{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:33:13Z","timestamp":1777523593373,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T00:00:00Z","timestamp":1616457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Evaluate the effects of alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol on patients with unilateral cleft lip and palate (UCLP) along with maxillary protraction using cone beam computed tomography (CBCT) records and a finite element modeling (FEM) model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      Twenty-five patients (aged 9-13 years) with UCLP having a GOSLON score 3 were selected for this prospective single-arm cohort study after obtaining necessary informed consent. A 9-week Alt-RAMEC protocol using a custom-made fan-shaped expansion screw was initiated, which was followed by 6-month facemask wear. Pre (T1) and posttreatment (T2) records including CBCT were taken and were evaluated for treatment changes in all 3 dimensions using paired\n                      <jats:italic>t<\/jats:italic>\n                      test. Additionally, a FEM model (ANSYS 15.0) using the Alt-RAMEC protocol was also analyzed for the displacement and stress on various craniofacial structures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Significant forward movement of the maxilla along with clockwise rotation of mandible along with statistically significant increase in lower molar height and upper incisor proclination (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05) was observed. CBCT evaluation showed a statistical significant decrease in buccal alveolar bone thickness and increase in molar inclination (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05). Finite element modeling analysis highlighted that the maximum displacement occurred at the anterior region with stresses radiating till the anterior nasal spine, zygomatic arch, and sphenoid bone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Alt- RAMEC protocol combined with facemask protraction can lead to significant maxillary advancement, with some transient decrease in buccal bone thickness noted thereby warranting long-term studies to further assess its effect on the dentofacial apparatus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656211000968","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T05:10:06Z","timestamp":1616476206000},"page":"166-176","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Evaluation of Alt-RAMEC With Facemask in Patients With Unilateral Cleft lip and Palate (UCLP) Using Cone Beam Computed Tomography (CBCT) and Finite Element Modeling\u2014A Clinical Prospective Study"],"prefix":"10.1177","volume":"59","author":[{"given":"Shalvi","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4201-4235","authenticated-orcid":false,"given":"Puneet","family":"Batra","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3031-8469","authenticated-orcid":false,"given":"Sreevatsan","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5875-9170","authenticated-orcid":false,"given":"Karan","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,3,23]]},"reference":[{"key":"e_1_3_4_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-5406(00)70245-9"},{"key":"e_1_3_4_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40510-017-0192-y"},{"key":"e_1_3_4_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjp092"},{"key":"e_1_3_4_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-5406(95)70003-X"},{"key":"e_1_3_4_6_1","doi-asserted-by":"publisher","DOI":"10.2319\/012008-35.1"},{"key":"e_1_3_4_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9416(82)90285-8"},{"key":"e_1_3_4_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjr001"},{"key":"e_1_3_4_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9416(73)90109-7"},{"issue":"2","key":"e_1_3_4_10_1","first-page":"145","article-title":"Face mask therapy of preadolescents with unilateral cleft lip and palate","volume":"64","author":"Buschang PH","year":"1994","unstructured":"Buschang PH, Porter C, Genecov E, Genecov D, Sayler KE. 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