Clinical and

        Research Articles

This section of Hilgers Publications contains the most poignant and reproduced articles of over 90 written by members of the Hilgers family.  Each article, saved​ in .pdf format, can be accessed by simply clicking on the picture next to each article description.  These articles have been written and published in refereed scientific and clinical journals.  Please enjoy!


The PIT and the Pendulum:

Pendulum-Integrated TADs      

This article, co-written by Drs. James Hilgers,

Shannon Hilgers Nissen and Stephen Tracey

highlights the use of non-compliant therapy involving the utilization of TADs for anchorage following treatment with one of the family

of Pendulum™ appliances.

Adolescent Pregnancy: A Review
of Dental Treatment Guidelines

Dr. Kelly Hilgers et al. discuss the principles for medical management of these patients. While  not unlike those used for adult females, the higher incidence of complications coupled with social and consent issues make their overall management more complex.

Orthodontic Treatment Veneers

This article, co-authored by Dr. James Hilgers and Dr. Debra Cook demonstrates a simple kit method​ of building up a composite veneer on congenitally pegged upper lateral incisors.

This method holds space for a ceramic veneer to be placed at a later date.


The Use of the Diode        Laser in Orthodontics

This article, co-written by Dr. James Hilgers and Dr. Stephen Tracey describes how to use a Diode laser to remove redundant tissue, improve tissue esthetics and simple exposures of tissue covered teeth to aid in treatment.


Association Between Childhood Obesity and Smooth-surface Caries in Posterior Teeth

The purpose of this study by Dr. Kelly Hilgers et al. was to determine if increased body mass index (BMI) is associated with an increased risk for dental caries.


Bios-A Bracket Evolution,

         A Systems Revolution


Dr. Hilgers gives a detailed description of​

Ormco's Bios System.  Designed by Dr. Hilgers,

the Bios brackets give substance and thought to light wire Bio-progressive orthodontics. The approach is to explain goals and methods.


Hyperefficient Orthodontics

​​This article, co-written by James Hilgers and Steven Tracey gives force to new techniques used to treat cases following time proven Bio-Progressive Principles.  Within are description of molar distalizers used in conjunction with Bios mechanics. 


Mike+Hilgers+orthodontics+cephalometrics+HNC ortho+mission viejo+california

Accuracy of linear measurements from imaging plate and lateral cephalometric images derived from cone-beam computed tomography

​​Dr. Michael Hilgers discusses using cone-beam tomography to create a lateral headfilm and the

associated accuracy of doing so.


Accuracy of cone-beam computed tomography imaging of the temporomandibular joint:
Comparisons with panoramic radiology and linear tomography

​​Dr. Michael Hilgers compares cone-beam tomography to a panorex when evaluating

the temporo-mandibular joint.


Accuracy of linear temporo-

mandibular joint measurements

with cone beam computed

tomography and digital

cephalometric radiography

​​Dr. Mike Hilgers, et al discuss TMJ radiology 


Not a Moment Too Soon...

​​In an interview with, Dr. Hilgers

explores the reasons for and against early

treatment.  There are certain types of

problems that deserve immediate attention

but there are many others that are more

efficiently and economically treated later.


The Mini-distalizing Appliance


​​The mini-distalizing appliance is the latest in​

the Pendulum family appliances that focuses

on expansion with the secondary benefit of moderate molar distilization.  A smaller cleaner

appliance, it uses the teeth for stability so mustbe backed up with other anchorage.


Orthodontic Treatment Provided

by Pediatric Dentists


​​The purpose of this study, written by Dr. Kelly Hilgers, et al., was to document orthodontic treatment currently provided by pediatric dentists for comparison with past and future studies and to ascertain variables that influence practitioners’ orthodontic treatment patterns.


Dentomaxillofacial Cone-beam CT for Orthodontic Assessment


​​Cone-beam CT affords the possibility of providing 2D simulated cephalographic projections from 3D datasets. The ability to reconstruct such traditional cephalograms means that existing data bases can still be used for orthodontic treatment projections. Article by Dr. Michael Hilgers.


Orthodontic Offices 2009:
Grow, Thrive and Be Exceptional!


​​A short article, written by designer Joyce Matlack. describes the transformation of the orthodontic office of Dr. James Hilgers and Dr. Shannon Hilgers Nissen.  Demonstrates the changes necessary to compete in today's orthodontic environment.


Twelve Reasons for Taking a

     Giant Step Backwards


​​Dr. James Hilgers describes a new terminal molar tube design that simplifies archwire placement. Accent terminal tubes have a funneled entrance, no tie wings and miniature size that is possible since the advent of super-elatic archwires.


A Palatal Expansion Appliance for

    Non-compliance Therapy


​​Dr. James Hilgers used the term "non-compliance therapy" for the first time in orthodontic literature when he described a palatally borne expansion appliance that effectively rotated molars, expanded the upper arch and initiated Cl II correction.


Lingual Orthodontics -

         A Status Report, Part IV


​​In the first article ever written on lingual orthodontics, Dr. James Hilgers et al. discuss their experiences with this new and exciting

technology.  Lingual orthodontics, used to assuage adult esthetic discomfort with labial braces started a trend that continues today.


Lingual Orthodontics -

         A Status Report, Part 1


​​This discussion centers on the general diagnostic and treatment planning considerations of lingual orthodontics for patient selection.  Written by James Hilgers, et al., it was the first to describe the treatment modalities using lingual braces.


Bioprogressive Therapy

        Part 2: Principles


​​The clinician needs to base his treatment mechanics on the results he or she want to achieve with the goals and objectives they have in mind.  In this article about the principles of the Bioprogressive™ therapy, Dr. James Hilgers et al. clarify this "begin with the end in mind" approach.


Bio-Progressive Therapy, Part 4: The Use of Superimposition Areas to Establish Treatment Design


​​In this article, the authors (Hilgers, et al.) demonstrate the use of the Visual Treatment Objective as a management tool. It establishes five superimposition areas, which then allow us to establish seven evaluation areas.


Bioprogressive Therapy, Part 6:

Forces Used in Mechanotherapy


​​Co-written by Drs. James Hilgers, Ruel Bench

and Carl Gugino, this bioprogressive article

defines the forces used with this technique.

Root surface areas and anchorage from both

muscle and cortical bone are highlighted.


Bio-Progressive Therapy, Part 8:   Mixed Dentition Treatment


​​The purpose of this article, written by James Hilgers et al., is to clarify the basic objectives of early treatment and thereby elucidate, from a practical standpoint, those cases that truly deserve early therapy and those cases that would be best treated in a single phase.


Bio-Progressive Therapy, Part 10: Mechanics for Class II Division II


​​The treatment sequences involved in the treatment of non-extraction Cl II, DII malocclusions are discussed in this Bioprogressive article. The concept of advancing the incisors to clear the lower

and using intra-oral elastic conduct.


Bio-Progressive Therapy, Part 12: Finishing and Retention


​​Band removal, contact space closure, semi-permanent retention and the adjustment

and use of the Ricketts retainer are discussed

in this Bioprogressive article written by Hilgers

et. al.


Bioprogressive Simplified, Part 2: The Linear Dynamic System


​​The Linear Dynamic System, a new bracket

system developed and marketed by Ormco

incorporated the ideas suggested in his

Bioprogressive Simplified articles by Dr.

James Hilgers.


The Aysmmetrical "T" Loop

            Closing Archwire

The asymmetrical T-loop archwire, fabricated

in TMA wire affords the clinician the ability to open or close the bite while closing anterior spaces. Invented by Dr. James Hilgers, this pre-formed wire is marketed by Ormco Corporation.

Dolphin 3D and Oral and

 Maxillofacial Radiology Practice

​​In this short communication, Dr. Michael Hilgers

et al. explain why Dolphin 3D is such a useful

application for oral and maxillofacial radiology



Maxillofacial Cone-beam CT for

      Orthodontic Assessment


​​CBCT using the iCat system permits reconstructions that are comparable to traditional cephalometric projections. In this article Dr. Michael Hilgers et al. discuss using existing databases for treatment projections.


Bio-Progressive Therapy, Part 1: The Management Umbrella


​​In the first of a 12 part series for the JCO,

Drs. James Hilgers, Ruel Bench and Garl Gugino

describe the management umbrella under which

the Bio-progressive principles are delivered. 


The Gold Standard in

Orthodontic Mechanics -

Vcctor TAS

This is the first article on Ormco's Vector

TAS mini-screws written by its inventors,

Drs. Hilgers, Graham, Sheffler and

Tracey.  They reviewed some of the most 

common design features and uses of

mini-screws in orthodontic mechanics.



Orthodontic Training in Pediatric Dental Residencies


​​The purpose of this study was to determine the amount and types of orthodontic training in pediatric dental residencies. A twenty-one-item survey was mailed to sixty directors of pediatric dental residencies. Described in an

article by Dr. Kelly Hilgers et al.


Functional Finishing-The Concepts

    The Tools, The Techniques


​​In this Clinical Impressions article, Dr. James Hilgers describes the mechanics involved in finishing orthodontic cases in a functional and muscle driven manner.  He elucidates the concepts and techniques involved in detailing for completing with an outstanding result.


Memorial to Dr. Robert M. Ricketts


​​In this memorial published in the Journal of Clinical Orthodontics, Dr. James Hilgers muses about the passing of his mentor, friend, teacher and boss.  Working for Dr. Ricketts from 1971-75 was one of the highlights of his orthodontic career and it shows in this short dissertation describing his experiences.


The Pendulum Appliance for

  Class II Non-Compliance Therapy


​​In a landmark article that started an evolution

toward non-compliant treatment, Dr. James

Hilgers describes mechotherapy using what he has dubbed the Pendulum™Appliance.  It is the first of many in a family of appliances that is used to distalize the upper molars.


​​Lingual braces were now starting to take their

place in the orthodontic world.  Even current royalty wanted to be treated with this new and innovative technology.  Dr. Hilgers et al. discuss mechanical principles using lingual braces. A great smile, that's how you nab a prince.


Lingual Orthodontics -

         A Status Report, Part V


Bio-Progressive Therapy, Part 3: Visual Treatment Objective or VTO


​​Beginning with the end in mind is especially

important in treatment planning.  In this

"how to" oriented article, Drs. Hilgers, Bench

and Gugino describe the process of creating

a visual treatment objective or VTO.


Bio-Progressive Therapy, Part 5: Orthopedics in Bio-Progressive Therapy


​​Hilgers et al. discuss the use of headgear orthopedics to the maxillae.  Includes multiple case demonstrations and describes the apparent and not so apparent results of mid-facial orthopedics.


Bio-Progressive Therapy, Part 7:

The Utility and Sectional Arches


​​Probably the most recognizable single entity in the Bio-Progressive Therapy would be that of the Utility Arch. It forms the base unit around which the mechanics in all types of cases can be employed.

Dr. James Hilgers et al. discuss the use of these archwires.


Bio-Progressive Therapy, Part 9: Mechanics for Class II Division I


​​Dr. James Hilgers, et al. discuss the sequential

treatment mechanics devised for Class II, DI

malocclusions. This article deals with both the

non-extraction and extraction treatment of

these malocclusions


Bio-Progressive Therapy, Part 11: Mechanics for Extraction Cases


​​Dr. James Hilgers, et al. discuss the sequential

treatment mechanics devised for treatment

of extraction cases including bite opening.

segmental cuspid space closure and anterior

retraction.  Second bicuspid extractions and

anchorage maintenance are discussed.


Bioprogressive Simplified, Part 1: 

Diagnosis and Treatment Plans


​​This, the first of four articles written by

Dr. James Hilgers, started to define a simpler, easier method of using Bioprogressive principles in an effective manner.  This article discusses the diagnostic system using VTOs.


Bioprogressive Simplified, Part 3: Nonextraction Therapy


​​Dr. James Hilgers, et al. discuss the sequential

treatment mechanics devised for the nonextraction of Class II, DI malocclusions. This article deals with both the orthopedics and​ segmental mechanics used in these cases.


L'uso del Diode Laser 

    in Ortodonzia


​​Questo artice è la versione spagnola del JCO

versione scritta da Drs. James Hilgers e Stephen Tracey. Altre foto e descrizioni di trattamento ampliare l'appeal di questo primo articolo mai scritto circa l'uso laser a diodi in aggiunta alla ortodonzia. Dr. Hilgers parla un italiano fluente.


Adventures in Orthodontics...

Article in Orthodontic Products


​​In an article in Orthodontic Products, the office

of Drs. James Hilgers and associate Debra

Cook is described.  Defining what it takes to be

successful in orthodontic practice, the author

interviews Hilgers' staff and patients to come

up with a winning formula.


Using Pendulum Appliances: An

Interview with Dr. Hilgers


​​In an interview with Ray Bedette on, Dr. James Hilgers expounds on changes and advancements in the use of the Pendulum family of appliances.  He addresses some of the misconceptions and problems that orthodontists have using this molar distalizer.


Bioprogressive Simplified, Part 4: Extraction Therapy


​​Dr. James Hilgers discusses a simplified way of treating extraction cases without the complex

loop systems commonly utilized in more traditional Bioprogressive mechanics.  Hilgers

describes the diagnostic and in-treatment

decisions needed in a more simplified approach.


Knowing When to Say When


​​The post retention period is beginning to be

more and more important for orthodontists.

Most orthodontists acknowledge that stability

can be very fragile unless the patient continues to wear some sort of retention for a lifetime.  In this article, Dr. James Hilgers highlights the techniques involved in maintaining long term stability.


Klasse-II-Behandlung - Fragebogen und Fallbeispiele


​​In diesem Artikel für eine deutsche kieferorthopädischen Fachzeitschrift geschrieben, antwortet Dr. James Hilgers 12 Fragen über hyperefficient und Nichteinhaltung der Kieferorthopädie. Er erklärt die Verwendung des

MDA-Appliance und Herbst Appliances. Dr. Hilgers spricht fließend Deutsch.


Bios™ is a light-wire, higher-torque
version of the Orthos™ appliance system.
It is designed for the orthodontist who
doesn’t fill the slot and depends on functional
adaptation more and dominance
mechanics less. This article, written by Dr.

James Hilgers, for Clinical Impressions.


BIOS -A Bracket Evolution,

A Systems Revolution


Keeping Control - An Update

on Noncompliance Treatment


​​Orthodontic Products published this article

written by James Hilgers about the nature of maintaining control when treating with non-compliant therapy.  In it he addresses the concerns over anchorage loss when distalizing molars and discusses the advantages of using the Herbst Appliance in certain situations.


Kelly+Hilgers+pediatric dentistry+arizona+dentistry+hncortho+mission viejo+california

Localized Aggressive Periodontitis in a Six-year-old: A Case Report


The purpose of this report was to describe an approach to diagnose and effectively treat a
pediatric patient with localized aggressive periodontitis. A 6-year-old female presented with clinical and radiographic evidence of severe attachment loss around several primary teeth.



The New Patient Phone Call


​​This is undoubtedly the most important phone call ever received in an orthodontic office. Handling it with focus and deliberation is the key to being successful to patient assimilation.  Dr. James

Hilgers, in this article, describes techniques

and scripting that can be used in this situation,

notes how imperative it is to have time and the

right person on the phone.


The Pendulum Appliance -

   Maintaining the Gain


The second of two articles, Dr. Hilgers presents

a treatise on the ways of holding anchorage

once the upper molars have been distalized.

From Herbst appliances to Quick Nance Appliances,

all of the anchorage units available have been elucidated.


The Pendulum Appliance-

          An Update


Written by Dr. James Hilgers, this article in

Clinical Impressions (CI) elucidates some

of the new thoughts on using the Pendulum

molar distalizer. Explains some of the

nuances of treating with this appliance.


Kelly+Hilgers+pediatric dentistry+orthodontics+arizona+hncorthodontics+mission viejo+california

Very little is known about orthodontic treatment
provided by general dentists in the United
States. Although orthodontic treatment provided
by nonorthodontists has been evaluated in the
past, previous investigators sampled only general practitioners from a few states, not from the nation as a whole.


Orthodontic Treatment Provided by General Dentists


Scheduling - Part I


This article, Part I of a two part series was

published in Clinical Impressions.  This first part deals with the criteria around which a successful scheduling system is built.  It deals with measuring certain parameters that determine how the ideal scheduling system should be structured.


Scheduling - Part I​I


Part II of this series deals with the scheduling

system that takes into account doctor time,

assistant time and procedure time.  This is

integrated into a scheduling system that, if 

properly adhered to, should keep you running

on time.


This article, written by Drs. James Hilgers and Rand Bennett, is an update of all the the  features of the pendulum appliance.  This article deals with the specifics of molar distalization and ends with the space creation in the upper arch.


The Pendulum Appliance -

   Creating the Gain


Kelly+Hilgers+Michael+orthodontics+pediatric dentistry+HNC orthodontics+arizona+mission viejo+california

Childhood obesity and skeletal maturation assessed with Fishman’s hand-wrist analysis


Dr. Kelly Hilgers writes about the relationship

between an early taken hand-wrist analysis

(Fishman's) and the onset of childhood obesity

and the accuracy of obesity predictabilty.


The Era of Hyperefficient

        Orthodontics - Part I


​​This article, written by Dr. James Hilgers, is the first to tie all of the different methods of Cl II correction directly to treated cases.  It shows both the diagnostic criteria, VTOs and written 

summary description on 6 different kinds of cases where molar distalization is used.


The Era of Hyperefficient

        Orthodontics - Part II


​​This article, written by Dr. James Hilgers, is the first

to tie all of the different methods of Cl II correction directly to treated cases.  It shows both the diagnostic criteria, VTOs and written summary description on 6 different kinds of cases where

molar distalization is used.


​​This article, published in October 2012 shows the use of composite buttons to hold down

"in-house made" Essix retainers, especially

when used to realign slightly crowded teeth.

The second part of the article shows how to

use a composite and chain (C&C) to attach

a gold chain directly to impacted cuspids.


Two Easy Pieces


The Rise of Permanent Retention

      7 Principles for

            Stability Maintainance


​​This article, co-written by Drs. Hilgers,

Miroue, Nissen and Tracey delineates the seven

factors involved in maintaining an orthodontic

result for a lifetime.  This article gives the

reader the tools to accomplish this feat.

Publication date Jan. 2013 in the JCO.


Written in 1995 by Dr. James Hilgers, it's

amazing how many of his prognostications

have actually occurred.  It was before Invisalign and some of the ultra-competitiveness in orthodontics. Part I discusses the Good, the

Bad and the Ugly.


On The Future of Orthodontics

                Part I


Written in 1995 by Dr. James Hilgers, this

treatise continues with not only some of the problems orthodontics is encountering but

also delves into some of the solutions.  This

is the second half of this very long but informative article.



On The Future of Orthodontics

                Part II


Indirect Bonding- Getting

The Monkey Off Your Back

The Linear Dynamic System was the

first broad change in Bioprogressive

appliances since the evolution of

directly bonded brackets.  It 

incorporated new cast double 

convertible terminal tubes and 

accentuated light wire treatment

in .018 slot brackets.


Linear Dynamic System

This article, written for Clinical Impressions

by Dr. James Hilgers may seem a bit outdated in this era of digital scanning and commercial indirect bonding techniques but it can be useful for simple indirect bonding needs, especially partial bonding or retreatment situations.



Hyperefficient Orthodontic Treatment Using Tandem Mechanics 

This article written by Dr. Hilgers for Seminars

in Orthodontics demonstrates how to

efficiently use the Pendulum Appliance in conjunction with a fixed functional appliance,

the Herbst.  This tandem of both a functional

and tooth moving appliance is the ultimate in noncompliant therapy.

The Pendulum Appliance-

Twenty-five Years Later

In an article for the JCO Dr. Shannon Hilgers Nissen captures succinctly what we've learned about the Pendulum Appliance and it's different iterations over

the last 25 years.



The Pendulis Appliance for

Bone-Anchored Maxillary

Molar Distalization

In an article for the JCO Drs. Nappee and Hilgers describe an appliance that uses a single palatal mini-screw for an easily adjustable and removable iteration of the classic pendulum appliance.


Hilgers InForms...


Hilgers InForms are an elegant but simple way

to communicate with patients, dental colleagues

and parents.  To try them out just click on the 

arrow next to the InForm to bring up these in

interactive .pdf files.

Dental Request InForm

Progress Report InForm

Final Results InForm

New Patient Inform

Extraction Request Inform