A 13-year, 9-month-old girl presented with the chief complaint of crowding and protrusion of her anterior teeth. She was dolichofacial with a Class II Division 1 occlusion and had reached the final phase of her skeletal growth. Clinical symptoms and tomograms were indicative of a TMJ dysfunction. Because orthognathic surgery was not accepted by the patient and her parents, a Herbst appliance became the choice of treatment. An optimal occlusion and a good facial appearance were achieved after 24 months of treatment. TMJ tomograms at the end of treatment showed a more physiologic condylar position. Long-term follow-up 7 years after the end of treatment showed a very stable occlusion and an acceptable facial appearance. World J Orthod 2009;10:243–251.