Alternate Rapid Maxillary Expansion Research Articles

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

Abstract
 Objectives
 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.
 Materials and Methods
 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.
 Results
 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<0.05). No statistically significant changes were observed in both groups(p>0.05) in mandible. The changes in maxillary intercanine, interpremolar widths between the two groups were statistically significant(p<0.05). In the posteroanterior measurements, only statistically significant difference was found between the groups in internasal width(p<0.05).
 Conclusions
 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. 
 Clinical Relevance
 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.
 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.

Comparative Study of Maxillary Expansion by Alternate Rapid Maxillary Expansion and Constriction Versus Hyrax Expansion

Aim of study: was to evaluate the skeletal and dental effects of maxillary expansion by alternate rapid maxillary expansions and constrictions technique in comparison to conventional RME expansion by Hyrax by using PA cephalometry. Material and methods: Twenty patients with constricted maxillary arch represented with an unilateral or bilateral posterior cross bite were selected with ages ranged from 12-15 years. Patients were divided randomly into two equal groups by computer aided randomization according to the protocol of expansion into (Group I): who received alternate rapid maxillary expansions and constrictions (Alt-RAMEC) protocol and (Group II): who received conventional RME protocol. Results: Skeletally, the Latero-Nasal Width and the Maxillary width recorded higher mean values in Alt-RAMEC group than RME group with statistical significance. Dentally, all linear and angular measurements recorded higher mean values postoperatively in Alt-RAMEC group than RME group with no statistical significance except upper inter-incisal width mesial. Conclusions: Alt-RAMEC protocol produces highly skeletal effects by increasing the nasal width and the maxillary width.

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.

A Bayesian network meta-analysis of orthopaedic treatment in Class III malocclusion: Maxillary protraction with skeletal anchorage or a rapid maxillary expander.

To evaluate and compare the effectiveness of orthopaedic treatment for Class III malocclusions using skeletal anchorage or a rapid maxillary expander for maxillary protraction. Electronic databases, including PubMed, EMBASE, Cochrane Library and Web of Science, were searched for randomized controlled trials (RCTs) and non-randomized clinical trials (CCTs) for orthopaedic treatment of Class III malocclusions. Five interventions were studied: a facemask with a maxillary temporary anchorage device (MTAD), a bone-anchored rapid maxillary expansion (BARME), a rapid maxillary expansion (RME), an alternate rapid maxillary expansion and contraction (Alt-RAMEC), and a bone-anchored intermaxillary traction (BAIMT). Eight outcomes (SNA, SNB, ANB, overjet, SN-GoGn, ANS-Me, IMPA (L1-MP), and U1-PP) were statistically polled. We conducted network meta-analysis using R statistical software with the GeMTC package. Twenty-five studies met the inclusion criteria. Compared with the RME group, the Alt-RAMEC group (mean difference (MD): 1.3; 95% credibility interval (CrI): 0.26, 2.3) and MTAD group (MD: 0.85; 95% CrI: 0.065, 1.6) showed a better effect on ANB in CCTs. Regarding the vertical relationship, the BAIMT group (MD: -2.2; 95% CrI: -5.2, 0.73) showed a smaller effect regarding increasing the vertical dimension of ANS-Me. The RME, MTAD and Alt-RAMEC group showed a higher ability to decrease the angle of L1-MP. The Alt-RAMEC and MTAD protocol have a higher possibility to obtain a skeletal and tooth effect in sagittal relationships. The BAIMT protocol can acquire a better skeletal effect in sagittal relationships with less vertical and dental changes. More well-designed RCTs are needed to ensure that the conclusion is reliable.

Treatment of Class III malocclusion using Hybrid Hyrax, Face Mask and Alt-RAMEC Protocol: A Case Report in a Latin-American patient

The management of Class III malocclusion is one of the greatest challenges of orthodontics. Current treatments offer the possibility of using direct skeletal anchorage to improve clinical outcomes. This case shows the results of using a Hyrax hybrid palatal anchorage, Alt-RAMEC (Alternate Rapid Maxillary Expansion and Contraction protocol) and a facemask to treat a maxillary hypoplasia Class III malocclusion in a Latin-American patient. The appliance design and the protocol used are widely described. Clinical and cephalometric results suggest that it is a good treatment option for this Latino patient, with moderate malocclusion and limitations in the dental anchorage. Key words:ALT-RAMEC, Angle Class III, malocclusion, maxillary expansion, mini-screws, orthodontic anchorage, TADs.

Dentofacial Effects of Modified Alt-RAMEC Protocol Combined with the Facial Mask for Treatment of Preadolescent Caucasian Class III Patients

ABSTRACTIntroductionIn this study we analyzed dentoskeletal effects of orthopedic therapy with rapid palatal expander (RME), used according to modified Alt-RAMEC protocol, followed by facial mask in preadolescent patients with class III malocclusion.Materials and methodsThe sample consisted of 10 patients treated consecutively with the alternate rapid maxillary expansions and constrictions (Alt-RAMEC) protocol and facial mask before the pubertal growth spur the patients were re-evaluated after about one year of treatment. We compared the cephalometric analyses at T0 (before the treatment) and T1 (just after the end of the treatment—about 1 year), evaluating 18 parameters. The normality of each distribution was assessed with D’Agostino-Pearson normality test and significative differences between T0 and T1 were assessed with paired t test (p < 0.05).ResultsSagittal measurements of the maxilla (SNpSNa distance) showed significant improvements (p < 0.0001) with protraction effect at point A. Significant improvements were recorded also at Wits appraisal and overjet. Measures of the mandibular growth (Co-Gn) showed increased values at T1, as well as vertical dimension (SNpSNa-GoGn). No significant variations were recorded at the dental parameters.ConclusionThis protocol induces important skeletal effects, like advancement of the maxilla, also in preadolescent patients, while dental changes are minimal. Alt-RAMEC protocol seem to modulate maxillary development in patients near the pubertal growth spurt.How to cite this articleRota E, Ferrari M, et al. Dentofacial Effects of Modified Alt-RAMEC Protocol Combined with the Facial Mask for Treatment of Preadolescent Caucasian Class III Patients. Int J Clin Pediatr Dent 2019;12(3):222–228.

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.

The immediate effect of alternate rapid maxillary expansions and constrictions on the alveolus: a retrospective cone beam computed tomography study

BackgroundRapid maxillary expansion reduced the expander’s anchor teeth buccal alveolar bone thickness. However, the effects of alternate rapid maxillary expansions and constrictions (Alt-RAMEC) on the expander’s anchor teeth alveolar thickness has not been assessed. The purpose of this retrospective study was to evaluate the effects of Alt-RAMEC on the alveolus surrounding the anchor teeth of a double-hinged expander.MethodsTwenty-six individuals, including 12 males (11.5 ± 1.00 years) and 14 females (11.5 ± 0.90 years), who had double-hinged expander for 7 weeks of Alt-RAMEC and then 3 months of maxillary protraction, were included. Their cone beam computed tomography (CBCT) images taken 3–6 months before treatment (T0) and after 7 week of Alt-RAMEC (T1), were studied for the buccal alveolar bone thickness (BABT) and palatal alveolar bone thickness (PABT) of the expander’s anchor teeth (first molars and first and second premolars) in four axial sections. The intra-class correlation coefficient, Dahlberg’s formula, and paired t tests were used to analyze the method errors, and the intra-group changes of the BABT and PABT at T0-T1 were analyzed by paired t test (p < 0.05).ResultsThe 7 weeks of Alt-RAMEC significantly reduced the BABT of the expander’s anterior anchor teeth (0.54~ 70 mm, p < 0.05) and at the cervical region (0.14~ 0.25 mm, p < 0.05), but not at the apical region of the expander’s posterior anchor teeth. The reduction of BABT by 7 weeks of Alt-RAMEC was within the scope of the initial BABT. On the opposite, the Alt-RAMEC significantly (p < 0.05) increased the PABT in the anterior anchor teeth and the cervical region of posterior anchor teeth.ConclusionsA 7-week protocol of Alt-RAMEC with double-hinged expander for maxillary protraction might reduce the buccal alveolar bone thickness of the expander’s anchor teeth, although the reduction is within the scope of initial alveolar thickness of the expander’s anchor teeth.

Three-dimensional evaluation of the maxillary effects of two orthopaedic protocols for the treatment of Class III malocclusion: A prospective study.

To compare the three-dimensional maxillary dentoskeletal effects of a modified alternate rapid maxillary expansion and constriction facemask protocol (Alt-RAMEC/FM) with the traditional rapid maxillary expansion facemask protocol (RME/FM) performed in deciduous or early mixed dentition Class III patients. Orthodontic Clinic of the Section of Dentistry of the Department of Surgery and Translational Medicine of the University of Florence. Thirty-four Class III patients were enrolled and allocated by alternating assignment to either Alt-RAMEC/FM or RME/FM therapy. Prior to treatment, all patients were evaluated, and a cone beam computed tomography (CBCT) scan was acquired. After completion of the orthopaedic therapy (average interval 1.2years), a follow-up CBCT scan was obtained. Anatomic landmark identification on the CBCTs and subsequent quantification of the changes were performed. The primary outcome variable was the anteroposterior displacement of the anterior nasal spine (ANS AP). The treatment groups were compared with independent samples t tests. The patients in the two treatment groups showed a similar degree of compliance. No statistically significant differences were recorded for any variable when comparing the Alt-RAMEC/FM and RME/FM groups. In particular, the between-group difference for ANS AP was 0.0mm (95%CI: -0.6;0.7, P=0.933). Both Alt-RAMEC/FM and RME/FM produced favourable orthopaedic changes in Class III growing patients. Neither protocol was superior to the other in terms of maxillary protraction effectiveness.

Cone-beam computed tomography evaluation of bone plate and root length after maxillary expansion using tooth-borne and tooth-tissue-borne banded expanders.

The objective of this research was to evaluate the buccal bone plate and root length of maxillary permanent first molars using cone-beam computed tomography after maxillary expansion with different activation protocols. Cone-beam computed tomography images of growing patients were obtained from the orthodontic department of Pontifical Catholic University of Rio Grande do Sul in Brazil. The groups were Haas-type 2/4 turns, Haas-type 4/4 turns, hyrax-type 2/4 turns, and hyrax-type with alternate rapid maxillary expansions and constrictions (alt-RAMEC) 4/4 turns a day. Tooth length, periodontal insertion, alveolar bone thickness, and intermolar distances were evaluated. The data at the start oftreatment and 6months later were compared using generalized linear models. The intergroup differences were determined by univariate analysis of variance with the Bonferroni adjustment. Tooth length was significantly shortened after expansion in all groups (-0.28 to -0.51mm), except for the alt-RAMEC group. Bone level variables (bone level and bone level at the tooth tip) changed statistically in all groups, except for the Haas 4/4 turns group. There was significant periodontal attachment loss after rapid maxillary expansion with the hyrax/alt-RAMEC (5.09mm). The hyrax/alt-RAMEC andhyrax groups had more dehiscences, fenestrations, and exposures of the root. The consequence of rapid maxillary expansion using the hyrax was alveolar bone resorption, especially in the hyrax/alt-RAMEC group, whereas the Haas expander caused mild root resorption.

The effectiveness of alternating rapid maxillary expansion and constriction combined with maxillary protraction in the treatment of patients with a class III malocclusion: a systematic review and meta-analysis.

To establish the effectiveness of Alternate Rapid Maxillary Expansion and Constriction combined with Protraction Facial Mask (Alt-RAMEC/PFM) approach in treating Class III growing patients compared with PFM combined with conventional Rapid Maxillary Expansion (RME/PFM). Search sources: Unrestricted search in five electronic databases and manual searching were undertaken up to February 2018. Randomised clinical trials (RCTs) evaluating the effectiveness of Alt-RAMEC/PFM were selected. Screening of references, data extraction and assessment of bias risk were evaluated independently by two reviewers. Five RCTs comparing the Alt-RAMEC/PFM with RME/PFM met the inclusion criteria. Small but statistically significant mean differences favouring Alt-RAMEC/PFM protocol as measured by SNA angle (1.16°; 95% CI 0.65 to 1.66), SNB angle (0.67°; 95% CI 0.32 to 1.02) and ANB angle (0.66°; 95% CI 0.08 to 1.25) were noted. Alt-RAMEC/PFM exhibited a more favourable overjet correction when compared to RME/PFM, however, differences in other dental changes were insignificant. There is limited evidence with high risk of bias that Alt-RAMEC/PFM can result in a statistically significant increase in maxillary protraction compared with RME/PFM in Chinese subjects over the short-term. High-quality long-term RCTs with inclusion of patient-reported outcomes are required.

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.

Evaluation of the effects of two different Alt-RAMEC procedures: five weeks versus nine weeks

Abstract Objective To evaluate and compare the skeletal, dentoalveolar and soft tissue effects of two different alternate rapid maxillary expansion (RMEs) and constriction (Alt-RAMEC) procedures. Material and methods Thirty-two consecutive patients presenting with a skeletal Class III malocclusion were placed into two comparative groups. Group 1 consisted of 16 patients (5 females and 11 males; mean age: 11.45 ± 1.87 years) who had an Alt-RAMEC procedure for five weeks and Group 2 consisted of 16 patients (6 females and 10 males; mean age: 11.52 ± 1.29 years) who had an Alt-RAMEC procedure for nine weeks. The parents of the patients were instructed to open the screw twice per day for one week and to close it twice per day for the following week (0.20 mm per turn). Nine angular and 20 linear cephalometric variables were measured. Results The groups were well matched in relation to patient gender distribution, chronological age and initial cephalometric values. Both Alt-RAMEC procedures showed similar effects with no statistically significant differences. The maxillae moved slightly forward and the mandible moved slightly downward, the changes of which caused an improvement in the maxillo-mandibular relationship in both groups. The overjet slightly increased and the overbite decreased in both groups. The upper lip moved slightly forward during the nine-week treatment Alt-RAMEC group. Conclusion Despite the favourable and similar effects of both procedures, neither seems to be sufficient for the complete correction of a skeletal Class III malocclusion.

Is alternate rapid maxillary expansion and constriction an effective protocol in the treatment of Class III malocclusion? A systematic review

ABSTRACTIntroduction: the treatment of Class III malocclusion in early age is one of the greatest challenges for orthodontists, and the establishment of more effective treatment method is a constant concern for these professionals. Thus, the objective of this systematic review is to verify the effectiveness of the therapy protocol for alternate rapid maxillary expansion and constriction (Alt-RAMEC) in the early treatment of Class III malocclusion. Methods:searches were performed in the following electronic databases: Cochrane Library, Medline (EBSCO and PubMed), SciELO, LILACS and Scopus. The following inclusion criteria were used: in vivo studies conducted with early intervention (patient in craniofacial development phase) with the use of the Alt-RAMEC protocol. Reviews, case reports, editorials, and studies with syndromic patients or under use of systemic drug were excluded. Duplicates were also excluded. The studies were assessed for methodological quality using the Cochrane tool for assessment of risk of bias, and classified as high or low risk of bias. Results:53 articles were found. Duplicates exclusion was thus performed and 35 articles remained. After inclusion analysis, only 5 matched the criteria. Two articles were classified as low risk of bias and three as high risk of bias. It was observed that the Alt-RAMEC enable protraction in less time and with better results, promoting greater effectiveness in the protraction treatment of Class III malocclusion. Conclusions:Although there is positive evidence of the effectiveness of early treatment with the Alt-RAMEC protocol in patients with Class III malocclusion, further studies are needed to confirm its effectiveness using long-term methodology.

Residents' journal review

Residents' journal review

Early treatment of Class III malocclusion by RME and modified Tandem appliance

Patients with a skeletal Class III malocclusion and maxillary deficiency can be treated successfully using a combined protraction facemask and alternate rapid maxillary expansions and contractions (Alt-RAMEC). However, due to poor patient compliance during facemask therapy there has been growing interest in intraoral appliances for correcting Class III malocclusion. The tandem traction bow appliance (TTBA) is an intraoral appliance which has been used successfully for the treatment of growing Class III patients. This case report describes the management of a 10-year-old boy with a Class III malocclusion and maxillary deficiency treated with modified TTBA appliance.