{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:05:03Z","timestamp":1780067103347,"version":"3.54.0"},"reference-count":40,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Severe vertical maxillary excess (VME) is a skeletal abnormality that typically requires orthognathic surgery for correction. Nonsurgical orthodontic treatment has been a fascinating but challenging alternative, especially when adverse anatomic factors hamper or pose risks for intrusive tooth movement. Despite well-documented efficiency of temporary anchorage device (TAD)-aided nonsurgical treatment for VME, evidence is scarce regarding the treatment efficacy and safety for cases with adverse anatomic traits. In this case report, we present nonsurgical treatment of a patient with severe VME, maxillary protrusion, and retrognathism. Additional challenges included compromised periodontal health, low maxillary sinus floor, short roots with axes deviating from the center of basal bone, and thin labial cortical bone with partial deficiencies. With anchorage from a transpalatal arch (TPA) and TADs and elaborate biomechanical control strategies, significant maxillary full-arch intrusion and anterior retraction with adequate root torque control were achieved, resulting in counterclockwise mandibular rotation and notable profile improvement. One-year follow-up showed stable treatment results. This case provided evidence on how balance may be achieved between treatment efficacy and anatomical limitations using biomechanical control strategies.<\/jats:p>","DOI":"10.2319\/112224-958.1","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:16Z","timestamp":1752796816000},"page":"366-376","source":"Crossref","is-referenced-by-count":0,"title":["Nonsurgical treatment of severe vertical maxillary excess with short roots, thin bone, and a low maxillary sinus floor"],"prefix":"10.2319","volume":"96","author":[{"given":"Bin","family":"Li","sequence":"first","affiliation":[{"name":"PhD Candidate, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Huang","sequence":"additional","affiliation":[{"name":"PhD Candidate, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Research Assistant, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoran","family":"Xue","sequence":"additional","affiliation":[{"name":"Associate Professor, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianglong","family":"Han","sequence":"additional","affiliation":[{"name":"Professor, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ding","family":"Bai","sequence":"additional","affiliation":[{"name":"Professor, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Xu","sequence":"additional","affiliation":[{"name":"Associate Professor, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"issue":"4","key":"i1945-7103-96-3-366-b01","series-title":"Am J Orthod","first-page":"398","article-title":"The long face syndrome: vertical maxillary excess","volume":"70","author":"Schendel","year":"1976","unstructured":"Schendel SA,\nEisenfeld J,\nBell WH,\nEpker BN,\nMishelevich DJ. The long face syndrome: vertical maxillary excess. Am J Orthod. 1976;70(4):398\u2013408."},{"issue":"5","key":"i1945-7103-96-3-366-b02","series-title":"Semin Orthod","first-page":"648","article-title":"Treatment strategies for vertical maxillary excess: cases with and without anterior open bite","volume":"30","author":"Paik","year":"2024","unstructured":"Paik CH,\nLee MH,\nPark JH. Treatment strategies for vertical maxillary excess: cases with and without anterior open bite. Semin Orthod. 2024;30(5):648\u2013672."},{"key":"i1945-7103-96-3-366-b03","series-title":"SAGE Open Med Case Rep","first-page":"2050313X241256805","article-title":"Surgical-orthodontic approach for correcting vertical maxillary excess: case report","volume":"12","author":"Benkhalifa","year":"2024","unstructured":"Benkhalifa M,\nTobji S,\nMoatemri R,\nBen Amor A,\nDallel I,\nBen Amor W. Surgical-orthodontic approach for correcting vertical maxillary excess: case report. SAGE Open Med Case Rep. 2024;12:2050313X241256805."},{"key":"i1945-7103-96-3-366-b04","series-title":"Int J Surg Case Rep","first-page":"106354","article-title":"Surgical procedures for correcting vertical maxillary excess: a review","volume":"86","author":"Nasrun","year":"2021","unstructured":"Nasrun NE,\nTakeda S,\nMinamida Y, et al. Surgical procedures for correcting vertical maxillary excess: a review. Int J Surg Case Rep. 2021;86:106354."},{"issue":"2","key":"i1945-7103-96-3-366-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"264","article-title":"Vertical control of a Class II deep bite malocclusion with the use of orthodontic mini-implants","volume":"155","author":"Jung","year":"2019","unstructured":"Jung M. Vertical control of a Class II deep bite malocclusion with the use of orthodontic mini-implants. Am J Orthod Dentofacial Orthop. 2019;155(2):264\u2013275."},{"issue":"2","key":"i1945-7103-96-3-366-b06","series-title":"J Indian Orthod Soc","first-page":"183","article-title":"Treatment of vertical maxillary excess in skeletal class II hyperdivergent face using skeletal anchorage - an IBO case report","volume":"58","author":"Hegde","year":"2024","unstructured":"Hegde NS. Treatment of vertical maxillary excess in skeletal class II hyperdivergent face using skeletal anchorage - an IBO case report. J Indian Orthod Soc. 2024;58(2):183\u2013193."},{"issue":"4","key":"i1945-7103-96-3-366-b07","series-title":"Angle Orthod","first-page":"625","article-title":"Treatment of vertical maxillary excess without open bite in a skeletal Class II hyperdivergent patient","volume":"87","author":"Paik","year":"2017","unstructured":"Paik CH,\nPark HS,\nAhn HW. Treatment of vertical maxillary excess without open bite in a skeletal Class II hyperdivergent patient. Angle Orthod. 2017;87(4):625\u2013633."},{"issue":"1","key":"i1945-7103-96-3-366-b08","series-title":"Semin Orthod","first-page":"108","article-title":"Vertical control with TADs: procedures and protocols","volume":"24","author":"Krishnaswamy","year":"2018","unstructured":"Krishnaswamy N. Vertical control with TADs: procedures and protocols. Semin Orthod. 2018;24(1):108\u2013122."},{"issue":"5","key":"i1945-7103-96-3-366-b09","series-title":"Am J Orthod Dentofacial Orthop","first-page":"621","article-title":"Cephalometric evaluation of intrusion of maxillary posterior teeth by miniscrews in the treatment of open bite","volume":"161","author":"Akbaydogan","year":"2022","unstructured":"Akbaydogan LC,\nAkin M. Cephalometric evaluation of intrusion of maxillary posterior teeth by miniscrews in the treatment of open bite. Am J Orthod Dentofacial Orthop. 2022;161(5):621\u2013627."},{"issue":"6","key":"i1945-7103-96-3-366-b10","series-title":"Angle Orthod","first-page":"733","article-title":"Root resorption associated with maxillary buccal segment intrusion using variable force magnitudes: a randomized clinical trial","volume":"91","author":"Akl","year":"2021","unstructured":"Akl HE,\nEl-Beialy AR,\nEl-Ghafour MA,\nAbouelezz AM,\nEl-Sharaby FA. Root resorption associated with maxillary buccal segment intrusion using variable force magnitudes: a randomized clinical trial. Angle Orthod. 2021;91(6):733\u2013742."},{"key":"i1945-7103-96-3-366-b11","series-title":"BMC Oral Health","first-page":"91","article-title":"Knowledge of orthodontic tooth movement through the maxillary sinus: a systematic review","volume":"18","author":"Sun","year":"2018","unstructured":"Sun W,\nXia K,\nHuang X. et al. Knowledge of orthodontic tooth movement through the maxillary sinus: a systematic review. BMC Oral Health. 2018;18:91."},{"key":"i1945-7103-96-3-366-b12","series-title":"Eur Arch Paediatr Dent","first-page":"751","article-title":"Dense bone islands in pediatric patients: a case series study","volume":"22","author":"Alfahad","year":"2021","unstructured":"Alfahad S,\nAlostad M,\nDunkley S, et al. Dense bone islands in pediatric patients: a case series study. Eur Arch Paediatr Dent. 2021;22:751\u2013757."},{"issue":"1","key":"i1945-7103-96-3-366-b13","series-title":"Semin Orthod","first-page":"123","article-title":"Treatment of VME using extra-alveolar TADs: quantification of treatment effects","volume":"24","author":"Alteneiji","year":"2018","unstructured":"Alteneiji M,\nLiaw JJL,\nVaid NR,\nFerguson DJ,\nMakki L. Treatment of VME using extra-alveolar TADs: quantification of treatment effects. Semin Orthod. 2018;24(1):123\u2013134."},{"issue":"6","key":"i1945-7103-96-3-366-b14","series-title":"Am J Orthod Dentofacial Orthop","first-page":"775","article-title":"Biomechanical analysis of the maxillary molar intrusion: a finite element study","volume":"161","author":"Kawamura","year":"2022","unstructured":"Kawamura J,\nPark JH,\nTamaya N,\nOh JH,\nChae JM. Biomechanical analysis of the maxillary molar intrusion: a finite element study. Am J Orthod Dentofacial Orthop. 2022;161(6):775\u2013782."},{"issue":"5","key":"i1945-7103-96-3-366-b15","series-title":"Angle Orthod","first-page":"538","article-title":"Prediction of mandibular movement and its center of rotation for nonsurgical correction of anterior open bite via maxillary molar intrusion","volume":"88","author":"Kyunam","year":"2018","unstructured":"Kyunam K,\nKwangchul C,\nYoung-Chel P,\nSeo YH,\nHeekyu J,\nYoon JC. Prediction of mandibular movement and its center of rotation for nonsurgical correction of anterior open bite via maxillary molar intrusion. Angle Orthod. 2018;88(5):538\u2013544."},{"issue":"4","key":"i1945-7103-96-3-366-b16","series-title":"AJO-DO Clin Companion","first-page":"292","article-title":"Dentofacial orthopedics for a retrognathic mandible: total arch intrusion treatment","volume":"4","author":"Jung","year":"2024","unstructured":"Jung MH. Dentofacial orthopedics for a retrognathic mandible: total arch intrusion treatment. AJO-DO Clin Companion. 2024;4(4):292\u2013302."},{"issue":"5","key":"i1945-7103-96-3-366-b17","series-title":"Semin Orthod","first-page":"673","article-title":"Occlusal plane changes with mini-implants to solve complex cases","volume":"30","author":"Cury","year":"2024","unstructured":"Cury S,\nTupinamb\u00e1 RA,\nKozel JAA. Occlusal plane changes with mini-implants to solve complex cases. Semin Orthod. 2024;30(5):673\u2013683."},{"issue":"2","key":"i1945-7103-96-3-366-b18","series-title":"Angle Orthod","first-page":"173","article-title":"Geometric analysis of alveolar bone around the incisors after anterior retraction following premolar extraction","volume":"90","author":"Zhang","year":"2020","unstructured":"Zhang F,\nLee SC,\nLee JB,\nLee KM. Geometric analysis of alveolar bone around the incisors after anterior retraction following premolar extraction. Angle Orthod. 2020;90(2):173\u2013180."},{"issue":"1","key":"i1945-7103-96-3-366-b19","series-title":"BMC Oral Health","first-page":"295","article-title":"Three-dimensional (3D) quantitative evaluation of the morphological changes of the upper anterior alveolar bone after retraction of a maxillary incisor","volume":"23","author":"Liu","year":"2023","unstructured":"Liu H,\nXi X,\nLiu D. Three-dimensional (3D) quantitative evaluation of the morphological changes of the upper anterior alveolar bone after retraction of a maxillary incisor. BMC Oral Health. 2023;23(1):295."},{"issue":"1","key":"i1945-7103-96-3-366-b20","series-title":"Korean J Orthod","first-page":"42","article-title":"Comparison of soft tissue changes between incisor tipping and translation after premolar extraction","volume":"52","author":"Baik","year":"2022","unstructured":"Baik W,\nChoi S,\nCha J,\nYu H,\nLee K. Comparison of soft tissue changes between incisor tipping and translation after premolar extraction. Korean J Orthod. 2022;52(1):42\u201352."},{"issue":"4","key":"i1945-7103-96-3-366-b01","series-title":"Am J Orthod","first-page":"398","article-title":"The long face syndrome: vertical maxillary excess","volume":"70","author":"Schendel","year":"1976","unstructured":"Schendel SA,\nEisenfeld J,\nBell WH,\nEpker BN,\nMishelevich DJ. The long face syndrome: vertical maxillary excess. Am J Orthod. 1976;70(4):398\u2013408."},{"issue":"5","key":"i1945-7103-96-3-366-b02","series-title":"Semin Orthod","first-page":"648","article-title":"Treatment strategies for vertical maxillary excess: cases with and without anterior open bite","volume":"30","author":"Paik","year":"2024","unstructured":"Paik CH,\nLee MH,\nPark JH. Treatment strategies for vertical maxillary excess: cases with and without anterior open bite. Semin Orthod. 2024;30(5):648\u2013672."},{"key":"i1945-7103-96-3-366-b03","series-title":"SAGE Open Med Case Rep","first-page":"2050313X241256805","article-title":"Surgical-orthodontic approach for correcting vertical maxillary excess: case report","volume":"12","author":"Benkhalifa","year":"2024","unstructured":"Benkhalifa M,\nTobji S,\nMoatemri R,\nBen Amor A,\nDallel I,\nBen Amor W. Surgical-orthodontic approach for correcting vertical maxillary excess: case report. SAGE Open Med Case Rep. 2024;12:2050313X241256805."},{"key":"i1945-7103-96-3-366-b04","series-title":"Int J Surg Case Rep","first-page":"106354","article-title":"Surgical procedures for correcting vertical maxillary excess: a review","volume":"86","author":"Nasrun","year":"2021","unstructured":"Nasrun NE,\nTakeda S,\nMinamida Y, et al. Surgical procedures for correcting vertical maxillary excess: a review. Int J Surg Case Rep. 2021;86:106354."},{"issue":"2","key":"i1945-7103-96-3-366-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"264","article-title":"Vertical control of a Class II deep bite malocclusion with the use of orthodontic mini-implants","volume":"155","author":"Jung","year":"2019","unstructured":"Jung M. Vertical control of a Class II deep bite malocclusion with the use of orthodontic mini-implants. Am J Orthod Dentofacial Orthop. 2019;155(2):264\u2013275."},{"issue":"2","key":"i1945-7103-96-3-366-b06","series-title":"J Indian Orthod Soc","first-page":"183","article-title":"Treatment of vertical maxillary excess in skeletal class II hyperdivergent face using skeletal anchorage - an IBO case report","volume":"58","author":"Hegde","year":"2024","unstructured":"Hegde NS. Treatment of vertical maxillary excess in skeletal class II hyperdivergent face using skeletal anchorage - an IBO case report. J Indian Orthod Soc. 2024;58(2):183\u2013193."},{"issue":"4","key":"i1945-7103-96-3-366-b07","series-title":"Angle Orthod","first-page":"625","article-title":"Treatment of vertical maxillary excess without open bite in a skeletal Class II hyperdivergent patient","volume":"87","author":"Paik","year":"2017","unstructured":"Paik CH,\nPark HS,\nAhn HW. Treatment of vertical maxillary excess without open bite in a skeletal Class II hyperdivergent patient. Angle Orthod. 2017;87(4):625\u2013633."},{"issue":"1","key":"i1945-7103-96-3-366-b08","series-title":"Semin Orthod","first-page":"108","article-title":"Vertical control with TADs: procedures and protocols","volume":"24","author":"Krishnaswamy","year":"2018","unstructured":"Krishnaswamy N. Vertical control with TADs: procedures and protocols. Semin Orthod. 2018;24(1):108\u2013122."},{"issue":"5","key":"i1945-7103-96-3-366-b09","series-title":"Am J Orthod Dentofacial Orthop","first-page":"621","article-title":"Cephalometric evaluation of intrusion of maxillary posterior teeth by miniscrews in the treatment of open bite","volume":"161","author":"Akbaydogan","year":"2022","unstructured":"Akbaydogan LC,\nAkin M. Cephalometric evaluation of intrusion of maxillary posterior teeth by miniscrews in the treatment of open bite. Am J Orthod Dentofacial Orthop. 2022;161(5):621\u2013627."},{"issue":"6","key":"i1945-7103-96-3-366-b10","series-title":"Angle Orthod","first-page":"733","article-title":"Root resorption associated with maxillary buccal segment intrusion using variable force magnitudes: a randomized clinical trial","volume":"91","author":"Akl","year":"2021","unstructured":"Akl HE,\nEl-Beialy AR,\nEl-Ghafour MA,\nAbouelezz AM,\nEl-Sharaby FA. Root resorption associated with maxillary buccal segment intrusion using variable force magnitudes: a randomized clinical trial. Angle Orthod. 2021;91(6):733\u2013742."},{"key":"i1945-7103-96-3-366-b11","series-title":"BMC Oral Health","first-page":"91","article-title":"Knowledge of orthodontic tooth movement through the maxillary sinus: a systematic review","volume":"18","author":"Sun","year":"2018","unstructured":"Sun W,\nXia K,\nHuang X. et al. Knowledge of orthodontic tooth movement through the maxillary sinus: a systematic review. BMC Oral Health. 2018;18:91."},{"key":"i1945-7103-96-3-366-b12","series-title":"Eur Arch Paediatr Dent","first-page":"751","article-title":"Dense bone islands in pediatric patients: a case series study","volume":"22","author":"Alfahad","year":"2021","unstructured":"Alfahad S,\nAlostad M,\nDunkley S, et al. Dense bone islands in pediatric patients: a case series study. Eur Arch Paediatr Dent. 2021;22:751\u2013757."},{"issue":"1","key":"i1945-7103-96-3-366-b13","series-title":"Semin Orthod","first-page":"123","article-title":"Treatment of VME using extra-alveolar TADs: quantification of treatment effects","volume":"24","author":"Alteneiji","year":"2018","unstructured":"Alteneiji M,\nLiaw JJL,\nVaid NR,\nFerguson DJ,\nMakki L. Treatment of VME using extra-alveolar TADs: quantification of treatment effects. Semin Orthod. 2018;24(1):123\u2013134."},{"issue":"6","key":"i1945-7103-96-3-366-b14","series-title":"Am J Orthod Dentofacial Orthop","first-page":"775","article-title":"Biomechanical analysis of the maxillary molar intrusion: a finite element study","volume":"161","author":"Kawamura","year":"2022","unstructured":"Kawamura J,\nPark JH,\nTamaya N,\nOh JH,\nChae JM. Biomechanical analysis of the maxillary molar intrusion: a finite element study. Am J Orthod Dentofacial Orthop. 2022;161(6):775\u2013782."},{"issue":"5","key":"i1945-7103-96-3-366-b15","series-title":"Angle Orthod","first-page":"538","article-title":"Prediction of mandibular movement and its center of rotation for nonsurgical correction of anterior open bite via maxillary molar intrusion","volume":"88","author":"Kyunam","year":"2018","unstructured":"Kyunam K,\nKwangchul C,\nYoung-Chel P,\nSeo YH,\nHeekyu J,\nYoon JC. Prediction of mandibular movement and its center of rotation for nonsurgical correction of anterior open bite via maxillary molar intrusion. Angle Orthod. 2018;88(5):538\u2013544."},{"issue":"4","key":"i1945-7103-96-3-366-b16","series-title":"AJO-DO Clin Companion","first-page":"292","article-title":"Dentofacial orthopedics for a retrognathic mandible: total arch intrusion treatment","volume":"4","author":"Jung","year":"2024","unstructured":"Jung MH. Dentofacial orthopedics for a retrognathic mandible: total arch intrusion treatment. AJO-DO Clin Companion. 2024;4(4):292\u2013302."},{"issue":"5","key":"i1945-7103-96-3-366-b17","series-title":"Semin Orthod","first-page":"673","article-title":"Occlusal plane changes with mini-implants to solve complex cases","volume":"30","author":"Cury","year":"2024","unstructured":"Cury S,\nTupinamb\u00e1 RA,\nKozel JAA. Occlusal plane changes with mini-implants to solve complex cases. Semin Orthod. 2024;30(5):673\u2013683."},{"issue":"2","key":"i1945-7103-96-3-366-b18","series-title":"Angle Orthod","first-page":"173","article-title":"Geometric analysis of alveolar bone around the incisors after anterior retraction following premolar extraction","volume":"90","author":"Zhang","year":"2020","unstructured":"Zhang F,\nLee SC,\nLee JB,\nLee KM. Geometric analysis of alveolar bone around the incisors after anterior retraction following premolar extraction. Angle Orthod. 2020;90(2):173\u2013180."},{"issue":"1","key":"i1945-7103-96-3-366-b19","series-title":"BMC Oral Health","first-page":"295","article-title":"Three-dimensional (3D) quantitative evaluation of the morphological changes of the upper anterior alveolar bone after retraction of a maxillary incisor","volume":"23","author":"Liu","year":"2023","unstructured":"Liu H,\nXi X,\nLiu D. Three-dimensional (3D) quantitative evaluation of the morphological changes of the upper anterior alveolar bone after retraction of a maxillary incisor. BMC Oral Health. 2023;23(1):295."},{"issue":"1","key":"i1945-7103-96-3-366-b20","series-title":"Korean J Orthod","first-page":"42","article-title":"Comparison of soft tissue changes between incisor tipping and translation after premolar extraction","volume":"52","author":"Baik","year":"2022","unstructured":"Baik W,\nChoi S,\nCha J,\nYu H,\nLee K. Comparison of soft tissue changes between incisor tipping and translation after premolar extraction. Korean J Orthod. 2022;52(1):42\u201352."}],"container-title":["The Angle Orthodontist"],"original-title":[],"link":[{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/96\/3\/article-p366.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/96\/3\/article-p366.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/96\/3\/article-p366.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:12:01Z","timestamp":1780063921000},"score":1,"resource":{"primary":{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/96\/3\/article-p366.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":40,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.2319\/112224-958.1","relation":{},"ISSN":["1945-7103","0003-3219"],"issn-type":[{"value":"1945-7103","type":"electronic"},{"value":"0003-3219","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}