Evaluation of Different Anchorage-supported Appliances and Expansion Procedures for Face Mask Treatment
Condition: Malocclusion, Angle Class III
MeSH terms: Prognathism; Malocclusion; Malocclusion, Angle Class III
Study type: Interventional

Summary: 
      The purpose of this study is to assess and compare the effect of two appliances (Hybrid-Hyrax
      expander/ Bonded rapid maxillary expander (RME)) supported by different anchorage units and
      two different expansion procedures (routine rapid maxillary expansion protocol (routine)/
      alternative rapid expansion and constriction protocol (alt-RAMEC)) on maxillary protraction
      during face mask (FM) treatment.
    

Detailed description: 
      Face mask therapy is an effective method in the treatment of class III malocclusions due to
      maxillary insufficiency. In face mask treatment, various intraoral devices are used to
      transmit protraction forces to the maxilla. According to the anchorage unit, these appliances
      are divided into tooth-supported and bone-supported. The traditional bonded rapid maxillary
      expander (RME) is a tooth-supported appliance that allows expansion and is generally used
      with face masks. However, it causes many side effects due to the transmission of protraction
      forces through the teeth. Hybrid appliances supported by skeletal and dental anchorage may be
      preferred over bonded RME in the maxilla for face mask treatment based on their lower dental
      side effects and high skeletal contribution.

      Before transferring the protraction forces to the maxilla using a face mask, expansion is
      first performed with intraoral devices according to the patient's needs. For this purpose,
      two different expansion procedures are currently used: routine rapid maxillary expansion
      (routine) and alternative rapid maxillary expansion and contraction (alt-RAMEC). In the
      routine rapid maxillary expansion procedure, the expander screw is turned twice a day until
      the expansion phase is complete. Unlike the routine procedure, in the alt-RAMEC procedure,
      each week of expansion is followed by a week of contraction. The duration of the
      expansion-contraction process varies between 7-9 weeks, depending on the patient's need for
      expansion. These opening and closing phases are increased maxillary protraction by loosening
      the intermaxillary sutures.

      The main purpose of this study is to compare the effects of different combinations of
      appliances and procedures on maxillary protraction during face mask treatment and determine
      the most powerful method. Sixty patients who were planned to apply face mask treatment were
      included in the study and divided into four groups (n=15) (Group 1: Hybrid-Hyrax expander and
      alt-RAMEC procedure, Group 2: Bonded RME and alt-RAMEC procedure, group 3: Hybrid Hyrax
      expander and routine protocol, group 4: Bonded RME and routine protocol). To investigate
      skeletal changes, lateral cephalometric films were taken before (T0) and after (T1)
      treatment. Dolphin Imaging software and AutoCad 2023 software were used for cephalometric
      measurements.
    

Intervention name(s): Face mask with Hybrid-Hyrax; Face mask with Bonded RME; Alternative Rapid Maxillary Expansion and Contraction Protocol (Alt-RAMEC); Routine Rapid Maxillary Expansion Protocol
Intervention type(s): Device; Device; Procedure; Procedure
Intervention description(s): Participants were treated with face mask using a Hybrid-Hyrax appliance as an anchor in the maxillary arch. The anchorage of hybrid-hyrax appliance was provided by bands adapted to the maxillary first permanent molars and two mini screws in the anterior palate. Force transmission was achieved using intermaxillary elastics that were connected to the face mask arms from the hooks of the hybrid-hyrax appliance in the maxillary canine region.; Participants were treated with face mask using a bonded RME appliance as an anchor in the maxillary arch. The anchorage of bonded RME appliance was provided by maxillary posterior teeth covered with acrylic cap. Force transmission was achieved using intermaxillary elastics that were connected to the face mask arms from the hooks of the bonded RME in the maxillary canine region.; In the groups that started with the Alt-Ramec protocol, the parents expanded the appliance screw twice a day in the first week and closed it in the opposite direction in the following week. This process was continued for 7-9 weeks according to the patient's need for expansion.; In the groups that started with the routine protocol, parents activated the expansion screw twice a day for 1-2 weeks, depending on the patient's need for expansion.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: facemask treatment