Alt-Ramec

Alternate Rapid Maxillary Expansion and Constriction (Alt RAMEC) is a protocol that has gained attention in orthodontic research. It involves a combination of rapid maxillary expansion (RME) and rapid maxillary constriction (RMC) to correct dental and skeletal discrepancies in patients.

The protocol involves the use of a palatal expander to expand and then constrict the palate.

Studies compared Alt RAMEC to traditional RME and found that Alt RAMEC resulted in greater expansion, improved dental and skeletal outcomes in patients treated with Alt RAMEC compared to RME alone.

Within Whole Body Breathing theory, craniosacral rhythm is thought to be the bodies natural ALT-RAMEC, an is driven by the inhale-exhale cycle. On the inhale: The accessory muscles of breathing attached to the skull pull the skull bones apart, while the increased CSF pressure on the inhale pushes the skull apart from the inside.

Studies:

Skeletal, soft tissue, and airway changes following the alternate maxillary expansions and constrictions protocol

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.

Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol: A Comprehensive Literature Review

Based on the literature review, the following conclusions were made:

The application of the Alt-RAMEC protocol before maxillary protraction is an effective method for early treatment of patients with Class III malocclusion.

In most of the studies, the Alt-RAMEC protocol appears to be more effective than RME.

Further long-term studies on the Alt-RAMEC protocol are needed.

Büyükçavuş MH. Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol: A Comprehensive Literature Review. Turk J Orthod. 2019 Mar;32(1):47-51. doi: 10.5152/TurkJOrthod.2019.18021. Epub 2019 Mar 1. PMID: 30944900; PMCID: PMC6436906. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436906/

Effects of Decreased Occlusal Loading during Growth on the Mandibular Bone Characteristics

Background Bone mass and mineralization are largely influenced by loading. The purpose of this study was to evaluate the reaction of the entire mandibular bone in response to decreased load during growth. It is hypothesized that decreased muscular loading will lead to bone changes as seen during disuse, i.e. loss of bone mass. Methods and Findings Ten 21-day-old Wistar strain male rats were divided into two groups (each n=5) and fed on either a hard- or soft-diet for 11 weeks. Micro-computed tomography was used for the investigation of bone mineralization, bone volume, bone volume fraction (BV/TV) and morphological analysis. Mandibular mineralization patterns were very consistent, showing a lower degree of mineralization in the ramus than in the corpus. In the soft-diet group, mineralization below the molars was significantly increased (p<0.05) compared to the hard diet group. Also, bone volume and BV/TV of the condyle and the masseter attachment were decreased in the soft-diet group (p<0.05). Morphological analysis showed inhibited growth of the ramus in the soft-diet group (p<0.05). Conclusion Decreased loading by a soft diet causes significant changes in the mandible. However, these changes are very region-specific, probably depending on the alterations in the local loading regime. The results suggest that muscle activity during growth is very important for bone quality and morphology.

Hichijo, N., Tanaka, E., Kawai, N., Ruijven, L., & Langenbach, G. (2015). Effects of Decreased Occlusal Loading during Growth on the Mandibular Bone Characteristics. PLoS ONE, 10. https://doi.org/10.1371/journal.pone.0129290.

The effect of weight loading and subsequent release from loading on the postnatal skeleton.

INTRODUCTION The relationship between load and the structure and mechanical properties of mature bones has been thoroughly described. In contrast, this relationship has been studied much less in immature bones, which consist of bony tissue and cartilaginous growth plate, during the postnatal period. This paper describes the effect of an externally applied load on the bones of young fast-growing chicks; in particular, we examine the effect on the growth plate, which regulates longitudinal bone growth, and the consequences in terms of bone structural and mechanical properties. MATERIALS AND METHODS The tibial growth plates from chicks subjected to external load and control chicks, immediately after loading and following 5 days of load release, were studied by histological staining and quantitative PCR. The contralateral tibiae were mechanically tested by three-point bending and their structural features determined by micro-CT. RESULTS At the end of the external loading period, the tibias of the experimental group were shorter and their growth plate narrower than in controls. However, at this time point, effects were not yet apparent in the bones' structural or mechanical parameters. After a further 5 days of no external load, bones and growth plates of the experimental group demonstrated the phenomenon of 'catch-up': the thickness of the growth plate exceeded that of the control; however the relative expression of genes controlling chondrocyte differentiation (collagen II and X) did not change, while the expression of factors related to growth-plate ossification (osteopontin, alkaline phosphatase) and cartilage and bone calcification (matrix and bone Gla proteins) was upregulated as a result of the catch-up process. At this time, however, the tibiae of the experimental group showed inferior mechanical and structural properties relative to the control group. CONCLUSION External loading during bone elongation negatively affects the mechanical and structural properties of the skeleton. The effect is first noticeable in the growth plate, which regulates bone growth, and is exhibited in the bone phenotype after a lag period.

Reich, A., Sharir, A., Zelzer, E., Hacker, L., Monsonego-Ornan, E., & Shahar, R. (2008). The effect of weight loading and subsequent release from loading on the postnatal skeleton.. Bone, 43 4, 766-74 . https://doi.org/10.1016/j.bone.2008.06.004.