ALT-RAMEC PROTOCOL: A MODERN STRATEGY FOR ORTHODONTIC CORRECTION OF CLASS 3 SKELETAL PATHOLOGY

Abstract

Skeletal Class III is a complex orthodontic pathology often associated with maxillary deficiency. The traditional method of correction is rapid maxillary expansion (RME) combined with a protraction facemask. Liou and colleagues proposed an alternative protocol, Alt-RAMEC, which is based on cyclic expansion and constriction of the circum-maxillary sutures, promoting more pronounced maxillary protraction. The aim of the study. To analyze the scientific data on the effectiveness and benefits of using the Alt-RAMEC protocol in orthodontic practice. Materials and methods. The analysis was carried out using keywords by a retrospective review of relevant scientific papers using the online services PubMed and ResearchGate. The results. The Alt-RAMEC protocol involves daily expansion with the Hyrex screw by 1 mm for one week, followed by reversing the screw in the opposite direction. Subsequently, over a period of 7-9 weeks, weekly opening and closing of the screw are alternated, which ensures gradual mobilization of the circum-maxillary sutures. Subsequent maxillary protraction with a facemask promotes more pronounced forward advancement compared to conventional RME. The study by Liou et al. demonstrated significant orthopedic changes: maxillary protraction amounted to 5,8±2,3 mm with Alt-RAMEC, exceeding the values achieved with traditional RME (2,6 ±1,5 mm). Conclusions. The Alt-RAMEC protocol is a perspective method of orthodontic treatment of maxillary retrognathia, especially in children with cleft lip and palate. It provides occlusal stability, minimizes bone resorption, and improves aesthetics and occlusion. An alternative to RME, this approach effectively moves the upper jaw forward while avoiding over-expansion, making it optimal for early orthodontic intervention in skeletal class III