{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:10:01Z","timestamp":1780071001338,"version":"3.54.0"},"reference-count":52,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective:<\/jats:title>\n To describe the orthodontic treatment of a nongrowing 30-year-old woman with asymmetric severe skeletal Class II malocclusions (asymmetric Angle Class II), large overjet (16\u00a0mm), large overbite (8\u00a0mm), two congenitally missing mandibular incisors (presenting a deciduous anterior tooth), and signs and symptoms of temporomandibular joint disorder (TMD).<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n We used novel improved super-elastic Ni-Ti alloy wires (ISWs) combined with Ni-Ti alloy coil springs, power hooks, and a zygomatic implant as reinforced anchorage to provide a constant and continuous mild force to the dentition.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n We successfully distalized maxillary molars, premolars, and retracted anterior teeth and corrected the asymmetric Angle Class II molar relationship using this system of zygomatic anchorage in conjunction with ISWs, Ni-Ti alloy open-coil springs, and crimpable power hook. The maxillary molars were distalized, and postero-occlusal relationships were improved to achieve Class I canine and molar relationships on both sides. Intrusion of the upper molars made the mandibular plane close. Ideal overbite and overjet relationships were established. Facial esthetics were improved with decreased upper and lower lip protrusion, and no symptoms of TMD were observed after treatment.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The orthodontic treatment described here is a promising anchorage technique alternative to traditional techniques to improve severe skeletal Class II with TMD.<\/jats:p>\n <\/jats:sec>","DOI":"10.2319\/010414-13.1","type":"journal-article","created":{"date-parts":[[2014,4,9]],"date-time":"2014-04-09T08:13:29Z","timestamp":1397031209000},"page":"919-930","source":"Crossref","is-referenced-by-count":9,"title":["Asymmetric severe skeletal Class II division 1 patient with temporomandibular joint disorder treated with zygomatic anchorage devices and Ni-Ti alloy wires"],"prefix":"10.2319","volume":"84","author":[{"given":"Takayoshi","family":"Ishida","sequence":"first","affiliation":[{"name":"Assistant Professor, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University (TMDU), Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ono","sequence":"additional","affiliation":[{"name":"Professor, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University (TMDU), Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-84-5-919-b01","series-title":"Oral Surg Oral Med Oral Pathol","first-page":"138","article-title":"Condylar resorption in orthognathic surgery: the role of intermaxillary fixation","volume":"78","author":"Bouwman\n JP,","year":"1994","unstructured":"Bouwman\n JP, \n \n Kerstens\n HC, \n \n Tuinzing\n DB. \n \n Condylar resorption in orthognathic surgery: the role of intermaxillary fixation. Oral Surg Oral Med Oral Pathol. 1994;78:138\u2013141."},{"key":"i0003-3219-84-5-919-b02","series-title":"Am J Orthod Dentofacial Orthop","first-page":"415","article-title":"Mandibular distraction osteogenesis in a skeletal Class II patient with obstructive sleep apnea","volume":"131","author":"Hamada\n T,","year":"2007","unstructured":"Hamada\n T, \n \n Ono\n T, \n \n Otsuka\n R, \n et al. \n Mandibular distraction osteogenesis in a skeletal Class II patient with obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2007;131:415\u2013425."},{"key":"i0003-3219-84-5-919-b03","series-title":"Int J Oral Maxillofac Surg","first-page":"81","article-title":"Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite: a clinical and radiological study","volume":"27","author":"Hoppenreijs\n TJ,","year":"1998","unstructured":"Hoppenreijs\n TJ, \n \n Freihofer\n HP, \n \n Stoelinga\n PJ, \n \n Tuinzing\n DB, \n \n van't Hof\n MA. \n \n Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite: a clinical and radiological study. Int J Oral Maxillofac Surg. 1998;27:81\u201391."},{"key":"i0003-3219-84-5-919-b04","series-title":"Oral Surg Oral Med Oral Pathol","first-page":"274","article-title":"Condylar atrophy and osteoarthrosis after bimaxillary surgery","volume":"69","author":"Kerstens\n HC,","year":"1990","unstructured":"Kerstens\n HC, \n \n Tuinzing\n DB, \n \n Golding\n RP, \n \n van der Kwast\n WA. \n \n Condylar atrophy and osteoarthrosis after bimaxillary surgery. Oral Surg Oral Med Oral Pathol. 1990;69:274\u2013280."},{"key":"i0003-3219-84-5-919-b05","series-title":"J Craniomaxillofac Surg","first-page":"53","article-title":"Condylar resorption after orthognathic surgery: evaluation of treatment in 8 patients","volume":"22","author":"Merkx\n MA,","year":"1994","unstructured":"Merkx\n MA, \n \n Van Damme\n PA. \n \n Condylar resorption after orthognathic surgery: evaluation of treatment in 8 patients. J Craniomaxillofac Surg. 1994;22:53\u201358."},{"key":"i0003-3219-84-5-919-b06","series-title":"J Oral Maxillofac Surg","first-page":"448","article-title":"The contributing role of condylar resorption to skeletal relapse following mandibular advancement surgery: report of five cases","volume":"49","author":"Moore\n KE,","year":"1991","unstructured":"Moore\n KE, \n \n Gooris\n PJ, \n \n Stoelinga\n PJ. \n \n The contributing role of condylar resorption to skeletal relapse following mandibular advancement surgery: report of five cases. J Oral Maxillofac Surg. 1991;49:448\u2013460."},{"key":"i0003-3219-84-5-919-b07","series-title":"Open Dent J","first-page":"240","article-title":"Influence of psychosocial factors and habitual behavior in temporomandibular disorder-related symptoms in a working population in Japan","volume":"6","author":"Nishiyama\n A,","year":"2012","unstructured":"Nishiyama\n A, \n \n Kino\n K, \n \n Sugisaki\n M, \n \n Tsukagoshi\n K. \n \n Influence of psychosocial factors and habitual behavior in temporomandibular disorder-related symptoms in a working population in Japan. Open Dent J. 2012;6:240\u2013247."},{"key":"i0003-3219-84-5-919-b08","series-title":"J Med Dent Sci","first-page":"103","article-title":"Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders","volume":"53","author":"Sato\n F,","year":"2006","unstructured":"Sato\n F, \n \n Kino\n K, \n \n Sugisaki\n M, \n et al. \n Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders. J Med Dent Sci. 2006;53:103\u2013109."},{"key":"i0003-3219-84-5-919-b09","series-title":"Sleep Med Rev","first-page":"S1087-0792(13)00088-9","article-title":"Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review","volume":"pii","author":"Kendzerska\n TB,","year":"2013","unstructured":"Kendzerska\n TB, \n \n Smith\n PM, \n \n Brignardello-Petersen\n R, \n \n Leung\n RS, \n \n Tomlinson\n GA. \n \n Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review. Sleep Med Rev. 2013;pii:S1087-0792(13)00088-9."},{"key":"i0003-3219-84-5-919-b10","series-title":"Treatment of Malocclusion of the Teeth. 7th ed","author":"Angle\n EH.","year":"1907","unstructured":"Angle\n EH. \n \n Treatment of Malocclusion of the Teeth. 7th ed. Philadelphia, Pa: S. S. White Dental Mfg. Company; 1907."},{"key":"i0003-3219-84-5-919-b11","series-title":"Dental Items of Interest","first-page":"421","article-title":"The upper first molar as a basis of diagnosis in orthdontia","volume":"28","author":"Angle\n EH.","year":"1906","unstructured":"Angle\n EH. \n \n The upper first molar as a basis of diagnosis in orthdontia. Dental Items of Interest. 1906;28:421\u2013426."},{"key":"i0003-3219-84-5-919-b12","series-title":"Am J Orthod Dentofacial Orthop","first-page":"735","article-title":"A roentgenographic cephalometric analysis of cephalofacial dental relationships","volume":"41","author":"Sassouni\n V.","year":"1955","unstructured":"Sassouni\n V. \n \n A roentgenographic cephalometric analysis of cephalofacial dental relationships. Am J Orthod Dentofacial Orthop. 1955;41:735\u2013764."},{"key":"i0003-3219-84-5-919-b13","series-title":"Am J Orthod Oral Surg","first-page":"597","article-title":"Occipital and cervical anchorage and their application to the orthodontic problem","volume":"31","author":"Jerrold\n HE.","year":"1945","unstructured":"Jerrold\n HE. \n \n Occipital and cervical anchorage and their application to the orthodontic problem. Am J Orthod Oral Surg. 1945;31:597\u2013607."},{"key":"i0003-3219-84-5-919-b14","series-title":"An Orthodontic Philosophy","first-page":"27","article-title":"Factors in headgear design and application","author":"Ricketts\n RM.","year":"1971","unstructured":"Ricketts\n RM. \n \n Factors in headgear design and application. In: GuginoCF, ed. An Orthodontic Philosophy. Denver, Colo: Rocky Mountain; 1971:27\u201332."},{"key":"i0003-3219-84-5-919-b15","series-title":"Am J Orthod","first-page":"333","article-title":"Unilateral headgear: lateral forces as unavoidable side effects","volume":"77","author":"Baldini\n G.","year":"1980","unstructured":"Baldini\n G. \n \n Unilateral headgear: lateral forces as unavoidable side effects. Am J Orthod. 1980;77:333\u2013340."},{"key":"i0003-3219-84-5-919-b16","series-title":"Eur J Orthod","first-page":"507","article-title":"Maxillary unilateral molar distalization with sliding mechanics: a preliminary investigation","volume":"23","author":"Keles\n A.","year":"2001","unstructured":"Keles\n A. \n \n Maxillary unilateral molar distalization with sliding mechanics: a preliminary investigation. Eur J Orthod. 2001;23:507\u2013515."},{"key":"i0003-3219-84-5-919-b17","series-title":"Angle Orthod","first-page":"221","article-title":"A mechanical appraisal of the Kloehn extraoral assembly","volume":"43","author":"Oosthuizen\n L,","year":"1973","unstructured":"Oosthuizen\n L, \n \n Dijkman\n JF, \n \n Evans\n WG. \n \n A mechanical appraisal of the Kloehn extraoral assembly. Angle Orthod. 1973;43:221\u2013232."},{"key":"i0003-3219-84-5-919-b18","series-title":"J Clin Orthod","first-page":"402","article-title":"Modified Nance appliance for unilateral molar distalization","volume":"26","author":"Reiner\n TJ.","year":"1992","unstructured":"Reiner\n TJ. \n \n Modified Nance appliance for unilateral molar distalization. J Clin Orthod. 1992;26:402\u2013404."},{"key":"i0003-3219-84-5-919-b19","series-title":"J Clin Orthod","first-page":"689","article-title":"Dr. Junji Sugawara on the skeletal anchorage system. Interview by Dr. Larry W. 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Am J Orthod Dentofacial Orthop. 2013;144:583\u2013593."},{"key":"i0003-3219-84-5-919-b21","series-title":"J Jpn Orthod Soc","first-page":"641","article-title":"Development of the super-elastic Ti-Ni alloy wire appropriate to the oral environment","volume":"53","author":"Otsubo\n K.","year":"1994","unstructured":"Otsubo\n K. \n \n Development of the super-elastic Ti-Ni alloy wire appropriate to the oral environment. J Jpn Orthod Soc. 1994;53:641\u2013650."},{"key":"i0003-3219-84-5-919-b22","series-title":"J Jpn Dent Mater","first-page":"521","article-title":"Influence of temperature on the force level of a super-elastic Ni-Ti alloy wire under strain","volume":"12","author":"Otsubo\n K.","year":"1993","unstructured":"Otsubo\n K. \n \n Influence of temperature on the force level of a super-elastic Ni-Ti alloy wire under strain. J Jpn Dent Mater. 1993;12:521\u2013527."},{"key":"i0003-3219-84-5-919-b23","series-title":"Am J Orthod Dentofacial Orthop","first-page":"36","article-title":"Experimental determination of optimal force system required for control of anterior tooth movement in sliding mechanics","volume":"135","author":"Sia\n S,","year":"2009","unstructured":"Sia\n S, \n \n Shibazaki\n T, \n \n Koga\n Y, \n \n Yoshida\n N. \n \n Experimental determination of optimal force system required for control of anterior tooth movement in sliding mechanics. Am J Orthod Dentofacial Orthop. 2009;135:36\u201341."},{"key":"i0003-3219-84-5-919-b24","series-title":"J Orofac Pain","first-page":"145","article-title":"Effect of parafunctional clenching on TMD pain","volume":"12","author":"Glaros\n AG,","year":"1998","unstructured":"Glaros\n AG, \n \n Tabacchi\n KN, \n \n Glass\n EG. \n \n Effect of parafunctional clenching on TMD pain. J Orofac Pain. 1998;12:145\u2013152."},{"key":"i0003-3219-84-5-919-b25","series-title":"J Prosthet Dent","first-page":"670","article-title":"Vertical dimension: a study of clinical rest position and jaw muscle activity","volume":"45","author":"Rugh\n JD,","year":"1981","unstructured":"Rugh\n JD, \n \n Drago\n CJ. \n \n Vertical dimension: a study of clinical rest position and jaw muscle activity. J Prosthet Dent. 1981;45:670\u2013675."},{"key":"i0003-3219-84-5-919-b26","series-title":"J Dent Res","first-page":"1259","article-title":"Randamaized clinical trial of treatment for TMJ disc displacement","volume":"89","author":"Haketa\n T,","year":"2010","unstructured":"Haketa\n T, \n \n Kino\n K, \n \n Sugisaki\n M, \n \n Ohta\n T. \n \n Randamaized clinical trial of treatment for TMJ disc displacement. J Dent Res. 2010;89:1259\u20131263."},{"key":"i0003-3219-84-5-919-b01","series-title":"Oral Surg Oral Med Oral Pathol","first-page":"138","article-title":"Condylar resorption in orthognathic surgery: the role of intermaxillary fixation","volume":"78","author":"Bouwman\n JP,","year":"1994","unstructured":"Bouwman\n JP, \n \n Kerstens\n HC, \n \n Tuinzing\n DB. \n \n Condylar resorption in orthognathic surgery: the role of intermaxillary fixation. Oral Surg Oral Med Oral Pathol. 1994;78:138\u2013141."},{"key":"i0003-3219-84-5-919-b02","series-title":"Am J Orthod Dentofacial Orthop","first-page":"415","article-title":"Mandibular distraction osteogenesis in a skeletal Class II patient with obstructive sleep apnea","volume":"131","author":"Hamada\n T,","year":"2007","unstructured":"Hamada\n T, \n \n Ono\n T, \n \n Otsuka\n R, \n et al. \n Mandibular distraction osteogenesis in a skeletal Class II patient with obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2007;131:415\u2013425."},{"key":"i0003-3219-84-5-919-b03","series-title":"Int J Oral Maxillofac Surg","first-page":"81","article-title":"Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite: a clinical and radiological study","volume":"27","author":"Hoppenreijs\n TJ,","year":"1998","unstructured":"Hoppenreijs\n TJ, \n \n Freihofer\n HP, \n \n Stoelinga\n PJ, \n \n Tuinzing\n DB, \n \n van't Hof\n MA. \n \n Condylar remodelling and resorption after Le Fort I and bimaxillary osteotomies in patients with anterior open bite: a clinical and radiological study. Int J Oral Maxillofac Surg. 1998;27:81\u201391."},{"key":"i0003-3219-84-5-919-b04","series-title":"Oral Surg Oral Med Oral Pathol","first-page":"274","article-title":"Condylar atrophy and osteoarthrosis after bimaxillary surgery","volume":"69","author":"Kerstens\n HC,","year":"1990","unstructured":"Kerstens\n HC, \n \n Tuinzing\n DB, \n \n Golding\n RP, \n \n van der Kwast\n WA. \n \n Condylar atrophy and osteoarthrosis after bimaxillary surgery. Oral Surg Oral Med Oral Pathol. 1990;69:274\u2013280."},{"key":"i0003-3219-84-5-919-b05","series-title":"J Craniomaxillofac Surg","first-page":"53","article-title":"Condylar resorption after orthognathic surgery: evaluation of treatment in 8 patients","volume":"22","author":"Merkx\n MA,","year":"1994","unstructured":"Merkx\n MA, \n \n Van Damme\n PA. \n \n Condylar resorption after orthognathic surgery: evaluation of treatment in 8 patients. J Craniomaxillofac Surg. 1994;22:53\u201358."},{"key":"i0003-3219-84-5-919-b06","series-title":"J Oral Maxillofac Surg","first-page":"448","article-title":"The contributing role of condylar resorption to skeletal relapse following mandibular advancement surgery: report of five cases","volume":"49","author":"Moore\n KE,","year":"1991","unstructured":"Moore\n KE, \n \n Gooris\n PJ, \n \n Stoelinga\n PJ. \n \n The contributing role of condylar resorption to skeletal relapse following mandibular advancement surgery: report of five cases. J Oral Maxillofac Surg. 1991;49:448\u2013460."},{"key":"i0003-3219-84-5-919-b07","series-title":"Open Dent J","first-page":"240","article-title":"Influence of psychosocial factors and habitual behavior in temporomandibular disorder-related symptoms in a working population in Japan","volume":"6","author":"Nishiyama\n A,","year":"2012","unstructured":"Nishiyama\n A, \n \n Kino\n K, \n \n Sugisaki\n M, \n \n Tsukagoshi\n K. \n \n Influence of psychosocial factors and habitual behavior in temporomandibular disorder-related symptoms in a working population in Japan. Open Dent J. 2012;6:240\u2013247."},{"key":"i0003-3219-84-5-919-b08","series-title":"J Med Dent Sci","first-page":"103","article-title":"Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders","volume":"53","author":"Sato\n F,","year":"2006","unstructured":"Sato\n F, \n \n Kino\n K, \n \n Sugisaki\n M, \n et al. \n Teeth contacting habit as a contributing factor to chronic pain in patients with temporomandibular disorders. J Med Dent Sci. 2006;53:103\u2013109."},{"key":"i0003-3219-84-5-919-b09","series-title":"Sleep Med Rev","first-page":"S1087-0792(13)00088-9","article-title":"Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review","volume":"pii","author":"Kendzerska\n TB,","year":"2013","unstructured":"Kendzerska\n TB, \n \n Smith\n PM, \n \n Brignardello-Petersen\n R, \n \n Leung\n RS, \n \n Tomlinson\n GA. \n \n Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review. Sleep Med Rev. 2013;pii:S1087-0792(13)00088-9."},{"key":"i0003-3219-84-5-919-b10","series-title":"Treatment of Malocclusion of the Teeth. 7th ed","author":"Angle\n EH.","year":"1907","unstructured":"Angle\n EH. \n \n Treatment of Malocclusion of the Teeth. 7th ed. Philadelphia, Pa: S. S. White Dental Mfg. Company; 1907."},{"key":"i0003-3219-84-5-919-b11","series-title":"Dental Items of Interest","first-page":"421","article-title":"The upper first molar as a basis of diagnosis in orthdontia","volume":"28","author":"Angle\n EH.","year":"1906","unstructured":"Angle\n EH. \n \n The upper first molar as a basis of diagnosis in orthdontia. Dental Items of Interest. 1906;28:421\u2013426."},{"key":"i0003-3219-84-5-919-b12","series-title":"Am J Orthod Dentofacial Orthop","first-page":"735","article-title":"A roentgenographic cephalometric analysis of cephalofacial dental relationships","volume":"41","author":"Sassouni\n V.","year":"1955","unstructured":"Sassouni\n V. \n \n A roentgenographic cephalometric analysis of cephalofacial dental relationships. Am J Orthod Dentofacial Orthop. 1955;41:735\u2013764."},{"key":"i0003-3219-84-5-919-b13","series-title":"Am J Orthod Oral Surg","first-page":"597","article-title":"Occipital and cervical anchorage and their application to the orthodontic problem","volume":"31","author":"Jerrold\n HE.","year":"1945","unstructured":"Jerrold\n HE. \n \n Occipital and cervical anchorage and their application to the orthodontic problem. Am J Orthod Oral Surg. 1945;31:597\u2013607."},{"key":"i0003-3219-84-5-919-b14","series-title":"An Orthodontic Philosophy","first-page":"27","article-title":"Factors in headgear design and application","author":"Ricketts\n RM.","year":"1971","unstructured":"Ricketts\n RM. \n \n Factors in headgear design and application. In: GuginoCF, ed. An Orthodontic Philosophy. Denver, Colo: Rocky Mountain; 1971:27\u201332."},{"key":"i0003-3219-84-5-919-b15","series-title":"Am J Orthod","first-page":"333","article-title":"Unilateral headgear: lateral forces as unavoidable side effects","volume":"77","author":"Baldini\n G.","year":"1980","unstructured":"Baldini\n G. \n \n Unilateral headgear: lateral forces as unavoidable side effects. Am J Orthod. 1980;77:333\u2013340."},{"key":"i0003-3219-84-5-919-b16","series-title":"Eur J Orthod","first-page":"507","article-title":"Maxillary unilateral molar distalization with sliding mechanics: a preliminary investigation","volume":"23","author":"Keles\n A.","year":"2001","unstructured":"Keles\n A. \n \n Maxillary unilateral molar distalization with sliding mechanics: a preliminary investigation. 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J Jpn Dent Mater. 1993;12:521\u2013527."},{"key":"i0003-3219-84-5-919-b23","series-title":"Am J Orthod Dentofacial Orthop","first-page":"36","article-title":"Experimental determination of optimal force system required for control of anterior tooth movement in sliding mechanics","volume":"135","author":"Sia\n S,","year":"2009","unstructured":"Sia\n S, \n \n Shibazaki\n T, \n \n Koga\n Y, \n \n Yoshida\n N. \n \n Experimental determination of optimal force system required for control of anterior tooth movement in sliding mechanics. Am J Orthod Dentofacial Orthop. 2009;135:36\u201341."},{"key":"i0003-3219-84-5-919-b24","series-title":"J Orofac Pain","first-page":"145","article-title":"Effect of parafunctional clenching on TMD pain","volume":"12","author":"Glaros\n AG,","year":"1998","unstructured":"Glaros\n AG, \n \n Tabacchi\n KN, \n \n Glass\n EG. \n \n Effect of parafunctional clenching on TMD pain. 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