{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:05:39Z","timestamp":1780070739530,"version":"3.54.0"},"reference-count":64,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"st1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To investigate the proportion of skeletal\/dentoalveolar components for correction of Class II malocclusion in relation to the pubertal growth peak (PGP) among patients treated with the mandibular advancement locking unit (MALU) appliance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective study of 27 orthodontic patients (age range: 12\u201318 years; mean age 14.9 years) with skeletal Class II Division 1 malocclusion who were treated with the MALU appliance until they reached Class I occlusion with overjet and overbite within normal range. Pretreatment (T1) and posttreatment (T2) lateral cephalograms were analyzed using standard cephalometrics and sagittal occlusion analysis to assess changes in the dentoalveolar and skeletal complex. The cervical vertebral maturation (CVM) method was used to determine participants' skeletal maturation in T1 cephalograms. Based on this maturation, participants were divided into two groups: the peak group (treatment initiation before or during PGP [peak group, n=15]) or the postpeak group (treatment initiation after the PGP [n = 12]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>No significant differences between groups were found at T1 for most of the skeletal and dental parameters investigated. At T2, the mean ANB angle and proclination of the mandibular incisors were significantly smaller in the peak group than in the postpeak group. In the peak group, skeletal correction comprised 54% and dental correction 46% of the total change at T2, while in the postpeak group the corresponding figures were 24% and 76%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Treatment initiated before or during PGP seems to result in a more favorable SNA\/SNB relationship and less tipping of the mandibular incisors than when treatment is initiated after PGP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/071316-549.1","type":"journal-article","created":{"date-parts":[[2017,1,25]],"date-time":"2017-01-25T10:13:22Z","timestamp":1485339202000},"page":"363-370","source":"Crossref","is-referenced-by-count":5,"title":["Mode of correction is related to treatment timing in Class II patients treated with the mandibular advancement locking unit (MALU) appliance"],"prefix":"10.2319","volume":"87","author":[{"given":"Muhsin","family":"Candir","sequence":"first","affiliation":[{"name":"Public Dental Service Orthodontist, Kirkenes, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Kerosuo","sequence":"additional","affiliation":[{"name":"Professor, University of Troms\u00f8, Institute of Clinical Dentistry, Troms\u00f8, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-87-3-363-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"31","article-title":"Efficiency of early and late Class II Division 1 treatment","volume":"121","author":"von Bremen \n              J,","year":"2002","unstructured":"von Bremen \n              J, \n            \n            \n              Pancherz \n              H. \n            \n          \n          Efficiency of early and late Class II Division 1 treatment. Am J Orthod Dentofacial Orthop. 2002;121:31\u201337."},{"key":"i0003-3219-87-3-363-b02","series-title":"Am J Orthod","first-page":"1","article-title":"The Herbst appliance\u2014its biologic effects and clinical use","volume":"87","author":"Pancherz \n              H.","year":"1985","unstructured":"Pancherz \n              H. \n            \n          \n          The Herbst appliance\u2014its biologic effects and clinical use. Am J Orthod. 1985;87:1\u201320."},{"key":"i0003-3219-87-3-363-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"582","article-title":"Treatment effects of the edgewise Herbst appliance: a cephalometric and tomographic investigation","volume":"130","author":"VanLaecken \n              R,","year":"2006","unstructured":"VanLaecken \n              R, \n            \n            \n              Martin \n              CA, \n            \n            \n              Dischinger \n              T, \n            \n            \n              Razmus \n              T, \n            \n            \n              Ngan \n              P. \n            \n          \n          Treatment effects of the edgewise Herbst appliance: a cephalometric and tomographic investigation. Am J Orthod Dentofacial Orthop. 2006;130:582\u2013593."},{"key":"i0003-3219-87-3-363-b04","series-title":"Am J Orthod Dentofacial Orthop","first-page":"15","article-title":"Thirty-two-year follow-up study of Herbst therapy: a biometric dental cast analysis","volume":"145","author":"Pancherz \n              H,","year":"2014","unstructured":"Pancherz \n              H, \n            \n            \n              Bjerklin \n              K, \n            \n            \n              Lindskog-Stokland \n              B, \n            \n            \n              Hansen \n              K. \n            \n          \n          Thirty-two-year follow-up study of Herbst therapy: a biometric dental cast analysis. Am J Orthod Dentofacial Orthop. 2014;145:15\u201327."},{"key":"i0003-3219-87-3-363-b05","series-title":"Eur J Orthod","first-page":"352","article-title":"Herbst\/multibracket appliance treatment of Class II Division 1 malocclusions in early and late adulthood: a prospective cephalometric study of consecutively treated subjects","volume":"28","author":"Ruf \n              S,","year":"2006","unstructured":"Ruf \n              S, \n            \n            \n              Pancherz \n              H. \n            \n          \n          Herbst\/multibracket appliance treatment of Class II Division 1 malocclusions in early and late adulthood: a prospective cephalometric study of consecutively treated subjects. Eur J Orthod. Aug2006;28:352\u2013360."},{"key":"i0003-3219-87-3-363-b06","series-title":"Eur J Orthod","first-page":"747","article-title":"Dentoskeletal changes in adult Class II Division 1 Herbst treatment\u2014how much is left after the retention period?","volume":"34","author":"Bock \n              NC,","year":"2012","unstructured":"Bock \n              NC, \n            \n            \n              Ruf \n              S. \n            \n          \n          Dentoskeletal changes in adult Class II Division 1 Herbst treatment\u2014how much is left after the retention period?\n          Eur J Orthod. 2012;34:747\u2013753."},{"key":"i0003-3219-87-3-363-b07","series-title":"Am J Orthod","first-page":"273","article-title":"Dentofacial orthopedics in relation to somatic maturation. An analysis of 70 consecutive cases treated with the Herbst appliance","volume":"88","author":"Pancherz \n              H,","year":"1985","unstructured":"Pancherz \n              H, \n            \n            \n              Hagg \n              U. \n            \n          \n          Dentofacial orthopedics in relation to somatic maturation. An analysis of 70 consecutive cases treated with the Herbst appliance. Am J Orthod. 1985;88:273\u2013287."},{"key":"i0003-3219-87-3-363-b08","series-title":"J Orofac Orthop","first-page":"511","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 \n              L,","year":"2009","unstructured":"Frye \n              L, \n            \n            \n              Diedrich \n              PR, \n            \n            \n              Kinzinger \n              GS. \n            \n          \n          Class II treatment with fixed functional orthodontic appliances before and after the pubertal growth peak\u2014a cephalometric study to evaluate differential therapeutic effects. J Orofac Orthop. 2009;70:511\u2013527."},{"key":"i0003-3219-87-3-363-b09","series-title":"Am J Orthod","first-page":"611","article-title":"Skeletal ossification and the adolescent growth spurt","volume":"69","author":"Grave \n              KC,","year":"1976","unstructured":"Grave \n              KC, \n            \n            \n              Brown \n              T. \n            \n          \n          Skeletal ossification and the adolescent growth spurt. Am J Orthod. 1976;69:611\u2013619."},{"key":"i0003-3219-87-3-363-b10","series-title":"Semin Orthod","first-page":"119","article-title":"The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics","volume":"11","author":"Baccetti \n              T,","year":"2005","unstructured":"Baccetti \n              T, \n            \n            \n              Franchi \n              L, \n            \n            \n              McNamara \n              JA\n              Jr. \n            \n          \n          The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics. Semin Orthod. 2005;11:119\u2013129."},{"key":"i0003-3219-87-3-363-b11","series-title":"J Orofac Orthop","first-page":"327","article-title":"The development of the cervical vertebrae as an indicator of skeletal maturity: comparison with the classic method of hand-wrist radiograph","volume":"70","author":"Stiehl \n              J,","year":"2009","unstructured":"Stiehl \n              J, \n            \n            \n              Muller \n              B, \n            \n            \n              Dibbets \n              J. \n            \n          \n          The development of the cervical vertebrae as an indicator of skeletal maturity: comparison with the classic method of hand-wrist radiograph. J Orofac Orthop. 2009;70:327\u2013335."},{"key":"i0003-3219-87-3-363-b12","series-title":"Angle Orthod","first-page":"1123","article-title":"de Miranda Costa LF, Vitral RW, Fraga MR, Bolognese AM, Maia LC. Cervical vertebral maturation as a biologic indicator of skeletal maturity","volume":"82","author":"Santiago \n              RC,","year":"2012","unstructured":"Santiago \n              RC, \n            \n          \n          de Miranda Costa LF, Vitral RW, Fraga MR, Bolognese AM, Maia LC. Cervical vertebral maturation as a biologic indicator of skeletal maturity. Angle Orthod. 2012;82:1123\u20131131."},{"key":"i0003-3219-87-3-363-b13","series-title":"Angle Orthod","first-page":"311","article-title":"A cephalometric study of class II Division 1 malocclusions treated with the Jasper Jumper appliance","volume":"69","author":"Covell \n              DA\n              Jr,","year":"1999","unstructured":"Covell \n              DA\n              Jr, \n            \n            \n              Trammell \n              DW, \n            \n            \n              Boero \n              RP, \n            \n            \n              West \n              R. \n            \n          \n          A cephalometric study of class II Division 1 malocclusions treated with the Jasper Jumper appliance. Angle Orthod. 1999;69:311\u2013320."},{"key":"i0003-3219-87-3-363-b14","series-title":"Am J Orthod Dentofacial Orthop","first-page":"286","article-title":"Treatment effects of the mandibular anterior repositioning appliance on patients with Class II malocclusion","volume":"123","author":"Pangrazio-Kulbersh \n              V,","year":"2003","unstructured":"Pangrazio-Kulbersh \n              V, \n            \n            \n              Berger \n              JL, \n            \n            \n              Chermak \n              DS, \n            \n            \n              Kaczynski \n              R, \n            \n            \n              Simon \n              ES, \n            \n            \n              Haerian \n              A. \n            \n          \n          Treatment effects of the mandibular anterior repositioning appliance on patients with Class II malocclusion. Am J Orthod Dentofacial Orthop. 2003;123:286\u2013295."},{"key":"i0003-3219-87-3-363-b15","series-title":"J Clin Orthod","first-page":"681","article-title":"Modified edgewise-Herbst appliance","volume":"30","author":"Schiavoni \n              R,","year":"1996","unstructured":"Schiavoni \n              R, \n            \n            \n              Bonapace \n              C, \n            \n            \n              Grenga \n              V. \n            \n          \n          Modified edgewise-Herbst appliance. 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A cephalometric investigation. Am J Orthod. 1982;82:104\u2013113."},{"key":"i0003-3219-87-3-363-b18","series-title":"Am J Orthod","first-page":"382","article-title":"The analysis of errors in orthodontic measurements","volume":"8","author":"Houston \n              WJ.","year":"1983","unstructured":"Houston \n              WJ. \n            \n          \n          The analysis of errors in orthodontic measurements. Am J Orthod. 1983;8:382\u2013390."},{"key":"i0003-3219-87-3-363-b19","series-title":"Angle Orthod","first-page":"56","article-title":"Reproducibility of cephalometric landmarks and errors of measurements of cephalometric cranial distances","volume":"44","author":"Midtgard \n              J,","year":"1974","unstructured":"Midtgard \n              J, \n            \n            \n              Bjork \n              G, \n            \n            \n              Linder-Aronson \n              S. \n            \n          \n          Reproducibility of cephalometric landmarks and errors of measurements of cephalometric cranial distances. Angle Orthod. 1974;44:56\u201361."},{"key":"i0003-3219-87-3-363-b20","series-title":"Eur J Orthod","first-page":"470","article-title":"Dentoskeletal effects during Herbst-multibracket appliance treatment: a comparison of lingual and labial approaches","volume":"38","author":"Bock \n              NC,","year":"2016","unstructured":"Bock \n              NC, \n            \n            \n              Ruf \n              S, \n            \n            \n              Wiechmann \n              D, \n            \n            \n              Jilek \n              T. \n            \n          \n          Dentoskeletal effects during Herbst-multibracket appliance treatment: a comparison of lingual and labial approaches. Eur J Orthod. 2016;38:470\u2013477."},{"key":"i0003-3219-87-3-363-b21","series-title":"Angle Orthod","first-page":"239","article-title":"Dentoskeletal effects and facial profile changes in young adults treated with the Herbst appliance","volume":"69","author":"Ruf \n              S,","year":"1999","unstructured":"Ruf \n              S, \n            \n            \n              Pancherz \n              H. \n            \n          \n          Dentoskeletal effects and facial profile changes in young adults treated with the Herbst appliance. Angle Orthod. 1999;69:239\u2013246."},{"key":"i0003-3219-87-3-363-b22","series-title":"Am J Orthod Dentofacial Orthop","first-page":"607","article-title":"Temporomandibular joint remodeling in adolescents and young adults during Herbst treatment: a prospective longitudinal magnetic resonance imaging and cephalometric radiographic investigation","volume":"115","author":"Ruf \n              S,","year":"1999","unstructured":"Ruf \n              S, \n            \n            \n              Pancherz \n              H. \n            \n          \n          Temporomandibular joint remodeling in adolescents and young adults during Herbst treatment: a prospective longitudinal magnetic resonance imaging and cephalometric radiographic investigation. Am J Orthod Dentofacial Orthop. 1999;115:607\u2013618."},{"key":"i0003-3219-87-3-363-b23","series-title":"Angle Orthod","first-page":"947","article-title":"Mandibular growth changes and cervical vertebral maturation: a cephalometric implant study","volume":"77","author":"Gu \n              Y,","year":"2007","unstructured":"Gu \n              Y, \n            \n            \n              McNamara \n              JA\n              Jr. \n            \n          \n          Mandibular growth changes and cervical vertebral maturation: a cephalometric implant study. Angle Orthod. 2007;77:947\u2013953."},{"key":"i0003-3219-87-3-363-b24","series-title":"Eur J Orthod","first-page":"164","article-title":"Dentoskeletal effects of Twin Block and Herbst appliances in patients with Class II division 1 mandibular retrognathy","volume":"36","author":"Baysal \n              A,","year":"2014","unstructured":"Baysal \n              A, \n            \n            \n              Uysal \n              T. \n            \n          \n          Dentoskeletal effects of Twin Block and Herbst appliances in patients with Class II division 1 mandibular retrognathy. Eur J Orthod. 2014;36:164\u2013172."},{"key":"i0003-3219-87-3-363-b25","series-title":"Am J Orthod Dentofacial Orthop","article-title":"Use of cervical vertebral maturation to determine skeletal age","author":"Wong \n              RW,","year":"2009","unstructured":"Wong \n              RW, \n            \n            \n              Alkhal \n              HA, \n            \n            \n              Rabie \n              AB. \n            \n          \n          Use of cervical vertebral maturation to determine skeletal age. 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Jan2009;79(1):173\u2013177."},{"key":"i0003-3219-87-3-363-b29","series-title":"Angle Orthod","first-page":"23","article-title":"Efficiency of three mandibular anchorage forms in Herbst treatment: a cephalometric investigation","volume":"75","author":"Weschler \n              D,","year":"2005","unstructured":"Weschler \n              D, \n            \n            \n              Pancherz \n              H. \n            \n          \n          Efficiency of three mandibular anchorage forms in Herbst treatment: a cephalometric investigation. Angle Orthod. 2005;75:23\u201327."},{"key":"i0003-3219-87-3-363-b30","series-title":"Eur J Orthod","first-page":"609","article-title":"Reduced mandibular cast splints an alternative in Herbst therapy? A prospective multicentre study","volume":"29","author":"von Bremen \n              J,","year":"2007","unstructured":"von Bremen \n              J, \n            \n            \n              Pancherz \n              H, \n            \n            \n              Ruf \n              S. \n            \n          \n          Reduced mandibular cast splints an alternative in Herbst therapy? A prospective multicentre study. Eur J Orthod. 2007;29:609\u2013613."},{"key":"i0003-3219-87-3-363-b31","series-title":"Eur J Orthod","first-page":"167","article-title":"Effects of headgear Herbst and mandibular step-by-step advancement versus conventional Herbst appliance and maximal jumping of the mandible","volume":"24","author":"Du \n              X,","year":"2002","unstructured":"Du \n              X, \n            \n            \n              Hagg \n              U, \n            \n            \n              Rabie \n              AB. \n            \n          \n          Effects of headgear Herbst and mandibular step-by-step advancement versus conventional Herbst appliance and maximal jumping of the mandible. Eur J Orthod. 2002;24:167\u2013174."},{"key":"i0003-3219-87-3-363-b32","series-title":"Angle Orthod","first-page":"316","article-title":"An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth","volume":"72","author":"Baccetti \n              T,","year":"2002","unstructured":"Baccetti \n              T, \n            \n            \n              Franchi \n              L, \n            \n            \n              McNamara \n              JA\n              Jr. \n            \n          \n          An improved version of the cervical vertebral maturation (CVM) method for the assessment of mandibular growth. Angle Orthod. 2002;72:316\u2013323."},{"key":"i0003-3219-87-3-363-b01","series-title":"Am J Orthod Dentofacial Orthop","first-page":"31","article-title":"Efficiency of early and late Class II Division 1 treatment","volume":"121","author":"von Bremen \n              J,","year":"2002","unstructured":"von Bremen \n              J, \n            \n            \n              Pancherz \n              H. \n            \n          \n          Efficiency of early and late Class II Division 1 treatment. Am J Orthod Dentofacial Orthop. 2002;121:31\u201337."},{"key":"i0003-3219-87-3-363-b02","series-title":"Am J Orthod","first-page":"1","article-title":"The Herbst appliance\u2014its biologic effects and clinical use","volume":"87","author":"Pancherz \n              H.","year":"1985","unstructured":"Pancherz \n              H. \n            \n          \n          The Herbst appliance\u2014its biologic effects and clinical use. 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Am J Orthod Dentofacial Orthop. 2006;130:582\u2013593."},{"key":"i0003-3219-87-3-363-b04","series-title":"Am J Orthod Dentofacial Orthop","first-page":"15","article-title":"Thirty-two-year follow-up study of Herbst therapy: a biometric dental cast analysis","volume":"145","author":"Pancherz \n              H,","year":"2014","unstructured":"Pancherz \n              H, \n            \n            \n              Bjerklin \n              K, \n            \n            \n              Lindskog-Stokland \n              B, \n            \n            \n              Hansen \n              K. \n            \n          \n          Thirty-two-year follow-up study of Herbst therapy: a biometric dental cast analysis. Am J Orthod Dentofacial Orthop. 2014;145:15\u201327."},{"key":"i0003-3219-87-3-363-b05","series-title":"Eur J Orthod","first-page":"352","article-title":"Herbst\/multibracket appliance treatment of Class II Division 1 malocclusions in early and late adulthood: a prospective cephalometric study of consecutively treated subjects","volume":"28","author":"Ruf \n              S,","year":"2006","unstructured":"Ruf \n              S, \n            \n            \n              Pancherz \n              H. \n            \n          \n          Herbst\/multibracket appliance treatment of Class II Division 1 malocclusions in early and late adulthood: a prospective cephalometric study of consecutively treated subjects. Eur J Orthod. Aug2006;28:352\u2013360."},{"key":"i0003-3219-87-3-363-b06","series-title":"Eur J Orthod","first-page":"747","article-title":"Dentoskeletal changes in adult Class II Division 1 Herbst treatment\u2014how much is left after the retention period?","volume":"34","author":"Bock \n              NC,","year":"2012","unstructured":"Bock \n              NC, \n            \n            \n              Ruf \n              S. \n            \n          \n          Dentoskeletal changes in adult Class II Division 1 Herbst treatment\u2014how much is left after the retention period?\n          Eur J Orthod. 2012;34:747\u2013753."},{"key":"i0003-3219-87-3-363-b07","series-title":"Am J Orthod","first-page":"273","article-title":"Dentofacial orthopedics in relation to somatic maturation. 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J Orofac Orthop. 2009;70:511\u2013527."},{"key":"i0003-3219-87-3-363-b09","series-title":"Am J Orthod","first-page":"611","article-title":"Skeletal ossification and the adolescent growth spurt","volume":"69","author":"Grave \n              KC,","year":"1976","unstructured":"Grave \n              KC, \n            \n            \n              Brown \n              T. \n            \n          \n          Skeletal ossification and the adolescent growth spurt. 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