{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:06:25Z","timestamp":1790571985564,"version":"4.1.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100015774","name":"University of Malta","doi-asserted-by":"publisher","award":["CDORP02"],"award-info":[{"award-number":["CDORP02"]}],"id":[{"id":"10.13039\/501100015774","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,18]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Trial design<\/jats:title>\n                    <jats:p>This was a randomized, controlled trial designed to compare outcomes between the use of dental and skeletal anchorage, using the Face mask\/Alternate Rapid Maxillary Expansion and Contraction (FM\/Alt-RAMEC) protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and participants<\/jats:title>\n                    <jats:p>The study was carried out at Mater Dei Hospital, Malta and included prepubertal skeletal Class III malocclusion patients where the aetiology was primarily maxillary hypoplasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Two groups were assigned. Group I was treated with FM\/Alt-RAMEC and group II was treated with skeletally anchored FM\/Alt-RAMEC. Wear-time (WT) of the FM was monitored using TheraMon microsensors. Patients were instructed to wear the FM for 12\u201314 hours\/day for 9 months. Changes were evaluated with lateral cephalograms and analysed with Wilcoxon and Mann\u2013Whitney U tests. ANOVA was used to analyse the effect of gender on compliance parameters. Spearman\u2019s correlation coefficient was used to assess the correlation between compliance and skeletal changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the skeletal and dentoalveolar changes in patients treated with these two protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>The primary outcome was to assess skeletal and dentoalveolar outcomes in patients treated with skeletally anchored FM\/RME and tooth-borne FM\/RME; utilizing Alt-RAMEC protocol. The secondary outcome was compliance rate and adherence to FM wear among patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Randomization<\/jats:title>\n                    <jats:p>Randomizer software and the sealed envelope technique were used to randomly allocate patients 1:1 into either group I (tooth-borne FM\/Alt-RAMEC) or group II (skeletally anchored FM\/Alt-RAMEC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Blinding<\/jats:title>\n                    <jats:p>It was not possible to blind to treatment allocation, but blinding was used when assessing the outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Numbers randomized and analysed. Thirty-five patients were allocated. Group I consisted of 18 subjects and group II consisted of 17 subjects. One patient in group I dropped out due to illness, so 17 subjects in each group completed the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Post-treatment changes in group I showed significant increases in SNA (2.10\u00b0), ANB (3.90\u00b0), Wits (4.70 mm), and overjet (5.40 mm). Group II showed significant increases in ANB (3.10\u00b0), Wits (3.20 mm), and overjet (4.50 mm). Wearing time for group I patients was 7.87 \u00b1 2.88 hours\/day and for group II was 6.98 \u00b1 2.68 hours\/day, with no significant difference between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>Lack of long-term follow-up post-treatment, making the conclusion applicable only in the short term.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Harms<\/jats:title>\n                    <jats:p>No harm was observed in both groups<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the large difference between the measured and the patient-reported daily WT, both tooth-borne and skeletally anchored FM\/Alt-RAMEC showed positive, similar, skeletal and dental effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>ISRCTN12197405.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejo\/cjad018","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T15:31:02Z","timestamp":1683819062000},"page":"517-527","source":"Crossref","is-referenced-by-count":11,"title":["The effect of tooth borne versus skeletally anchored Alt-RAMEC protocol in early treatment of Class III malocclusion: a single-centre randomized clinical trial"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7020-068X","authenticated-orcid":false,"given":"Emad Eddin","family":"Alzoubi","sequence":"first","affiliation":[{"name":"Department of Child Dental Health and Orthodontics, University of Malta , Msida , Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8306-6491","authenticated-orcid":false,"given":"Simon","family":"Camilleri","sequence":"additional","affiliation":[{"name":"Department of Child Dental Health and Orthodontics, University of Malta , Msida , Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1696-6649","authenticated-orcid":false,"given":"Mohammed","family":"Al Muzian","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, University of Edinburgh , Edinburgh , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"Attard","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, University of Malta , Msida , Malta"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"2023091805150586700_CIT0001","first-page":"7","article-title":"Components of class III malocclusion in juveniles and adolescents","volume":"56","author":"Guyer","year":"1986","journal-title":"Angle Orthodontist"},{"key":"2023091805150586700_CIT0002","first-page":"171","article-title":"Craniofacial changes in Class III malocclusion as related to skeletal and dental maturation","volume":"132","author":"Tiziano","year":"2007","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0003","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1053\/j.sodo.2007.05.006","article-title":"Growth in the Untreated Class III Subject","volume":"13","author":"Baccetti","year":"2007","journal-title":"Seminars in Orthodontics."},{"key":"2023091805150586700_CIT0004","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S0889-5406(96)70161-0","article-title":"Soft tissue and dentoskeletal profile changes associated with maxillary expansion and protraction headgear treatment","volume":"109","author":"Ngan","year":"1996","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0005","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S0889-5406(98)70306-3","article-title":"Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy","volume":"113","author":"Baccetti","year":"1998","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0006","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0889-5406(98)70141-6","article-title":"Cephalometric effects of face mask\/expansion therapy in Class III children: a comparison of three age groups","volume":"113","author":"Kapust","year":"1998","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0007","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1597\/03-107.1","article-title":"A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions","volume":"42","author":"Liou","year":"2005","journal-title":"Cleft Palate-Craniofacial Journal."},{"key":"2023091805150586700_CIT0008","first-page":"154","article-title":"Effective maxillary orthopaedic protraction for growing Class III patients: a clinical application simulates distraction osteogenesis","volume":"6","author":"Liou","year":"2005","journal-title":"Progress in Orthodontics"},{"key":"2023091805150586700_CIT0009","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1093\/ejo\/cjq006","article-title":"Activation-deactivation rapid palatal expansion and reverse headgear in Class III cases","volume":"32","author":"Isci","year":"2010","journal-title":"European Journal of Orthodontics"},{"key":"2023091805150586700_CIT0010","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1093\/ejo\/cjab057","article-title":"Post-pubertal effects of the Alt-RAMEC\/FM and RME\/FM protocols for the early treatment of Class III malocclusion: a retrospective controlled study","volume":"44","author":"Masucci","year":"2021","journal-title":"European Journal of Orthodontics"},{"key":"2023091805150586700_CIT0011","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/ocr.12051","article-title":"Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study","volume":"17","author":"Masucci","year":"2014","journal-title":"Orthodontics and Craniofacial Research"},{"key":"2023091805150586700_CIT0012","doi-asserted-by":"crossref","first-page":"100603","DOI":"10.1016\/j.ortho.2021.100603","article-title":"A retrospective long-term comparison of early RME-facemask versus late Hybrid-Hyrax, alt-RAMEC and miniscrew-supported intraoral elastics in growing Class III patients","volume":"20","author":"Papadopoulou","year":"2022","journal-title":"Int Orthod."},{"key":"2023091805150586700_CIT0013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/ocr.12339","article-title":"A Bayesian network meta-analysis of orthopaedic treatment in Class III malocclusion: maxillary protraction with skeletal anchorage or a rapid maxillary expander","volume":"23","author":"Wu","year":"2020","journal-title":"Orthodontics & Craniofacial Research."},{"key":"2023091805150586700_CIT0014","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1080\/14653125.2018.1518187","article-title":"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","volume":"45","author":"Almuzian","year":"2018","journal-title":"Journal of Orthodontics"},{"key":"2023091805150586700_CIT0015","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1093\/ejo\/cju012","article-title":"Quantifying patient adherence during active orthodontic treatment with removable appliances using microelectronic wear-time documentation","volume":"37","author":"Sch\u00e4fer","year":"2015","journal-title":"European Journal of Orthodontics"},{"key":"2023091805150586700_CIT0016","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1093\/ejo\/cjt091","article-title":"Optimal force for maxillary protraction facemask therapy in the early treatment of class III malocclusion","volume":"36","author":"Yepes","year":"2014","journal-title":"European Journal of Orthodontics"},{"key":"2023091805150586700_CIT0017","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s00056-013-0143-2","article-title":"Questionnaire study of electronic wear-time tracking as experienced by patients and parents during treatment with removable orthodontic appliances","volume":"74","author":"Schott","year":"2013","journal-title":"Journal of Orofacial Orthopedics\/ Fortschritte der Kieferorthop\u00e4die"},{"key":"2023091805150586700_CIT0018","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2319\/111517-787.1","article-title":"The cervical vertebral maturation method: a user\u2019s guide","volume":"88","author":"McNamara","year":"2018","journal-title":"Angle Orthodontist"},{"key":"2023091805150586700_CIT0019","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/ocr.12040","article-title":"Efficacy of orthopaedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis","volume":"17","author":"Cordasco","year":"2014","journal-title":"Orthodontics and Craniofacial Research"},{"key":"2023091805150586700_CIT0020","doi-asserted-by":"crossref","first-page":"764","DOI":"10.2319\/071614-497.1","article-title":"Effectiveness of maxillary protraction using a hybrid hyrax-facemask combination: a controlled clinical study","volume":"85","author":"Nienkemper","year":"2015","journal-title":"Angle Orthodontist"},{"key":"2023091805150586700_CIT0021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2196-1042-14-5","article-title":"Maxillary protraction using a hybrid hyrax-facemask combination","volume":"14","author":"Nienkemper","year":"2013","journal-title":"Progress in Orthodontics"},{"key":"2023091805150586700_CIT0022","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.ajodo.2016.04.016","article-title":"Wear-time recording during early Class III facemask treatment using TheraMon chip technology","volume":"150","author":"Stocker","year":"2016","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0023","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1111\/ocr.12052","article-title":"Maturation of the middle phalanx of the third finger and cervical vertebrae: a comparative and diagnostic agreement study","volume":"17","author":"Perinetti","year":"2014","journal-title":"Orthodontics and Craniofacial Research"},{"key":"2023091805150586700_CIT0024","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S0889-5406(98)70306-3","article-title":"Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy","volume":"113","author":"Baccetti","year":"1998","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0025","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S0889-5406(98)70306-3","article-title":"Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy","volume":"113","author":"Baccetti","year":"1998","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0026","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40510-022-00429-0","article-title":"Long-term skeletal and dentoalveolar effects of hybrid rapid maxillary expansion and facemask treatment in growing skeletal Class III patients: a retrospective follow-up study","volume":"23","author":"Maino","year":"2022","journal-title":"Progress in Orthodontics"},{"key":"2023091805150586700_CIT0027","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1093\/ejo\/cjz086","article-title":"Comparison of skeletal anchorage and tooth-borne maxillary protraction followed by fixed appliance in Class III malocclusion","volume":"42","author":"Lee","year":"2021","journal-title":"European Journal of Orthodontics"},{"key":"2023091805150586700_CIT0028","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1067\/mod.2003.44","article-title":"Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances","volume":"123","author":"Westwood","year":"2003","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0029","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1179\/14653121043056","article-title":"Is early class III protraction facemask treatment effective? A multicenter, randomized, controlled trial: 15-month follow-up","volume":"37","author":"Mandall","year":"2010","journal-title":"Journal of Orthodontics"},{"key":"2023091805150586700_CIT0030","first-page":"3640","article-title":"Techniques for attaching orthodontic wires to mini-screws","volume":"44","author":"Ludwig","year":"2010","journal-title":"Journal of Clinical Orthodontics"},{"key":"2023091805150586700_CIT0031","doi-asserted-by":"crossref","first-page":"S7474","DOI":"10.1016\/j.ajodo.2005.09.029","article-title":"The bone thickness of the palate for orthodontic mini-implant anchorage in adults","volume":"131","author":"Kang","year":"2007","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0032","first-page":"323","article-title":"Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: the hybrid hyrax","volume":"11","author":"Wilmes","year":"2010","journal-title":"World Journal of Orthodontics"},{"key":"2023091805150586700_CIT0033","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/BF02173243","article-title":"Tragezeitmesser in der Kieferorthop\u00e4die-cui bono? \u00dcberlegungen zum State-of-the-art bei Tragezeitmessung und Complianceforschung in der Kieferorthop\u00e4die","volume":"52","author":"Witt","year":"1991","journal-title":"Fortschr Kieferorthop."},{"key":"2023091805150586700_CIT0034","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/S0889-5406(96)70037-9","article-title":"Perceived orthodontist behaviours predict patient satisfaction, orthodontist-patient relationship, and patient adherence in orthodontic treatment","volume":"110","author":"Sinha","year":"1996","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0035","doi-asserted-by":"crossref","first-page":"56","DOI":"10.2319\/042313-315.1","article-title":"Objective assessment of patient compliance with removable orthodontic appliances: a cross-sectional cohort study","volume":"84","author":"Tsomos","year":"2014","journal-title":"Angle Orthodontist"},{"key":"2023091805150586700_CIT0036","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.ajodo.2014.04.020","article-title":"Microelectronic wear-time documentation of removable orthodontic devices detects heterogeneous wear behaviour and individualizes treatment planning","volume":"146","author":"Schott","year":"2014","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023091805150586700_CIT0037","doi-asserted-by":"crossref","first-page":"88","DOI":"10.2319\/020616-104.1","article-title":"Objective assessment of compliance with intra- and extraoral removable appliances","volume":"87","author":"Arreghini","year":"2017","journal-title":"Angle Orthodontist"}],"container-title":["European Journal of Orthodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejo\/article-pdf\/45\/5\/517\/51609695\/cjad018.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejo\/article-pdf\/45\/5\/517\/51609695\/cjad018.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T03:17:29Z","timestamp":1695007049000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejo\/article\/45\/5\/517\/7160362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,11]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,11]]},"published-print":{"date-parts":[[2023,9,18]]}},"URL":"https:\/\/doi.org\/10.1093\/ejo\/cjad018","relation":{},"ISSN":["0141-5387","1460-2210"],"issn-type":[{"value":"0141-5387","type":"print"},{"value":"1460-2210","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,10,1]]},"published":{"date-parts":[[2023,5,11]]}}}