{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:09:58Z","timestamp":1778764198274,"version":"3.51.4"},"reference-count":52,"publisher":"Elsevier BV","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["ajodo.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Orthodontics and Dentofacial Orthopedics"],"published-print":{"date-parts":[[2026,5]]},"DOI":"10.1016\/j.ajodo.2025.11.017","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T08:26:55Z","timestamp":1774427215000},"page":"605-616.e1","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["The relation between normodivergent and hyperdivergent skeletal patterns and the outcome of activator treatment"],"prefix":"10.1016","volume":"169","author":[{"given":"Nahren","family":"Gorges","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7829-9116","authenticated-orcid":false,"given":"Henk Simon","family":"Brand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinder","family":"Kuitert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Burcu","family":"Aydin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajodo.2025.11.017_bib1","series-title":"Classification of malocclusion","author":"Angle","year":"1899"},{"key":"10.1016\/j.ajodo.2025.11.017_bib2","article-title":"Treatment of malocclusion of the teeth: angle\u2019s system. Greatly Enl. and entirely rewritten, with six hundred and forty-one illustrations","author":"Angle","year":"1907","journal-title":"Philadelphia: S.S. White dental manufacturing Co"},{"key":"10.1016\/j.ajodo.2025.11.017_bib3","series-title":"Contemporary orthodontics","first-page":"96","author":"Proffit","year":"2000"},{"key":"10.1016\/j.ajodo.2025.11.017_bib4","series-title":"Essentials for orthodontic practice","first-page":"170","author":"Riolo","year":"2003"},{"key":"10.1016\/j.ajodo.2025.11.017_bib5","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/0002-9416(80)90299-7","article-title":"Differential diagnosis of Class II malocclusions. Part 1. Facial types associated with Class II malocclusions","volume":"78","author":"Moyers","year":"1980","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib6","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/S0889-5406(97)70287-7","article-title":"Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition","volume":"111","author":"Baccetti","year":"1997","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"10.1016\/j.ajodo.2025.11.017_bib7","first-page":"177","article-title":"Components of Class II malocclusion in children 8-10 years of age","volume":"51","author":"McNamara","year":"1981","journal-title":"Angle Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib8","series-title":"Early treatment of Class II malocclusion with excessive overjet: evaluating oral health-related quality of life, randomised controlled trials on headgear activator treatment and costs [thesis]","author":"Kallunki","year":"2021"},{"key":"10.1016\/j.ajodo.2025.11.017_bib9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1053\/j.sodo.2005.10.005","article-title":"Class II malocclusions: diagnostic and clinical considerations with and without treatment","volume":"12","author":"Bishara","year":"2006","journal-title":"Semin Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib10","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1177\/0022034515581643","article-title":"Candidate gene analyses of skeletal variation in malocclusion","volume":"94","author":"da Fontoura","year":"2015","journal-title":"J Dent Res"},{"key":"10.1016\/j.ajodo.2025.11.017_bib11","first-page":"210","article-title":"Class II Division. 2 malocclusion","volume":"28","author":"Strang","year":"1958","journal-title":"Angle Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0002-9416(63)90062-9","article-title":"Some biologic aspects of orthodontic treatment in the transitional dentition","volume":"49","author":"Harvold","year":"1963","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib13","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1111\/j.1834-7819.2007.tb00484.x","article-title":"Contemporary Class II orthodontic and orthopaedic treatment: a review","volume":"52","author":"Tadic","year":"2007","journal-title":"Aust Dent J"},{"issue":"74-6","key":"10.1016\/j.ajodo.2025.11.017_bib14","first-page":"79","article-title":"Extra-oral appliances in orthodontic treatment","volume":"43","author":"Almuzian","year":"2016","journal-title":"Dent Update"},{"key":"10.1016\/j.ajodo.2025.11.017_bib15","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/0002-9416(82)90463-8","article-title":"Histologic analysis of temporomandibular joint adaptation to protrusive function in young adult rhesus monkeys (Macaca mulatta)","volume":"82","author":"McNamara","year":"1982","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib16","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/0002-9416(70)90023-0","article-title":"Application and appliance manipulation of functional forces","volume":"58","author":"Hotz","year":"1970","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib17","first-page":"89","article-title":"Mandibular growth and class II treatment","volume":"36","author":"Marschner","year":"1966","journal-title":"Angle Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib18","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/0002-9416(84)90004-6","article-title":"A cephalometric analysis of skeletal and dental changes contributing to Class II correction in activator treatment","volume":"85","author":"Pancherz","year":"1984","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib19","first-page":"587","article-title":"Results of Class II functional appliance treatment","volume":"16","author":"Schulhof","year":"1982","journal-title":"J Clin Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib20","series-title":"Removable orthodontic appliances","first-page":"229","article-title":"The bionator","author":"Ascher","year":"1977"},{"key":"10.1016\/j.ajodo.2025.11.017_bib21","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/0002-9416(72)90107-8","article-title":"The scope and limitations of treatment with the activator","volume":"61","author":"Tulley","year":"1972","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib22","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S0002-9416(84)90028-9","article-title":"Prediction of mandibular growth rotation evaluated from a longitudinal implant sample","volume":"86","author":"Skieller","year":"1984","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib23","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/0002-9416(74)90114-6","article-title":"Activators: a practical approach","volume":"66","author":"Hirzel","year":"1974","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib24","series-title":"Orthodontics in daily practice","first-page":"556","article-title":"The activator","author":"Woodside","year":"1974"},{"key":"10.1016\/j.ajodo.2025.11.017_bib25","first-page":"271","article-title":"The mechanism of Class II correction during Herbst therapy in relation to the vertical jaw base relationship: a cephalometric roentgenographic study","volume":"67","author":"Ruf","year":"1997","journal-title":"Angle Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib26","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1093\/ejo\/4.4.279","article-title":"Overjet correction by a combined headgear and activator","volume":"4","author":"van Beek","year":"1982","journal-title":"Eur J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib27","first-page":"185","article-title":"Combination headgear-activator","volume":"18","author":"van Beek","year":"1984","journal-title":"J Clin Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib28","doi-asserted-by":"crossref","first-page":"305","DOI":"10.4103\/ejd.ejd_274_16","article-title":"Determination of Tweed\u2019s cephalometric norms in Bengali population","volume":"11","author":"Kumari","year":"2017","journal-title":"Eur J Dent"},{"key":"10.1016\/j.ajodo.2025.11.017_bib29","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/0022-3913(76)90026-3","article-title":"Significance of the Frankfort-mandibular plane angle to prosthodontics","volume":"36","author":"DiPietro","year":"1976","journal-title":"J Prosthet Dent"},{"key":"10.1016\/j.ajodo.2025.11.017_bib30","series-title":"Orthodontic cephalometry","author":"Athanasiou","year":"1995"},{"key":"10.1016\/j.ajodo.2025.11.017_bib31","series-title":"Anthropometric facial proportions in medicine","author":"Farkas","year":"1987"},{"key":"10.1016\/j.ajodo.2025.11.017_bib32","series-title":"A syllabus in roentgenographic cephalometry","author":"Krogman","year":"1957"},{"key":"10.1016\/j.ajodo.2025.11.017_bib33","series-title":"Handbook of orthodontics","first-page":"235","author":"Moyers","year":"1988"},{"key":"10.1016\/j.ajodo.2025.11.017_bib34","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/S0889-5406(05)80438-X","article-title":"Long-term stability and prediction of soft tissue changes after LeFort I surgery","volume":"104","author":"Hack","year":"1993","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"10.1016\/j.ajodo.2025.11.017_bib35","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/0002-9416(82)90489-4","article-title":"The mechanism of Class II correction in Herbst appliance treatment. A cephalometric investigation","volume":"82","author":"Pancherz","year":"1982","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib36","first-page":"189","article-title":"Vertical dentofacial changes during Herbst appliance treatment. A cephalometric investigation","volume":"15","author":"Pancherz","year":"1982","journal-title":"Swed Dent J Suppl"},{"key":"10.1016\/j.ajodo.2025.11.017_bib37","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/ejo\/25.1.87","article-title":"The effects of activator treatment on the craniofacial structures of Class II division 1 patients","volume":"25","author":"Basciftci","year":"2003","journal-title":"Eur J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib38","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/ejo\/23.5.569","article-title":"The clinical significance of error measurement in the interpretation of treatment results","volume":"23","author":"Kamoen","year":"2001","journal-title":"Eur J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib39","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2319\/060117-369.1","article-title":"Treatment changes of hypo- and hyperdivergent Class II Herbst patients","volume":"88","author":"Rogers","year":"2018","journal-title":"Angle Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib40","first-page":"741","article-title":"An analysis of the corrective contribution in activator treatment","volume":"74","author":"Cozza","year":"2004","journal-title":"Angle Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib41","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1093\/ejo\/cjm003","article-title":"Effects of activator and high-pull headgear combination therapy: skeletal, dentoalveolar, and soft tissue profile changes","volume":"29","author":"Mar\u015fan","year":"2007","journal-title":"Eur J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib42","first-page":"334","article-title":"Cephalometric appraisal of Class II treatment effects after functional and fixed appliances: a retrospective study","volume":"39","author":"Zelderloo","year":"2017","journal-title":"Eur J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib43","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/1367691","article-title":"Reliability of growth indicators and efficiency of functional treatment for skeletal Class II malocclusion: current evidence and controversies","volume":"2017","author":"Perinetti","year":"2017","journal-title":"BioMed Res Int"},{"issue":"1","key":"10.1016\/j.ajodo.2025.11.017_bib44","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1177\/00220345630420014701","article-title":"Variations in the growth pattern of the human mandible: longitudinal radiographic study by the implant method","volume":"42","author":"Bj\u00f6rk","year":"1963","journal-title":"J Dent Res"},{"key":"10.1016\/j.ajodo.2025.11.017_bib45","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/0002-9416(55)90112-3","article-title":"The rates of growth of several facial components measured from serial cephalometric roentgenograms","volume":"41","author":"Nanda","year":"1955","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib46","series-title":"Center for Human Growth and Development","first-page":"13","article-title":"Craniofacial growth theory and orthodontic treatment","author":"Carlson","year":"1990"},{"key":"10.1016\/j.ajodo.2025.11.017_bib47","first-page":"134","article-title":"Prediction of the age of maximum puberal growth in body height","volume":"37","author":"Bj\u00f6rk","year":"1967","journal-title":"Angle Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib48","doi-asserted-by":"crossref","first-page":"755","DOI":"10.2319\/100113-719.1","article-title":"Mandibular growth comparisons of Class I and Class II Division 1 skeletofacial patterns","volume":"84","author":"Jacob","year":"2014","journal-title":"Angle Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib49","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/ejo\/cjq187","article-title":"Soft tissue effects of Twin Block and Herbst appliances in patients with Class II Division 1 mandibular retrognathy","volume":"35","author":"Baysal","year":"2013","journal-title":"Eur J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib50","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/0002-9416(53)90082-7","article-title":"Cephalometrics for you and me","volume":"39","author":"Steiner","year":"1953","journal-title":"Am J Orthod"},{"key":"10.1016\/j.ajodo.2025.11.017_bib51","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s00056-009-9938-6","article-title":"Class II treatment with fixed functional orthodontic appliances before and after the pubertal growth peak\u2014a cephalometric study to evaluate differential therapeutic effects","volume":"70","author":"Frye","year":"2009","journal-title":"J Orofac Orthop"},{"key":"10.1016\/j.ajodo.2025.11.017_bib52","first-page":"64","article-title":"Orthodontists\u2019 preferences and selection criteria for functional appliances","volume":"9","author":"Badri","year":"2021","journal-title":"J Res Med Dent Sci"}],"container-title":["American Journal of Orthodontics and Dentofacial Orthopedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0889540625005396?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0889540625005396?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:30:09Z","timestamp":1778761809000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0889540625005396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":52,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["S0889540625005396"],"URL":"https:\/\/doi.org\/10.1016\/j.ajodo.2025.11.017","relation":{},"ISSN":["0889-5406"],"issn-type":[{"value":"0889-5406","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The relation between normodivergent and hyperdivergent skeletal patterns and the outcome of activator treatment","name":"articletitle","label":"Article Title"},{"value":"American Journal of Orthodontics and Dentofacial Orthopedics","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajodo.2025.11.017","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026","name":"copyright","label":"Copyright"}]}}