Early intervention is associated with better patient compliance will provide better orthopedic response in skeletal class III malocclusion. However, treatment in the mixed or permanent dentition can produce favorable results, so The collaborate use of rapid maxillary expansion and facemask has been a contemporary technique for the maxillary protraction in growing patients with Class III and there is a assumption that the rapid maxillary expansion opens the circumaxillary sutures and facilitates maxillary protraction. It has been reported that the amount of maxillary protraction was 5–6 mm in 5 months under the protocol of alternate rapid maxillary expansions and constrictions (Alt-RAMEC) and was significantly more than rapid maxillary expansion. It was because Alt-RAMEC opened the circumaxillary sutures more extensively than rapid maxillary expansion. This article highlights the combined use of facemask with Alt-RAMEC to treat midface deficiency in growing patients.

Keywords: Skeletal class III, growing patients, Alt-RAMEC.

1. 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 Mar;42(2):121-7
2. 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
3. Liou EJ. Toothborne orthopedic maxillary protraction in Class III patients. J Clin Orthod. 2005;39:68–75.
4. Baik HS. Clinical results of the maxillary protraction in Korean children. American Journal of Orthodontics and Dentofacial Orthopedics. 1995 Dec 1;108(6):583-92.
5. Burstone CJ, Marcotte MR, Taylor TD. Problem solving in orthodontics: Goal-oriented treatment strategies. Chicago, IL: Quintessence; 2000 Oct 1.
6. Westwood PV, McNamara JA Jr, Baccetti T, Franchi L, Sarver DM. Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop 2003;123:306-20.
7. Wang YC, Chang PM, Liou EJ. Opening of circumaxillary sutures by alternate rapid maxillary expansions and constrictions. Angle Orthod 2009;79:230–4.
8. Hiyama S, Suda N, Ishii-Suzuki M, Tsuiki S, Ogawa M, Suzuki S, Kuroda T. Effects of maxillary protraction on craniofacial structures and upper-airway dimension. Angle Orthod. 2002;72: 43–47
9. Takada K, Petdachai S, Sakuda M. Changes in dentofacial morphology in skeletal Class III children treated by a modified maxillary protraction headgear and a chin cup: a longitudinal cephalometric appraisal. Eur J Orthod. 1993;15: 211–221.
10. Ngan, P.; Yiu, C.; Hu, A.; Hägg, U.; Wei, S.H.; and Gunel, E.: Cephalometric and occlusal changes following maxillary expansion and protraction, Eur. J. Orthod. 20:237-254, 1998..
11. Kapust AJ, Sinclair PM, Turley PK. Cephalometric effects of face mask/expansion therapy in Class III children: a comparison of three age groups. Am J Orthod Dentofacial Orthop. 1998;113:204–212.
12. Nartallo-Turley PE, Turley PK. Cephalo-metric effects of combined palatal expansion and facemask therapy on Class III malocc-lusion. Angle Orthod. 1998;68:217– 224.

Dr M. Jeevan Kumar

Department of Orthodontics, Vishnu Dental College, Bhimavarm, Andhra Pradesh, Pin code: 534202

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