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Soft tissue evaluation after maxillary protraction with RPE or with the ALT-RAMEC protocol

A controlled 3D study

Untersuchung des Weichgewebes nach Oberkieferprotraktion mit RPE oder dem ALT-RAMEC-Protokoll

Eine kontrollierte 3-D-Studie

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

Abstract

Purpose

To evaluate soft tissue changes following maxillary protraction with different expansion protocols using three-dimensional (3D) stereophotogrammetry.

Methods

Pretreatment (T0) and postprotraction (T1) stereophotogrammetry and lateral cephalometric images of skeletal class III patients were included in this retrospective study. In all, 32 patients were treated either with a combination of rapid palatal expansion and facemask (RPE/FM; n = 16; mean age: 9.94 ± 0.68 years) or with alternate rapid maxillary expansion and constriction together with a facemask (Alt-RAMEC/FM; n = 16; mean age: 9.74 ± 1.35 years). As a control group 16 untreated patients were recruited (mean age: 9.46 ± 0.8 years). For superimpositioning of the 3D images taken at T0 and T1, the face was divided into defined regions and 3D and differences between the groups were evaluated using 3‑matic software (Materialise Europe, Leuven, Belgium). Cephalometric analyses were also performed.

Results

While the increases in the cephalometric parameters SNA and ANB were significantly greater in the treatment groups, the value for SNB also increased in the control group (p < 0.05). The results of the stereophotogrammetry analyses demonstrated that the mean changes in the RPE/FM and in the Alt-RAMEC/FM groups were significantly different for the midface compared to the control group (0.33 ± 0.26 mm, 0.3 ± 0.31 mm, 0.1 ± 0.18 mm). The maximum positive, negative, and mean changes were also significantly different between the treatment and control groups for the upper lip (p < 0.05). For the lower lip and the chin significant backward movements in the RPE/FM as well as in the Alt-RAMEC/FM group (−1.06 ± 1.26 mm, −0.68 ± 0.45 mm) were observed, while the control group (0.09 ± 0.53 mm) presented changes in the opposite direction. Regarding soft tissue changes, no significant differences were found between the RPE/FM and Alt-RAMEC/FM groups.

Conclusion

Both treatment protocols improved the soft tissue profile due to a forward movement of the midface and the upper lip, and a backward movement of the lower lip and chin, compared to the control group.

Zusammenfassung

Zielsetzung

Evaluierung von Weichgewebeveränderungen nach einer Oberkieferprotraktion mit verschiedenen Expansionsprotokollen mittels dreidimensionaler (3-D) Stereophotogrammetrie.

Methoden

In diese retrospektive Studie wurden sowohl vor (T0) als auch nach der Protraktion (T1) Stereophotogrammetrie- und laterale Fernröntgenseitaufnahmen von Patienten der skelettalen Klasse III aufgenommen. Insgesamt wurden 32 Patienten entweder mit einer Kombination aus schneller Gaumennahterweiterung und Gesichtsmaske (RPE/FM; n = 16; Durchschnittsalter: 9,94 ± 0,68 Jahre) oder mit abwechselnder schneller Gaumennahterweiterung und -konstriktion in Kombination mit einer Gesichtsmaske (Alt-RAMEC/FM; n = 16; Durchschnittsalter: 9,74 ± 1,35 Jahre) behandelt. Als Kontrollgruppe wurden 16 unbehandelte Patienten rekrutiert (mittleres Alter: 9,46 ± 0,8 Jahre). Für die Überlagerung der bei T0 und T1 aufgenommenen 3‑D-Bilder wurde das Gesicht in bestimmte Regionen eingeteilt und die 3‑D- und Unterschiede zwischen den Gruppen mit der Software 3‑matic (Materialise Europe, Leuven, Belgien) wurden ausgewertet. Ferner wurden kephalometrische Analysen durchgeführt.

Ergebnisse

Während die Anstiege der kephalometrischen Parameter SNA und ANB in den Behandlungsgruppen signifikant ausgeprägter waren, stieg der Wert für SNB auch in der Kontrollgruppe an (p < 0,05). Die Ergebnisse der stereophotogrammetrischen Analysen zeigten, dass die mittleren Veränderungen in der RPE/FM- und in der Alt-RAMEC/FM-Gruppe für das Mittelgesicht im Vergleich zur Kontrollgruppe signifikant unterschiedlich waren (0,33 ± 0,26 mm, 0,3 ± 0,31 mm, 0,1 ± 0,18 mm). Die maximalen positiven, negativen und mittleren Veränderungen waren ebenfalls signifikant unterschiedlich zwischen den Behandlungsgruppen und der Kontrollgruppe für die Oberlippe (p < 0,05). Für Unterlippe und Kinn wurden sowohl in der RPE/FM- als auch in der Alt-RAMEC/FM-Gruppe signifikante Rückwärtsbewegungen (‑1,06 ± 1,26 mm, -0,68 ± 0,45 mm) beobachtet, während die Kontrollgruppe (0,09 ± 0,53 mm) Veränderungen in entgegengesetzter Richtung aufwies. Hinsichtlich der Weichgewebeveränderungen wurden keine signifikanten Unterschiede zwischen der RPE/FM- und der Alt-RAMEC/FM-Gruppe festgestellt.

Schlussfolgerung

Beide Behandlungsprotokolle verbesserten die Weichgewebeparameter durch eine Vorwärtsbewegung des Mittelgesichts und der Oberlippe sowie durch eine Rückwärtsbewegung der Unterlippe und des Kinns, verglichen mit der Kontrollgruppe.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthodontics, Faculty of Dentistry, Marmara University, 9/34854, Maltepe/Istanbul, Turkey

    Elvan Onem Ozbilen DDS Specialist in Orthodontics &  Hanife Nuray Yilmaz DDS PhD

  2. Private Practice, Istanbul, Turkey

    Mustafa Onur Ari DDS Specialist in Orthodontics

  3. Department of Orthodontics, Faculty of Dentistry, Istanbul Kent University, Istanbul, Turkey

    Sibel Biren DDS PhD

Authors
  1. Elvan Onem Ozbilen DDS Specialist in Orthodontics
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  2. Mustafa Onur Ari DDS Specialist in Orthodontics
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  3. Hanife Nuray Yilmaz DDS PhD
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  4. Sibel Biren DDS PhD
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Corresponding author

Correspondence to Elvan Onem Ozbilen DDS Specialist in Orthodontics.

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Conflict of interest

E.O. Ozbilen, M.O. Ari, H.N. Yilmaz and S. Biren declare that they have no competing interests.

Ethical standards

The present controlled retrospective study was approved by the Ethical Committee of Marmara University, Faculty of Dentistry (21 December 2020, 2020/87, Istanbul, Turkey) and was conducted in accordance with the Declaration of Helsinki of 1975 as revised in 2013. Consent to participate: An informed consent was obtained from all the patients included in the treatment and control groups.

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Ozbilen, E.O., Ari, M.O., Yilmaz, H.N. et al. Soft tissue evaluation after maxillary protraction with RPE or with the ALT-RAMEC protocol. J Orofac Orthop 84 (Suppl 3), 200–209 (2023). https://doi.org/10.1007/s00056-022-00428-0

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  • DOI: https://doi.org/10.1007/s00056-022-00428-0

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