DEPARTMENT OF ORTHODONTICS

AND DENTOFACIAL ORTHOPAEDICS

GOOD MORNING
TOPIC-THEORIES OF
GROWTH
GROWTH
It may be defined as a
physiologic increase in size,
weight and mass of living
organism.
At the Macroscopic level,
growth is exemplified by an
increase in height and weight,
while at the Microscopic level
, it is accompanied by an
increase in number of cells
and their size.
`
 GROWTH FACTORS
• HEREDITY • ENVIRONMENTAL
THEORIES
1. Remodelling theory (Brash)
2. Genetic theory (Brodie)
3. Sicher’s theory of sutural growth
dominance
4. Scott’s theory of cartilaginous
growth dominance
5. Functional matrix concept and its
recent modifications
6. Servosystem theory (Petrovic)
7. Multifactorial theory (Van Limborg)
8. Hunter-Enlow growth equivalent
theory
9. Enlow expending V priniciple
REMODELLING THEORY
• In 1930, Brash proposed that
bone grows only by surface
remodelling-selective addition
at one surface and resorption
on the other.
• He stated that growth of the
jaws is characterised by the
deposition of bone at the
posterior surfaces of the
maxilla and mandible.
The theory had its limitations
It could not explain the role of
sutures and cartilages in the
growth of craniofacial skeleton.
Genetic theory (A.BRODIE-1941)
• He stated that genes
determine and control the
whole process of craniofacial
growth.
 Sicher’s theory of sutural growth
dominance
• Sicher observed the staining of the
bones of animals fed on madder
and concluded that sutures were
causing the growth since they
were the sites of active staining in
experiments.
• According to him, the primary
event in craniofacial growth was
the proliferation of the connective
tissue between bones which
caused them to grow and
elongate.
• Sicher thought that growth of the
cranium occured due to the
apposition at the sutures which
determined the adult facial form.
• The maxilla grew forward due to the
growth at circummaxillary sutural
system and recognised the
endochondral nature of the cranial
base .
• He felt that growth at these places
was intrinsic and genetically
regulated primary growth.
• He treated the mandible like a
bent long bone which grew at
both ends . Mandible grew
both by interstitial growth
and by apposition
• Sicher stressed that growth
at the sutures and the
cartilages was under
strong genetic control with
a minor contribution from
the local environmental
factors.
• Disadvantages of theory
• It could not explain the massive
craniofacial structural alterations
that were observed in subjects with
soft tissue deformities of the CNS
and craniofacial tissues.
• Experiments by Scott and
colleagues revealed that cranial
sutures grew by direct ossification
of connective tissue without any
cartilaginous precursor while
Sicher believed them to be similar
to synchondroses.
 Scott’s theory of cartilaginous
growth dominance
• James H Scott, an Irish anatomist
proposed the nasel septum theory
as the single and unified theory of
craniofacial growth.
• According to this theory, sutures
play little or no direct role in the
growth of the craniofacial skeleton.
• Scott concluded that nasal septum
is mostly active and vital for
craniofacial growth both prenatally
and postnatally.
• The anteroinferior growth of the
nasal septal cartilage which is
buttressed against the cranial base
“pushes” the midface downward
and forward .
• According to Scott, bone
separation must precede
before the adaptive sutural
bone growth occurs.
• There are two suture
systems
1. Posterior suture system lies
behind the maxilla and
separates it from palatine ,
lateral mass of ethmoid,
lacrimal, zygomatic and vomar
bones.
2. Anterior suture system
separates premaxilla, nasal and
vomer bone. The second suture
system disappears in the human
face during later part of fetal
period and after birth.
Evidences against the theory
• Moss and Bloonberg found
only slight deformity after
extirpation of septal cartilage.
They concluded that septal
cartilage provides only
mechanical support for the
nasal bones and is not a
primary growth center.
• This theory is not considered
to be an active contributor for
vertical development of face.
Enlow’s expanding “v” principle
• V – pattern of growth
occurs in number of
regions like-

- Base of mandible
- Body of mandible
- Palate
 Enlow’s counterpart principle
According to this principle, growth
of any given facial or cranial part
relates Specifically to the other
structural and geometric
counterpart in face and cranium.
There are regional relationship
through out the whole face and
cranium. If each regional part and
it’s particular counterpart enlarge
to some extend, balance growth
occurs.
• Imbalance in the relationship are
produced by difference in amounts,
directions and time of growth
between the counterparts.
• For Example:
1) Nasomaxillary complex and anterior
cranial fossa are mutual counterparts
2) Maxillary and mandibular arches are
mutual counterparts.
Functional matrix concept and its recent
modifications
• The most popular hypothesis
of Moss emphasizes that
osseous growth of skull is
secondary.
• This theory is based on
functional cranial component
theory of Van der klaauw.
• Moss stresses the dominance
of non osseous structures of
craniofacial complex over the
bony parts. He claims that
growth of skeletal component
is largely dependent on
growth of functional matrices.
 Functional cranial component
( tissues, organs, spaces, skeletal part )

Skeletal unit Functional matrix

(bone, cartilage tendons)

Micro skeletal unit Macro skeletal unit

(Various parts of maxilla ( Endocranial surface
and mandible) of calaveria)
 Functional matrix

Periosteal matrices Capsular matrices

( muscles, vessels, nerves, ( neurocranial capsule &
glands ) orofacial capsule )

Acts directly on skeletal unit Acts indirectly

Produce a secondary compen- Produce a secondary

atory transformation by translation in space
Deposition & Resorption by expansion
Functional cranial component
• A number of relatively
independent functions are
carried out in the
craniofacial region, like
respiration, chewing,
swallowing, etc.
• Each of these function are
carried out by functional
cranial component.
• Neurocranial capsule :
This capsule sandwiched in
between layer of skin and
duramater.
The neurocranial capsule
surrounds and protects the
neurocranial capsular
functional matrix which is
brain, leptomeninges and CSF.
• Orofacial capsule : this is
sandwiched in between
covering layer of skin and
mucosa.
• This capsule surrounds and
protects the oro-
nasopharyngeal spaces.
• Most orthodontic therapy is
based on the fact that when
this functional matrix grows
or is moved, the related
skeletal unit ( the alveolar
bone ) responds appropriately
to this morphogenetically
primary demand
Functional matrix hypothesis revisited:1.The role of
mechanotransduction
• Periodic advances in the biomedical,
bioengineering and computer science allow
the creation of increasingly more
comprehensive revisions of the functional
matrix hypothesis.
• The FMH postulates two types of
functional matrices. This new version deals
only with the responses to periosteal
matrices. It now includes the molecular
and cellular processes underlying the triad
of active skeletal growth processes-
-deposition
- resorption
- maintenance
• FMH – revisit presents seamless
description between several level of
bone structure and operation from
genomic to organ level.
• The inclusion of two complementary
concepts-
1) Mechanotransduction occurs in
single bone cells.
2) Bone cells are computational
elements that function multicellularly
as a connected cellular network.
 Mechanotransduction
• Mechanosensing process enable
a cell to sense and to response to
extrinsic loading by using the
process of mechanoreception
and mechanotransduction.
• The mechanoreception transmits
an extra cellular physical
stimulus into a receptr cell, the
mechanotransduction
transforms the stimulus into an
intra cellular signal.
 Osseous mechanotransduction
• Static and dynamic loading are applied to
bone tissue, leading to deform both extra
cellular matrix and bone cells.
• When stimulus threshold level exceeded,
the loaded tissues responds by triad of
bone cell adaptation process.
• Osseous mechanotransduction is
unique in 4 ways-
1-Other mechanosensary cells are
cytologically specialized but bone
cells are not.
2-One bone loading stimulus can
evoke three adaptational
responses where as non osseous
processes generally evoke one.
3-Osseous signal transmission is
Aneural.
4-Evoked bone adaptational
response are confined with in each
‘bone organ’ independently.
• There are 2 mechanotransductive
process-
1) Ionic or electric
2) mechanical- through physical
continuity of the
transmembrane molecule integrin.

• It is by such an interconnected
physical chain of molecular levers
that periosteal functional matrix
activity may regulate the genomic
activity of its strained skeletal unit
bone cells, including their phenotypic
expression.
Functional matrix hypothesis revisited: 2.
the role of an osseous connected cellular
network
• Bone as an osseous connected
cellular network (CCN):
•All bone cells, except osteoclasts,
are extensively interconnected by
GAP-junction that form an osseous
CCN. Each osteocyte enclosed with
in its mineralized lacuna, has many
cytoplasmic (canalicular) processes
that interconnected with similar
processes of up to 12 neighboring
cells
• Gap-junction exhibit both electrical
and fluorescent dye transmission, in
addition to permitting the
intercellular transmission of ions and
small molecules.
• Mechanotransductively activated bone
cells, e.g. osteocyte, can initiate
membrane action potentials capable
of transmission through
interconnected Gap-junction.
• In network theory, cells are organiged
in to “layers”
1) an initial input
2) intermediate or hidden layer
3) a final out put
Functional matrix hypothesis revisited:
3. The genomic thesis
It claims that the genome contains
all the information needed for
growth and development of an
organism from intrauterine life to
senescence.
It holds the necessary information
to regulate
1)The intranuclear formation and
transcription of mRNA.
• 2)Importantly, without the later
addition of any other information,
to regulate also all of the
intracellular and intercellular
process of subsequent, and
structurally more complex cells,
tissue, organ, and organismal
morphogenesis.
• All (phenotypic) feature are
ultimately determined by the DNA
sequence of the genome.
The functional matrix hypothesis revisited :4.
The epigenetic antithesis and the resolving
synthesis
• The epigenetic antithesis :
The epigenetic antithesis, detailing both
processes and mechanism, is integrative,
seeking to clarify the causal chain
between genome and phenotype.
• Its goal is to identify and describe
comprehensively the series of initiating
biological process and their related
underlying (biochemical, biophysical)
responsive mechanisms that are
effective at each hierarchical level of
increasing structural and operational
complexity.
 The Resolving Synthesis
• Morphogenesis is regulated (controlled,
caused) by the activity of both genomic
and epigenetic processes and mechanisms.
• Both are necessary, neither alone are
sufficient cause and only their integrated
activities provides the necessary and
sufficient causes of growth and
development.
• Genomic factors are considered as
intrinsic and prior causes, epigenetic
factors are considered as extrinsic and
proximate cause.
• Epigenetic processes and events are the
immediately proximate causes of
development and as such they are the
primary agencies.
 Hunter- Enlow growth equivalent
theory
• There are four morphogenetically
distinct regions in the human skull :
• Growth occurs at sutures,
periosteal and endosteal
surfaces and synchondroses.
• Growth is the combination of
complex remodelling at
periosteal and endosteal
surfaces as well as translation
of whole bone in space.
• According to Hunter-Enlow,
the face can be seen as
consisting of specifc horizonta
and vertical ‘equivalents’
which match each other in
general size or position if
harmoinious face is to exist.
• Example- the anterior cranial
base, the maxilla and the body
of mandible
This growth is provided by the
increased anterior-posterior
Distance in the ramus which bridges the
pharynx.
The ramus provides the horizontal
growth equivalent to
the elongation of the spheno-occipital
segment.
• This theory is supported by
Petrovic who attempted to
define the cybernetic feedback
control loops existing in the
biological system.
 Von Limborgh’s Compromise
theory
• Von limborg explains the process of
growth and development after review of
the sutural theory, cartilaginous theory
and functional matrix theories.
• He suggested the five factors that have
been believed to control the growth.
1) Intrinsic genetic factors- genetic control
of skeletal units themselves.
2) Local epigenetic factors : genetic
control originating from adjacent
structures like brain eyes etc.
3) General epigenetic factors : genetic
factors determining growth from
distant structures like sex hormones ,
growth hormones.
4) Local environmental factors : non
genetic factors from external
environment like habits, muscle force.
5) General environmental factors : general
influences such as nutrition, oxygen.
• This theory explains the
interaction between the genetic
and environmental factors.
• The growth of muscle and soft
tissues has a genetic component.
Few points of Von Limborgh’s view :
• Intrinsic genetic factors mainly
control the chondrocranial growth.
• Desmocranial growth is controlled by
few intrinsic genetic factors.
• Cartilaginous part considered as
growth centers.
• Sutural growth controlled by both
influence from cartilage and adjacent
skull structure.
• Periosteal growth largely
depends upon growth of
adjacent structures.
• Suture and Periosteal growth
are also influenced by local
non genetic environmental
factors.
 Servo System Theory 1982
• Using the language of cybernetics,
petrovic reasoned that it is the
interaction of a series of causal change
and feedback mechanism which
determines the growth of various
craniofacial regions.
• Primary cartilage growth – if growth
results from cell division of
differentiated chondroblasts
(epiphyseal cartilage of long bones,
cartilages of synchondrosis of cranial
base and nasal septum), it appears to
be subjected to general extrinsic
factors and more specifically to
somatotropic hormone,
somatomedin, sexual hormone and
thyroxine.
• Secondary cartilage growth : if
growth results from cell divisions
of prechondroblasts, (coronoid and
angular cartilage of mandible, mid-
palatal suture cartilage ) it is
subjected to local extrinsic factors.
• According to this theory control of
primary cartilage takes a cybernetic
form of a command, whereas in
contrast, control of secondary
cartilage (e.g. mandibular condyle) is
comprised not only of a direct effect
of cell multiplication but also of
indirect effects.
• Cybernetic is an organized system
that operates through signals that
transmit information.
• Petrovic used a cybernetic model for
the physiologic phenomena involved
in facial growth.
• In servo system the main input is not
constant but varies with time
Explanation of Theory