Evaluation of the effects of two different Alt-RAMEC procedures: five weeks versus nine weeks


Share / Export Citation / Email / Print / Text size:

Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine


ISSN: 2207-7472
eISSN: 2207-7480





Volume / Issue / page

Volume 38 (2022)
Volume 37 (2021)
Volume 36 (2020)
Volume 35 (2019)
Volume 34 (2018)
Volume 33 (2017)
Volume 32 (2016)
Volume 31 (2015)
Related articles

VOLUME 33 , ISSUE 2 (November 2017) > List of articles

Evaluation of the effects of two different Alt-RAMEC procedures: five weeks versus nine weeks

Mevlut Celikoglu * / Muhammet Hilmi Buyukcavus

Citation Information : Australasian Orthodontic Journal. Volume 33, Issue 2, Pages 249-257, DOI: https://doi.org/10.21307/aoj-2020-103

License : (CC BY 4.0)

Published Online: 30-July-2021



Objective: To evaluate and compare the skeletal, dentoalveolar and soft tissue effects of two different alternate rapid maxillary expansion (RMEs) and constriction (Alt-RAMEC) procedures.

Material and methods: Thirty-two consecutive patients presenting with a skeletal Class III malocclusion were placed into two comparative groups. Group 1 consisted of 16 patients (5 females and 11 males; mean age: 11.45 ± 1.87 years) who had an Alt-RAMEC procedure for five weeks and Group 2 consisted of 16 patients (6 females and 10 males; mean age: 11.52 ± 1.29 years) who had an Alt-RAMEC procedure for nine weeks. The parents of the patients were instructed to open the screw twice per day for one week and to close it twice per day for the following week (0.20 mm per turn). Nine angular and 20 linear cephalometric variables were measured.

Results: The groups were well matched in relation to patient gender distribution, chronological age and initial cephalometric values. Both Alt-RAMEC procedures showed similar effects with no statistically significant differences. The maxillae moved slightly forward and the mandible moved slightly downward, the changes of which caused an improvement in the maxillo-mandibular relationship in both groups. The overjet slightly increased and the overbite decreased in both groups. The upper lip moved slightly forward during the nine-week treatment Alt-RAMEC group.

Conclusion: Despite the favourable and similar effects of both procedures, neither seems to be sufficient for the complete correction of a skeletal Class III malocclusion.

Content not available PDF Share



1. Guyer EC, Ellis EE 3rd, McNamara JA Jr, Behrents RG. Components of Class III malocclusion in juveniles and adolescents. Angle Orthod 1986;56:7-30.

2. Thilander B, Myrberg N. The prevalence of malocclusion in Swedish schoolchildren. Scand J Dent Res 1973;81:12-21.

3. Celikoglu M, Akpinar S, Yavuz I. The pattern of malocclusion in a sample of orthodontic patients from Turkey. Med Oral Patol Oral Cir Bucal 2010;15:e791-6.

4. Haas AJ. The treatment of maxillary deficiency by opening the midpalatal suture. Angle Orthod 1965;35:200-17.

5. Haas AJ. Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod 1970;57:219-55.

6. Turley PK. Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction headgear. J Clin Orthod 1988;22:314-25.

7. Baik HS. Clinical results of the maxillary protraction in Korean children. Am J Orthod Dentofacial Orthop 1995;108:583-92.

8. Altug Z, Arslan AD. Skeletal and dental effects of a mini maxillary protraction appliance. Angle Orthod 2006;76:360-8.

9. Celikoglu M, Oktay H. Effects of maxillary protraction for early correction of class III malocclusion. Eur J Orthod 2014;36:86-92.

10. Celikoglu M, Yavuz I, Unal T, Oktay H, Erdem A. Comparison of the soft and hard tissue effects of two different protraction mechanisms in class III patients: a randomized clinical trial. Clin Oral Investig 2015;19:2115-22.

11. Yavuz I, Halicioğlu K, Ceylan I. Face mask therapy effects in two skeletal maturation groups of female subjects with skeletal Class III malocclusions. Angle Orthod 2009;79:842-8.

12. Liou EJ. Effective maxillary orthopedic protraction for growing Class III patients: a clinical application simulates distraction osteogenesis. Prog Orthod 2005;6:154-71.

13. Wang YC, Chang PM, Liou EJ. Opening of circumaxillary sutures by alternate rapid maxillary expansions and constrictions. Angle Orthod 2009;79:230-4.

14. Haas AJ. Long-term posttreatment evaluation of rapid palatal expansion. Angle Orthod 1980;50:189-217.

15. Liou EJ, Tsai WC. A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 2005;42:121-7.

16. Isci D, Turk T, Elekdag-Turk S. Activation-deactivation rapid palatal expansion and reverse headgear in Class III cases. Eur J Orthod 2010;32:706-15.

17. Canturk BH, Celikoglu M. Comparison of the effects of face mask treatment started simultaneously and after the completion of the alternate rapid maxillary expansion and constriction procedure. Angle Orthod 2015;85:284-91.

18. Franchi L, Baccetti T, Masucci C, Defraia E. Early Alt-RAMEC and facial mask protocol in class III malocclusion. J Clin Orthod 2011;45:601-9.

19. Masucci C, Franchi L, Giuntini V, Defraia E. Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study. Orthod Craniofac Res 2014;17:259-69.

20. Rathi AR, Kumari NR, Vadakkepuriyal K, Santhkumar M. Treatment of skeletal class III malocclusion using face mask therapy with alternate rapid maxillary expansion and constriction (AltRAMEC) protocol. J Indian Soc Pedod Prev Dent 2015;33:341-3.

21. Yilmaz BS, Kucukkeles N. Skeletal, soft tissue, and airway changes following the alternate maxillary expansions and constrictions protocol. Angle Orthod 2014;84:868-77.

22. Pandis N. Sample calculations for comparison of 2 means. Am J Orthod Dentofacial Orthop 2012;141:519-21.

23. Liou EJ. Toothborne orthopedic maxillary protraction in Class III patients. J Clin Orthod 2005;39:68-75.

24. Kilic N, Celikoglu M, Oktay H. Effects of the functional regulator III on profile changes in subjects with maxillary deficiency. Eur J Orthod 2010;32:729-34.

25. Kaya D, Kocadereli I, Kan B, Tasar F. Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions; a pilot study. Angle Orthod 2011;81:639-46.

26. Feres MF, Raza H, Alhadlaq A, El-Bialy T. Rapid maxillary expansion effects in Class II malocclusion: A systematic review. Angle Orthod 2015;85:1070-9.

27. Nur M, Kayipmaz S, Bayram M, Celikoglu M, Kilkis D, Sezgin OS. Conventional frontal radiographs compared with frontal radiographs obtained from cone beam computed tomography. Angle Orthod 2012;82:579-84.

28. Celikoglu M, Nur M, Kilkis D, Sezgin OS, Bayram M. Mesiodistal tooth dimensions and anterior and overall Bolton ratios evaluated by cone beam computed tomography. Aust Orthod J 2013;29:153-8.

29. Celikoglu M, Bayram M, Sekerci AE, Buyuk SK, Toy E. Comparison of pharyngeal airway volume among different vertical skeletal patterns: a cone-beam computed tomography study. Angle Orthod 2014;84:782-7.