Department of Orthodontics, School and Hospital of Stomatology, Shandong University, and Shandong Provincial Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan, Shandong Province, China.
Resident, MDS, Hospital of Stomatology, Hebei Medical University, Number 383, East Zhong Shan Road, Shijiazhuang, Hebei Province 050017, China.
Am J Orthod Dentofacial Orthop. 2021 Mar;159(3):321-332. doi: 10.1016/j.ajodo.2019.12.028. Epub 2021 Jan 22.
This study aimed to investigate the relative efficacy of maxillary protraction combined with a modified alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol compared with conventional protocols in the early orthopedic treatment of skeletal Class III malocclusion.
A sample of 39 patients was divided into 3 groups on the basis of different interventions. Conventional facemask (FM) with splint-type intraoral devices was performed in the FM group (7 males and 5 females; mean age, 9.53 ± 1.37 years). Maxillary expansion with an activation rate of 0.5 mm/d (twice a day) followed by FM therapy was applied in the rapid maxillary expansion group (RME/FM) (6 males and 6 females; mean age, 9.31 ± 1.60 years). In the Alt-RAMEC/FM group (7 males and 8 females; mean age, 10.01 ± 1.31 years), Alt-RAMEC was started simultaneously and throughout the entire course of maxillary protraction, with repetitive alternations between activation and deactivation of expanders (0.5 mm/d for 7 days). The patients in all groups were instructed to wear FMs for a minimum of 12 h/d. Pretreatment and posttreatment lateral cephalograms were all traced and measured.
The Alt-RAMEC group showed statistically more significant maxillary advancement than other groups (A-VRP, 3.87 mm vs 3.04 mm [RME/FM], vs 2.04 mm [FM]; P <0.05). Analysis of variance did not reveal significant intergroup differences in palatal plane angulation changes (P >0.05). No pronounced mandibular clockwise rotations were noted in the Alt-RAMEC/FM group with distinct intergroup differences (P <0.05). There were more skeletal effects (88.7%) during overjet correction in the Alt-RAMEC/FM protocol.
A combination of the modified Alt-RAMEC protocol with FM revealed more favorable skeletal effects compared with FM and RME/FM protocols in treating prepubertal patients with maxillary deficiency.
本研究旨在探讨上颌骨牵引联合改良交替快速扩弓和缩窄（Alt-RAMEC）方案与传统方案在骨骼 III 类错畸形早期矫形治疗中的相对疗效。
根据不同的干预措施，将 39 例患者分为 3 组。常规面架（FM）联合夹板式口内装置用于 FM 组（7 男 5 女；平均年龄 9.53±1.37 岁）。上颌扩弓采用 0.5mm/d（每日两次）的激活率，随后进行 FM 治疗，用于 RME/FM 组（6 男 6 女；平均年龄 9.31±1.60 岁）。在 Alt-RAMEC/FM 组（7 男 8 女；平均年龄 10.01±1.31 岁）中，同时开始并贯穿整个上颌骨牵引过程中进行 Alt-RAMEC，扩弓器的激活和停用重复交替（7 天 0.5mm/d）。所有组的患者均被指示每天至少佩戴 FM 12 小时。所有患者均进行了治疗前和治疗后的侧位头颅侧位片描记和测量。
Alt-RAMEC 组上颌骨的前向移动明显大于其他组（A-VRP，3.87mm 比 3.04mm[RME/FM]，比 2.04mm[FM]；P<0.05）。方差分析显示，各组之间的腭平面角度变化无显著差异（P>0.05）。在 Alt-RAMEC/FM 组中，没有明显的下颌顺时针旋转，各组之间有明显的差异（P<0.05）。在 Alt-RAMEC/FM 方案中，过度矫正的骨骼效果（88.7%）更多。
与 FM 和 RME/FM 方案相比，FM 联合改良 Alt-RAMEC 方案在治疗青春前期上颌骨发育不足的患者时，具有更有利的骨骼效果。
