Evaluation of the short term efficacy of the modified Alt-RAMEC protocol in the treatment of retrognathic maxilla

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.