## 2 Methods
### Combined Use of SBJA and High-Pull J-Hook Headgear
With growth, the maxillary molars protruded, but the protruding of the maxillary anterior teeth was suppressed, and the occlusal plane (occlusal plane to FH) changed from 15.0\({}^{\circ}\) to 10.5\({}^{\circ}\), and transformed into an anterior elevation (Figure 9, Table 3). Wits appraisal was \(-\)0.5 mm. The left central incisor cervical exposure while smiling decreased from 5.5 mm to 0.0 mm, thus improving the gummy smile (Figure 10A). In addition, the overbite improved, and the molar relationship changed from class II to class I (Figure 10B). No root resorption was observed in the maxillary anterior teeth (Figure 11). Figure 10: Facial photograph and intra-oral photograph of Case 2 at the end of the first stage of treatment; facial photograph and enlarged photograph of the mouth at the end of the first stage of treatment (**A**); intra-oral photograph at the end of first stage of treatment (**B**). Figure 9: Superimposed images of Case 2; overall (SN plane, reference point S) (**A**); maxilla (palatal plane, reference point ANS) and mandible (mandibular marginal plane, reference point Me) (**B**). Case 3. Findings from initial examination  
The patient was a Japanese girl of 8 years 10 months old at the time of the initial examination, with a chief complaint of rattling anterior teeth. In terms of family history, the patient's mother had teeth crowding. There were no records in her history of current illness or medical history that were particularly problematic. She had no notable habits. In terms of facial findings (Figure 12A), the frontal view did not demonstrate any deviation of the mandible. When smiling, however, the distance between the upper lip to the maxillary left central incisor cervical line was 4.0 mm, and a gummy smile was evident. In the lateral view, a protrusion of the upper lip was observed. In the intra-oral findings (Figure 12B), the occlusal relationship of the molars was Angle Class II on both the left and right sides, and the overjet was +5.0 mm on both sides. In addition, the overbite was +3.0 mm. The maxillary anterior teeth were crowded, and the maxillary and mandibular dentition midlines were coincident with the facial midline. The dental age was stage IIIB, and narrowed dental arches were exib  
Figure 11: Panoramic radiograph (**A**) and lateral roentgenographic cephalogram (**B**) of Case 2 at the end of the first stage of treatment. Figure 12: Facial photographs and intra-oral photographs at initial examination for Case 3; facial photograph and enlarged photograph of the mouth at initial examination (**A**); intra-oral photograph at initial examination (**B**). and lower jaws. The length, however, of the dental arch was normal for both the upper and lower jaws, exhibiting a parabolic morphology. The panoramic radiographs (Figure 13) showed no abnormalities in the number of teeth. In the cephalogram angle measurement (Table 5), the SNA angle was 84.5\({}^{\circ}\), the SNB angle was 78.5\({}^{\circ}\), and the ANB angle was +6.0\({}^{\circ}\), thus exhibiting skeletal class II. The Frankfort-mandibular plane angle (FMA) was 26.0\({}^{\circ}\). U1 to SN was 109.0\({}^{\circ}\) and the maxillary anterior teeth showed labial inclination. In addition, FMIA was 52.0\({}^{\circ}\). In the cephalogram distance measurement (Table 6), the maxillary anterior tooth height (Is-Is') was 29.5 mm, so that with reference to [PERSON] et al. [18], the patient's maxillary anterior teeth were high. Wits appraisal was \(-\)0.5 mm. Diagnosis  
This patient was diagnosed as a case of skeletal class II, accompanied by a gummy smile due to the vertical excessive growth of the upper jaw, and crowding. Treatment approach  
First, we decided to improve the crowding of the maxillary anterior teeth with a sectional arch. After that, we decided to use SBJA for the purpose of improving skeletal maxillary prognathism in order to suppress maxillary growth and promote mandibular growth.