The development of skeletal class III is often due to an underdeveloped maxilla in which case early treatment requires transverse expansion and protrusion of the maxilla. Two main protocols applied to achieve this goal are: conventional RME (rapid maxillary expansion) and the Alt-RAMEC protocol introduced in 2005 by Eric Liou.
The aim of this literature review is to compare the effectiveness of these two techniques and to determine when the use of the Alt-RAMEC/FM protocol is more effective compared to conventional RME/FM.
For the purpose of this study, a literature review was performed using PubMed and Google Scholar. A keyword-based search yielded 247 articles. Among these, only ten articles presented a comparative analysis of RME/FM and Alt-RAMEC/FM therapies in class III patients.
Compared with conventional RME, the Alt-RAMEC protocol achieves greater effect on the sutures of the nasomaxillary complex without excessive maxillary expansion. This is of great benefit, especially in prepubertal patients in whom suture ossification is at a more advanced level. In cases without transversal discrepancies, it is possible to control the degree of maxillary expansion. The application of Alt-RAMEC and facemask resulted in a greater skeletal effect in the protrusion of the nasomaxillary complex compared to the standard protocol
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Almuzian M., E. McConnell, M. Ali Darendeliler, F.Alharbi, H. Mohammed 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,. J Orthod 2018;45(4);250-9.
Çelebi F, Çelikdelen M. Comparison of the Changes Following Two Treatment Approaches: Rapid Maxillary Expansion Versus Alternate Rapid Maxillary Expansion and Constriction. Turk J Orthod 2020; 33(1): 1-7.
Chen X, Xie X. 2012. The e ect of two different methods of rapid maxillary expansion on treatment results of skeletal class III malocclusion patients with maxillary protractionin early permanent dentition. Shanghai J Stomatol. 21(5): 580–583.
Do-deLatour, T.B., Ngan, P., Martin, C.A., Razmus, T. and Gunel, E. (2009) Effect of alternate maxillary expansion and contraction on protraction of the maxilla: a pilot study. Hong Kong Dental Journal, 6, 72–82.3.
Fischer, B., Masucci, C., Ruellas, A., Cevidanes, L., Giuntini, V., Nieri, M., Nardi, C. Franchi, L., McNamara, J.A. Jr and Defraia, E. Three- dimensional evaluation of the maxillary effects of two orthopaedic protocols for the treatment of Class III malocclusion: A prospective study. Orthodontics & craniofacial research, 2018; 21, 248–257.7.
Hardy, D. K., Cubas, Y. P., & Orellana, M. F. Prevalence of angle class III malocclusion: A systematic review and meta-analysis. Open Journal of Epidemiology,2012; 2(4), 75-83. http://www.scirp.org/html/1-1890020_24715.htm
Isci, D., Turk, T. and Elekdag-Turk, S. Activation-deactivation rapid palatal expansion and reverse headgear in Class III cases. European Journal of Orthodontics,2010; 32, 706–715.4.
Liou, E.J. Effective maxillary orthopedic protraction for growing Class III patients: a clinical application simulates distraction osteogenesis. Progress in Orthodontics, 2005; 6, 154–171.
Liou, W., Zhou, Y., Wang, X., Liu, D. and Zhou, S. Effect of maxillary protraction with alternating rapid palatal expansion and constriction vs expansion alone in maxillary retrusive patients: a single-center, randomized controlled trial. AJODO 2015; Oct;148(4):641-51.;doi: 10.1016/j.ajodo.2015.04.038.
Liu, Y., Hou, R., Jin, H., Zhang, X., Wu, Z., Li, Z. and Guo, J. Relative effectiveness of facemask therapy with alternate maxillary expansion and constriction in the early treatment of Class III malocclusion. AJODO, 2021 Mar;159(3):321-332
Masucci C., Franchi, L., Giuntini, V. and Defraia, E. Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study. Orthodontics & craniofacial research, 2014;17, 259–269.5.
Masucci C., Lorenzo Franchi, Debora Franceschi, Felicita Pierleoni, Veronica Giuntini, Post-pubertal effects of the Alt-RAMEC/FM and RME/FM protocols for the early treatment of Class III malocclusion: a retrospective controlled study, European Journal of Orthodontics, Volume 44, Issue 3, June 2022, Pages 303–310, https://doi.org/10.1093/ejo/cjab057
Meazzini M.C., C.Torre, A. Cappello, R. Tintinelli, E. De Ponti, F. Mazzoleni; Long-term follow-up of late maxillary orthopedic advancement with the Liou-Alternate rapid maxillary expansion-constriction technique in patients with skeletal Class III malocclusion; AJODO 2021 Aug;160(2):221-230.doi: 10.1016/j.ajodo.2020.04.027. Epub 2021 Jun 26.
Ozbilena E. О., Yilmazb HN, Kucukkeles N. Comparison of the effects of rapid maxillary expansion and alternate rapid maxillary expansion and constriction protocols followed by facemask therapy. Korean J Orthod 2019;49:49-58.
Sakamoto T. Effective treatment timing for the application of orthopedic force in the skeletal class III malocclusion. Am. J. Orthod. 1981 Oct;80(4):411-6. doi: 10.1016/0002-9416(81)90175-5
Tiziano Baccetti, Lorenzo Franchi, James A. McNamara, The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics, Seminars in Orthodontics, Volume 11, Issue 3, 2005, Pages 119-129, ISSN 1073-8746, https://doi.org/10.1053/j.sodo.2005.04.005.
Xiong Z, Jie K, Zhao G, Lin Q. The effect of maxillary protraction therapy on skeletal class III malocclusion with two different methods of rapid maxillary expansion. Chin J Stomato Res. 2017;11(3):5.
Yao N, Lin W, Yogjia G, Bin Z, Wenqian X, Meiqin G. A comparative study on maxillary protraction therapy with two different methods of rapid palatal expansion. Chin of Stomato Res. 2015, 35 :(9): 767-769.
Yu-Chi Wanga; Peter M.S. Changb; Eric Jein-Wein Liou; Opening of Circumaxillary Sutures by Alternate Rapid Maxillary Expansions and Constrictions. Angle Orthod 2009 Mar;79(2):230-4. doi: 10.2319/031208-141.1.
