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Published in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie 3/2023

28-09-2022 | Original Article

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

A controlled 3D study

Authors: Assistant Prof. Elvan Onem Ozbilen, DDS Specialist in Orthodontics, Mustafa Onur Ari, DDS Specialist in Orthodontics, Associate Prof. Hanife Nuray Yilmaz, DDS PhD, Prof. Sibel Biren, DDS PhD

Published in: Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie | Special Issue 3/2023

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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.
Literature
1.
go back to reference Liu Z, McGrath C, Hägg U (2009) The impact of malocclusion/orthodontic treatment need on the quality of life: a systematic review. Angle Orthod 79:585–591CrossRefPubMed Liu Z, McGrath C, Hägg U (2009) The impact of malocclusion/orthodontic treatment need on the quality of life: a systematic review. Angle Orthod 79:585–591CrossRefPubMed
2.
go back to reference Guyer EC, Ellis EE 3rd, McNamara JA Jr, Behrents RG (1986) Components of class III malocclusion in juveniles and adolescents. Angle Orthod 56:7–30PubMed Guyer EC, Ellis EE 3rd, McNamara JA Jr, Behrents RG (1986) Components of class III malocclusion in juveniles and adolescents. Angle Orthod 56:7–30PubMed
3.
go back to reference Ngan P, Moon W (2015) Evolution of class III treatment in orthodontics. Am J Orthod Dentofacial Orthop 148:22–36CrossRefPubMed Ngan P, Moon W (2015) Evolution of class III treatment in orthodontics. Am J Orthod Dentofacial Orthop 148:22–36CrossRefPubMed
4.
go back to reference Cordasco G, Matarese G, Rustico L, Fastuca S, Caprioglio A, Lindauer S et al (2014) Efficacy of orthopedic treatment with protraction facemask on skeletal class III malocclusion: a systematic review and meta-analysis. Orthod Craniofac Res 17:133–143CrossRefPubMed Cordasco G, Matarese G, Rustico L, Fastuca S, Caprioglio A, Lindauer S et al (2014) Efficacy of orthopedic treatment with protraction facemask on skeletal class III malocclusion: a systematic review and meta-analysis. Orthod Craniofac Res 17:133–143CrossRefPubMed
5.
go back to reference Sung SJ, Baik HS (1998) Assessment of skeletal and dental changes by maxillary protraction. Am J Orthod Dentofacial Orthop 114:492–502CrossRefPubMed Sung SJ, Baik HS (1998) Assessment of skeletal and dental changes by maxillary protraction. Am J Orthod Dentofacial Orthop 114:492–502CrossRefPubMed
6.
go back to reference Baccetti T, McGill JS, Franchi L, McNamara JA Jr, Tollaro I (1998) Skeletal effects of early treatment of class III malocclusion with maxillary expansion and face-mask therapy. Am J Orthod Dentofacial Orthop 113:333–343CrossRefPubMed Baccetti T, McGill JS, Franchi L, McNamara JA Jr, Tollaro I (1998) Skeletal effects of early treatment of class III malocclusion with maxillary expansion and face-mask therapy. Am J Orthod Dentofacial Orthop 113:333–343CrossRefPubMed
7.
go back to reference Gautam P, Valiathan A, Adhikari R (2009) Skeletal response to maxillary protraction with and without maxillary expansion: a finite element study. Am J Orthod Dentofacial Orthop 135:723–728CrossRefPubMed Gautam P, Valiathan A, Adhikari R (2009) Skeletal response to maxillary protraction with and without maxillary expansion: a finite element study. Am J Orthod Dentofacial Orthop 135:723–728CrossRefPubMed
8.
go back to reference Liou EJW, Tsai WC (2005) A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 42:121–127CrossRefPubMed Liou EJW, Tsai WC (2005) A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 42:121–127CrossRefPubMed
9.
go back to reference Do-deLatour TB, Ngan P, Martin C, Razmus T, Gunel E (2009) Effect of alternate maxillary expansion and contraction on protraction of the maxilla: a pilot study. Hong Kong Dent J 6:72–82 Do-deLatour TB, Ngan P, Martin C, Razmus T, Gunel E (2009) Effect of alternate maxillary expansion and contraction on protraction of the maxilla: a pilot study. Hong Kong Dent J 6:72–82
10.
go back to reference Masucci C, Franchi L, Giuntini V, Defraia E (2014) Short-term effects of a modified Alt-RAMEC protocol for early treatment of class III malocclusion: a controlled study. Orthod Craniofac Res 17:259–269CrossRefPubMed Masucci C, Franchi L, Giuntini V, Defraia E (2014) Short-term effects of a modified Alt-RAMEC protocol for early treatment of class III malocclusion: a controlled study. Orthod Craniofac Res 17:259–269CrossRefPubMed
11.
go back to reference Melo Pithon M, de Lima Santos N, Rangel Barreto Dos Santos C, Carvalho Souza Baião F, Costa Rangel Pinheiro M, Matos Neto M et al (2016) Is alternate rapid maxillary expansion and constriction an effective protocol in the treatment of class III malocclusion? A systematic review. Dental Press J Orthod 21:34–42CrossRef Melo Pithon M, de Lima Santos N, Rangel Barreto Dos Santos C, Carvalho Souza Baião F, Costa Rangel Pinheiro M, Matos Neto M et al (2016) Is alternate rapid maxillary expansion and constriction an effective protocol in the treatment of class III malocclusion? A systematic review. Dental Press J Orthod 21:34–42CrossRef
12.
go back to reference Almuzian M, McConnell E, Darendeliler MA, Alharbi F, Mohammed H (2018) The effectiveness of alternating rapid maxillary expansion and constriction combined with maxillary protraction in the treatment of patients with a class III malocclusion: a systematic review and meta-analysis. J Orthod 45:250–259CrossRefPubMed Almuzian M, McConnell E, Darendeliler MA, Alharbi F, Mohammed H (2018) The effectiveness of alternating rapid maxillary expansion and constriction combined with maxillary protraction in the treatment of patients with a class III malocclusion: a systematic review and meta-analysis. J Orthod 45:250–259CrossRefPubMed
13.
go back to reference Büyükçavuş MH (2019) Alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol: a comprehensive literature review. Turk J Orthod 32:47–51CrossRefPubMedPubMedCentral Büyükçavuş MH (2019) Alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol: a comprehensive literature review. Turk J Orthod 32:47–51CrossRefPubMedPubMedCentral
14.
go back to reference Liu Y, Hou R, Jin H, Zhang X, Wu Z, Li Z et al (2021) Relative effectiveness of facemask therapy with alternate maxillary expansion and constriction in the early treatment of class III malocclusion. Am J Orthod Dentofacial Orthop 159:321–332CrossRefPubMed Liu Y, Hou R, Jin H, Zhang X, Wu Z, Li Z et al (2021) Relative effectiveness of facemask therapy with alternate maxillary expansion and constriction in the early treatment of class III malocclusion. Am J Orthod Dentofacial Orthop 159:321–332CrossRefPubMed
15.
go back to reference Sitaropoulou V, Yilmaz HN, Yilmaz B, Kucukkeles N (2020) Three-dimensional evaluation of treatment results of the Alt-RAMEC and facemask protocol in growing patients. J Orofac Orthop 81:407–418CrossRefPubMed Sitaropoulou V, Yilmaz HN, Yilmaz B, Kucukkeles N (2020) Three-dimensional evaluation of treatment results of the Alt-RAMEC and facemask protocol in growing patients. J Orofac Orthop 81:407–418CrossRefPubMed
16.
go back to reference Kilic N, Catal G, Kiki A, Oktay H (2010) Soft tissue profile changes following maxillary protraction in class III subjects. Eur J Orthod 32:419–424CrossRefPubMed Kilic N, Catal G, Kiki A, Oktay H (2010) Soft tissue profile changes following maxillary protraction in class III subjects. Eur J Orthod 32:419–424CrossRefPubMed
17.
go back to reference Arman A, Toygar TU, Abuhijleh E (2004) Profile changes associated with different orthopedic treatment approaches in class III malocclusions. Angle Orthod 74:733–740PubMed Arman A, Toygar TU, Abuhijleh E (2004) Profile changes associated with different orthopedic treatment approaches in class III malocclusions. Angle Orthod 74:733–740PubMed
18.
go back to reference Celikoglu M, Yavuz I, Unal T, Oktay H, Erdem A (2015) Comparison of the soft and hard tissue effects of two different protraction mechanisms in class III patients: a randomized clinical trial. Clin Oral Investig 19:2115–2122CrossRefPubMed Celikoglu M, Yavuz I, Unal T, Oktay H, Erdem A (2015) Comparison of the soft and hard tissue effects of two different protraction mechanisms in class III patients: a randomized clinical trial. Clin Oral Investig 19:2115–2122CrossRefPubMed
19.
go back to reference Ngan P, Hägg U, Yiu C, Merwin D, Wei SH (1996) Soft tissue and dentoskeletal profile changes associated with maxillary expansion and protraction headgear treatment. Am J Orthod Dentofacial Orthop 109:38–49CrossRefPubMed Ngan P, Hägg U, Yiu C, Merwin D, Wei SH (1996) Soft tissue and dentoskeletal profile changes associated with maxillary expansion and protraction headgear treatment. Am J Orthod Dentofacial Orthop 109:38–49CrossRefPubMed
20.
go back to reference Kiliçoĝlu H, Kirliç Y (1998) Profile changes in patients with class III malocclusions after delaire mask therapy. Am J Orthod Dentofacial Orthop 113:453–462PubMed Kiliçoĝlu H, Kirliç Y (1998) Profile changes in patients with class III malocclusions after delaire mask therapy. Am J Orthod Dentofacial Orthop 113:453–462PubMed
21.
go back to reference Moshkelgosha V, Raoof A, Sardarian A, Salehi P (2017) Photogrammetric comparison of facial soft tissue profile before and after protraction facemask therapy in class III children (6–11 years old). J Dent 18:7–16 Moshkelgosha V, Raoof A, Sardarian A, Salehi P (2017) Photogrammetric comparison of facial soft tissue profile before and after protraction facemask therapy in class III children (6–11 years old). J Dent 18:7–16
22.
go back to reference Chen X, Xie X (2012) The effect of two different methods of rapid maxillary expansion on treatment results of skeletal class III malocclusion patients with maxillary protraction in early permanent dentition. Shanghai Kou Qiang Yi Xue 21:580–583PubMed Chen X, Xie X (2012) The effect of two different methods of rapid maxillary expansion on treatment results of skeletal class III malocclusion patients with maxillary protraction in early permanent dentition. Shanghai Kou Qiang Yi Xue 21:580–583PubMed
23.
go back to reference Ras F, Habets L, Van Ginkel F, Prahl-Andersen B (1996) Quantification of facial morphology using stereophotogrammetry—demonstration of a new concept. J Dent 24:369–374CrossRefPubMed Ras F, Habets L, Van Ginkel F, Prahl-Andersen B (1996) Quantification of facial morphology using stereophotogrammetry—demonstration of a new concept. J Dent 24:369–374CrossRefPubMed
24.
go back to reference Kau CH, Richmond S, Zhurov AI, Knox J, Chestnutt I, Hartles F et al (2005) Reliability of measuring facial morphology with a 3-dimensional laser scanning system. Am J Orthod Dentofacial Orthop 128:424–430CrossRefPubMed Kau CH, Richmond S, Zhurov AI, Knox J, Chestnutt I, Hartles F et al (2005) Reliability of measuring facial morphology with a 3-dimensional laser scanning system. Am J Orthod Dentofacial Orthop 128:424–430CrossRefPubMed
25.
go back to reference Baysal A, Sahan AO, Ozturk MA, Uysal T (2016) Reproducibility and reliability of three-dimensional soft tissue landmark identification using three-dimensional stereophotogrammetry. Angle Orthod 86:1004–1009CrossRefPubMedPubMedCentral Baysal A, Sahan AO, Ozturk MA, Uysal T (2016) Reproducibility and reliability of three-dimensional soft tissue landmark identification using three-dimensional stereophotogrammetry. Angle Orthod 86:1004–1009CrossRefPubMedPubMedCentral
26.
go back to reference Hoefert CS, Bacher M, Herberts T, Krimmel M, Reinert S, Hoefert S et al (2010) Implementing a superimposition and measurement model for 3D sagittal analysis of therapy-induced changes in facial soft tissue: a pilot study. J Orofac Orthop 71:221–234CrossRefPubMed Hoefert CS, Bacher M, Herberts T, Krimmel M, Reinert S, Hoefert S et al (2010) Implementing a superimposition and measurement model for 3D sagittal analysis of therapy-induced changes in facial soft tissue: a pilot study. J Orofac Orthop 71:221–234CrossRefPubMed
27.
go back to reference Elnagar MH, Elshourbagy E, Ghobashy S, Khedr M, Kusnoto B, Evans CA (2017) Three-dimensional assessment of soft tissue changes associated with bone-anchored maxillary protraction protocols. Am J Orthod Dentofacial Orthop 152:336–347CrossRefPubMed Elnagar MH, Elshourbagy E, Ghobashy S, Khedr M, Kusnoto B, Evans CA (2017) Three-dimensional assessment of soft tissue changes associated with bone-anchored maxillary protraction protocols. Am J Orthod Dentofacial Orthop 152:336–347CrossRefPubMed
28.
go back to reference Krneta Đokić B, Zhurov A, Richmond S, Verdenik I, Ovsenik M (2020) 3D soft-tissue evaluation of a class III treatment with rapid maxillary expander and face mask in pre-pubertal phase—a retrospective cohort study. Orthod Craniofac Res 23:323–331CrossRefPubMed Krneta Đokić B, Zhurov A, Richmond S, Verdenik I, Ovsenik M (2020) 3D soft-tissue evaluation of a class III treatment with rapid maxillary expander and face mask in pre-pubertal phase—a retrospective cohort study. Orthod Craniofac Res 23:323–331CrossRefPubMed
29.
go back to reference Dindaroğlu F, Kutlu P, Duran GS, Görgülü S, Aslan E (2016) Accuracy and reliability of 3D stereophotogrammetry: a comparison to direct anthropometry and 2D photogrammetry. Angle Orthod 86:487–494CrossRefPubMedPubMedCentral Dindaroğlu F, Kutlu P, Duran GS, Görgülü S, Aslan E (2016) Accuracy and reliability of 3D stereophotogrammetry: a comparison to direct anthropometry and 2D photogrammetry. Angle Orthod 86:487–494CrossRefPubMedPubMedCentral
30.
go back to reference Dindaroğlu F, Duran GS, Görgülü S (2016) Effects of rapid maxillary expansion on facial soft tissues. J Orofac Orthop 77:242–250CrossRefPubMed Dindaroğlu F, Duran GS, Görgülü S (2016) Effects of rapid maxillary expansion on facial soft tissues. J Orofac Orthop 77:242–250CrossRefPubMed
31.
go back to reference Foersch M, Jacobs C, Wriedt S, Hechtner M, Wehrbein H (2015) Effectiveness of maxillary protraction using facemask with or without maxillary expansion: a systematic review and meta-analysis. Clin Oral Investig 19:1181–1192CrossRefPubMed Foersch M, Jacobs C, Wriedt S, Hechtner M, Wehrbein H (2015) Effectiveness of maxillary protraction using facemask with or without maxillary expansion: a systematic review and meta-analysis. Clin Oral Investig 19:1181–1192CrossRefPubMed
32.
33.
go back to reference Djordjevic J, Jadallah M, Zhurov AI, Toma AM, Richmond S (2013) Three-dimensional analysis of facial shape and symmetry in twins using laser surface scanning. Orthod Craniofac Res 16:146–160CrossRefPubMed Djordjevic J, Jadallah M, Zhurov AI, Toma AM, Richmond S (2013) Three-dimensional analysis of facial shape and symmetry in twins using laser surface scanning. Orthod Craniofac Res 16:146–160CrossRefPubMed
34.
go back to reference Metzger TE, Kula KS, Eckert GJ, Ghoneima AA (2013) Orthodontic soft-tissue parameters: a comparison of cone-beam computed tomography and the 3dMD imaging system. Am J Orthod Dentofacial Orthop 144:672–681CrossRefPubMed Metzger TE, Kula KS, Eckert GJ, Ghoneima AA (2013) Orthodontic soft-tissue parameters: a comparison of cone-beam computed tomography and the 3dMD imaging system. Am J Orthod Dentofacial Orthop 144:672–681CrossRefPubMed
35.
go back to reference Maal TJ, van Loon B, Plooij JM, Rangel F, Ettema AM, Borstlap WA et al (2010) Registration of 3‑dimensional facial photographs for clinical use. J Oral Maxillofac Surg 68:2391–2401CrossRefPubMed Maal TJ, van Loon B, Plooij JM, Rangel F, Ettema AM, Borstlap WA et al (2010) Registration of 3‑dimensional facial photographs for clinical use. J Oral Maxillofac Surg 68:2391–2401CrossRefPubMed
36.
go back to reference Ozbilen EO, Yilmaz HN, Kucukkeles N (2019) Comparison of the effects of rapid maxillary expansion and alternate rapid maxillary expansion and constriction protocols followed by facemask therapy. Korean J Orthod 49:49–58CrossRef Ozbilen EO, Yilmaz HN, Kucukkeles N (2019) Comparison of the effects of rapid maxillary expansion and alternate rapid maxillary expansion and constriction protocols followed by facemask therapy. Korean J Orthod 49:49–58CrossRef
Metadata
Title
Soft tissue evaluation after maxillary protraction with RPE or with the ALT-RAMEC protocol
A controlled 3D study
Authors
Assistant Prof. Elvan Onem Ozbilen, DDS Specialist in Orthodontics
Mustafa Onur Ari, DDS Specialist in Orthodontics
Associate Prof. Hanife Nuray Yilmaz, DDS PhD
Prof. Sibel Biren, DDS PhD
Publication date
28-09-2022
Publisher
Springer Medizin
Published in
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie / Issue Special Issue 3/2023
Print ISSN: 1434-5293
Electronic ISSN: 1615-6714
DOI
https://doi.org/10.1007/s00056-022-00428-0

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