Is alternate rapid maxillary expansion and constriction an effective protocol in the treatment of Class III malocclusion? A systematic review

Abstract

Introduction: the treatment of Class III malocclusion in early age is one of the greatest challenges for orthodontists, and the establishment of more effective treatment method is a constant concern for these professionals. Thus, the objective of this systematic review is to verify the effectiveness of the therapy protocol for alternate rapid maxillary expansion and constriction (Alt-RAMEC) in the early treatment of Class III malocclusion. Methods:searches were performed in the following electronic databases: Cochrane Library, Medline (EBSCO and PubMed), SciELO, LILACS and Scopus. The following inclusion criteria were used: in vivo studies conducted with early intervention (patient in craniofacial development phase) with the use of the Alt-RAMEC protocol. Reviews, case reports, editorials, and studies with syndromic patients or under use of systemic drug were excluded. Duplicates were also excluded. The studies were assessed for methodological quality using the Cochrane tool for assessment of risk of bias, and classified as high or low risk of bias. Results:53 articles were found. Duplicates exclusion was thus performed and 35 articles remained. After inclusion analysis, only 5 matched the criteria. Two articles were classified as low risk of bias and three as high risk of bias. It was observed that the Alt-RAMEC enable protraction in less time and with better results, promoting greater effectiveness in the protraction treatment of Class III malocclusion. Conclusions:Although there is positive evidence of the effectiveness of early treatment with the Alt-RAMEC protocol in patients with Class III malocclusion, further studies are needed to confirm its effectiveness using long-term methodology.

Maxillary expansion, constriction, and protraction through facial mask to correct anterior crossbite: case report

“…The proposed treatment consisting of maxillary expansion and constriction followed by maxillary protraction with facial mask resulted in satisfactory skeletal, dental, and facial parameters, which agreed with the literature. 2,5,9,13 The comparison of pre-and post-treatment cephalogram revealed the overjet increasing of 5.5 mm, evidenced by the anterior crossbite correction and good sagittal relation. Before treatment, the boy had a concave facial profile that changed to a straight profile after treatment.…”

“…Thus, skeletal Class III malocclusion can be characterized by maxillary retrognathism, mandibular prognathism, or both, regardless of the sagittal relation between dental arches. [1][2][3][4][5] Individuals with skeletal Class III malocclusion have concave profile caused by facial medium third deficiency, lack of zygomatic prominence, and excess of the facial lower third. Moreover, maxillary atresia, lower lip protrusion, and anterior crossbite may be present.…”

“…Because of greater orthopedic than orthodontic effects, Class III malocclusion must be diagnosed and treated at deciduous or mixed dentition due to better prognosis before the pubertal growth spurt between 4 and 12 years-old, with differences between boys and girls. [1][2][5][6]8 The literature reports that rapid maxillary expansion RME with or without maxillary protraction is the best early treatment for growing individuals with short-term good outcomes. [2][3][4][5]9,[12][13] The facial mask is used to achieve maxillary protraction and anterior displacement, delivering directed and constant orthopedic forces.…”

“…[1][2][5][6]8 The literature reports that rapid maxillary expansion RME with or without maxillary protraction is the best early treatment for growing individuals with short-term good outcomes. [2][3][4][5]9,[12][13] The facial mask is used to achieve maxillary protraction and anterior displacement, delivering directed and constant orthopedic forces. [2][3][4]14 The literature reports different types of facial masks as follows: Delaire, Petit, Turley, Sky Hook, among others.…”

“…2,8 The protocol of maxillary expansion and constriction consists of alternating movements of rapid expansion and constriction of the maxilla, mainly aiming at greater maxillary expansion, enabling greater maxillary protraction, because the protraction effectiveness depending on the opening of the surrounding maxillary sutures. 5 Taking into consideration the successful orthopedic treatment of the skeletal Class III malocclusion by maxillary protraction and the different protocols for the prior adjustment of the transversal maxillary dimension, no consensus exists on RME effect on the maxillary repositioning. Therefore, this study aimed to report the maxillary expansion and constriction with maxillary protraction in a boy with skeletal Class III at mixed dentition.…”