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Abstract

Objective:

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.

Materials and Methods:

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.

Results:

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.

Conclusion:

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.

Keywords

Alt-RAMEC maxillary protraction facemask unilateral cleft lip and palate

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References

Alcan

Keles

Erverdi

. The effects of a modified protraction headgear on maxilla. Am J Orthod Dentofacial Orthop. 2000;117(1):27–38.

Al-Mozany

Dalci

Almuzian

Gonzalez

Tarraf

. Treatment of class III malocclusions in the growing patient. Prog Orthod. 2017;18(1):1–9.

Baccetti

Franchi

Mucedero

Cozza

. Treatment and post-treatment effects of facemask therapy on the sagittal pharyngeal dimensions in class III subjects. Eur J Orthod. 2010;32(3):346–350.

Baik

. Clinical results of the maxillary protraction in Korean children. Am J Orthod Dentofacial Orthop. 1995;108(6):583–592.

Ballanti

Lione

Fanucci

Franchi

Baccetti

Cozza

. Immediate and post-retention effects of rapid maxillary expansion investigated by computed tomography in growing patients. Angle Orthod. 2009;79(1):24–29.

Bell

. A review of maxillary expansion in relationto rate of expansion and patient’s age. Am J Orthod. 1982;81:32–33.

Bhad

Nayak

Doshi

. A new approach of assessing sagittal dysplasia: the W angle. Eur J Orthod. 2013;35(1):66–70.

Biederman

Chem

. Rapid correction of Class III malocclusion by midpalatal expansion. Am J Orthod Dentofac Orthop. 1973;63(1):47–55.

Buschang

Porter

Genecov

Sayler

. Face mask therapy of preadolescents with unilateral cleft lip and palate. Angle Orthod. 1994;64(2):145–150.

10.

Büyükçavuş

. Alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol: a comprehensive literature review. Turk J Orthod. 2019;32(1):47–51.

11.

Canturk

Celikglov

. Comparison of the effects of facemask treatment started simultaneously and after completion of the alternate rapid maxillary expansion and constriction procedure. Angle Orthod. 2015;85(2):284–291.

12.

Cekikoglu

Buyukvcavus

. Changes in pharyngeal airway dimensions and hyoid bone position after maxillary protraction with different alternate rapid maxillary expansion a construction protocols: a prospective clinical study. Angle Orthod. 2017;87(4):519–525.

13.

Clough

. Original formulation of the finite element method. Finite Element Anal Des. 1990;7(2):89–101.

14.

Delatour

Nigan

Martin

Ramus

Gunel

. Effects of alternate maxillary expansion and contraction on protraction of maxilla: a pilot study. Hong Kong Dent J. 2009;6(2):72–82.

15.

Gandedkar

Liou

EJW

. The immediate effects of alternate rapid maxillary expansions and constrictions on the alveolus: a retrospective cone beam computed tomography study. Prog Orthod. 2018;19(40):10–15.

16.

Gautam

Valiathan

Adhikari

. Skeletal response to maxillary protraction with and without maxillary expansion: a finite element study. Am J Orthod Dentofacial Orthop. 2009;135(6):723–728.

17.

Haas

. Long-term posttreatment evaluation of rapid palatal expansion. Angle Orthod. 1980;50(3):189–217.

18.

Haas

. Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod Dentofacial Orthop. 1970;57(3):219–255.

19.

Hakan

Palomo

. Three-dimensional evaluation of upper airway following rapid maxillary expansion—a CBCT study. Angle Orthod. 2014;84(2):265–273.

20.

Isci

Turk

Elekdag-Turk

. Activation–deactivation rapid palatal expansion and reverse headgear in Class III cases. Eur J Orthod. 2010;32(6):706–715.

21.

Iseri

Tekkaya

Oztan

Bilgic

. Biomechanical effect of rapid maxillary expansion on the craniofacial skeleton, studied by the finite element method. Eur J Orthod. 1998;20(4):347–356.

22.

Johnston

Jr . Balancing the books on orthodontic treatment: an integrated analysis of change. Br J Orthod. 1996;23(2):93–102.

23.

Khanderparker

Kamat

Shetye

Cleft maxillary hypoplasia: review of treatment options. Med Res Chron. 2017;4(5):501–550.

24.

Levy-Bercowski

Deleon

Stockstill

. Orthognathic cleft-surgical/orthodontic treatment. Semin Orthod. 2011;17(3):197–206.

25.

Liou

. Toothborne orthopedic maxillary protraction in Class III patients. J Clin Orthod. 2005;39(2):68–75.

26.

Liou

EJW

Tsai

. A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J. 2005;42(2):121–127.

27.

Mars

Plint

Houston

Bergland

Semb

. The Goslon Yardstick: a new system of assessing dental arch relationships in children with unilateral clefts of the lip and palate. Cleft Palate Craniofac J. 1987;24(4):314–322.

28.

Meazzini

Zappia

Tortora

Autelitano

Tintinelli

. Short- and long-term effects of late maxillary advancement with the Liou-Alt-RAMEC protocol in unilateral cleft lip and palate. Cleft Palate Craniofac J. 2019;20(10):1–9.

29.

Neela

Mascarenhas

Husain

. A new sagittal dysplasia indicator: the YEN angle. World J Orthod. 2009;10(2):147–151.

30.

O’Brien

Wright

Conboy

Sanjie

Mandall

Chadwick

Connolly

Cook

Birnie

Hammond

, et al. Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial. Am J Orthod Dentofacial Orthop. 2003;124(2):128–137.

31.

Onem Ozbilen

Yilmaz

Kucukkeles

. Comparison of the effects of rapid maxillary expansion and alternate rapid maxillary expansion and constriction protocols followed by facemask therapy. Korean J Orthod. 2019;49(1):49–58.

32.

Podesser

Williams

Crismani

Bantleon

. Evaluation of the effects of rapid maxillary expansion in growing children using computer tomography scanning: a pilot study. Eur J Orthod. 2007;29(1):37–44.

33.

Priyadarshini

Mahesh

Chandrashekar

Sundara

Arun

Reddy

. Stress and displacement patterns in the craniofacial skeleton with rapid maxillary expansion-a finite element method study. Prog Orthod. 2017;18(1):17–25.

34.

Stenson

Kepler

. Bias in prospective research and how to avoid it. Clin Spine Surg. 2019;32(6):254–255.

35.

Tindlund

. Prediction of sagittal skeletal response to maxillary protraction in patients with cleft lip and palate before the age 10 years. Cleft Palate Craniofac J. 1994;31:295–308.

36.

Tindlund

Rygh

. Maxillary protraction: different effects on facial morphology in unilateral and bilateral cleft lip and palate patients. Cleft Palate Craniofac J. 1993;30(2):208–221.

37.

Vaughn

Mason

Moon

Turley

. 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.

38.

Wang

Chang

PMS

Liou

EJW

. Opening of circumaxillary sutures by alternate rapid maxillary expansions and constrictions. Angle Orthod. 2009;79(2):230–234.

39.

Williams

Sarver

Sadowsky

Bradley

. Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study. Semin Orthod. 1997;3(4):265.

40.

Yen

. Protocols for late maxillary protraction in cleft lip and palate patients at Childrens Hospital Los Angeles. Semin Orthod. 2011;17(2):138–148. doi:10.1053/j.sodo.2011.01.001

41.

Yilmaz

Kucukkeles

. Skeletal, soft tissue, and airway changes following the alternate maxillary expansions and constrictions protocol. Angle Orthod. 2014;84(5):868–877.

42.

Zhang

Jia

Huang

Liu

. Long-term stability of maxillary protraction therapy in Class III patients with complete unilateral cleft lip and palate. Angle Orthod. 2019;89(2):214–220.

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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

Abstract

Objective:

Materials and Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material