. GroupII demonstrated a5.73° increase in SNA, which was statistically significant, while this increase was 3.13° in groupI (p < 0.001). Results for Co‑A and A‑PTV showed asignificant increase for groupII only (groupI: 1.02 mm, 1.06 mm, groupII: 3.02 mm, 2.21 mm; p < 0.05 and p < 0.01, respectively). In addition, groupII presented significant increase for the values of ANB, N‑A-Pg, SN/MP, Wits, U1-SN, U1-L1, U1-PTV, U1-FHP, U6-PTV, U6-FHP, overjet, Ss-PTV, UL-PTV and UL‑S line (p < 0.001). The treatment mean times were 7.3months in groupI and 4.7months in groupII (p < 0.01). Applying the facemask after having followed the Alt-RAMEC protocol induced more skeletal, dentoalveolar and soft tissue changes in comparison to the conventional facemask protocol in patients with unilateral cleft lip and palate.