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

Objective: To compare the long-term dentoskeletal effects of early treatment with banded or bonded RME (Rapid Maxillary Expansion)-Face Mask (RME-FM) versus late treatment with bonded Hybrid-Hyrax, alt-RAMEC (Alternate Rapid Maxillary Expansion and Contraction) and intraoral Class III elastics anchored to miniscrew-reinforced-Lower-lingual-Arch (alt-RAMEC-HH-LLA) in growing, maxillary retrognathic patients. Materials and Methods: Two groups were matched at long-term follow-up retrospectively. Patients received either early RME-FM (n = 16, 5 males, 11 females, age T1: 6.5 ± 0.9 years, age T2: 15.8 ± 2.5 years) or late alt-RAMEC-HH-LLA (n = 15, 7 males, 8 females, age T1: 12.52 ± 0.94 years, age T2: 16.8 ± 0.9 years). Total follow-up was 9.2 ± 2.3 years and 4.2 ± 0.2 years respectively, including fixed appliances to compete treatment. Results: Both treatments resulted in Class III correction except one unsuccessful case of alt-RAMEC-HH-LLA. Active maxillary protraction was 1.6 ± 0.5years with RME-FM and 0.5 years with alt-RAMEC-HH-LLA being significantly shorter (P < 0.001). Values at T2 estimation with multivariate linear regression for correlated multiple outcomes, conditional on baseline estimates, age and sex showed alt-RAMEC-HH-LLA inducing significantly more retroclined lower incisors (mean: −6.11°; 95%CI: −10.66, −1.57; P = 0.01), less overbite (mean: −1.28 mm; 95%CI: −1.79, −0.761; P < 0.001), less maxillo (Co-A)- (mean: −4.54 mm; 95%CI: −7.91, −1.16; P = 0.01) mandibular (Co-Gn) (mean: −10.5 mm; 95%CI: −17.45, −3.55; P = 0.003) projections/size, more open gonial angle (mean: 4.93°; 95%CI: 2.27, 7.59; P < 0.001), and less S-N length (mean: -5.04 mm; 95%CI: −6.57, −3.51; P < 0.001). Conclusions: Patients treated with either early RME-FM or late Alt-RAMEC-HH-LLA had comparable overall post-pubertal skeletal and overjet corrections. However, the late Alt-RAMEC-HH-LLA showed less correction of dentoalveolar compensations and in particular of the mandibular incisors. The overbite, maxillary and mandibular projection and size were lower and the gonial angle was more open.