Alternate Rapid Maxillary Expansion and Construction versus Rapid Maxillary Expansion combined with Face Mask: Which is a more effective method for Maxillary Protraction?

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Nuri C. Tanrısever, Hatice Gökalp This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8414011/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Class III malocclusion characterized by maxillary deficiency is treated with orthopedic approaches during the growth period and with Le-Fort I osteotomy in adulthood. Achieving effective maxillary protraction during growth typically requires mobilization of the circummaxillary sutures through expansion prior to facemask (FM) therapy. Although rapid maxillary expansion (RME) separates not only the midpalatal suture but also contributes to the disarticulation of the circummaxillary sutures, its effect on these sutures is often more limited than expected due to their strong interdigitation. To enhance sagittal advancement by disarticulating the circummaxillary sutures, Liou and Tsai introduced the Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC) protocol in combination with a 2-Hinged Screw Maxillary Expander (2-HME), which shifts the center of rotation toward the pterygoid plates, thereby producing a more pronounced anterior displacement of the maxillary segments. The aim of this study is to evaluate by comparing with Le-Fort I whether the Alt-RAMEC/2-HME protocol produces greater anterior maxillary displacement compared with the RME/FM approach. Material Metod: The material of this single-center retrospective study included 42 individuals with skeletal Class III malocclusion characterized by maxillary deficiency who were treated with Alt-RAMEC/2-HME, RME/FM and Le-Fort I selected from the archives of Ankara University Department of Orthodontics. Skeletal and dental changes in the sagittal and vertical planes at T0 and T1 were measured linearly on lateral cephalometric radiographs using the AutoCAD program. Data was analyzed using SPSS 26 at a significance level of p˂0.05. Results In the late skeletal period, the shorter-duration Alt-RAMEC/2-HME protocol obtained a level of maxillary advancement comparable to that achieved with RME/FM applied at an earlier developmental stage. The magnitude of advancement in both protocols remained lower than that obtained with Le-Fort I. The RME/FM results were longer and more dentoalveolar compared to Alt-RAMEC/2-HME. Both methods produced mandibular posterior rotation, which was more pronounced in RME. Conclusion In the maxillary deficiency during the late growth period, skeletal maxillary advancement can be achieved using the Alt-RAMEC protocol alone, without the need for FM. Considering this outcome, the indication for Le-Fort I may be re-evaluated. The RME/FM resulted in greater dentoalveolar effects compared with Alt-RAMEC/2-HME. maxillary protraction rapid maxillary expansion alternate rapid maxillary expansion and construction Le fort 1 surgery Figures Figure 1 Figure 2 Background The goal of maxillary expansion in Class III malocclusion characterized by maxillary retrusion, with or without transverse deficiency, is to mobilize the surrounding sutures directly or indirectly connected to the maxilla [ 36 ]. Palatal expansion does not just separate the mid-palatal suture, it separates the circum-zygomatic and circum-maxillary sutural systems as well [ 7 ]. The nature of maxillary expansion’s force, where it is transmitted through the craniofacial complex, and how it triggers a cellular reaction was revealed in studies employing a dry skull, rhesus monkeys, and finite element models [ 4 , 6 , 12 , 13 , 16 , 20 , 21 , 22 , 33 ]. Maxillary bone relates to most contiguous bones via sutures, the expansion force is distributed both in the maxilla and extends into the surrounding maxillary structures [ 6 , 20 ]. On the other hand, the effect of rapid maxillary expansion (RME) is less significant on surrounding sutures in the maxilla than expected due to the anatomic conditions with the heavy interdigitation of all sutures surrounding the palatine bone. The most critical part of the palatine-maxillary region is the palatine bone, which is connected to both the sphenoid bone, part of the skull base, and the palatal portion of the maxillary bone. The horizontal part of the palatine bone articulates coronally with the palatal part of the maxillary bone. Indeed, there is evidence that coronally oriented circum-maxillary sutures were opened less than those sagittally oriented [ 38 ]. On the other hand, significant maxillary protraction requires well opened circum-maxillary sutures. Several studies have revealed that factors that play a role during sutural synostosis are the type of rapid maxillary expander, and rate and rhythm of the expansion protocol on the type of maxillary movement [ 9 , 15 , 31 , 37 ]. The expansion width and frequency of RME, direct versus indirect articulation of the circum-maxillary suture to the maxilla, or orientation of circum-maxillary sutures to the maxilla all affect the amount of maxillary-suture opening also [ 23 , 38 ]. Liou and Tsai introduced the use of the 2-Hinged Maxillary Expander (2-HME) in conjunction with the Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC) protocol to promote sagittal progression by disarticulating the circummaxillary sutures while preserving the transverse dimension of the maxilla. In the Hyrax expander and single-stage RME method, the rotation center is located in the PNS, causing the maxilla to rotate backward due to resorption in the posterior maxillary region. In contrast, in this expansion model, the rotation center is located in the pterygoid plates, causing the maxillary halves to rotate forward [ 24 , 25 ]. RME promoting maxillary advancement by separating the circummaxillary sutures is a method frequently used prior to face mask (FM) for the treatment of Class III malocclusion characterized with maxillary retrusion [ 5 , 9 , 14 , 15 , 28 , 31 , 34 ]. On the other hand, once this skeletal growth has ceased, Le Fort I surgery is performed. It is claimed that the maxilla, especially from the palatomaxillary region, is separated in a manner similar to distraction osteogenesis using the repeated opening/closing protocol of Alt-RAMEC [ 19 , 25 ]. In this case, the question arises as to whether the skeletal results obtained with Alt-RAMEC during the period when skeletal growth is nearing completion are as effective as Le Fort I. The aim of this retrospective study was to test whether the repetitive weekly protocol of Alt-RAMEC with displaces the maxilla more anteriorly than a single course of RME/FM by comparing Le Fort I osteotomy. Material and Method The material of this single-center retrospective study consisted of pre-treatment (T0) and post-treatment (T1) lateral cephalometric radiographs of 42 individuals with Class III malocclusion characterized by maxillary deficiency treated with Alt-RAMEC/2-HME (Group 1) (mean chronological age 15.35 ± 1.01; mean skeletal age 15.25 ± 1.17; 9 females, 4 males), RME/FM (Group 2) (mean chronological age 11.4 ± 1.16; mean skeletal age 12.25 ± 1.02; 7 females, 7 males) and Le Fort 1 surgery (Group 3) from the archives of the Department of Orthodontics, Faculty of Dentistry, Ankara University. In Group 1, the 2-HME was opened twice a day, twice in the morning and evening, for a total of four times a day for a 1 mm expansion per day during the first week; it was closed with the same rhythm during the second week. This sequential series was repeated for 9 weeks, ceased with expansion. In Group 2, a Mc Namara-type hyrax expander was opened twice a day, once in the morning and once in the evening, for a 0.5 mm expansion for 1 week with a single course of RME. At the end of 7-week expansion, Petit-type face mask were used with bilateral 450-gm elastics that wear the between FM and the premolars’ region of the Mc Namara-type expander with at 40-degree angle to the maxillary occlusal plane for 21 hours per day. The total treatment time was 10.1 ± 1.9 months. Maxillary advancement was performed with Le Fort I surgery in Group 3. Sagittal and vertical skeletal-dental linear measurements were made on lateral cephalometric radiographs at T0 and T1. Measurements were made by the same researcher (N.T.) with AutoCAD (AutoCAD 2025, Autodesk Inc., San Francisco, CA, USA), adjusting to 1 cm in the program 10 mm cephalostat bar image on digitally obtained lateral cephalometric radiographs, . Metod Sagittal and vertical linear measurements were made on lateral cephalometric radiographs according to points determined according to the Cartesian coordinate system. The X coordinate plane of the Cartesian coordinate system was created with an angle of + 7° from the T point centered under the TW plane passing through the Tuberculum Sella (T) and Wings (W) points; the Y coordinate plane was created perpendicular to the X plane from the T point (Figs. 1 and 2). Fıgure 1. Reference planes Fıgure 2. Points. (A) point: Subspinal point. (B) point: Supramental point. (Is): Incisor superior. (As): Apex superior. (Ii): Incisor inferior (Ai): Apex inferior (Pr): Prosthion. (Id): Infradentale (UM): Upper Molar (LM): Lower Molar (UMA): Upper Molar Apex (LMA): Lower Molar Apex Statistical Method In this study, data analysis was performed using SPSS 26. Measurements of the study groups in the T0 and T1 periods were compared using the Wilcoxon rank-ordered sign test, and differences between measurements in the T1-T0 periods were compared using the Mann-Whitney U analysis. The reliability of the measurements taken one week apart was evaluated using intraclass correlation coefficients (ICCs). Accordingly, the ICC values for all pre- and post-treatment measurements were found to be 0.90 or higher, indicating a high level of reliability. Statistical evaluations were made at a significance level of p˂0.05. Results At the T0 and T1 periods, the maxilla were significantly displaced anteriorly in all three groups, while the mandible showed downward rotation only in Groups I and II (Table 1 ). Anterior displacement of the maxilla at A point ranged from 0,26 to 4.00 mm in the Alt-RAMEC/2-HME group, and from 0.64 to 4.74 mm in the RME/FM group (Table 2 ). Maxillary protraction was statistically similar in Alt-RAMEC/2-HME and RME/FM compared to Group 3 (Table 2 ). The overall advancement of the maxilla at A point was 1,87 ± 2,13 mm in the Alt-RAMEC/2-HME group, compared with 2,69 ± 2,05 mm in the RME/FM group. The posterior rotation of the mandible was related to the counterclockwise rotation of the maxilla and dental tipping of the maxillary and mandibular molars (Table 2 ). The maxillary incisors crown tipped anteriorly in RME/FM group more than Alt-RAMEC/2-HME and the maxillary incisors rooth tipped anteriorly in RME/FM group more than Alt-RAMEC/2-HME. The maxillary incisors crown moved downwardly in RME/FM group more than Alt-RAMEC/2-HME and the maxillary incisors rooth moved downwardly in RME/FM group more than Alt-RAMEC/2-HME. The maxillary molars crown tipped anteriorly in RME/FM group more than Alt-RAMEC/2-HME and the maxillary molars root tipped anteriorly in RME/FM group more than Alt-RAMEC/2-HME. The maxillary molars crown moved downwardly in RME/FM group more than Alt-RAMEC/2-HME and the maxillary molars root moved downwardly in RME/FM group more than Alt-RAMEC/2-HME (Table 2 ). Table 1 Comparison of linear measurements at T0 and T1 periods in the study groups. Group 1 Group 2 Group 3 Measurements T0 (Mean ± SS) T1 (Mean ± SS) p T0 (Mean ± SS) T1 (Mean ± SS) p T0 (Mean ± SS) T1 (Mean ± SS) p Skeletal Sagittal A-Y 50,44 ± 3,73 52,31 ± 4,67 0,005* 48,25 ± 5,39 50,94 ± 4,33 0,002* 53,87 ± 4,76 62,23 ± 4,40 0,001* B-Y 49,30 ± 8,19 48,35 ± 9,06 0,249 45,77 ± 9,01 43,96 ± 7,09 0,013* 54,59 ± 6,14 53,90 ± 5,93 0,079 Pr-Y 51,79 ± 4,90 53,88 ± 5,82 0,001* 48,11 ± 5,70 51,34 ± 4,69 0,001* 56,69 ± 5,31 64,75 ± 4,98 0,001* Id-Y 50,85 ± 7,62 48,46 ± 7,88 0,001* 47,15 ± 8,47 45,38 ± 6,38 0,019* 56,26 ± 7,31 55,87 ± 6,51 0,064 Vertical A-X 52,64 ± 3,85 52,63 ± 4,33 0,925 50,90 ± 4,77 50,51 ± 4,97 0,315 55,11 ± 3,09 54,56 ± 3,44 0,171 B-X 90,38 ± 6,01 92,80 ± 4,72 0,005* 85,87 ± 5,95 88,71 ± 5,79 0,002* 87,29 ± 12,33 85,90 ± 10,77 0,087 Pr-X 64,06 ± 5,09 64,25 ± 4,77 0,801 58,87 ± 4,83 59,64 ± 5,04 0,028* 66,71 ± 3,75 65,72 ± 3,20 0,013* Id-X 85,96 ± 6,24 87,86 ± 5,60 0,048* 81,12 ± 6,04 83,10 ± 6,89 0,008* 82,09 ± 6,70 79,90 ± 4,47 0,012* Dental Sagittal İS-Y 52,39 ± 5,97 55,04 ± 6,95 0,002* 48,68 ± 6,66 53,12 ± 5,12 0,001* 56,43 ± 5,60 64,89 ± 5,98 0,001* AS-Y 44,77 ± 3,51 46,54 ± 4,68 0,005* 41,94 ± 5,21 44,64 ± 4,66 0,001* 52,23 ± 6,94 60,21 ± 6,68 0,001* İİ-Y 53,66 ± 6,66 51,67 ± 6,56 0,001* 50,69 ± 6,89 48,71 ± 5,62 0,003* 57,60 ± 6,19 57,05 ± 5,81 0,148 Aİ-Y 44,66 ± 8,52 44,64 ± 9,48 0,826 40,81 ± 9,58 39,79 ± 8,12 0,221 53,01 ± 10,89 51,59 ± 11,30 0,006* UM-Y 27,65 ± 5,40 29,08 ± 5,48 0,001* 25,78 ± 6,35 29,31 ± 5,25 0,001* 28,15 ± 2,61 35,42 ± 4,46 0,001* UMA-Y 28,51 ± 4,10 29,76 ± 4,42 0,012* 26,38 ± 4,85 29,96 ± 3,55 0,001* 28,32 ± 2,09 35,57 ± 4,54 0,001* LM-Y 30,64 ± 6,77 29,01 ± 7,49 0,006* 25,62 ± 7,37 25,51 ± 5,65 1,000 30,41 ± 3,55 30,75 ± 3,88 0,451 LMA-Y 21,87 ± 7,94 21,99 ± 9,12 0,624 17,41 ± 8,67 16,79 ± 6,92 0,158 27,48 ± 4,67 27,48 ± 4,42 0,730 Vertical İS-X 75,16 ± 5,16 74,83 ± 5,57 0,593 70,53 ± 4,90 71,57 ± 4,97 0,033* 75,98 ± 4,34 75,56 ± 2,36 0,777 AS-X 53,93 ± 4,62 53,90 ± 5,02 0,727 50,10 ± 4,67 50,54 ± 4,12 0,382 55,81 ± 2,62 55,09 ± 2,66 0,014* İİ-X 75,13 ± 5,89 76,20 ± 5,49 0,116 69,62 ± 5,61 70,68 ± 5,23 0,030* 77,67 ± 4,54 75,01 ± 2,94 0,003* Aİ-X 92,59 ± 5,80 94,65 ± 4,55 0,010* 87,40 ± 5,90 89,84 ± 5,48 0,002* 88,40 ± 9,73 87,14 ± 8,76 0,014* UM-X 65,94 ± 3,92 67,32 ± 3,71 0,016* 61,06 ± 4,41 62,94 ± 3,94 0,008* 65,90 ± 3,22 64,99 ± 2,94 0,031* UMA-X 53,14 ± 3,51 52,64 ± 3,93 0,345 48,01 ± 4,03 49,07 ± 3,89 0,041* 49,48 ± 4,60 48,92 ± 4,66 0,028* LM-X 73,83 ± 4,16 75,14 ± 3,51 0,052 67,76 ± 4,01 69,64 ± 4,38 0,003* 70,91 ± 2,84 70,35 ± 3,52 0,048* LMA-X 86,51 ± 4,30 88,03 ± 3,89 0,035* 79,59 ± 3,96 82,77 ± 3,21 0,003* 83,76 ± 2,91 83,36 ± 4,03 0,059 Significance level: *p ˂0.05 Table 2 Comparison of differences between T1 and T0 periods for the study groups. Skeletal Parameters Group 1 Group 2 Group 3 p Difference Mean ± SS Mean ± SS Mean ± SS Sagittal A-Y 1,87 ± 2,13 2,69 ± 2,05 8,36 ± 2,87 , 000* 3 > 1,2 B-Y -0,95 ± 2,39 -1,81 ± 2,93 -0,69 ± 1,32 0,628 Pr-Y 2,09 ± 2,43 3,23 ± 1,78 8,06 ± 2,77 , 000* 3 > 2 > 1 Id-Y -2,39 ± 1,78 -1,77 ± 3,05 -0,39 ± 2,23 0,059 Vertical A-X -0,01 ± 1,87 -0,39 ± 1,65 -0,55 ± 1,46 0,650 B-X 2,42 ± 2,75 2,84 ± 2,34 -1,39 ± 3,01 , 000* 1,2 > 3 Pr-X 0,19 ± 2,25 0,76 ± 1,1 -0,99 ± 1,65 0,008* 2 > 3 Id-X 1,9 ± 3,31 1,98 ± 2,45 -2,19 ± 3,18 0,001* 3 > 1,2 Dental Sagittal İS-Y 2,64 ± 2,66 4,44 ± 2,54 8,46 ± 2,22 , 000* 3 > 2 > 1 AS-Y 1,76 ± 2,2 2,7 ± 2,19 7,98 ± 1,57 , 000* 3 > 1,2 İİ-Y -1,99 ± 1,23 -1,98 ± 1,92 -0,55 ± 1,4 0,039* 1,2 > 3 Aİ-Y -0,02 ± 2,98 -1,02 ± 2,93 -1,41 ± 1,46 0,173 UM-Y 1,43 ± 1,55 3,53 ± 2,18 7,27 ± 2,34 , 000* 3 > 2 > 1 UMA-Y 1,26 ± 1,69 3,58 ± 2,29 7,25 ± 2,67 , 000* 3 > 2 > 1 LM-Y -1,63 ± 1,81 -0,11 ± 2,87 0,34 ± 2,98 0,152 LMA-Y 0,11 ± 3,04 -0,61 ± 3,28 0 ± 1,36 0,827 Vertical İS-X -0,34 ± 1,66 1,04 ± 1,54 -0,42 ± 2,45 0,051 AS-X -0,03 ± 1,41 0,44 ± 1,55 -0,72 ± 1,2 0,085 İİ-X 1,07 ± 2,4 1,06 ± 1,41 -2,66 ± 3,19 , 000* Aİ-X 2,06 ± 2,71 2,44 ± 1,91 -1,26 ± 2,22 , 000* 1,2 > 3 UM-X 1,38 ± 1,93 1,89 ± 2 -0,91 ± 1,39 , 000* 1,2 > 3 UMA-X -0,5 ± 1,93 1,06 ± 1,58 -0,56 ± 1,14 0,016* 2 > 1,3 LM-X 1,31 ± 2,32 1,88 ± 1,89 -0,56 ± 0,96 0,001* 1,2 > 3 LMA-X 1,52 ± 2,27 3,19 ± 2,31 -0,39 ± 1,47 , 000* 1,2 > 3 Significance level: *p ˂0.05 Discussion The results of this retrospective archival study demonstrated that the 9-week Alt-RAMEC/2-HME provided nearly the same degree of maxillary advancement as the 10-month RME/FM. The amount of maxillary anterior displacement achieved in the group treated with 9-week Alt-RAMEC alone, without the use of an extraoral appliance, was quite close to the value obtained in the group treated with 10-month FM after RME (2.69 ± 2.05 mm vs. 1.87 ± 2.13 mm). Only maxillary advancement close to the FM with Alt-RAMEC seems to be associated with Alt-RAMEC's weekly repeated protocol. This assumes a geometrically anterior displacement or repositioning of the maxilla without the possibility for bone resorption behind the maxillary tuberosities [ 3 , 25 ]. Thus, the maxilla is consistently displace anteriorly with the 2-hinged expander. The total amount of maxillary advancement was 1,87 ± 2,13 mm in 2.1 months for the Alt-RAMEC group in contrast with 2,69 ± 2,05 in 10.1 months with a RME/FM. The amount of maxillary advencement in the Alt-RAMEC/2-HME group was almost similar to that in RME/FM. Here, the 2-hinged expander combined with the Alt-RAMEC may have contributed greater amount of maxillary advancement. The design of 2-hinged expander is consistently displace the maxilla anteriorly. Because of the two hinges, the expander rotates each half of the maxilla outward and forward around the palatomaxillary region, rather than around the posterior nasal spine, as the hyrax expander does. This assumes a geometrically anterior displacement or repositioning of the maxilla without the possibility for bone resorption behind the junction of horizontal part of palatal bone and palatine part of maxilla [ 21 , 22 , 24 , 25 ]. Maxillary expansion with spontaneous maxillary advancement has an advantage over a face mask that requires patient compliance [ 15 , 28 , 34 ]. Maxillary expansion before maxillary advancement with FM to facilitate maxillary protraction is a current practice in the treatment of Class III malocclusions characterized with the maxillary retrusion [ 28 , 35 ]. The literature has reported that both the Alt-RAMEC/FM combination [ 19 , 25 , 26 , 27 ] and the RME/FM combination provide more effective maxillary advancement [ 8 , 10 ]. In this study, with the only 9-week Alt-RAMEC/2-HME was achieved a maxillary protraction very similar to that applied 10,1 ± 1,9 months of RME/FM (A; 1.87 ± 2.13 mm versus 2.69 ± 2.05 mm). At this point, it would not be wrong to think that clinically effective maxillary advancement is achieved with Alt-RAMEC alone, without a FM. Liou and Tsai explained the more effective maxillary advancement with Alt-RAMEC compared to RME by the creation of a distraction-like osteogenesis-like reaction in the circummaxillary sutures with expansion/protraction. 18 On the other hand, the FM poses problems in terms of aesthetics, comfort, and social interactions, negatively impacting the skeletal effects of the treatment [ 1 , 11 , 18 ]. In this study, the upper incisor moved anteriorly with Alt-RAMEC/2-HME in a bodily, while the RME/FM moved anteriorly with the same amount of root movement and greater crown tipping. According to this result, while greater anterior movement at point A was expected with Alt-RAMEC/2-HME, similar results were found with RME/FM, as the amount of distal root movement of the upper incisors was the same in both groups. In this study, maxillary molars were positioned anteriorly with crown tipping using RME/FM; more vertical movement was observed with the McNamara-type expander, despite the occlusal capping. This may be due to protraction elastics applied at a 40-degree angle from maxillary occlusal plane. Therefore, in the RME/FM group, Class III combined with maxillary retrusion was eliminated by posterior rotation of the mandible due to vertical movement of the maxillary molars, rather than anterior movement of the maxilla. Statistical analysis revealed that the maxillary molars in the Alt-RAMEC/2-HME group, compared to the RME/FM group, moved anteriorly in bodily but less. However, the crucial point here is the which application and the time it takes to achieve maxillary movement In fact, with only Alt-RAMEC/2-HME, a controlled upper molar movement was observed in both sagittal and vertical directions in approximately 2 months, while with RME/FM, an upper molar movement was observed predominantly in the vertical direction after approximately 10 months. The maxilla is repositioned in its entirety with the Le Fort I osteotomy. An average maxillary advancement of 5–8 mm is achieved with the Le Fort I [ 32 ]. The findings of this study are consistent with the literature. The Le Fort I osteotomy has some complications, such as intraoperative vascular and neural complications and postoperative stability and relapse [ 2 , 17 ]. The literature has reported that Alt-RAMEC achieves almost as much maxillary advancement as Le Fort I osteotomy in cases of cleft lip and palate [ 29 , 30 ]. However, because this study consisted of cases without cleft lip and palate, the Le Fort I osteotomy was naturally more effective in terms of maxillary advancement than Alt-RAMEC. Conclusion In the maxillary deficiency during the late growth period, skeletal maxillary advancement can be achieved using the Alt-RAMEC alone with 2-hinged expander, without the need for FM therapy. The RME/FM combination resulted in more dentoalveolar effects compared with Alt-RAMEC/2-HME. Before making decision on Le Fort 1 surgery, it may be beneficial to consider Alt-RAMEC for the positive late-stage effect on the maxilla. Abbreviations RME: Rapid Maxillary Expansion (RME) Alt-RAMEC: Alternate Rapid Maxillary Expansion and Construction 2-HME: 2-Hinged Maxillary Expander FM: Face Mask PNS: Posterior Nasal Spina Declarations 2) Ethics approval and consent to participate The research was approved by the Ankara University Faculty of Dentistry Ethics Committee. Since the research is a retrospective archive study, consent to participate is not applicable.. 3) Consent for publication Not applicable 4) Availability of data and materials The data and material used during the current study are available from the corresponding author on request. 5) Competing Interest Not applicable 6) Funding Not applicable 7) Author’s Contribution Conceptualization, N.C.T. and H.G.; methodology, N.C.T. and H.G.; investigation, N.C.T. and H.G.; writing—original draft preparation, N.C.T. and H.G.; writing—review and editing, N.C.T. and H.G.; supervision, H.G.; All authors have read and agreed to the final version of the manuscript. 8) Acknowledgements Not applicable References Turley PK (2007) Treatment of the Class III malocclusion with maxillary expansion and protraction. Semin Orthod 13(3). Cleall JF (1974) Growth of the palate and maxillary dental arch. J Dent Res 53(5):1226–1234. 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Biederman W (1973) Rapid correction of Class III malocclusion by midpalatal expansion. Am J Orthod Dentofacial Orthop 63:47–55. Jafari A, Shetty KS, Kumar M (2003) Study of stress distribution and displacement of various craniofacial structures following application of transverse orthopedic forces—a three-dimensional FEM study. Angle Orthod 73:12–20. Işeri H, Tekkaya AE, Öztan Ö, Bilgic S (1998) Biomechanical effects of rapid maxillary expansion on the craniofacial skeleton studied by the finite element method. Eur J Orthod 20(4):347–356. Turley PK (2002) Managing the developing Class III malocclusion with palatal expansion and facemask therapy. Am J Orthod Dentofacial Orthop 122(4):349–352. Liu W, et al (2015) Effect of maxillary protraction with alternating rapid palatal expansion and constriction versus expansion alone in maxillary retrusive patients: a randomized controlled trial. Am J Orthod Dentofacial Orthop 148:641–651. Masucci C, et al (2014) Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study. Orthod Craniofac Res 17:259–269. Do-de Latour TB, et al (2009) Effect of alternate maxillary expansion and contraction on protraction of the maxilla: a pilot study. Hong Kong Dent J 6:72–82. da Luz Vieira G, et al (2009) Dentoskeletal effects of maxillary protraction in cleft patients with repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 46:391–398. Abu Alhaija ES, Karajeh MA (2013) Acceptability and attractiveness of intra- and extra-oral orthodontic appliances. Int J Orthod 24:11–17. Ierardo G, et al (2018) Skin irritation from a facial mask in Class III malocclusion: evaluation of individual silicone chin cups in 100 children. Minerva Stomatol 67:45–48. Franchi L, et al (2024) Clinical management of facemasks for early treatment of Class III malocclusion: a survey among SIDO members. Dent J (Basel) 12(7):207. Mistry TA, Mistry A (2021) Comparison of conventional Le Fort I advancement, anterior maxillary segmental distraction, and distraction osteogenesis of the maxilla for cleft maxillary hypoplasia: a systematic review. J Cleft Lip Palate Craniofac Anomal 8(1):49–55. Baas EM, et al (2015) Skeletal stability after bilateral sagittal split osteotomy or distraction osteogenesis of the mandible: a randomized clinical trial. Int J Oral Maxillofac Surg 44(5):615–620. Iannetti G, et al (2013) Complications of orthognathic surgery: a retrospective study on 3236 patients. Eur Rev Med Pharmacol Sci 17(3):379–384. Meazzini MC, et al (2019) Short- and long-term effects of late maxillary advancement with the Liou–Alt-RAMEC protocol in unilateral cleft lip and palate. Cleft Palate Craniofac J 56(2):159–167. Meazzini MC (2020) Treatment of maxillary hypoplasia in cleft lip and palate patients: keeping the total burden of care as low as possible. J Cleft Lip Palate Craniofac Anomal 7(1):1–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8414011","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":564194991,"identity":"1604f157-9e60-49a9-b8e7-d30d06b1266c","order_by":0,"name":"Nuri C. Tanrısever","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYPACCQj1gYHBAMJiw6eaGaGFcQayFh78WqBMHmK0mLOfP/i5cI+FPb9E8rHPNjV3jPlnH37A8KHsMIO99AGsWix7kpmlZzyTSJw5Iy15ds6xZ2YS59IMGGecO8zAw5eAVYvBDWYGaZ4DEgkGZ84YM+ewHbZhOMNgwMzbBtSCw2VALcy/gVrs7c+c/8xs8e+wjfwZ9g/Mf/FrYQPZwriBvYeZmbHtsJnBGR4DEAO3ljPJZtZALYkzjrcZM/b2HTY2PMNTcLDnXDoPzxkcWo4ffHyb50CdPX8z82OGH98OG847w77xwY8yazn2HuxasIMDDPhichSMglEwCkYBQQAAI75UmBoHDSQAAAAASUVORK5CYII=","orcid":"","institution":"Ankara University","correspondingAuthor":true,"prefix":"","firstName":"Nuri","middleName":"C.","lastName":"Tanrısever","suffix":""},{"id":564194992,"identity":"ef0563d0-0cc5-40e1-a601-f71d51fb0a66","order_by":1,"name":"Hatice Gökalp","email":"","orcid":"","institution":"Ankara University","correspondingAuthor":false,"prefix":"","firstName":"Hatice","middleName":"","lastName":"Gökalp","suffix":""}],"badges":[],"createdAt":"2025-12-20 19:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8414011/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8414011/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103013625,"identity":"8d3b75aa-517a-4818-a6d8-23e6ef564c5e","added_by":"auto","created_at":"2026-02-19 16:02:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":515088,"visible":true,"origin":"","legend":"\u003cp\u003eReference planes\u003c/p\u003e","description":"","filename":"FIG1.png","url":"https://assets-eu.researchsquare.com/files/rs-8414011/v1/727cbd2fcf5a5a0081a1e845.png"},{"id":103050289,"identity":"fcfbad06-dc93-4761-8602-4173dbb70abe","added_by":"auto","created_at":"2026-02-20 07:49:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":372195,"visible":true,"origin":"","legend":"\u003cp\u003ePoints. (A) point: Subspinal point. (B) point: Supramental point. (Is): Incisor superior. (As): Apex superior. (Ii): Incisor inferior (Ai): Apex inferior (Pr): Prosthion. (Id): Infradentale (UM): Upper Molar (LM): Lower Molar (UMA): Upper Molar Apex (LMA): Lower Molar Apex\u003c/p\u003e","description":"","filename":"FIG2.png","url":"https://assets-eu.researchsquare.com/files/rs-8414011/v1/07fd1f7403b2d648d90936d8.png"},{"id":108526566,"identity":"e51cd230-bacd-4035-8ff2-6ea8c5cf9796","added_by":"auto","created_at":"2026-05-05 15:12:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1429268,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8414011/v1/57092216-8b55-4c34-843d-df5f6286c6a2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Alternate Rapid Maxillary Expansion and Construction versus Rapid Maxillary Expansion combined with Face Mask: Which is a more effective method for Maxillary Protraction?","fulltext":[{"header":"Background","content":"\u003cp\u003eThe goal of maxillary expansion in Class III malocclusion characterized by maxillary retrusion, with or without transverse deficiency, is to mobilize the surrounding sutures directly or indirectly connected to the maxilla [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Palatal expansion does not just separate the mid-palatal suture, it separates the circum-zygomatic and circum-maxillary sutural systems as well [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The nature of maxillary expansion\u0026rsquo;s force, where it is transmitted through the craniofacial complex, and how it triggers a cellular reaction was revealed in studies employing a dry skull, rhesus monkeys, and finite element models [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Maxillary bone relates to most contiguous bones via sutures, the expansion force is distributed both in the maxilla and extends into the surrounding maxillary structures [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. On the other hand, the effect of rapid maxillary expansion (RME) is less significant on surrounding sutures in the maxilla than expected due to the anatomic conditions with the heavy interdigitation of all sutures surrounding the palatine bone. The most critical part of the palatine-maxillary region is the palatine bone, which is connected to both the sphenoid bone, part of the skull base, and the palatal portion of the maxillary bone. The horizontal part of the palatine bone articulates coronally with the palatal part of the maxillary bone. Indeed, there is evidence that coronally oriented circum-maxillary sutures were opened less than those sagittally oriented [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. On the other hand, significant maxillary protraction requires well opened circum-maxillary sutures. Several studies have revealed that factors that play a role during sutural synostosis are the type of rapid maxillary expander, and rate and rhythm of the expansion protocol on the type of maxillary movement [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The expansion width and frequency of RME, direct versus indirect articulation of the circum-maxillary suture to the maxilla, or orientation of circum-maxillary sutures to the maxilla all affect the amount of maxillary-suture opening also [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Liou and Tsai introduced the use of the 2-Hinged Maxillary Expander (2-HME) in conjunction with the Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC) protocol to promote sagittal progression by disarticulating the circummaxillary sutures while preserving the transverse dimension of the maxilla. In the Hyrax expander and single-stage RME method, the rotation center is located in the PNS, causing the maxilla to rotate backward due to resorption in the posterior maxillary region. In contrast, in this expansion model, the rotation center is located in the pterygoid plates, causing the maxillary halves to rotate forward [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRME promoting maxillary advancement by separating the circummaxillary sutures is a method frequently used prior to face mask (FM) for the treatment of Class III malocclusion characterized with maxillary retrusion [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. On the other hand, once this skeletal growth has ceased, Le Fort I surgery is performed. It is claimed that the maxilla, especially from the palatomaxillary region, is separated in a manner similar to distraction osteogenesis using the repeated opening/closing protocol of Alt-RAMEC [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In this case, the question arises as to whether the skeletal results obtained with Alt-RAMEC during the period when skeletal growth is nearing completion are as effective as Le Fort I.\u003c/p\u003e \u003cp\u003eThe aim of this retrospective study was to test whether the repetitive weekly protocol of Alt-RAMEC with displaces the maxilla more anteriorly than a single course of RME/FM by comparing Le Fort I osteotomy.\u003c/p\u003e"},{"header":"Material and Method","content":"\u003cp\u003eThe material of this single-center retrospective study consisted of pre-treatment (T0) and post-treatment (T1) lateral cephalometric radiographs of 42 individuals with Class III malocclusion characterized by maxillary deficiency treated with Alt-RAMEC/2-HME (Group 1) (mean chronological age 15.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01; mean skeletal age 15.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17; 9 females, 4 males), RME/FM (Group 2) (mean chronological age 11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16; mean skeletal age 12.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02; 7 females, 7 males) and Le Fort 1 surgery (Group 3) from the archives of the Department of Orthodontics, Faculty of Dentistry, Ankara University.\u003c/p\u003e \u003cp\u003eIn Group 1, the 2-HME was opened twice a day, twice in the morning and evening, for a total of four times a day for a 1 mm expansion per day during the first week; it was closed with the same rhythm during the second week. This sequential series was repeated for 9 weeks, ceased with expansion. In Group 2, a Mc Namara-type hyrax expander was opened twice a day, once in the morning and once in the evening, for a 0.5 mm expansion for 1 week with a single course of RME. At the end of 7-week expansion, Petit-type face mask were used with bilateral 450-gm elastics that wear the between FM and the premolars\u0026rsquo; region of the Mc Namara-type expander with at 40-degree angle to the maxillary occlusal plane for 21 hours per day. The total treatment time was 10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 months. Maxillary advancement was performed with Le Fort I surgery in Group 3.\u003c/p\u003e \u003cp\u003eSagittal and vertical skeletal-dental linear measurements were made on lateral cephalometric radiographs at T0 and T1.\u003c/p\u003e \u003cp\u003eMeasurements were made by the same researcher (N.T.) with AutoCAD (AutoCAD 2025, Autodesk Inc., San Francisco, CA, USA), adjusting to 1 cm in the program 10 mm cephalostat bar image on digitally obtained lateral cephalometric radiographs, .\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMetod\u003c/h2\u003e \u003cp\u003eSagittal and vertical linear measurements were made on lateral cephalometric radiographs according to points determined according to the Cartesian coordinate system. The X coordinate plane of the Cartesian coordinate system was created with an angle of +\u0026thinsp;7\u0026deg; from the T point centered under the TW plane passing through the Tuberculum Sella (T) and Wings (W) points; the Y coordinate plane was created perpendicular to the X plane from the T point (Figs.\u0026nbsp;1 and 2).\u003c/p\u003e \u003cp\u003eFıgure 1. Reference planes\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFıgure 2. Points. (A) point: Subspinal point. (B) point: Supramental point. (Is): Incisor superior. (As): Apex superior. (Ii): Incisor inferior (Ai): Apex inferior (Pr): Prosthion. (Id): Infradentale (UM): Upper Molar (LM): Lower Molar (UMA): Upper Molar Apex (LMA): Lower Molar Apex\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStatistical Method\u003c/h3\u003e\n\u003cp\u003eIn this study, data analysis was performed using SPSS 26. Measurements of the study groups in the T0 and T1 periods were compared using the Wilcoxon rank-ordered sign test, and differences between measurements in the T1-T0 periods were compared using the Mann-Whitney U analysis. The reliability of the measurements taken one week apart was evaluated using intraclass correlation coefficients (ICCs). Accordingly, the ICC values for all pre- and post-treatment measurements were found to be 0.90 or higher, indicating a high level of reliability. Statistical evaluations were made at a significance level of p˂0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAt the T0 and T1 periods, the maxilla were significantly displaced anteriorly in all three groups, while the mandible showed downward rotation only in Groups I and II (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Anterior displacement of the maxilla at A point ranged from 0,26 to 4.00 mm in the Alt-RAMEC/2-HME group, and from 0.64 to 4.74 mm in the RME/FM group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Maxillary protraction was statistically similar in Alt-RAMEC/2-HME and RME/FM compared to Group 3 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The overall advancement of the maxilla at A point was 1,87\u0026thinsp;\u0026plusmn;\u0026thinsp;2,13 mm in the Alt-RAMEC/2-HME group, compared with 2,69\u0026thinsp;\u0026plusmn;\u0026thinsp;2,05 mm in the RME/FM group. The posterior rotation of the mandible was related to the counterclockwise rotation of the maxilla and dental tipping of the maxillary and mandibular molars (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The maxillary incisors crown tipped anteriorly in RME/FM group more than Alt-RAMEC/2-HME and the maxillary incisors rooth tipped anteriorly in RME/FM group more than Alt-RAMEC/2-HME. The maxillary incisors crown moved downwardly in RME/FM group more than Alt-RAMEC/2-HME and the maxillary incisors rooth moved downwardly in RME/FM group more than Alt-RAMEC/2-HME. The maxillary molars crown tipped anteriorly in RME/FM group more than Alt-RAMEC/2-HME and the maxillary molars root tipped anteriorly in RME/FM group more than Alt-RAMEC/2-HME. The maxillary molars crown moved downwardly in RME/FM group more than Alt-RAMEC/2-HME and the maxillary molars root moved downwardly in RME/FM group more than Alt-RAMEC/2-HME (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of linear measurements at T0 and T1 periods in the study groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGroup 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMeasurements\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSkeletal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSagittal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50,44\u0026thinsp;\u0026plusmn;\u0026thinsp;3,73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e52,31\u0026thinsp;\u0026plusmn;\u0026thinsp;4,67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e48,25\u0026thinsp;\u0026plusmn;\u0026thinsp;5,39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e50,94\u0026thinsp;\u0026plusmn;\u0026thinsp;4,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e53,87\u0026thinsp;\u0026plusmn;\u0026thinsp;4,76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e62,23\u0026thinsp;\u0026plusmn;\u0026thinsp;4,40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e49,30\u0026thinsp;\u0026plusmn;\u0026thinsp;8,19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e48,35\u0026thinsp;\u0026plusmn;\u0026thinsp;9,06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e45,77\u0026thinsp;\u0026plusmn;\u0026thinsp;9,01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e43,96\u0026thinsp;\u0026plusmn;\u0026thinsp;7,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,013*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e54,59\u0026thinsp;\u0026plusmn;\u0026thinsp;6,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e53,90\u0026thinsp;\u0026plusmn;\u0026thinsp;5,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePr-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e51,79\u0026thinsp;\u0026plusmn;\u0026thinsp;4,90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e53,88\u0026thinsp;\u0026plusmn;\u0026thinsp;5,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e48,11\u0026thinsp;\u0026plusmn;\u0026thinsp;5,70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e51,34\u0026thinsp;\u0026plusmn;\u0026thinsp;4,69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e56,69\u0026thinsp;\u0026plusmn;\u0026thinsp;5,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e64,75\u0026thinsp;\u0026plusmn;\u0026thinsp;4,98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eId-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e50,85\u0026thinsp;\u0026plusmn;\u0026thinsp;7,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e48,46\u0026thinsp;\u0026plusmn;\u0026thinsp;7,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e47,15\u0026thinsp;\u0026plusmn;\u0026thinsp;8,47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e45,38\u0026thinsp;\u0026plusmn;\u0026thinsp;6,38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,019*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e56,26\u0026thinsp;\u0026plusmn;\u0026thinsp;7,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e55,87\u0026thinsp;\u0026plusmn;\u0026thinsp;6,51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eVertical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52,64\u0026thinsp;\u0026plusmn;\u0026thinsp;3,85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e52,63\u0026thinsp;\u0026plusmn;\u0026thinsp;4,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e50,90\u0026thinsp;\u0026plusmn;\u0026thinsp;4,77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e50,51\u0026thinsp;\u0026plusmn;\u0026thinsp;4,97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e55,11\u0026thinsp;\u0026plusmn;\u0026thinsp;3,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e54,56\u0026thinsp;\u0026plusmn;\u0026thinsp;3,44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e90,38\u0026thinsp;\u0026plusmn;\u0026thinsp;6,01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e92,80\u0026thinsp;\u0026plusmn;\u0026thinsp;4,72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e85,87\u0026thinsp;\u0026plusmn;\u0026thinsp;5,95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e88,71\u0026thinsp;\u0026plusmn;\u0026thinsp;5,79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e87,29\u0026thinsp;\u0026plusmn;\u0026thinsp;12,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e85,90\u0026thinsp;\u0026plusmn;\u0026thinsp;10,77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePr-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e64,06\u0026thinsp;\u0026plusmn;\u0026thinsp;5,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e64,25\u0026thinsp;\u0026plusmn;\u0026thinsp;4,77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e58,87\u0026thinsp;\u0026plusmn;\u0026thinsp;4,83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e59,64\u0026thinsp;\u0026plusmn;\u0026thinsp;5,04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,028*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e66,71\u0026thinsp;\u0026plusmn;\u0026thinsp;3,75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e65,72\u0026thinsp;\u0026plusmn;\u0026thinsp;3,20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,013*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eId-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e85,96\u0026thinsp;\u0026plusmn;\u0026thinsp;6,24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e87,86\u0026thinsp;\u0026plusmn;\u0026thinsp;5,60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,048*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e81,12\u0026thinsp;\u0026plusmn;\u0026thinsp;6,04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e83,10\u0026thinsp;\u0026plusmn;\u0026thinsp;6,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,008*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e82,09\u0026thinsp;\u0026plusmn;\u0026thinsp;6,70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e79,90\u0026thinsp;\u0026plusmn;\u0026thinsp;4,47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,012*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDental\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSagittal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eİS-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52,39\u0026thinsp;\u0026plusmn;\u0026thinsp;5,97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e55,04\u0026thinsp;\u0026plusmn;\u0026thinsp;6,95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e48,68\u0026thinsp;\u0026plusmn;\u0026thinsp;6,66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e53,12\u0026thinsp;\u0026plusmn;\u0026thinsp;5,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e56,43\u0026thinsp;\u0026plusmn;\u0026thinsp;5,60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e64,89\u0026thinsp;\u0026plusmn;\u0026thinsp;5,98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAS-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e44,77\u0026thinsp;\u0026plusmn;\u0026thinsp;3,51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e46,54\u0026thinsp;\u0026plusmn;\u0026thinsp;4,68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e41,94\u0026thinsp;\u0026plusmn;\u0026thinsp;5,21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e44,64\u0026thinsp;\u0026plusmn;\u0026thinsp;4,66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e52,23\u0026thinsp;\u0026plusmn;\u0026thinsp;6,94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e60,21\u0026thinsp;\u0026plusmn;\u0026thinsp;6,68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eİİ-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e53,66\u0026thinsp;\u0026plusmn;\u0026thinsp;6,66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e51,67\u0026thinsp;\u0026plusmn;\u0026thinsp;6,56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e50,69\u0026thinsp;\u0026plusmn;\u0026thinsp;6,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e48,71\u0026thinsp;\u0026plusmn;\u0026thinsp;5,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e57,60\u0026thinsp;\u0026plusmn;\u0026thinsp;6,19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e57,05\u0026thinsp;\u0026plusmn;\u0026thinsp;5,81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAİ-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e44,66\u0026thinsp;\u0026plusmn;\u0026thinsp;8,52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e44,64\u0026thinsp;\u0026plusmn;\u0026thinsp;9,48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e40,81\u0026thinsp;\u0026plusmn;\u0026thinsp;9,58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e39,79\u0026thinsp;\u0026plusmn;\u0026thinsp;8,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e53,01\u0026thinsp;\u0026plusmn;\u0026thinsp;10,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e51,59\u0026thinsp;\u0026plusmn;\u0026thinsp;11,30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,006*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUM-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e27,65\u0026thinsp;\u0026plusmn;\u0026thinsp;5,40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29,08\u0026thinsp;\u0026plusmn;\u0026thinsp;5,48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e25,78\u0026thinsp;\u0026plusmn;\u0026thinsp;6,35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e29,31\u0026thinsp;\u0026plusmn;\u0026thinsp;5,25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e28,15\u0026thinsp;\u0026plusmn;\u0026thinsp;2,61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e35,42\u0026thinsp;\u0026plusmn;\u0026thinsp;4,46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUMA-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e28,51\u0026thinsp;\u0026plusmn;\u0026thinsp;4,10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29,76\u0026thinsp;\u0026plusmn;\u0026thinsp;4,42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,012*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e26,38\u0026thinsp;\u0026plusmn;\u0026thinsp;4,85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e29,96\u0026thinsp;\u0026plusmn;\u0026thinsp;3,55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e28,32\u0026thinsp;\u0026plusmn;\u0026thinsp;2,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e35,57\u0026thinsp;\u0026plusmn;\u0026thinsp;4,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLM-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e30,64\u0026thinsp;\u0026plusmn;\u0026thinsp;6,77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29,01\u0026thinsp;\u0026plusmn;\u0026thinsp;7,49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,006*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e25,62\u0026thinsp;\u0026plusmn;\u0026thinsp;7,37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e25,51\u0026thinsp;\u0026plusmn;\u0026thinsp;5,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e30,41\u0026thinsp;\u0026plusmn;\u0026thinsp;3,55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e30,75\u0026thinsp;\u0026plusmn;\u0026thinsp;3,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMA-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e21,87\u0026thinsp;\u0026plusmn;\u0026thinsp;7,94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21,99\u0026thinsp;\u0026plusmn;\u0026thinsp;9,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e17,41\u0026thinsp;\u0026plusmn;\u0026thinsp;8,67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e16,79\u0026thinsp;\u0026plusmn;\u0026thinsp;6,92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e27,48\u0026thinsp;\u0026plusmn;\u0026thinsp;4,67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e27,48\u0026thinsp;\u0026plusmn;\u0026thinsp;4,42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,730\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eVertical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eİS-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75,16\u0026thinsp;\u0026plusmn;\u0026thinsp;5,16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e74,83\u0026thinsp;\u0026plusmn;\u0026thinsp;5,57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e70,53\u0026thinsp;\u0026plusmn;\u0026thinsp;4,90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e71,57\u0026thinsp;\u0026plusmn;\u0026thinsp;4,97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,033*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e75,98\u0026thinsp;\u0026plusmn;\u0026thinsp;4,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e75,56\u0026thinsp;\u0026plusmn;\u0026thinsp;2,36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAS-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e53,93\u0026thinsp;\u0026plusmn;\u0026thinsp;4,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e53,90\u0026thinsp;\u0026plusmn;\u0026thinsp;5,02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e50,10\u0026thinsp;\u0026plusmn;\u0026thinsp;4,67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e50,54\u0026thinsp;\u0026plusmn;\u0026thinsp;4,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e55,81\u0026thinsp;\u0026plusmn;\u0026thinsp;2,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e55,09\u0026thinsp;\u0026plusmn;\u0026thinsp;2,66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,014*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eİİ-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75,13\u0026thinsp;\u0026plusmn;\u0026thinsp;5,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e76,20\u0026thinsp;\u0026plusmn;\u0026thinsp;5,49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e69,62\u0026thinsp;\u0026plusmn;\u0026thinsp;5,61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e70,68\u0026thinsp;\u0026plusmn;\u0026thinsp;5,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,030*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e77,67\u0026thinsp;\u0026plusmn;\u0026thinsp;4,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e75,01\u0026thinsp;\u0026plusmn;\u0026thinsp;2,94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAİ-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e92,59\u0026thinsp;\u0026plusmn;\u0026thinsp;5,80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e94,65\u0026thinsp;\u0026plusmn;\u0026thinsp;4,55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e87,40\u0026thinsp;\u0026plusmn;\u0026thinsp;5,90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e89,84\u0026thinsp;\u0026plusmn;\u0026thinsp;5,48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e88,40\u0026thinsp;\u0026plusmn;\u0026thinsp;9,73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e87,14\u0026thinsp;\u0026plusmn;\u0026thinsp;8,76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,014*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUM-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e65,94\u0026thinsp;\u0026plusmn;\u0026thinsp;3,92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e67,32\u0026thinsp;\u0026plusmn;\u0026thinsp;3,71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,016*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e61,06\u0026thinsp;\u0026plusmn;\u0026thinsp;4,41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e62,94\u0026thinsp;\u0026plusmn;\u0026thinsp;3,94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,008*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e65,90\u0026thinsp;\u0026plusmn;\u0026thinsp;3,22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e64,99\u0026thinsp;\u0026plusmn;\u0026thinsp;2,94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,031*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUMA-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e53,14\u0026thinsp;\u0026plusmn;\u0026thinsp;3,51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e52,64\u0026thinsp;\u0026plusmn;\u0026thinsp;3,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e48,01\u0026thinsp;\u0026plusmn;\u0026thinsp;4,03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e49,07\u0026thinsp;\u0026plusmn;\u0026thinsp;3,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,041*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e49,48\u0026thinsp;\u0026plusmn;\u0026thinsp;4,60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e48,92\u0026thinsp;\u0026plusmn;\u0026thinsp;4,66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,028*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLM-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e73,83\u0026thinsp;\u0026plusmn;\u0026thinsp;4,16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e75,14\u0026thinsp;\u0026plusmn;\u0026thinsp;3,51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e67,76\u0026thinsp;\u0026plusmn;\u0026thinsp;4,01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e69,64\u0026thinsp;\u0026plusmn;\u0026thinsp;4,38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e70,91\u0026thinsp;\u0026plusmn;\u0026thinsp;2,84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e70,35\u0026thinsp;\u0026plusmn;\u0026thinsp;3,52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0,048*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMA-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e86,51\u0026thinsp;\u0026plusmn;\u0026thinsp;4,30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e88,03\u0026thinsp;\u0026plusmn;\u0026thinsp;3,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,035*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e79,59\u0026thinsp;\u0026plusmn;\u0026thinsp;3,96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c7\"\u003e \u003cp\u003e82,77\u0026thinsp;\u0026plusmn;\u0026thinsp;3,21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0,003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c9\"\u003e \u003cp\u003e83,76\u0026thinsp;\u0026plusmn;\u0026thinsp;2,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c10\"\u003e \u003cp\u003e83,36\u0026thinsp;\u0026plusmn;\u0026thinsp;4,03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0,059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eSignificance level: *p ˂0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of differences between T1 and T0 periods for the study groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eSkeletal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDifference\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSagittal\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,87\u0026thinsp;\u0026plusmn;\u0026thinsp;2,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,69\u0026thinsp;\u0026plusmn;\u0026thinsp;2,05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8,36\u0026thinsp;\u0026plusmn;\u0026thinsp;2,87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;1,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,95\u0026thinsp;\u0026plusmn;\u0026thinsp;2,39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,81\u0026thinsp;\u0026plusmn;\u0026thinsp;2,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,69\u0026thinsp;\u0026plusmn;\u0026thinsp;1,32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePr-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,09\u0026thinsp;\u0026plusmn;\u0026thinsp;2,43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,23\u0026thinsp;\u0026plusmn;\u0026thinsp;1,78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8,06\u0026thinsp;\u0026plusmn;\u0026thinsp;2,77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eId-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2,39\u0026thinsp;\u0026plusmn;\u0026thinsp;1,78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,77\u0026thinsp;\u0026plusmn;\u0026thinsp;3,05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,39\u0026thinsp;\u0026plusmn;\u0026thinsp;2,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eVertical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,01\u0026thinsp;\u0026plusmn;\u0026thinsp;1,87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0,39\u0026thinsp;\u0026plusmn;\u0026thinsp;1,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,55\u0026thinsp;\u0026plusmn;\u0026thinsp;1,46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,42\u0026thinsp;\u0026plusmn;\u0026thinsp;2,75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,84\u0026thinsp;\u0026plusmn;\u0026thinsp;2,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1,39\u0026thinsp;\u0026plusmn;\u0026thinsp;3,01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePr-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,19\u0026thinsp;\u0026plusmn;\u0026thinsp;2,25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,76\u0026thinsp;\u0026plusmn;\u0026thinsp;1,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,99\u0026thinsp;\u0026plusmn;\u0026thinsp;1,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0,008*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eId-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,9\u0026thinsp;\u0026plusmn;\u0026thinsp;3,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,98\u0026thinsp;\u0026plusmn;\u0026thinsp;2,45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2,19\u0026thinsp;\u0026plusmn;\u0026thinsp;3,18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;1,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSagittal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"16\" nameend=\"c2\" namest=\"c1\" rowspan=\"17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eİS-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,64\u0026thinsp;\u0026plusmn;\u0026thinsp;2,66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,44\u0026thinsp;\u0026plusmn;\u0026thinsp;2,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8,46\u0026thinsp;\u0026plusmn;\u0026thinsp;2,22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAS-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,76\u0026thinsp;\u0026plusmn;\u0026thinsp;2,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,7\u0026thinsp;\u0026plusmn;\u0026thinsp;2,19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7,98\u0026thinsp;\u0026plusmn;\u0026thinsp;1,57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;1,2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eİİ-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,99\u0026thinsp;\u0026plusmn;\u0026thinsp;1,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,98\u0026thinsp;\u0026plusmn;\u0026thinsp;1,92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,55\u0026thinsp;\u0026plusmn;\u0026thinsp;1,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0,039*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAİ-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,02\u0026thinsp;\u0026plusmn;\u0026thinsp;2,98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1,02\u0026thinsp;\u0026plusmn;\u0026thinsp;2,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1,41\u0026thinsp;\u0026plusmn;\u0026thinsp;1,46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUM-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,43\u0026thinsp;\u0026plusmn;\u0026thinsp;1,55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,53\u0026thinsp;\u0026plusmn;\u0026thinsp;2,18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7,27\u0026thinsp;\u0026plusmn;\u0026thinsp;2,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUMA-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,26\u0026thinsp;\u0026plusmn;\u0026thinsp;1,69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,58\u0026thinsp;\u0026plusmn;\u0026thinsp;2,29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7,25\u0026thinsp;\u0026plusmn;\u0026thinsp;2,67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u0026thinsp;\u0026gt;\u0026thinsp;2\u0026thinsp;\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLM-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,63\u0026thinsp;\u0026plusmn;\u0026thinsp;1,81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0,11\u0026thinsp;\u0026plusmn;\u0026thinsp;2,87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,34\u0026thinsp;\u0026plusmn;\u0026thinsp;2,98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLMA-Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,11\u0026thinsp;\u0026plusmn;\u0026thinsp;3,04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0,61\u0026thinsp;\u0026plusmn;\u0026thinsp;3,28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u0026thinsp;\u0026plusmn;\u0026thinsp;1,36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eVertical\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eİS-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,34\u0026thinsp;\u0026plusmn;\u0026thinsp;1,66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,04\u0026thinsp;\u0026plusmn;\u0026thinsp;1,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,42\u0026thinsp;\u0026plusmn;\u0026thinsp;2,45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAS-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,03\u0026thinsp;\u0026plusmn;\u0026thinsp;1,41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,44\u0026thinsp;\u0026plusmn;\u0026thinsp;1,55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,72\u0026thinsp;\u0026plusmn;\u0026thinsp;1,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eİİ-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,07\u0026thinsp;\u0026plusmn;\u0026thinsp;2,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,06\u0026thinsp;\u0026plusmn;\u0026thinsp;1,41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2,66\u0026thinsp;\u0026plusmn;\u0026thinsp;3,19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAİ-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,06\u0026thinsp;\u0026plusmn;\u0026thinsp;2,71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,44\u0026thinsp;\u0026plusmn;\u0026thinsp;1,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1,26\u0026thinsp;\u0026plusmn;\u0026thinsp;2,22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUM-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,38\u0026thinsp;\u0026plusmn;\u0026thinsp;1,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,89\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,91\u0026thinsp;\u0026plusmn;\u0026thinsp;1,39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUMA-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,5\u0026thinsp;\u0026plusmn;\u0026thinsp;1,93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,06\u0026thinsp;\u0026plusmn;\u0026thinsp;1,58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,56\u0026thinsp;\u0026plusmn;\u0026thinsp;1,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0,016*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u0026thinsp;\u0026gt;\u0026thinsp;1,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLM-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,31\u0026thinsp;\u0026plusmn;\u0026thinsp;2,32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,88\u0026thinsp;\u0026plusmn;\u0026thinsp;1,89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,56\u0026thinsp;\u0026plusmn;\u0026thinsp;0,96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0,001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLMA-X\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,52\u0026thinsp;\u0026plusmn;\u0026thinsp;2,27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,19\u0026thinsp;\u0026plusmn;\u0026thinsp;2,31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,39\u0026thinsp;\u0026plusmn;\u0026thinsp;1,47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e,\u003cb\u003e000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,2\u0026thinsp;\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eSignificance level: *p ˂0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this retrospective archival study demonstrated that the 9-week Alt-RAMEC/2-HME provided nearly the same degree of maxillary advancement as the 10-month RME/FM.\u003c/p\u003e \u003cp\u003eThe amount of maxillary anterior displacement achieved in the group treated with 9-week Alt-RAMEC alone, without the use of an extraoral appliance, was quite close to the value obtained in the group treated with 10-month FM after RME (2.69 ± 2.05 mm vs. 1.87 ± 2.13 mm). Only maxillary advancement close to the FM with Alt-RAMEC seems to be associated with Alt-RAMEC's weekly repeated protocol. This assumes a geometrically anterior displacement or repositioning of the maxilla without the possibility for bone resorption behind the maxillary tuberosities [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Thus, the maxilla is consistently displace anteriorly with the 2-hinged expander.\u003c/p\u003e \u003cp\u003eThe total amount of maxillary advancement was 1,87 ± 2,13 mm in 2.1 months for the Alt-RAMEC group in contrast with 2,69 ± 2,05 in 10.1 months with a RME/FM. The amount of maxillary advencement in the Alt-RAMEC/2-HME group was almost similar to that in RME/FM. Here, the 2-hinged expander combined with the Alt-RAMEC may have contributed greater amount of maxillary advancement. The design of 2-hinged expander is consistently displace the maxilla anteriorly. Because of the two hinges, the expander rotates each half of the maxilla outward and forward around the palatomaxillary region, rather than around the posterior nasal spine, as the hyrax expander does. This assumes a geometrically anterior displacement or repositioning of the maxilla without the possibility for bone resorption behind the junction of horizontal part of palatal bone and palatine part of maxilla [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Maxillary expansion with spontaneous maxillary advancement has an advantage over a face mask that requires patient compliance [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMaxillary expansion before maxillary advancement with FM to facilitate maxillary protraction is a current practice in the treatment of Class III malocclusions characterized with the maxillary retrusion [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]. The literature has reported that both the Alt-RAMEC/FM combination [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e] and the RME/FM combination provide more effective maxillary advancement [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. In this study, with the only 9-week Alt-RAMEC/2-HME was achieved a maxillary protraction very similar to that applied 10,1 ± 1,9 months of RME/FM (A; 1.87 ± 2.13 mm versus 2.69 ± 2.05 mm). At this point, it would not be wrong to think that clinically effective maxillary advancement is achieved with Alt-RAMEC alone, without a FM. Liou and Tsai explained the more effective maxillary advancement with Alt-RAMEC compared to RME by the creation of a distraction-like osteogenesis-like reaction in the circummaxillary sutures with expansion/protraction.\u003csup\u003e18\u003c/sup\u003e On the other hand, the FM poses problems in terms of aesthetics, comfort, and social interactions, negatively impacting the skeletal effects of the treatment [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, the upper incisor moved anteriorly with Alt-RAMEC/2-HME in a bodily, while the RME/FM moved anteriorly with the same amount of root movement and greater crown tipping. According to this result, while greater anterior movement at point A was expected with Alt-RAMEC/2-HME, similar results were found with RME/FM, as the amount of distal root movement of the upper incisors was the same in both groups. In this study, maxillary molars were positioned anteriorly with crown tipping using RME/FM; more vertical movement was observed with the McNamara-type expander, despite the occlusal capping. This may be due to protraction elastics applied at a 40-degree angle from maxillary occlusal plane. Therefore, in the RME/FM group, Class III combined with maxillary retrusion was eliminated by posterior rotation of the mandible due to vertical movement of the maxillary molars, rather than anterior movement of the maxilla. Statistical analysis revealed that the maxillary molars in the Alt-RAMEC/2-HME group, compared to the RME/FM group, moved anteriorly in bodily but less. However, the crucial point here is the which application and the time it takes to achieve maxillary movement In fact, with only Alt-RAMEC/2-HME, a controlled upper molar movement was observed in both sagittal and vertical directions in approximately 2 months, while with RME/FM, an upper molar movement was observed predominantly in the vertical direction after approximately 10 months.\u003c/p\u003e \u003cp\u003eThe maxilla is repositioned in its entirety with the Le Fort I osteotomy. An average maxillary advancement of 5–8 mm is achieved with the Le Fort I [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]. The findings of this study are consistent with the literature. The Le Fort I osteotomy has some complications, such as intraoperative vascular and neural complications and postoperative stability and relapse [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. The literature has reported that Alt-RAMEC achieves almost as much maxillary advancement as Le Fort I osteotomy in cases of cleft lip and palate [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, because this study consisted of cases without cleft lip and palate, the Le Fort I osteotomy was naturally more effective in terms of maxillary advancement than Alt-RAMEC.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the maxillary deficiency during the late growth period, skeletal maxillary advancement can be achieved using the Alt-RAMEC alone with 2-hinged expander, without the need for FM therapy. The RME/FM combination resulted in more dentoalveolar effects compared with Alt-RAMEC/2-HME. Before making decision on Le Fort 1 surgery, it may be beneficial to consider Alt-RAMEC for the positive late-stage effect on the maxilla.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRME: Rapid Maxillary Expansion (RME)\u003c/p\u003e\n\u003cp\u003eAlt-RAMEC: Alternate Rapid Maxillary Expansion and Construction\u003c/p\u003e\n\u003cp\u003e2-HME: 2-Hinged Maxillary Expander\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFM: Face Mask\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePNS: Posterior Nasal Spina\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e2)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved by the Ankara University Faculty of Dentistry Ethics Committee.\u003c/p\u003e\n\u003cp\u003eSince the research is a retrospective archive study, consent to participate is not applicable..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3) Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4) Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and material used during the current study are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5) Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6) Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7) Author’s Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, N.C.T. and H.G.; methodology, N.C.T. and H.G.; investigation, N.C.T. and H.G.; writing—original draft preparation, N.C.T. and H.G.; writing—review and editing, N.C.T. and H.G.; supervision, H.G.; All authors have read and agreed to the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8) Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTurley PK (2007) Treatment of the Class III malocclusion with maxillary expansion and protraction. Semin Orthod 13(3).\u003c/li\u003e\n\u003cli\u003eCleall JF (1974) Growth of the palate and maxillary dental arch. J Dent Res 53(5):1226\u0026ndash;1234.\u003c/li\u003e\n\u003cli\u003eBoryor A, et al (2008) Stress distribution and displacement analysis during an intermaxillary disjunction\u0026mdash;a three-dimensional FEM study of a human skull. J Biomech 41(2):376\u0026ndash;382.\u003c/li\u003e\n\u003cli\u003eChaconas SJ, Caputo AA (1982) Observation of orthopedic force distribution produced by maxillary orthodontic appliances. Am J Orthod 82(6):492\u0026ndash;501.\u003c/li\u003e\n\u003cli\u003eGardner GE, Kronman JH (1971) Cranioskeletal displacements caused by rapid palatal expansion in the rhesus monkey. Am J Orthod 59(2):146\u0026ndash;155.\u003c/li\u003e\n\u003cli\u003eGautam P, Valiathan A, Adhikari R (2007) Stress and displacement patterns in the craniofacial skeleton with rapid maxillary expansion: a finite element method study. Am J Orthod Dentofacial Orthop 132(1):5.e1\u0026ndash;5.e11.\u003c/li\u003e\n\u003cli\u003eHolberg C (2005) Effects of rapid maxillary expansion on the cranial base\u0026mdash;an FEM-analysis. J Orofac Orthop 66(1):54\u0026ndash;66.\u003c/li\u003e\n\u003cli\u003eIşeri H, et al (1998) Biomechanical effects of rapid maxillary expansion on the craniofacial skeleton, studied by the finite element method. Eur J Orthod 20(4):347\u0026ndash;356.\u003c/li\u003e\n\u003cli\u003eItoh T, et al (1985) Photoelastic effects of maxillary protraction on the craniofacial complex. Am J Orthod 88(2):117\u0026ndash;124.\u003c/li\u003e\n\u003cli\u003eJafari A, Shetty KS, Kumar M (2003) Study of stress distribution and displacement of various craniofacial structures following application of transverse orthopedic forces\u0026mdash;a three-dimensional FEM study. Angle Orthod 73(1):12\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003eTimms DJ (1980) A study of basal movement with rapid maxillary expansion. Am J Orthod 77(5):500\u0026ndash;507.\u003c/li\u003e\n\u003cli\u003eWang YC, Chang PMS, Liou EJW (2009) Opening of circumaxillary sutures by alternate rapid maxillary expansions and constrictions. Angle Orthod 79(2):230\u0026ndash;234.\u003c/li\u003e\n\u003cli\u003eHaas AJ (1970) Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod 57:219\u0026ndash;255.\u003c/li\u003e\n\u003cli\u003eMelsen B (1975) Palatal growth studied on human autopsy material: a histologic microradiographic study. Am J Orthod 68(1):42\u0026ndash;54.\u003c/li\u003e\n\u003cli\u003eda Silva Filho OG, Boas MC, Capelozza Filho L (1991) Rapid maxillary expansion in the primary and mixed dentitions: a cephalometric evaluation. Am J Orthod Dentofacial Orthop 100(2):171\u0026ndash;179.\u003c/li\u003e\n\u003cli\u003eVardimon AD, Brosh T, Spiegler A, Lieberman M, Pitaru S (1998) Rapid palatal expansion. Part 1: mineralization pattern of the midpalatal suture in cats. Am J Orthod Dentofacial Orthop 113(4):371\u0026ndash;378.\u003c/li\u003e\n\u003cli\u003eLeonardi R, et al (2011) Early post-treatment changes of circumaxillary sutures in young patients treated with rapid maxillary expansion. Angle Orthod 81(1):36\u0026ndash;41.\u003c/li\u003e\n\u003cli\u003eLiou EJW, Tsai WC (2005) A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 42(2):121\u0026ndash;127.\u003c/li\u003e\n\u003cli\u003eLiou EJW, Chen PKT (2003) New orthodontic and orthopaedic managements on the premaxillary deformities in patients with bilateral cleft before alveolar bone grafting. Ann Coll Surg Hong Kong 7(3):73\u0026ndash;82.\u003c/li\u003e\n\u003cli\u003eMcNamara JA Jr (1987) An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod 21:598\u0026ndash;608.\u003c/li\u003e\n\u003cli\u003eTurley PK (1988) Orthopedic correction of Class III malocclusion with palatal expansion and custom protractor headgear. J Clin Orthod 22:314\u0026ndash;325.\u003c/li\u003e\n\u003cli\u003eMelsen B (1975) Palatal growth studied on human autopsy material: a histologic microradiographic study. Am J Orthod Dentofacial Orthop 68(1):42\u0026ndash;54.\u003c/li\u003e\n\u003cli\u003eda Silva Filho OG, Boas CV, Capelozza Filho L (1991) Rapid maxillary expansion in the primary and mixed dentitions: a cephalometric evaluation. Am J Orthod Dentofacial Orthop 100(2):171\u0026ndash;179.\u003c/li\u003e\n\u003cli\u003eGhoneima A, et al (2011) Effects of rapid maxillary expansion on the cranial and circummaxillary sutures. Am J Orthod Dentofacial Orthop 140(4):510\u0026ndash;519.\u003c/li\u003e\n\u003cli\u003eCelikoglu M, Oktay H (2014) Effects of maxillary protraction for early correction of Class III malocclusion. Eur J Orthod 36(1):86\u0026ndash;92.\u003c/li\u003e\n\u003cli\u003eIsci D, Turk T, Elekdag-Turk S (2010) Activation\u0026ndash;deactivation rapid palatal expansion and reverse headgear in Class III cases. Eur J Orthod 32(6):706\u0026ndash;715.\u003c/li\u003e\n\u003cli\u003eBiederman W (1973) Rapid correction of Class III malocclusion by midpalatal expansion. Am J Orthod Dentofacial Orthop 63:47\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003eJafari A, Shetty KS, Kumar M (2003) Study of stress distribution and displacement of various craniofacial structures following application of transverse orthopedic forces\u0026mdash;a three-dimensional FEM study. Angle Orthod 73:12\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003eIşeri H, Tekkaya AE, \u0026Ouml;ztan \u0026Ouml;, Bilgic S (1998) Biomechanical effects of rapid maxillary expansion on the craniofacial skeleton studied by the finite element method. Eur J Orthod 20(4):347\u0026ndash;356.\u003c/li\u003e\n\u003cli\u003eTurley PK (2002) Managing the developing Class III malocclusion with palatal expansion and facemask therapy. Am J Orthod Dentofacial Orthop 122(4):349\u0026ndash;352.\u003c/li\u003e\n\u003cli\u003eLiu W, et al (2015) Effect of maxillary protraction with alternating rapid palatal expansion and constriction versus expansion alone in maxillary retrusive patients: a randomized controlled trial. Am J Orthod Dentofacial Orthop 148:641\u0026ndash;651.\u003c/li\u003e\n\u003cli\u003eMasucci C, et al (2014) Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class III malocclusion: a controlled study. Orthod Craniofac Res 17:259\u0026ndash;269.\u003c/li\u003e\n\u003cli\u003eDo-de Latour TB, et al (2009) Effect of alternate maxillary expansion and contraction on protraction of the maxilla: a pilot study. Hong Kong Dent J 6:72\u0026ndash;82.\u003c/li\u003e\n\u003cli\u003eda Luz Vieira G, et al (2009) Dentoskeletal effects of maxillary protraction in cleft patients with repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 46:391\u0026ndash;398.\u003c/li\u003e\n\u003cli\u003eAbu Alhaija ES, Karajeh MA (2013) Acceptability and attractiveness of intra- and extra-oral orthodontic appliances. Int J Orthod 24:11\u0026ndash;17.\u003c/li\u003e\n\u003cli\u003eIerardo G, et al (2018) Skin irritation from a facial mask in Class III malocclusion: evaluation of individual silicone chin cups in 100 children. Minerva Stomatol 67:45\u0026ndash;48.\u003c/li\u003e\n\u003cli\u003eFranchi L, et al (2024) Clinical management of facemasks for early treatment of Class III malocclusion: a survey among SIDO members. Dent J (Basel) 12(7):207.\u003c/li\u003e\n\u003cli\u003eMistry TA, Mistry A (2021) Comparison of conventional Le Fort I advancement, anterior maxillary segmental distraction, and distraction osteogenesis of the maxilla for cleft maxillary hypoplasia: a systematic review. J Cleft Lip Palate Craniofac Anomal 8(1):49\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003eBaas EM, et al (2015) Skeletal stability after bilateral sagittal split osteotomy or distraction osteogenesis of the mandible: a randomized clinical trial. Int J Oral Maxillofac Surg 44(5):615\u0026ndash;620.\u003c/li\u003e\n\u003cli\u003eIannetti G, et al (2013) Complications of orthognathic surgery: a retrospective study on 3236 patients. Eur Rev Med Pharmacol Sci 17(3):379\u0026ndash;384.\u003c/li\u003e\n\u003cli\u003eMeazzini MC, et al (2019) Short- and long-term effects of late maxillary advancement with the Liou\u0026ndash;Alt-RAMEC protocol in unilateral cleft lip and palate. Cleft Palate Craniofac J 56(2):159\u0026ndash;167.\u003c/li\u003e\n\u003cli\u003eMeazzini MC (2020) Treatment of maxillary hypoplasia in cleft lip and palate patients: keeping the total burden of care as low as possible. J Cleft Lip Palate Craniofac Anomal 7(1):1\u0026ndash;7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"maxillary protraction, rapid maxillary expansion, alternate rapid maxillary expansion and construction, Le fort 1 surgery","lastPublishedDoi":"10.21203/rs.3.rs-8414011/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8414011/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eClass III malocclusion characterized by maxillary deficiency is treated with orthopedic approaches during the growth period and with Le-Fort I osteotomy in adulthood. Achieving effective maxillary protraction during growth typically requires mobilization of the circummaxillary sutures through expansion prior to facemask (FM) therapy. Although rapid maxillary expansion (RME) separates not only the midpalatal suture but also contributes to the disarticulation of the circummaxillary sutures, its effect on these sutures is often more limited than expected due to their strong interdigitation. To enhance sagittal advancement by disarticulating the circummaxillary sutures, Liou and Tsai introduced the Alternate Rapid Maxillary Expansions and Constrictions (Alt-RAMEC) protocol in combination with a 2-Hinged Screw Maxillary Expander (2-HME), which shifts the center of rotation toward the pterygoid plates, thereby producing a more pronounced anterior displacement of the maxillary segments. The aim of this study is to evaluate by comparing with Le-Fort I whether the Alt-RAMEC/2-HME protocol produces greater anterior maxillary displacement compared with the RME/FM approach.\u003c/p\u003e\u003ch2\u003eMaterial Metod:\u003c/h2\u003e \u003cp\u003eThe material of this single-center retrospective study included 42 individuals with skeletal Class III malocclusion characterized by maxillary deficiency who were treated with Alt-RAMEC/2-HME, RME/FM and Le-Fort I selected from the archives of Ankara University Department of Orthodontics. Skeletal and dental changes in the sagittal and vertical planes at T0 and T1 were measured linearly on lateral cephalometric radiographs using the AutoCAD program. Data was analyzed using SPSS 26 at a significance level of p˂0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the late skeletal period, the shorter-duration Alt-RAMEC/2-HME protocol obtained a level of maxillary advancement comparable to that achieved with RME/FM applied at an earlier developmental stage. The magnitude of advancement in both protocols remained lower than that obtained with Le-Fort I. The RME/FM results were longer and more dentoalveolar compared to Alt-RAMEC/2-HME. Both methods produced mandibular posterior rotation, which was more pronounced in RME.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn the maxillary deficiency during the late growth period, skeletal maxillary advancement can be achieved using the Alt-RAMEC protocol alone, without the need for FM. Considering this outcome, the indication for Le-Fort I may be re-evaluated. The RME/FM resulted in greater dentoalveolar effects compared with Alt-RAMEC/2-HME.\u003c/p\u003e","manuscriptTitle":"Alternate Rapid Maxillary Expansion and Construction versus Rapid Maxillary Expansion combined with Face Mask: Which is a more effective method for Maxillary Protraction?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 16:02:04","doi":"10.21203/rs.3.rs-8414011/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b6c1749-87e4-498b-9ea2-03c6ddc616fc","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T15:10:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 16:02:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8414011","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8414011","identity":"rs-8414011","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}