A comparison of alternate-rapid maxillary expansion and constriction protocol with conventional rapid maxillary expansion in Class III malocclusion patients – A systematic review and meta-analysis

POINT 1

Figure 1: PRISMA 2020 flow diagram versus text: Figure 1 lists “Duplicate records removed” as n = 996, whereas the result text states 396 duplicates. Kindly confirm which value is correct.

In our opinion, since only 537 records were identified, it sounds inappropriate that n = 996 were the duplicates that were identified.

The matter written in the results section appears to be right. “The initial electronic database search on PubMed/MEDLINE, Cochrane Library, and DOAJ resulted in 537 titles. 396 articles were cited as duplicates.”

Hence, in Figure 1, the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 flow diagram where it is denoted as “Duplicate records removed (n = 996)” needs to be corrected.

POINT 2

The pooled mean difference for overjet is reported as 0.57 (0.18, 0.96). However, the Forest plot depicting overjet in Figure 5 appears to suggest that the effect favors conventional rapid maxillary expansion (RME), while the narrative interpretation in the text describes the improvement as favoring alternate-rapid maxillary expansion and constriction (Alt-RAMEC).

“The Alt-RAMEC protocol demonstrated a significant improvement in overjet (mean difference = 0.57 [0.18, 0.96]), which indicates that this method is more effective in correcting overjet compared to conventional RME.”

“The pooled mean difference value obtained was 0.57 (0.18, 0.96), indicating that the overjet value post-treatment was greater with the Alt-RAMEC group as compared to RME.”

Could the authors clarify this mismatch in interpretation?

POINT 3

In the discussion section, it is mentioned as “Although a statistically significant reduction in overjet was observed between the ALT-RAMEC and conventional expansion groups (mean difference = 0.67 mm), the clinical significance of this change remains uncertain.”

However, the Forest plot in Figure 5, Table 6, and the text suggests a correction of 0.57mm.

We would be extremely grateful if you could kindly clarify the above-mentioned points with the authors concerned to ensure enhanced reader clarity of the published article.

The authors confirm that there was no conflict of interest, as also no use of artificial intelligence-assisted technology for assisting in the writing or editing of the letter addressed to the editor.

According to the guidelines regarding the number of authors for a letter to the editor, it has been mentioned as 2 authors only. Nevertheless, 3 authors have contributed to the three points raised regarding the article. However, it is left to your discretion regarding the number of authors to be included.

Thank you for your time and patience.