A Retrospective Evaluation of Conventional Rapid Maxillary Expansion versus Alternate Rapid Maxillary Expansion and Constriction Protocol Combined with Protraction Headgear in the Management of Developing Skeletal Class III Malocclusion.

Aims and Objectives: The reverse pull headgear has been widely used to intercept a developing skeletal Class III malocclusion with maxillary deficiency. Rapid maxillary expansion (RME) is recommended along with the reverse pull headgear because there is disruption of the circummaxillary and intermaxillary sutures. This, in turn, expedites the orthopedic effect of the reverse pull headgear. However, studies have shown that the circummaxillary sutures may not be fully disrupted by the use of RME alone. The protocol of alternate RME and constriction (Alt-RAMEC) has been found to produce much more beneficial effects. Hence, this retrospective study was conducted to compare and assess the results obtained in the two methods.

Materials and Methods: This study comprised pre- and post-treatment lateral cephalograms of two groups of nine patients each (total 18 patients - 10 females and 8 males) having skeletal Class III malocclusion (ANB<0°) due to a retrognathic maxilla with or without associated mandibular prognathism treated at the Department of Orthodontics of a teaching institute in Kerala. The patients were treated with either Alt-RAMEC/protraction or RME/protraction. The statistical analysis of the data was done using statistical package SPSS Version 16 software (SPSS Inc., Chicago, IL, USA).

Results: Skeletal, dental, and soft-tissue parameters in Group 2 (Alt-RAMEC group) showed very significant changes with the maxilla moving forward, mandible rotating backward and downward, and proclination of the maxillary incisors when compared to Group 1.

Conclusions: It may be concluded from the results of our study that the Alt-RAMEC protocol and reverse pull headgear might be more effective than conventional RME and the reverse pull headgear to correct a retruded maxilla in a developing skeletal Class III patient.