{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:30:02Z","timestamp":1787236202294,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: This study aimed to evaluate the immediate effects of a 2-hinged expander activated with the alternate rapid maxillary expansion\u2013constriction (Alt-RAMEC) protocol on craniofacial structures and the soft tissue periodontium in adolescents with skeletal Class III malocclusion characterized by maxillary retrusion. Methods: Lateral cephalograms obtained at baseline (T0) and immediately after treatment (T1) from 15 adolescents (6 females, 9 males; mean ages 12.6\u201313.1 years) treated with a 2-hinged expander using a 9-week Alt-RAMEC protocol were analyzed. A control group consisted of 27 untreated Class III individuals (7 females, 20 males; mean ages 12.5\u201312.6 years). Sagittal and vertical skeletal, dental, and soft tissue measurements were assessed using a Cartesian coordinate system. Periodontal parameters of supporting teeth were evaluated at T0 and T1. Statistical analysis was performed using the Mann\u2013Whitney U and Wilcoxon tests (p &lt; 0.05). Results: Significant anterior maxillary displacement was observed in the treatment group compared with controls (p &lt; 0.01), accompanied by increases in overjet and Wits appraisal (p &lt; 0.05), while mandibular position remained unchanged. The upper lip advanced in accordance with skeletal changes (p &lt; 0.05). Gingival index, bleeding index, and probing pocket depth increased significantly in supporting teeth (p &lt; 0.05), whereas plaque index remained stable (p &gt; 0.05). Conclusions: The 2-hinged expander combined with a 9-week Alt-RAMEC protocol induces immediate skeletal maxillary advancement in growing Class III patients with minimal dental compensation. Short-term periodontal changes suggest a transient inflammatory response associated with appliance therapy.<\/jats:p>","DOI":"10.3390\/jcm15082882","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:20:16Z","timestamp":1775816416000},"page":"2882","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Immediate Response of Craniofacial Structures and Soft Tissue Periodontium to the 2-Hinged Expander Activated by Alt-RAMEC During the Growth Period: A Single-Center, Prospective, Comparative Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Hatice","family":"G\u00f6kalp","sequence":"first","affiliation":[{"name":"Department of Orthodontics, School of Dentistry, University of Ankara, Ankara 06560, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuri Can","family":"Tanr\u0131sever","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dentistry, University of Ankara, Ankara 06560, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40.e1","DOI":"10.1590\/2177-6709.23.6.40.e1-10.onl","article-title":"Global distribution of malocclusion traits: A systematic review","volume":"23","author":"Alhammadi","year":"2018","journal-title":"Dent. 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