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Three-dimensional evaluation of treatment results of the Alt-RAMEC and facemask protocol in growing patients

Dreidimensionale Auswertung der Behandlungsergebnisse des Alt-RAMEC- und Gesichtsmaskenprotokolls bei wachsenden Patienten

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Purpose

The aim of this retrospective study was to evaluate the skeletal, dental, and soft tissue effects of the alternating rapid maxillary expansions and constrictions (Alt-RAMEC) protocol combined with a facemask in prepubertal patients.

Methods

The study group (mean age 9.74 ± 1.46 years) consisted of 20 patients with class III malocclusion characterized by maxillary retrognathism. They were treated with a facemask for 7 months following a 9‑week Alt-RAMEC protocol. Cone-beam computed tomography (CBCT) records and three-dimensional (3D) photographs taken before (T0) and after the protraction and retention period (T1) were evaluated. The study group was compared with a well-matched control group of 16 untreated patients (mean age 9.44 ± 0.79 years) with the same malocclusion. The records for the control group included cephalometric radiographs and 3D photographs.

Results

In the study group, significant forward movements of A point (3.49 mm), nasal (2.91 mm) and zygomatic bones were achieved. Intermolar, internasal, and interzygomatic widths increased. Soft tissue points followed the hard tissue movements, apart from b and pog. In the control group, A (0.97 mm), B (1.69 mm), Pog, and b points presented forward movement. Significant differences were found regarding the forward movement of the maxilla between the groups.

Conclusion

The Alt-RAMEC/facemask protocol was effective not only in the maxillary region but also in the midface.

Zusammenfassung

Zweck

Ziel dieser retrospektiven Studie war es, die skelettalen, dentalen und weichgewebigen Auswirkungen der alternierenden schnellen Gaumennahterweiterung und -konstriktion (Alt-RAMEC-Protokoll) in Kombination mit einer Gesichtsmaske bei präpubertären Patienten zu untersuchen.

Methoden

Die Studiengruppe (mittleres Alter 9,74 ± 1,46 Jahre) bestand aus 20 Patienten mit Klasse-III-Malokklusion mit retrognathem Oberkiefer. Sie wurden nach einem 9‑wöchigen Alt-RAMEC-Protokoll 7 Monate lang mit einer Gesichtsmaske behandelt. Digitale Volumentomographien (CBCT) und dreidimensionale (3D) Fotografien, die vor (T0) und nach der Protraktions- und Retentionszeit (T1) aufgenommen worden waren, wurden ausgewertet. Die Studiengruppe wurde mit einer gut abgestimmten Kontrollgruppe von 16 unbehandelten Patienten (Durchschnittsalter 9,44 ± 0,79 Jahre) mit der gleichen Malokklusion verglichen. Die Aufzeichnungen für die Kontrollgruppe umfassten kephalometrische Röntgenaufnahmen und 3D-Fotografien.

Ergebnisse

In der Studiengruppe wurden signifikante Vorwärtsbewegungen von A‑Punkt (3,49 mm) sowie Nasen- (2,91 mm) und Jochbein erzielt. Die intermolaren, internasalen und interzygomatischen Abstände nahmen zu. Weichteilpunkte folgten den Hartgewebebewegungen, abgesehen von b und pog. In der Kontrollgruppe zeigten die Punkte A (0,97 mm), B (1,69 mm), Pog und b eine Vorwärtsbewegung. Bezüglich der Vorwärtsbewegung des Oberkiefers wurden signifikante Unterschiede zwischen den Gruppen festgestellt.

Schlussfolgerung

Das Alt-RAMEC-Gesichtsmaske-Protokoll war nicht nur im Oberkieferbereich, sondern auch im Mittelgesicht wirksam.

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Abbreviations

3D:

Three-dimensional

Alt-RAMEC:

Alternating rapid maxillary expansions and constrictions

CBCT:

Cone-beam computed tomography

ICC:

Intraclass correlation coefficient

RME:

Rapid maxillary expansion

RP1:

Frankfort horizontal plane

RP1ceph:

Horizontal reference plane for the control group

RP2:

Vertical reference plane

RP2ceph:

Vertical reference plane for the control group

STRP:

Soft tissue reference plane

T0:

Initial

T1:

After protraction and retention period

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Authors and Affiliations

  1. Private Practice, Thessaloniki, Greece

    V. Sitaropoulou

  2. Faculty of Dentistry, Department of Orthodontics, Marmara University, Istanbul, Turkey

    H. N. Yilmaz

  3. Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakıf University, Istanbul, Turkey

    B. Yilmaz & N. Kucukkeles

Authors
  1. V. Sitaropoulou
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  2. H. N. Yilmaz
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  3. B. Yilmaz
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  4. N. Kucukkeles
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Corresponding author

Correspondence to H. N. Yilmaz.

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Conflict of interest

V. Sitaropoulou, H.N. Yilmaz, B. Yilmaz and N. Kucukkeles declare that they have no competing interests.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. This retrospective study was performed after consultation with the institutional ethics committee and in accordance with national legal requirements. For images or other information within the manuscript which identify patients, consent was obtained from them and/or their legal guardians. The study was approved by the ethical committee of Marmara University, Institute of Health Sciences (no: 24.12.2014-11).

Additional information

Authors Contribution

N. Kucukkeles constructed the idea. N. Kucukkeles and H.N. Yilmaz planned the methodology to reach the conclusion, and organized and supervised the course of the project and the writing of the article. V. Sitaropoulou and B. Yilmaz collected, managed and reported the data. All the authors analyzed the data and took responsibility in logical interpretation. N. Kucukkeles, H.N. Yilmaz and V. Sitaropoulou performed the writing of the manuscript. All the authors read and approved the final manuscript.

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Sitaropoulou, V., Yilmaz, H.N., Yilmaz, B. et al. Three-dimensional evaluation of treatment results of the Alt-RAMEC and facemask protocol in growing patients. J Orofac Orthop 81, 407–418 (2020). https://doi.org/10.1007/s00056-020-00240-8

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  • DOI: https://doi.org/10.1007/s00056-020-00240-8

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