{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T16:37:41Z","timestamp":1780418261543,"version":"3.54.1"},"reference-count":74,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the skeletal, soft tissue, and airway effects of the alternate maxillary expansions and constrictions (Alt-RAMEC) protocol in prepubertal patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>The appliance containing a double-hinged expansion screw was applied to 20 patients with Class III skeletal malocclusion characterized by maxillary retrognathia. The mean age of the study group was 9\u00a0years and 8\u00a0months. The patients' parents were instructed to open the screw by 1\u00a0mm per day during the first week and to close it by 1\u00a0mm per day the week after. This alternate opening and closing was repeated for 9 consecutive weeks. Cone beam computed tomography records and three-dimensional photographs were taken before treatment and after 9\u00a0week of the Alt-RAMEC protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Point A moved slightly forward (0.89\u00a0mm) and downward (0.92\u00a0mm) (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05). The average amount of expansion achieved at the level of point A was 5.54\u00a0mm (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05). Besides the maxilla, the expansive forces also affected the nasal bone, the zygomaticomaxillary and zygomaticotemporal sutures (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05). The soft tissue nasal width increased significantly. The airway volume of the anterior nasal compartment and the nasal cavity also increased (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Slight forward movement of point A occurred with the Alt-RAMEC protocol. The expansion affected not only the maxilla but also other structures of the face. Significant cutaneous changes occurred in the paranasal area. Some significant increase in the upper airway volume was obtained.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/092713-705.1","type":"journal-article","created":{"date-parts":[[2014,3,12]],"date-time":"2014-03-12T09:07:22Z","timestamp":1394615242000},"page":"117-126","source":"Crossref","is-referenced-by-count":14,"title":["Skeletal, soft tissue, and airway changes following the alternate maxillary expansions and constrictions protocol"],"prefix":"10.2319","volume":"85","author":[{"given":"Berza Sen","family":"Yilmaz","sequence":"first","affiliation":[{"name":"Clinical Instructor, Department of Orthodontics, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazan","family":"Kucukkeles","sequence":"additional","affiliation":[{"name":"Professor, Department of Orthodontics, Faculty of Dentistry, Marmara University, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"angl-86-02-15-b01","series-title":"Am J Orthod","first-page":"638","article-title":"Extraoral traction and class III treatment","volume":"80","author":"Cozzani\n              G.","year":"1981","unstructured":"Cozzani\n              G. \n          \n          Extraoral traction and class III treatment. Am J Orthod. 1981;80:638\u2013650."},{"key":"angl-86-02-15-b02","series-title":"Angle Orthod","first-page":"200","article-title":"The treatment of maxillary deficiency by opening the midpalatal suture","volume":"35","author":"Haas\n              AJ.","year":"1965","unstructured":"Haas\n              AJ. \n          \n          The treatment of maxillary deficiency by opening the midpalatal suture. Angle Orthod. 1965;35:200\u2013217."},{"key":"angl-86-02-15-b03","series-title":"J Clin Orthod","first-page":"598","article-title":"An orthopedic approach to the treatment of Class III malocclusion in young patients","volume":"21","author":"McNamara\n              JA\n              Jr.","year":"1987","unstructured":"McNamara\n              JA\n              Jr. \n          \n          An orthopedic approach to the treatment of Class III malocclusion in young patients. 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