The evaluation of soft and hard tissues BY using alt-RAMEC protocol for maxillary protraction in patients with unilateral cleft lip and palate

AIM: The aim of this study is to evaluate the hard and soft tissue effects and treatment times of Alt-RAMEC protocol with face mask (Alt-RAMEC+FM) or conventional face mask (FM) in patients with unilateral cleft lip and palate. MATERIAL and METHOD: This prospective study is done with 30 patients who have unilateral cleft lip and palate with skeletal and dental Class III malocclusion, referred to Ege University, Faculty of Dentistry, Department of Orthodontics between 2015 and 2017. The patients were evaluated with cervical vertebra maturation method (CVM) and divided into two groups, each consisting of 15 patients. Patients in Group I; (FM) (mean age: 10.0 ± 0.7 years) had conventional face mask and patients in the Group II; (Alt-RAMEC+FM) (mean age: 10.1 ± 2.4 years) had 7 weeks of Alt-RAMEC protocol with Hyrax appliance before face mask. The lateral cephalometric radiographs were evaluated before and after the treatment by using Dolphin Imaging Software Version 11.7. The skeletal, dentoalveolar and soft tissue measurements and treatment times were evaluated in both groups. RESULTS: In both groups, the maxillary measurements; SNA angle, Co-A, A-PTV and A-FHD increased significantly (p<0.001). In Alt-RAMEC+FM group, the increase in SNA (5.75°) was statistically significant when compared to the increase in FM group (3.13°) (p<0.001). In Alt-RAMEC+FM group, Co-A (FM group: 1.92 mm, Alt-RAMEC+FM group: 3.02 mm) (p<0.01) and A-PTV (FM group: 2.06 mm, Alt-RAMEC+FM group: 4.21 mm) (p<0.001) measurements were statistically significant when compared to the increase in FM group. In the mandibular measurements, both groups had similar results (p>0.05). In Alt-RAMEC+FM group, the increase in ANB, N-A-Pg and Wits were statistically significant when compared to the increase in FM group (p<0.001). In Alt-RAMEC+FM group, the increase in U1-SN, U1-L1, U1-PTV, U6-PTV, U6-FHD and overjet were statistically significant when compared to the increase in FM group (p<0,01, p<0.001). In Alt-RAMEC+FM group, the increase in Ss-PTV, UL-PTV, UL-S line were statistically significant when compared to the increase in FM group (p<0.001). There is a statistically significant difference (p<0.01) between the treatment times of the FM group (7.3 months) and Alt-RAMEC+FM group (4.7 months). Face mask was used with an average of 17 hours in both groups. CONCLUSION: Using face mask after Alt-RAMEC protocol causes more skeletal, dentoalveolar and soft tissue changes than the conventional face mask protocol in patients with unilateral cleft lip and palate. The treatment time of Alt-RAMEC+FM group was shorter than FM group. Keywords: Alt-RAMEC protocol, Unilateral cleft lip and palate, Maxillary protraction, Face mask