Alternate Rapid Maxillary Expansion And Constriction Research Articles

Effect of Slow Maxillary Expansion and Alternative Rapid Maxillary Expansion Protocols on Airway Volume in Cleft Palate Cases: A Cone Beam Computed Tomography Based Study.

A total of 22 patients with cleft palate aged 8 to 12 years were selected and categorized into two groups: the first group was treated with alternate rapid maxillary expansion and constriction (Alt-RAMEC) using an expander with differential opening (EDO) and facemask, while the second group was treated using slow maxillary expansion (SME) using an EDO. Finally, the pharyngeal airway volume in the two groups was compared using cone beam computed tomography (CBCT). CBCT scans were performed before expansion and six months following the expansion. Alveolar crest level, maxillary breadth, nasal cavity width, arch width, inclination of the molar teeth, buccal and palatal alveolar bone thickness, and maxillary alveolar width were all assessed. Paired t-tests (p=0.05) were applied to compare interphase data. The two groups showed a non-significant difference in terms of nasopharyngeal volume (cm3), oropharyngeal volume (cm3), and overall pre- and post-treatment results (p>0.005). Results of comparison of pre- and post-treatment periods in the Alt-RAMEC group revealed a significantly higher cleft volume (cm3) (p=0.001). Results of comparison of pre- and post-treatment periods in the SME group revealed a substantial rise in cleft volume (cm3) (p=0.003).Results from a comparison of the cleft volume (cm3) between the two study groups pre- and post-intervention revealed a non-significant difference (p=0.200 and 0.054, respectively).

Temporomandibular joint disc position and shape in patients submitted to two protocols of rapid maxillary expansion and face mask therapy: A randomized clinical trial.

The objective of this prospective study was to assess possible changes in the position and shape of the temporomandibular joint (TMJ) articular disc in patients treated with two protocols of rapid maxillary expansion (RME) and face mask (FM) therapy. A sample of 88 patients with Class III or Class III subdivision malocclusions, aged between 6 and 13 years, were consecutively selected and divided into three groups (G): G1-34 patients were treated with RME, followed by FM therapy; G2-34 patients were treated using RME according to modified alternate rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by FM therapy. These treated groups were randomly (1:1 allocation ratio) distributed according to the two treatment protocols. G3 - Control Group - 20 untreated patients were followed. Magnetic resonance imaging (MRI) TMJs were obtained before (T1) and after (T2) a treatment period or follow-up. McNemar test, Fisher's exact test and intra- and inter-observer concordance (K) were performed (p ≤ .05). There were no statistically significant differences in the baseline cephalometric variables at T1 between the groups. There were statistically significant differences between the groups (p < .001) in relation to the disc shape in T1, since G1 (8 TMJs -11.76%) presented higher occurrences of altered forms in comparison with G2 (no changes). No significant differences were observed in disc position CM and OM (G1 - p > .999; G2 - p = .063; G3 - p = .500) and shape (G1 - p > 0.999; G2 - p = .250; G3 - not calculable), between T1 × T2, in any of the groups studied. The two treatment protocols did not have adverse effects on the position and shape of the TMJ disc, in a short-term evaluation.

Comparison of Rapid Maxillary Expansion and Alternate Rapid Maxillary Expansion and Constriction Protocols with Face Mask Therapy.

This study compared dentoskeletal and soft tissue changes with face mask (FM) therapy. Rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocols were used with the two different types of expansion appliance, and their effects on the treatment outcome were investigated. The study consisted of 79 (37 and 42 patients in the RME and Alt-RAMEC groups with FM, respectively) patients who had received FM treatment. The effects of the RME/FM (20 female, 17 male) and Alt-RAMEC/FM (14 female, 28 male) protocols were evaluated using lateral cephalometric films. The chronological ages of the RME/FM and Alt-RAMEC/FM groups were 11.58 and 11.99 years, respectively. In addition, both groups were divided into two subgroups based on the design of the expansion appliance (Spolyar or full coverage type). Differences in all parameters were analyzed using Student's t-tests. The maxilla significantly moved forward in both the RME/FM and Alt-RAMEC/FM groups (p<0.001). No significant skeletal differences were observed between the groups. Sagittal movement of the upper incisors significantly increased, and the lower incisors significantly retruded in both groups. While similar skeletal changes were found between the Spolyar and full-coverage appliance groups, the upper incisors protruded significantly more in the full-coverage type. RME/FM and Alt-RAMEC/FM therapies were found to be efficient for maxillary protraction and resulted in similar skeletal changes. A full-coverage expansion appliance produced a more upper incisor protrusion than a spherical-type appliance.

Comparison of changes in the nasal cavity, pharyngeal airway, and maxillary sinus volumes after expansion and maxillary protraction with two protocols: Rapid palatal expansion versus alternate rapid maxillary expansion and constriction.

To evaluate and compare a series of volume changes in the nasal cavity (NC), nasopharynx, oropharynx, and maxillary sinuses (MS) in growing Class III patients after either rapid palatal expansion (RPE) or alternate rapid maxillary expansion and constriction (Alt-RAMEC) followed by facemask (FM) therapy, by using conebeam computed tomography (CBCT). Forty growing Class III patients were retrospectively selected and divided into two matched groups: RPE/FM (14 females, 6 males; mean age, 9.66 ± 1.23 years) and Alt-RAMEC/FM groups (14 females, 6 males; mean age, 10.28 ± 1.45 years). The anteroposterior and vertical displacements of Point A, the volumes of the NC, nasopharyngeal, oropharyngeal, and MS were measured at different time points: pretreatment (T1), postexpansion (T2), and postprotraction (T3). Both groups demonstrated significant maxilla advancement (by 1.3 mm) during expansion, with a statistically significant intergroup difference during protraction (RPE/FM, 1.1 mm; Alt-RAMEC/FM, 2.4 mm; p < 0.05) and throughout the treatment (RPE/FM, 2.4 mm; Alt-RAMEC/FM, 3.7 mm; p < 0.05). NC and nasopharyngeal airway volumes increased significantly in both groups after expansion, protraction, and treatment. The oropharyngeal and MS volumes increased in both groups after protraction and post-treatment. However, no volumetric differences were observed between the two groups. There was no significant difference in airway volume changes, including NC, nasopharyngeal, oropharyngeal airway, and MS, between RPE/FM and Alt-RAMEC/FM groups at different time points. Although there was significantly more forward movement after protraction in the Alt-RAMEC/FM group, the difference was deemed too small to be clinically relevant.

Assessment of influence of facemask treatment with skeletal anchorage on the temporomandibular joint using magnetic resonance imaging: a preliminary study.

The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.

Effect of Maxillary Expansion Treatment Protocols On Maxillary Sinus Volume, Pharyngeal Airway Volume, and Hyoid Bone Position: A Prospective, Cone Beam Computed Tomography (CBCT) Study

Aim: This study aimed to investigate the changes in maxillary sinus volume, pharyngeal airway volume, and hyoid bone position in patients treated with Rapid Maxillary Expansion (RME) and Alternate Rapid Maxillary Expansion and Constriction (AltRaMEC) – Facemask therapy and compare between the groups. Materials and Methods: The records of 15 patients between the age group of 8-14 years with Class I and Class III malocclusion were collected, and the patients were assigned into two groups. The first group comprised of 8patients (4 girls and 4 boys) who were treated with Rapid Maxillary Expansion. The second group comprised 7 patients (5 boys and 2 girls) treated with expansion devices using Alt-RaMEC protocol followed by maxillary protraction using a facemask. Pre and post-treatment CBCT scans were obtained and analyzed for changes in the pharyngeal airway, maxillary sinus volume, and hyoid bone position. The maxillary sinus volume was calculated in 3 dimensions by measuring the craniocaudal height, anteroposterior depth, and mediolateral width. Measurements were taken before and after the procedure to compare the groups and between the groups. The data were analyzed using Paired t-test and an Independent t-test. Results: In the RME group, a significant increase in the total maxillary sinus volume (mean difference = 520±576.57mm3), especially in the craniocaudal height, was seen, but no changes were noted in the pharyngeal airway and hyoid position. The AltRAMEC group showed a statistically significant increase in the maxillary sinus volume (anteroposteriorly) and nasopharyngeal volume with a p-value &lt;0.005. Comparing the maxillary sinus volume changes in RME and AltRAMEC groups showed a statistically significant increase in the volume of the maxillary sinuses in both groups, significantly higher in the RME group. Conclusion: RME and AltRAMEC protocol followed by facemask therapy caused a significant increase in the maxillary sinus volume, while no changes were noted in the nasopharynx, oropharynx, hypopharynx, and hyoid bone position. While comparing the treatment effects between the groups, RME showed a greater increase in maxillary sinus volume (p &lt; 0.05), specifically in the anteroposterior dimension. Since there are no changes in airway volume and hyoid position with the skeletal expansion protocols, there will be no difference in nasal resistance to airflow.

Comparison of the short-term effects of facemask therapy preceded by conventional rapid maxillary expansion or by an alternate rapid maxillary expansions and constrictions protocol : Aretrospective study.

We aimed to compare the short-term effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) with conventional rapid maxillary expansion (RME) followed by facemask (FM) therapy. A total of 30patients who had received facemask therapy after RME or Alt-RAMEC protocols were included in the study. The Alt-RAMEC/FM and RME/FM groups were created to be well-matched regarding cervical vertebral maturation stage and sex. In the Alt-RAMEC group (10males and 5females, 10.99 ± 1.80years), expansion screws were activated for aweek (two turns/day), then deactivated in the following week (two turns/day). The activation-deactivation protocol continued for 6 or 7weeks. In the RME/FM group (10males and 5females, 11.61 ± 1.20years), screw activation was performed according to the patients' requirements. Lateral cephalograms which had been taken at the beginning of treatment and at the end of the facemask therapy were analyzed. Intragroup and intergroup differences were statistically analyzed. Both groups showed asignificant sagittal advancement of the maxilla. However, the Alt-RAMEC/FM group showed statistically greater improvements than the RME/FM group for SNA (3.11 ± 1.79 vs. 1.45 ± 1.34, p = 0.008), ANB (4.29 ± 1.80 vs. 2.95 ± 1.19, p = 0.023), convexity (8.91 ± 4.29 vs. 5.61 ± 2.51, p = 0.016), and overjet (5.86 ± 2.29 vs. 4.61 ± 2.10, p < 0.001). The sagittal mandibular, vertical skeletal, dental, and soft tissue changes were similar between the groups (p > 0.05). The Alt-RAMEC protocol was found to be more effective in the correction of skeletal classIII malocclusion in the short term.

Early Treatment of Class III Malocclusion Using Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) Protocol with Facemask Therapy: A Case Report

Orthodontists face difficulty when it comes to treating Class III malocclusion. It is best to treat it at the growing stage with dentofacial orthopedics. Maxillary protraction using the Alternate Rapid Maxillary Expansion and Contraction (Alt-RAME) technique is an effective approach for treating skeletal Class III malocclusion at an early age. A 9-year-old female patient came to the Department of Orthodontics with a complaint of backwardly placed upper teeth and un-aesthetic dental as well as facial appearance. Intraoral examination revealed an anterior cross-bite of 1 mm. Molar relation was class III on the right side and super Class I on the left side. Slight crowding in lower arch and spacing in maxillary arch due to unerupted teeth was seen. The patient was diagnosed with Class III skeletal pattern associated with maxillary retrusion, average growth pattern, Class III molar relation on right side, super Class I molar relation on left side and a protrusive lower lip. The early treatment of such cases is essential, so that maxillary retrusion can be corrected with the help of orthopedic intervention. It was decided that the correction of skeletal Class III malocclusion will be done using Alt-RAMEC protocol along with facemask. Use of Alt-RAMEC protocol for correction of Class III malocclusion due to maxillary retrusion can help in early correction of Class III skeletal pattern and helps improving overall profile of the patient. This case report shows the result of using a hyrax bonded maxillary expander with Alt-RAMEC protocol along with a facemask to treat a Class III malocclusion associated with maxillary hypoplasia. A 9-year-old patient with skeletal class III malocclusion and anterior crossbite was treated using this protocol.

Does Alt-RAMEC protocol and facemask treatment affect dentoalveolar structures?

To evaluate dentoalveolar changes immediately after the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol and facemask (FM) treatment using cone-beam computed tomography images. Cone-beam computed tomography images of 20 patients (mean age = 9.64 ± 1.3 years) who received the Alt-RAMEC protocol before FM treatment were retrieved in this retrospective study. Dental and alveolar inclinations, buccal and palatal alveolar bone thickness, and buccal and palatal alveolar bone height changes were measured before treatment (T0), after the Alt-RAMEC protocol (T1), and after FM treatment (T2). Measurements for right and left molars were performed separately. The Shapiro-Wilks test was used to assess the conformity of the parameters to the normal distribution. The paired t-test and repeated measures analysis of variance were used for normally distributed data. The Wilcoxon signed-rank test and Friedman test were used for non-normally distributed data. The Bonferroni correction was used to reduce the chances of obtaining false-positive results. Statistical significance was set at P < .05. Buccal alveolar bone thickness and alveolar bone inclinations decreased significantly from T1 to T0 and showed no significant change from T2 to T1. The total reduction T2-T0 was statistically significant. The change in palatal alveolar bone thickness was not significant T1-T0 but increased significantly for T2-T1 and T2-T0. Buccal alveolar bone height, palatal alveolar bone height, and molar inclinations increased significantly T1-T0, but there was no significant change T2-T1. The total reduction at T2-T0 was statistically significant. The results of this study revealed that the effects of the Alt-RAMEC protocol on dentoalveolar tissues were similar to the changes reported in the literature after rapid palatal expansion.

Evaluation of Alt-RAMEC With Facemask in Patients With Unilateral Cleft lip and Palate (UCLP) Using Cone Beam Computed Tomography (CBCT) and Finite Element Modeling-A Clinical Prospective Study.

Evaluate the effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol on patients with unilateral cleft lip and palate (UCLP) along with maxillary protraction using cone beam computed tomography (CBCT) records and a finite element modeling (FEM) model. Twenty-five patients (aged 9-13 years) with UCLP having a GOSLON score 3 were selected for this prospective single-arm cohort study after obtaining necessary informed consent. A 9-week Alt-RAMEC protocol using a custom-made fan-shaped expansion screw was initiated, which was followed by 6-month facemask wear. Pre (T1) and posttreatment (T2) records including CBCT were taken and were evaluated for treatment changes in all 3 dimensions using paired t test. Additionally, a FEM model (ANSYS 15.0) using the Alt-RAMEC protocol was also analyzed for the displacement and stress on various craniofacial structures. Significant forward movement of the maxilla along with clockwise rotation of mandible along with statistically significant increase in lower molar height and upper incisor proclination (P < .05) was observed. CBCT evaluation showed a statistical significant decrease in buccal alveolar bone thickness and increase in molar inclination (P < .05). Finite element modeling analysis highlighted that the maximum displacement occurred at the anterior region with stresses radiating till the anterior nasal spine, zygomatic arch, and sphenoid bone. Alt- RAMEC protocol combined with facemask protraction can lead to significant maxillary advancement, with some transient decrease in buccal bone thickness noted thereby warranting long-term studies to further assess its effect on the dentofacial apparatus.

Determining the short-term effects of different maxillary protraction methods on pharyngeal airway dimensions.

This study sought to evaluate the effects of different maxillary protraction methods on the pharyngeal airway in Class III patients with maxillary retrognathia. A total of 59 individuals (31 females and 28 males) with a mean age of 11.38±1.24years were included in this study. Fifty-nine treated maxillary retrognathic patients who underwent different protraction methods were evaluated. Twenty patients treated with RME (Rapid Maxillary Expansion) made up the first group, and 20 patients treated with 5-week Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) protocol comprised the second group. Lastly, 19 patients on whom face masks with miniplates were applied were included in the skeletal anchorage (SA) group. Sixteen linear and four areal pharyngeal airway measurements were made on lateral cephalograms before and after treatment. Differences between the groups were assessed using analysis of variance (ANOVA) tests. The mean maxillary protraction levels were determined as 2.7, 3.69 and 4.01mm in the RME, Alt-RAMEC and SA groups, respectively. In the nasopharynx, AD1-PNS, AD2-PNS, PNS-Ba and PNS-Ho measurements revealed a significant increase in the SA group compared to the other groups (P<.05). In the oropharynx, PNS-Ep measurement increased significantly in the RME group (P<.05). In the total pharyngeal airway area, an increase was detected in the SA, Alt-RAMEC, and RME groups. The most effective protraction method in terms of pharyngeal airway dimensions, especially in the nasopharynx, is the application of the face mask with skeletal anchorage. A greater increase in vertical airway length (PNS-Ep) was observed with RME.

Relative effectiveness of facemask therapy with alternate maxillary expansion and constriction in the early treatment of Class III malocclusion

This study aimed to investigate the relative efficacy of maxillary protraction combined with a modified alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol compared with conventional protocols in the early orthopedic treatment of skeletal Class III malocclusion. A sample of 39 patients was divided into 3 groups on the basis of different interventions. Conventional facemask (FM) with splint-type intraoral devices was performed in the FM group (7 males and 5 females; mean age, 9.53±1.37years). Maxillary expansion with an activation rate of 0.5mm/d (twice a day) followed by FM therapy was applied in the rapid maxillary expansion group (RME/FM) (6 males and 6 females; mean age, 9.31±1.60years). In the Alt-RAMEC/FM group (7 males and 8 females; mean age, 10.01±1.31years), Alt-RAMEC was started simultaneously and throughout the entire course of maxillary protraction, with repetitive alternations between activation and deactivation of expanders (0.5mm/d for 7days). The patients in all groups were instructed to wear FMs for a minimum of 12h/d. Pretreatment and posttreatment lateral cephalograms were all traced and measured. The Alt-RAMEC group showed statistically more significant maxillary advancement than other groups (A-VRP, 3.87mm vs 3.04mm [RME/FM], vs 2.04mm [FM]; P<0.05). Analysis of variance did not reveal significant intergroup differences in palatal plane angulation changes (P>0.05). No pronounced mandibular clockwise rotations were noted in the Alt-RAMEC/FM group with distinct intergroup differences (P<0.05). There were more skeletal effects (88.7%) during overjet correction in the Alt-RAMEC/FM protocol. A combination of the modified Alt-RAMEC protocol with FM revealed more favorable skeletal effects compared with FM and RME/FM protocols in treating prepubertal patients with maxillary deficiency.

Comparison of Transversal Effects of Different Expansion Protocols: Alt-RAMEC versus RME

Abstract&#x0D; Objectives&#x0D; The aim of this study is evaluate the transversal effects of the Alt-RAMEC(Alternate Rapid Maxillary Expansion and Constriction) protocol on both craniofacial and dentoalveolar structures and to compare the transversal effects of the RME(Rapid Maxillary Expansion) protocol.&#x0D; Materials and Methods&#x0D; In our archive, selected patients were divided into two groups. Group 1 included 22 patients(12boys,10girls, mean age 11.61±2.11years) who had been treated with 5 weeks of Alt-RAMEC. Group 2 comprised 21 patients(11boys,10girls, mean age 11.66±1.23years) who had been treated with 1 week of RME. Transversal measurements were also performed on the study models pre-(T0) and post-treatment(T1) with digital caliper. Internasal, interzygomatic, interjugular and intergonial width measurements were made on posteroanterior radiographs. The initial measurements and the mean changes within the groups were analysed using a student’s t test.&#x0D; Results&#x0D; According to the results of the study, there was no statistically significant difference between the groups in terms of chronological age, gender distribution and initial values. The expansion protocols showed a statistically significant increase in the widths of intercanine, interpremolar, intermolar and alveolar base widths in the maxilla(p&lt;0.05). No statistically significant changes were observed in both groups(p&gt;0.05) in mandible. The changes in maxillary intercanine, interpremolar widths between the two groups were statistically significant(p&lt;0.05). In the posteroanterior measurements, only statistically significant difference was found between the groups in internasal width(p&lt;0.05).&#x0D; Conclusions&#x0D; Alt-RAMEC and RME protocols are effective treatment protocols for correction of transverse deficiency in growing patients. 5-weeks Alt-RAMEC protocol significantly increased intercanine and interpremolar widths compared to 1-week RME. &#x0D; Clinical Relevance&#x0D; Since there are no studies in the literature comparing the effects of two different expansion protocols in the transverse direction, this is both the first. Most importantly, clinicians will see which of these two protocols is more singular in the treatment of transversal problems.&#x0D; Keywords: RME, Alt-RAMEC, tranversal measurements

Comparison of the Changes Following Two Treatment Approaches: Rapid Maxillary Expansion Versus Alternate Rapid Maxillary Expansion and Constriction.

The aim of the present study was to evaluate the hard and soft tissue changes following rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) therapies. A total of 54 patients who needed maxillary expansion or Alt-RAMEC procedure were recruited and divided into two groups (27 subjects in the RME group and 27 subjects in the Alt-RAMEC group). Expansion screw was activated 0.5 mm/day (2 turns/day) in the RME group. Approximately 11 mm of expansion was achieved. In the Alt-RAMEC group, the screw was activated 1 mm/day (4 turns/day) during a period of 4 weeks. In the first and third weeks, the screw was opened; in the second and fourth weeks, the screw was closed. Cephalometric tracing and analyzing were done with the aid of digital software. Lateral cephalometric radiographs were obtained before (T0) and after (T1) RME and Alt-RAMEC applications. In the RME group, the maxilla moved forward and downward. Upper incisor retrusion was observed according to the reference planes. In addition, the tip of the nose moved forward, and the upper lip moved downward. In the Alt-RAMEC group, the nasolabial angle became more obtuse, and the stomion superius moved backward and downward. RME therapy resulted in skeletal and dental changes in the maxilla and related structures, favoring a contribution to solving Class III problems. No remarkable changes were recorded in the Alt-RAMEC group.

Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) May Be More Effective Than Rapid Maxillary Expansion Alone for Protraction Facial Mask Treatment

The effectiveness of Alt-RAMEC combined with maxillary protraction in the treatment of patients with a class III malocclusion: a systematic review and meta-analysis, Mohammed Almuzian, Elise McConnell, M. Ali Darendeliler, Fahad Alharbi & Hisham Mohammed. J Orthod 2018;45(4);250-9. No financial support was reported. Systematic review.

Treatment of maxillary hypoplasia in cleft lip and palate patients: Keeping the total burden of care as low as possible

Introduction: Maxillary hypoplasia is a common problem in cleft patients. The literature has shown that early treatment is unstable; nevertheless, early maxillary protraction may still be taken into consideration, if specific functional problems exist. On the other hand, long-term results of the application of the Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) technique, a maxillary protraction technique applied closer to the peak of growth, have been shown to be stable. Therefore, a later approach might be considered if the objective is purely occlusal/esthetic. Objective: The objective of this study was to describe the rationale behind a protocol for the treatment of maxillary hypoplasia in cleft lip and palate (CLP) patients where timing is guided by the different indications. Materials and Methods: We subdivided this study into two groups. (1) Early treatment group (preliminary study): 30 unilateral CLP (UCLP) and bilateral CLP patients were treated early with expansion and face mask with two specific functional indications: 22 were affected by middle ear infection, otitis media (OM), with subsequent hearing impairment, and 8 by obstructive sleep apnea (OSAS). The objective of early treatment thus, was purely functional. (2) Late adolescence treatment group (follow-up study): a different group of older patients was treated at a later stage with an esthetic-occlusal aim. Thirty-nine UCLP patients were consecutively treated with the Alt-RAMEC technique at an average age of 13.2 years (11.3–14.2 years) before protraction. The average age at long-term follow-up was 18.3 years (17.4–24.7 years). Results: (1) Early treatment group (preliminary results): the sagittal advancement of A-point, after the application of the face mask and expander, was 2.6 ± 1.2 mm. About 65% of the OM patients had a net improvement of all audiological symptoms (audiometric tests and tympanograms), and 100% of OSAS patients had a significant improvement of obstructive parameters (apnea-hypopnea index). (2) Late treatment group (follow-up study): the sagittal advancement of A-point, after the application of the Alt-RAMEC technique, was 5.6 ± 2.7 mm. The position of the maxilla was stable in the long term. Conclusion: Our results suggest that, even though skeletal relapse is expected after early correction of maxillary hypoplasia, there might be an indication in patients with functional problems, such as hearing or breathing disorders, to avoid more complex treatments. On the other hand, to correct the occlusal esthetic problem related to maxillary hypoplasia, it is advisable to wait till after growth peak and apply a modified Alt-RAMEC technique, with a double-hinged expander and to obtain more stable long-term results. This technique seems to significantly reduce, especially in female patients, the need for final orthognathic surgery.

3D effects of a bone-anchored intra-oral protraction in treating class III growing patient: a pilot study

ObjectivesThe aim of this prospective case series study is to assess the three-dimensional (3D) skeletal and soft tissue effects of the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol in conjunction with a miniscrew-supported class III elastic wear in class III growing patients.Materials and methodsFourteen consecutive participants (mean age 12.05 ± 1.09 years), who displayed class III malocclusions with retrognathic maxillae, were recruited. A cone beam computed tomography (CBCT) scan was acquired before commencing treatment (T1). All participants were treated with a tooth-bone-borne rapid maxillary expansion (hybrid MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. This was followed by full-time class III elastics, delivering 400 g/side, to protract the maxilla. When a positive overjet was achieved, protraction was ceased and a post-treatment CBCT scan (T2) was taken. The 3D analysis of pre- and post-treatment CBCT scans was blinded. The scans were registered on the anterior cranial base. The Euclidean distance between the two extracted surface models of the pre- and post-treatment scans was displayed as a color surface map.ResultsAll participants completed the intervention successfully. The majority of the participants showed protraction of the anterior maxillary region (71.4%) and in the zygomatic processes (64.2%). The maxilla significantly protracted (SNA 1.87° ± 1.06°; Vert.T-A 3.29 ± 1.54 mm), while the mandibular base significantly redirected posteriorly (SNB − 2.03° ± 0.85°, Vert.T-B − 3.43 ± 4.47 mm) and that was reflected on the ANB and Wits measurements. No adverse effects were observed.ConclusionClass III elastics combined with the Alt-RAMEC activation protocol of the hybrid MARME appliance is an effective treatment method for mild/moderate class III malocclusions. A long-term follow-up and comparisons with other treatment modalities are required.

Comparison of the effects of rapid maxillary expansion and alternate rapid maxillary expansion and constriction protocols followed by facemask therapy.

ObjectiveThe aim of this retrospective study was to evaluate and compare the changes in the pharyngeal airway (PA), maxillary sinus volume, and skeletal parameters after rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) followed by facemask (FM) therapy.MethodsThe records of 40 patients with skeletal Class III malocclusion due to maxillary retrognathism were collected, and the patients were assigned into two groups. The first group comprised 8 male and 12 female patients (mean age, 10.0 ± 1.1 years) treated using RME/FM for an average of 10 months. The second group comprised 10 male and 10 female patients (mean age, 9.64 ± 1.3 years) treated using Alt-RAMEC/FM for an average of 12 months. Cone-beam computed tomography images acquired before (T0) and after treatment (T1) were evaluated.ResultsRegarding the skeletal effects, significant differences between the groups were the increase in ANS-HRP (perpendicular distance of ANS to the horizontal reference plane, 0.99 mm, p <0.05) in the Alt-RAMEC/FM group and the decrease in PP-SN (palatal plane to Sella-Nasion plane, 0.93°, p < 0.05) in the RME/FM group. Maxillary sinus volumes increased significantly in both the groups, and the increase was statistically significantly higher in the Alt-RAMEC/FM group. Although no significant intergroup differences were observed in PA volumes, both lower (1,011.19 mm3) and total (1,601.21 mm3), PA volume increased significantly in the Alt-RAMEC/FM group.ConclusionsThe different expansion devices and protocols used with FM therapy do not seem to affect the forward movement of the maxilla and PA volumes. In contrast, the increase in maxillary sinus volume was greater in the Alt-RAMEC/FM protocol.

Short- and Long-Term Effects of Late Maxillary Advancement With the Liou-Alt-RAMEC Protocol in Unilateral Cleft Lip and Palate.

The objective of this retrospective longitudinal study was to evaluate short- and long-term results of the application of the Liou Alt-RAMEC (alternate rapid maxillary expansion and constriction) technique, a late orthopedic maxillary protraction technique, with intraoral anchorage, in patients with cleft. Twenty-six patients with unilateral cleft lip and palate (UCLP) were consecutively treated with the Alt-RAMEC technique. The average age of the patients was 11.7 years (10.3-13.2 years) before protraction and 18.3 years (17.4-21.1 years) at long-term follow-up. A sample of nontreated patients with UCLP was used as a control group. It was matched for sex, skeletal class III, and age (11.3 years). The control sample had records at the end of growth (18.7 years). The sagittal advancement of A-point, after the application of the technique, was 5.7 (2.17) mm. Some mandibular dentoalveolar and positional adaptation was noted. The position of the maxilla was stable in the long term. On the other hand, the UCLP control group showed hardly any growth at the maxillary level during the long-term follow-up period. Our results showed that the Alt-RAMEC technique, performed at the correct time, with a double-hinged expander, followed by class III spring or elastic traction, 24 hours per day, allows for satisfactory maxillary protraction, with, at this stage, apparently stable long-term results. Nevertheless, as only 50% of the patients had long-term follow-up data, we are still unable to predict the percentage of patients which will not eventually need orthognathic surgery.

A Retrospective Evaluation of Conventional Rapid Maxillary Expansion versus Alternate Rapid Maxillary Expansion and Constriction Protocol Combined with Protraction Headgear in the Management of Developing Skeletal Class III Malocclusion.

Aims and Objectives:The reverse pull headgear has been widely used to intercept a developing skeletal Class III malocclusion with maxillary deficiency. Rapid maxillary expansion (RME) is recommended along with the reverse pull headgear because there is disruption of the circummaxillary and intermaxillary sutures. This, in turn, expedites the orthopedic effect of the reverse pull headgear. However, studies have shown that the circummaxillary sutures may not be fully disrupted by the use of RME alone. The protocol of alternate RME and constriction (Alt-RAMEC) has been found to produce much more beneficial effects. Hence, this retrospective study was conducted to compare and assess the results obtained in the two methods.Materials and Methods:This study comprised pre- and post-treatment lateral cephalograms of two groups of nine patients each (total 18 patients – 10 females and 8 males) having skeletal Class III malocclusion (ANB<0°) due to a retrognathic maxilla with or without associated mandibular prognathism treated at the Department of Orthodontics of a teaching institute in Kerala. The patients were treated with either Alt-RAMEC/protraction or RME/protraction. The statistical analysis of the data was done using statistical package SPSS Version 16 software (SPSS Inc., Chicago, IL, USA).Results:Skeletal, dental, and soft-tissue parameters in Group 2 (Alt-RAMEC group) showed very significant changes with the maxilla moving forward, mandible rotating backward and downward, and proclination of the maxillary incisors when compared to Group 1.Conclusions:It may be concluded from the results of our study that the Alt-RAMEC protocol and reverse pull headgear might be more effective than conventional RME and the reverse pull headgear to correct a retruded maxilla in a developing skeletal Class III patient.