Evaluation of the short term efficacy of the modified Alt-RAMEC protocol in the treatment of retrognathic maxilla
Abstract
Introduction: Although correction of maxillary hypoplasia could be challenging for orthodontists, its effectiveness has been demonstrated by several studies that prescribed orthopaedic protraction of the upper jaw before puberty. Positive results have also been reported especially after the alternating expansion and constriction (Alternating Rapid Maxillary Expansion and Constriction, Alt-RAMEC) of the maxilla.
Our aim was to investigate how the use of the Alt-RAMEC protocol prior to facemask therapy enhances the protraction the upper jaw.
Method: Twenty pre-pubertal patients’ lateral cephalograms taken before and after treatment were evaluated. Patients with retrognathic maxilla were included in the study and they were treated with Hyrax and facemask according to the Alt- RAMEC protocol. Treatment efficacy was assessed by measuring the SNA, SNB, ANB angles, the Wits appraisal, ML-NL angle, and overjet (OJ).
Results: SNA: +1,41° (SD 1,09), SNB: –0,67° (SD 2,0), ANB: +2,06° (SD 1,85), Wits: +3,50 mm (SD 2,30), NL-ML: +0,93° (SD 1,98), OJ: +3,83 mm (SD 1,85).
Conclusions: During the prepubertal period, maxillary protraction with facemask after performing the Alt-RAMEC protocol promotes the maxillary growth and varies the lower facial height.
References
Chaturvedi S, Deshwal L, Phadnis P, et al: Nonsurgical Treatment of a Class III Patient with Alt-RAMEC Protocol and Facemask Therapy. J Ind Orthod Soc 2013; 47 (3): 159 -162. https://doi.org/10.5005/jp-journals10021-1149
Zhang W, Qu HC, Yu M, et al: The Effects of Maxillary Protraction with or without Rapid Maxillary Expansion and Age Factors in Treating Class III Malocclusion: A Meta-Analysis. PLoS One 2015; 10 (6): e0130096. https://doi.org/10.1371/journal.pone.0130096
Proffit WR, Fields HW, Larson BE, et al: Contemporary orthodontics 6th ed. Mosby Elsevier, St. Louis 2019; 440 -449.
Mandall N, Cousley R, Dibiase A, et al: Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial. J Orthod 2016; 43 (3): 164 -175. https://doi.org/10.1080/14653125.2016.1201302
Falck F, Zimmermann-Menzel K: Cephalometric changes in the treatment of class III using the Fränkel appliance. J Orofac Orthop 2008; 69 (2): 99 -109. https://doi.org/10.1007/s00056-008-0716-7
Baik HS, Jee SH, Lee KJ, et al: Treatment effects of Fränkel functional regulator III in children with class III malocclusions. Am J Orthod Dentofacial Orthop 2004; 125 (3): 294 -301. https://doi.org/10.1016/j.ajodo.2003.04.016
Levin AS, Mcnamara Ja JR, Franchi l, et al: Short-term and long-term treatment outcomes with the FR-3 appliance of Fränkel. Am J Orthod Dentofacial Orthop 2008; 134 (4): 513 -524. https://doi.org/10.1016/j.ajodo.2006.10.036
Foersch M, Jacobs C, Wriedt S, et al: Effectiveness of maxillary protraction using facemask with or without maxillary expansion: a systematic review and meta-analysis. Clin Oral Investig 2015; 19 (6): 1181 -1192. https://doi.org/10.1007/s00784-015-1478-4
Masucci C, Franchi L, Giuntini V, et al: Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study. Orthod Craniofac Res 2014; 17 (4): 259 -269.https://doi.org/10.1111/ocr.12051
Cordasco G, Matarese G, Rustico L, et al: Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis. Orthod Craniofac Res 2014; 17 (3): 133 -143. https://doi.org/10.1111/ocr.12040
Pavoni C, Mucedero M, Baccetti T, et al: The effects of facial mask/bite block therapy with or without rapid palatal expansion. Prog Orthod 2009; 10 (1): 20 -28.
Vaughn GA, MaSon B, Moon HB, et al: The effects of maxillary protraction therapy with or without rapid palatal expansion: a prospective, randomized clinical trial. Am J Orthod Dentofacial Orthop 2005; 128 (3): 299 -309. https://doi.org/10.1016/j.ajodo.2005.04.030
Isci D, Turk T, Elekdag-Turk S: Activation-deactivation rapid palatal expansion and reverse headgear in Class III cases. Eur J Orthod 2010; 32 (6): 706 -715. https://doi.org/10.1093/ejo/cjq006
Liou EJ Tsai WC: A new protocol for maxillary protraction in cleft patients: remaszkive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 2005; 42 (2): 121 -127. https://doi.org/10.1597/03-107.1
Pintér Z, Rill L, Vitályos g, et al: Applicability of the Moyers mixed dentition analysis for the Hungarian population. [A Moyers-féle vegyes fogazati analízis alkalmazhatóságának vizsgálata a magyarországi lakosság körében] Orv Hetil 2019; 160 (50): 1984 -1989. [Hungarian] https://doi.org/10.1556/650.2019.31571
Baccetti T, Franchi l, MCnamara JA: The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics. Seminars in Orthodontics 2005; 11: 119 -129. https://doi.org/10.1053/j.sodo.2005.04.005
Kim JH Viana MA, Graber TM, et al: The effectiveness of protraction face mask therapy: a meta-analysis. Am J Orthod Dentofacial Orthop 1999; 115 (6): 675 -685. https://doi.org/10.1016/S0889-5406(99)70294-5
Merwin D, Ngan P, Hagg U, et al: Timing for effective application of anteriorly directed orthopedic force to the maxilla. Am J Orthod Dentofacial Orthop 1997; 112 (3): 292 -299. https://doi.org/10.1016/S0889-5406(97)70259-2
Franchi L, Baccetti T, Mcnamara Ja JR: Postpubertal assessment of treatment timing for maxillary expansion and protraction therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop 2004; 126 (5): 555 -568. https://doi.org/10.1016/j.ajodo.2003.10.036
Frank D, Rill L, Kolarovszki B, et al: Classical and modern methods for the assessment of skeletal maturation and pubertal growth spurt. [Klasszikus és modern vizsgálómódszerek a csontérettségi kor és a pubertáskori növekedési csúcs meghatározására.] Orv Hetil 2018; 159 (35): 1423 -1432. [Hungarian] https://doi.org/10.1556/650.2018.31151
Nevzatoglu S, Kücükkeles N: Long-term results of surgically assisted maxillary protraction vs regular facemask. Angle Orthod 2014; 84 (6): 1002 -1009. https://doi.org/10.2319/120913-905.1
Da Luz Vieira G, De Menezes LM, De Lima EM, et al: Dentoskeletal Effects of Maxillary Protraction in Cleft Patients With Repetitive Weekly Protocol of Alternate Rapid Maxillary Expansions and Constrictions. Cleft Palate Craniofac J 2009; 46: 391 -398. https://doi.org/10.1597/07-144.1
Gyocsia, Kolarovszki B, Frank D: Adverse effects of orthodontic treatments. [Lehetséges mellékhatások a fogszabályozó kezelések kapcsán] Fogorv Szle 2016; 109 (4): 111 -118. [Hungarian] https://doi.org/10.33891/FSZ.109.4.111-118
Liu W, Zhou Y, Wang X, et al: Effect of maxillary protraction with alternating rapid palatal expansion and constriction vs expansion alone in maxillary retrusive patients: a single-center, randomized controlled trial. Am J Orthod Dentofacial Orthop 2015; 148: 641 -651. https://doi.org/10.1016/j.ajodo.2015.04.038
Yilmaz BS, Kucukkeles N: Skeletal, soft tissue, and airway changes following the alternate maxillary expansions and constrictions protocol. Angle Orthod 2014; 84 (5): 868 -877. https://doi.org/10.2319/092713-705.1
Wang YC, Chang PM, Liou EJ: Opening of circumaxillary sutures by alternate rapid maxillary expansions and constrictions. Angle Orthod 2009; 79 (2): 230 -234. https://doi.org/10.2319/031208-141.1
Copyright (c) 2022 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
.png)
1.png)
