Alternate Rapid Maxillary Expansion and Construction versus Rapid Maxillary Expansion combined with Face Mask: Which is a more effective method for Maxillary Protraction?

Purpose Class III malocclusion characterized by maxillary deficiency is treated with orthopedic approaches during the growth period and with Le-Fort I osteotomy in adulthood. Achieving effective maxillary protraction during growth typically requires mobilization of the circummaxillary sutures through expansion prior to facemask (FM) therapy. Although rapid maxillary expansion (RME) separates not only the midpalatal suture but also contributes to the disarticulation of the circummaxillary sutures, its effect on these sutures is often more limited than expected due to their strong interdigitation. To enhance sagittal advancement by disarticulating the circummaxillary sutures, Liou and Tsai introduced the Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC) protocol in combination with a 2-Hinged Screw Maxillary Expander (2-HME), which shifts the center of rotation toward the pterygoid plates, thereby producing a more pronounced anterior displacement of the maxillary segments. The aim of this study is to evaluate by comparing with Le-Fort I whether the Alt-RAMEC/2-HME protocol produces greater anterior maxillary displacement compared with the RME/FM approach. Material Metod: The material of this single-center retrospective study included 42 individuals with skeletal Class III malocclusion characterized by maxillary deficiency who were treated with Alt-RAMEC/2-HME, RME/FM and Le-Fort I selected from the archives of Ankara University Department of Orthodontics. Skeletal and dental changes in the sagittal and vertical planes at T0 and T1 were measured linearly on lateral cephalometric radiographs using the AutoCAD program. Data was analyzed using SPSS 26 at a significance level of p˂0.05. Results In the late skeletal period, the shorter-duration Alt-RAMEC/2-HME protocol obtained a level of maxillary advancement comparable to that achieved with RME/FM applied at an earlier developmental stage. The magnitude of advancement in both protocols remained lower than that obtained with Le-Fort I. The RME/FM results were longer and more dentoalveolar compared to Alt-RAMEC/2-HME. Both methods produced mandibular posterior rotation, which was more pronounced in RME. Conclusion In the maxillary deficiency during the late growth period, skeletal maxillary advancement can be achieved using the Alt-RAMEC protocol alone, without the need for FM. Considering this outcome, the indication for Le-Fort I may be re-evaluated. The RME/FM resulted in greater dentoalveolar effects compared with Alt-RAMEC/2-HME.