The Effectiveness of Alternating Rapid Maxillary Expansion and Constriction Combined with Maxillary Protraction in the Treatment of Patients with a Class III Malocclusion: A Systematic Review and Meta-analysis
Abstract
Objectives To establish the effectiveness of Alternate Rapid Maxillary Expansion and Constriction combined with Protraction Facial Mask (Alt-RAMEC/PFM) approach in treating Class III growing patients compared with PFM combined with conventional Rapid Maxillary Expansion (RME/PFM). Search sources Unrestricted search in five electronic databases and manual searching were undertaken up to February 2018. Data selection Randomised clinical trials (RCTs) evaluating the effectiveness of Alt-RAMEC/PFM were selected. Data extraction Screening of references, data extraction and assessment of bias risk were evaluated independently by two reviewers. Results Five RCTs comparing the Alt-RAMEC/PFM with RME/PFM met the inclusion criteria. Small but statistically significant mean differences favouring Alt-RAMEC/PFM protocol as measured by SNA angle (1.16°; 95% CI 0.65 to 1.66), SNB angle (0.67°; 95% CI 0.32 to 1.02) and ANB angle (0.66°; 95% CI 0.08 to 1.25) were noted. Alt-RAMEC/PFM exhibited a more favourable overjet correction when compared to RME/PFM, however, differences in other dental changes were insignificant. Conclusion There is limited evidence with high risk of bias that Alt-RAMEC/PFM can result in a statistically significant increase in maxillary protraction compared with RME/PFM in Chinese subjects over the short-term. High-quality long-term RCTs with inclusion of patient-reported outcomes are required.
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