GROWTH

AND DEVELOPMENT:
Theories

CONTENTS
Introduction
Principles of Growth
Theories of Growth
Conclusion
Bibliography

Principles of Skeletal
Growth
Epiphyseal Growth
Periosteal and Endosteal Growth
Sutural Growth
Remodelling
Cortical Drift

Theories Of Growth
Epiphyseal Growth
Periosteal and Endosteal Growth
Sutural Growth
Remodelling
Cortical Drift

Epiphyseal Growth
Initial growth of long bone Primary

Ossification centre [Diaphysis]

Secondary ossification centre
develops on ends of diaphysis
At junction of epiphysis and
diaphysis(epiphyseal plate) - major
growth in length occurs
Cartilaginous nature of plate lost at
growth termination Continuous long
bone formed
EPIPHYSEAL PLATE

Periosteal and Endosteal

Growth
Normal bone Ext Periosteal layer

Int Endosteal layer

Apposition of bone on selective
periosteal surfaces and selective
resorption Growth
Endosteal resorption and addition from
within also necessary for appropriate
thickness
Balanced apposition and resorption
facilitates proper growth

Sutural Growth
Explains that growth occurs at sutures
Not due to innate potential of sutures

to proliferate
Response to tension from adjacent soft
tissues

Remodelling
Occurs concurrently with increasing

bone size so that functional shape and

proportion maintained

(i) Surface remodelling

Leads to change in topography
(ii) Structural remodelling
Change in inherent architecture

A type of surface remodelling where surface

elevation/fins develop for the attachment of muscles and
tendons to the pterygoid plates

Structural remodelling where alignment of the

trabeculae along the lines of force can be appreciated

Cortical Drift
Bone/surface moves through space by
selective deposition and resorption on
cortical surfaces
Same cortical bone one side
deposition other side resorption

Whole maxilla translates showing definitive cortical drift

pattern

THEORIES OF
GROWTH

1.Genetic
theory :
BRODIE 1946
All growth pre planned and under
genetic influence
Morphologic traits transmitted
between generations
Mechanism of trait transmission,
nature of heredity, mode of heredity
were not known till 20th century

tors in support of genetic theory:

About two-thirds of genes play a role in the
craniofacial development
Genetic factors affecting size and form of the
final skeleton is clearly seen in many familial
developmental anomalies

ctors against genetic theory:

More assumed theory than proven

perhaps this part is genetically controlled

while that is not

this part is more controlled by heredity than
that

 Homeobox genes- Dlx-5 and Dlx-6

gene in Drosophila
play a role in appendage development
Mice severe craniofacial deformities
detected
Msx gene muscle segment
Sonic hedgehog- Its role is in patterning of facial
mesenchyme.
Decrease in hedgehog pathway- failure of nose to
develop
He concluded that - bones of the face show wide
variability in the rate and time of growth, sequence and
size attainment, but the growth of the pattern is
proportional, meaning a disharmony, if any, is present
before birth and becomes neither better nor worse

Genes causing various human

birth defects

COL2A1
Stickler
Cleft palate
GLI3
Greg
Premature closure of cranial
sutures,
extra digits
IRF6
Van der Wounde
Cleft lip/plate, with lip pits
IRF6
Popliteal pterygium
Cleft lip/palate, webbing across
joint
MSX1
Cleft lip/palate, missing teeth
.
TP63 Ectodermal dysplasia
Limb, teeth, hair defects
PAX9 Oligodontia
Missing teeth
TBX22
Ankyloglossia, cleft palate
TCOF1
Treacher Collins
Mid face hypoplasia, small jaw
DHCR7
Smith-Lemli-Optiz
Mental retardation, multiple
organ defect

Rahul Raman Doshi And Amol Somaji Patil. A Role Of Genes In Craniofacial Growth . Iioabj; Vol. 3; Issue 2; 2012: 19

2.Remodelling
Theory
BRASH 1930
Bone only grows appositionally at
the surfaces
Growth of jaws deposition of bone
at posterior surface of maxilla and
mandible(Hunterian growth)
bone
Calvarial growth
deposition ectocranial side
bone resorption endocranial side

3. Sutural Theory

WEINMANN & SICHER - 1940

The connective tissue and

cartilaginous joints principal

location intrinsic, genetically
regulated , primary growth of bone.
Paired parallel sutures that attach
facial areas to the skull and the
cranial base region push the nasomaxillary complex forwards to pace
its growth with that of the mandible.

Maxilla is attached to

the cranium by
frontomaxillary, ZM, ZT
& pterygopalatine
sutures, which are
parallel to each other.
Thus growth at these
areas would serve to
move maxilla forward &
downward

POINTS IN FAVOUR OF
THEORY
Periosteal remodelling of bone is
under strong local influences by the
functional environment.
Theory was consistent with the
understanding of the importance of
the cartilaginous structures &
skeletal joints in development &
postnatal growth of bones.

POINTS AGAINST
THEORY
Suture transplanted to other locations
does not continue to grow
Growth occurs in untreated cases of
cleft palate
Microcephaly and Hydrocephaly cases

4.Cartilagenous Theory/Nasal
Septum Theory
JAMES H SCOTT- 1956
Intrinsic growth controlling factors
were present only in cartilage and
periosteum
Proposed sutures play no direct role
merely permissive, secondary and
compensatory
Primarily Scott analysed only the
Nasal Septum as most active and
important

Accordingly

oSpheno-occipital synchondrosis responsible for growth of cranial base.

oNasal septal cartilage responsible for

growth of naso maxillary complex

oCondylar cartilage responsible

for the growth of mandible

Spheno-occipital Synchondroses

Synchondroses : Remnants of cartilage

between bone junction which is later
replaced by bone and act as growth
centers of the cranial base

Nasal septal cartilage

Anteroinferior growth of nasal septal

cartilage , drives the midface
downward and forward

Two kinds of experiments have been carried out

to test the idea that cartilage can serve as a true
growth
center:
1. Transplanting
nasal cartilage to cultural
medium did not give equivocal results, that is
sometimes it grew, sometimes it did not.
Indicating doubtful growth potential of the nasal
septal cartilage whereas,
If a piece of the epiphyseal plate of a long bone is
transplanted, it will continue to grow in a new
location,
Indicating that these cartilages have innate
potential.

Spheno Occipital Synchodrosis

Cartilage

from

here

also

grows

when

transplanted, but not as well

Difficulty in obtaining cartilage from cranial
base to transplant

Condylar Cartilage and Mandibular

Growth:Its being hypothesized that condylar cartilage is the
growth center for the growth of mandible.
Experiments

of

transplanting

condylar

cartilage

showed little or no growth potential.

Mandibular condyle thus do not have innate growth
potential and not a growth center.

2. Evaluation of the effect of growth on

removing cartilage at early age

Effect of removal of the nasal septal cartilage

on forward growth of the snout in the rabbit.

Profile view of man whose cartilaginous nasal

septum was removed at age 8, after an injury.

5.Functional Matrix Hypothesis

MELVIN MOSS 1962

Melvin Moss was inspired by the

ideas of Van der Klauuw (1952) that

bones were in reality , composed of
several FUNCTIONAL CRANIAL
COMPONENT, the size, shape &
position of which were relatively
independent of each other.
Bones do not grow ; Bones
are grown

4.FUNCTIONAL MATRIX HYPOTHESIS:- by Melvin Moss.

- Most accepted theory
- Melvin Moss was inspired by the ideas of
Van der Klaauw (1952) that bones were
in reality , composed of several
FUNCTIONAL CRANIAL COMPONENT ,
the size , shape & position of which were
relatively independent of each other.
- He experimentally verified & expanded
on these concepts & incorporated them
with his own in 1962

Bones do not grow ; Bones

THE ORIGIN, GROWTH AND MAINTAINANCE OF

ALL SKELETAL TISSUES AND ORGANS ARE
ALWAYS SECONDARY, COMPENSATORY AND
NECESSARY RESPONSES TO CHRONOLOGICALLY
MORPHOLOGICALLY PRIOR EVENTS THAT OCCUR
IN SPECIFICALLY RELATED NON-SKELETAL
TISSUES ORGANS OR FUNCTIONAL SPACES
(FUNCTIONAL MATRICES)

 MOSS said that Head is a composite structure,

operationally consisting of a number of relatively
independent functions
Digestion, Respiration, Speech, Olfaction, Balance,
Vision
Each function carried out by a group of soft tissues
which are supported and/or protected by related
skeletal elements.
Taken together the soft tissues & skeletal elements
related to a single function are termed as
FUNCTIONAL CRANIAL COMPONENT

Functional cranial component

Skeletal unit

Macroskeletal
E.g. MANDIBLE

Microskeletal
Coronoid Process
Of Mandible

Functional matrices

Periosteal
E.g.-Teeth and
Muscles

Capsular
E.g.- orofacial,
neurocranial

Each Such Component Is Composed Of

Two Parts
1. FUNCTIONAL MATRIX- which actually carries out
the functions. It includes- muscles, nerves, vessels,
glands, functioning spaces (nasopharynx/
oropharynx)
2. SKELETAL UNIT- whose biomechanical role is to
protect and/ or support its specific functional matrix

A functional matrix includes soft tissues like muscles,

glands, vessels, nerves fat, etc,.
Teeth are also a functional matrix.
Functional matrices are basically 2 types.
1.

Periosteal matrix

2.

Capsular matrix.

Periosteal matrix:Acts directly and actively on their related skeletal

units
Corresponds

to

immediate

local

environment,

typically muscles, blood vessels, and nerves.

E.g. Coronoid process is a microskeletal unit and its
Periosteal matrix is temporalis muscle.

Removal, denervation of temporalis muscle - decrease in

the size or total disappearance of coronoid process.
Functional hypertrophy/hyperactivity of temporalis
muscleincrease
in size
and change
shape
Hence
in simple
terms
it can beinstatedCoronoid process does not grow itself first.

Capsular matrix:
Include masses and spaces that
occupy a broader anatomical complex.
It acts indirectly and passively in their related
skeletal unit producing a secondary translation in
space.
These alterations in spatial position of skeletal
units are brought about by the expansion of orofacial capsules within which the facial bones

 Neurocranial

capsule:

1.In neurocranial capsule these covers

consist of skin and duramater whereas
in orofacial capsule it is the skin and
mucosa
2.The composition of this capsule (from
outward to inward) - 5 layers of scalp,
bone and duramater.

 Orofacial

capsule:

1.This capsule surrounds and protects the oro

nasopharyngeal functioning spaces.
2.It is the volumetric growth of these spaces which
is the primary morphogenetic event in facial
skeletal growth.

SKELETAL UNIT
All the skeletal tissue associated with single function is
called skeletal unit.
Composed of bone, cartilage and tendinuous tissue
MICRO SKELETAL UNITBone consist of number of small skeletal unit.
MACROSKELETAL UNITWhen adjoining micro skeletal units work to carry out
single cranial component.

MAXILLA
-orbital
-pneumatic
-basal
-nasal
-alveolar

Microskeletal Units Of Mandible:

Coronoid- related to functional demands of temporalis
Angular- related to activity of masseter and
medial pterygoid.
Basal unit- to inferior alveolar neurovascular
triad.
Alveolar unit related to presence/absence of teeth.

 Functional matrix theory revisited

Melvin moss in 1997 proposed continuation of
his classical FMH with the new concept. He
published series of articles in AJO-DO in 1997.
Revisit 1 The role of Mechanotransduction
Revisit 2 The role of Osseous Connected Cellular Network
Revisit 3 The genomic thesis
Revisit 4 The epigenetic antithesis and the resolving
synthesis

MECHANOTRANSDUCTI
ON
All vital cells are irritable- respond to

alteration in their external environment

Mechano-sensing helps cell to respond to
external stimuli by Mechano-reception and
Mechano- transduction
The former transmits extracellular physical
stimulus into a receptor cell
The latter transforms this information to
intracellular signal, mechanochemically or
electrically
Melvin L. Moss. The functional matrix hypothesis of mechanotransduction 1997American Journal ofOrthodontics and

Osseus Mechanotransduction- whenever a

load/ stimuli is applied on bone, it tends to
deform both extracellular matrix and bone cell
when it exceeds threshold value
Unique in 4 ways-

Most mechanosensing cells are cytologically

specialised but bone cells are not

One loading stimulus can evoke 3 responses,
others only 1
Osseus signal transmission is aneural
Evoked adaptational responses are confined in
each bone organ independently

Action of Mechanotransduction

Ionic process
Stretch activated channels
Electrical processes
Electromechanical
Electrokinetic
Electric

field strength

Mechanical processes

BONE AS OSSEUS CONNECTIVE CELLULAR

NETWORK
* All bone cells

except osteoclasts are extensively interconnected

by gap junction that form an osseous CCN.
* Vertically gap junctions connect periosteal osteoblasts with
preosteoblastic cells and these in turn are similarly
interconnected.
* Gap junctions -electrical synapses- they permit bi-directional
signal traffic
* They permit intercellular transmission of ion and small molecules
and electrical and fluorescent dye transmission.
* Mechanotransductively activated bone cells can initiate
membrane action potentials capable of transmission through
interconnecting gap junctions.
* A CCN is operationally analogous to an artificial neural network
in which massively parallel or parallel distributed signal
processing occurs.
* The network output informational signals move hierarchically
upward to regulate the skeletal unit adaptational responses of
the osteoblasts

GENOMIC THESIS
* DNA sequence of an individual determines the overall

phenotype
* Only 10 % genome related to phenotypic ontogenesis
The Genomic thesis in orofacial biology
* Genomic thesis claims that prenatal cranio facial development
is controlled by two inter related, temporarily sequential
processes:
* 1. Initial regulatory (Homeobox) gene activity.
* 2. Subsequent activity of two regulatory molecular groups:
growth factor families and steroid/thyroid/retinoic acid super
family.

* In the genomic thesis, morphogenesis is reduced to molecular

synthesis.
* It proposes no pathways from molecules to morphogenesis.

It is claimed that regulatory molecules can

* (1) alter the manner in which homeobox genes coordinate cell
migration and subsequent cell interactions that regulate growth
* (2) be involved in the genetic variations causing, or
contributing to the abnormal development of relatively common
cranio facial malformations perhaps modifying box gene
activity.
Specific implications of the genomic thesis
* poorly coordination control of form and size of structures or
group of structures (e.g. teeth, jaws) by regulator genes explain
the mismatches found in malocclusions and other dentofacial
deformities.
* And single regulatory (Homeobox) genes can control the
development of complex structures indicating that single
genes can determine the morphology of atleast some complex
structures including How characteristic noses or jaws are
inherited from generation to generation.

EPIGENETIC ANTI
THESIS
* Epigenetics- entire series of interaction, among cells
and cell products which lead to morphogenesis and
differentiation

* Epigenetic factors- all factors which impinge on vital

structures

* MECHANISM : It is the fundamental physical or

chemical process involved in an action/ reaction.

* The genomic thesis is denied because it is both

reductionist and molecular;

* descriptions of the causation (control, regulation) of all
hierarchically higher and structurally more complex
morphogenetic processes are reduced to explanations
of mechanisms at the molecular (DNA) level.

* Eg: the genomic thesis of craniofacial ontogenesis

passes directly from molecules to morphogenesis:

directly from DNA molecules to adult morphology,
ignoring the roles of many epigenetic processes and
mechanism competent to control (regulate, cause) the
large number of intervening and increasingly more
structurally complex, developmental stages

RESOLVING
* This is required as it is clear that both genomic and
epigenetic THESIS
processes were necessary to explain growth and
development

* Genomic factors - intrinsic

* epigenetic factors - extrinsic
* The fundamental argument of this resolving synthesis based

on an analysis of causation argues that morphogenesis is

regulated (controlled, caused) by the activity of both
genomic and epigenetic processes and mechanisms.
* Both are necessary causes; neither alone are sufficient
cause; and only their integrated activities provides the
necessary and sufficient causes of growth and development.

* Genomic factors - intrinsic and prior causes;

* Epigenetic factors- extrinsic and proximate causes.

5.VAN LIMBORGHS MUTIFACTORIAL

HYPOTHESIS
* Van Limborgh- 1970
Funtional matrix theory+ Sutural theory+ Genetic
theory= Van Limborghs Theory

* 1] Chondrocranial growth controlled mainly by intrinsic

genetic factors
* 2] Desmocranial growth is controlled by a few intrinsic
genetic factors
* 3]Cartilaginous part of skull- growth centre.
* 4]Sutural growth controlled mainly by influences
originating from skull cartilages & adjacent skull
structures.
* 5]periosteal growth depends upon growth of adjacent

VAN LIMBORGHS HYPOTHESIS

Craniofacial growth is controlled by 5 factors. They are:
1)Intrinsic Genetic factors: Genetics factors inherent to the skull tissues. They
exert influence within the cells and determine the characteristics of cells and tissues.
2)Epigenetic factors: are those which outside of the cells and tissues in which
they are produced. 2 typesLocal epigenetic factors- Genetically determined influences originating from
adjacent structures(brain, Eyes etc)
General Epigenetic factors- Genetically determined influences originating from
distant structures (Sex and growth hormones)

4)Local environmental factors- local non genetic influences originating from the
external environment (local external pressure, muscle forces).
5)General environment factors -General non genetic influences originating from
external environment (food, oxygen supply).

Neurotrophism
Neurotrophism
It is the nervous control of skeletal growth by transmission
of a substance through the axons
Guth defines Neurotrophism as an interaction between
nerves and cells which initiate or control molecular
modification in the cells.
Types of neurotrophism:Depending upon target cells and tissues there are 3 types:
Neuromuscular.
Neuroepithelial.
Neurovisceral.

NEUROMUSCULAR
* The normal contractility of skeletal muscle depends upon
ability of a neuron to transmit an efferent impulse.
* The physiological , morphological and biochemical
parameters of skeletal muscle depend on neurotrophic
function.
* Embryonic myogenesis, in vivo and in vitro, is
independent of neural innervation and so of trophic
control .
* Approximately at the stage of differentiation, neural
innervation is established without which further
myogenesis cannot continue.
* If muscle tissue is experimentally prevented from
becoming efferently innervated, motor end plates will
never develop. Also it is experimentally shown that
muscle receptors, muscle spindles and tendons require
afferent innervation for their development.

NEUROEPITHELIAL
* During early growth ,epithelium grows in spurts, which
is thought to occur immediately following repetitive
sensory nerve contact.

* If such processes were absent/ deficient, we can

expect orofacial hypoplasia, or malformation.

* Maxilla and mandibular hypoplasia are found

associated with a wide variety of intra oral and intra

nasal sensory deficits.

* The nerve supplying the taste bud not only carries

afferent impulses but also is responsible for
maintenance of existing epithelial taste buds.

NEUROVISCERAL
* Periosteal functional matrices regulate the size and
shape of specifically related skeletal unit.

* It is apparent that genetic control of structural

functional and chemical attribute of these same

matrices can not reside in the matrices them selves,
but rather reflect constant neurotrophically regulated
homeostatic control of genome.

*
* It is also clear that similar trophic control probably

exits for capsular matrices which passively regulate

position of both skeletal unit and periosteal matrices.
* Some degree of visceral neurotrophic control is
probable.
* Eg: salivary glands are trophically regulated.

* first structure to develop in the region of lower jaw is the

mandibular division of trigeminal nerve.

* The prior presence of the nerve has been postulated as

requisite for inducing osteogenesis by production of
neurotrophic factors.

* A study was done by Behrents and Johnston to evaluate the

role of trigeminal nerve in the regulation of facial growth.

* they created lesions in the root, ganglion or major sensory
branch of the nerve to find out role of the nerve.
* They concluded- it may exert some trophic influence on the
craniofacial complex, but they failed to support a major role
of the nerve.

6.Bioelectric
6.Bioelectrictheory:theory: The most familiar form of bioelectricity is that related
to neuromuscular activity.
But bone and other tissues like cartilage generate
electric potential in response to mechanical strain or
deformation.
These strain generated potentials serve as a
mechanism that permits bone to be remodeled in
response to mechanical stresses
Basset defines piezoelectricity as electricity resulting
from pressure on certain crystals.
In polycrystalline materials (bone) piezo-electricity
results from a summation of charges produced by
aggregation of the oriented regions within the
material.

* Direct pieizo-electric effect is generation of a charge in

response to pressure.
* Indirect piezoelectric effect is one in which the material
undergoes deformation, when it is placed in an electric field.

* Piezo-electric properties of bone and other biologic material

were reported by Fukada and Yasuda- demonstrated

Piezoelectricity in bone caused to oscillate at a low audio
frequency..
* Bassett and Becker showed that the specimen routinely
became negative on concave side and positive on the
convex.
* Frost suggested that deformation of bone surfaces subjected
to loads generates surface signals, which causes
mesenchymal cell activation.
* production of osteoclasts which subsequently undergo
transformation into osteoblasts which cause bone depostion.
* A negative feedback mechanism neutralizes the signals
overtime so that the resultant cell activity operates to

Factors known about strain

related potentials
*They are present in living organisms but are produced
by inanimate matrix rather than living cells.

*Exist in both dead and living bone, although they can

be modified by living cells.

*The potentials are generated only by changing loads

*The potential difference reached for physiologically
meaningful stress is of order of millivolts.

Applied aspects of
piezo-electric
* Osteogenesis:
phenomena
* Studies have demonstrated that bone

formation occurs in electronegative

regions(compression), and destruction
occurs in electropositive regions (tension).

* Electromagnetic fields were used by

* Basseett et.al.,. He found that callus formed
around the stimulated femur after 7- 14
days.

7. Servosystem theory
Dr Alexandre G. Petrovic and Jeanne J. Stutzmann around 1969-1972
The theory demonstrates a qualitative and quantitative relationship
between observationally and experimentally collected findings.
helps in broader understanding of orthodontic problems as the language
of cybernetics is compatible with expanding use of computers among
clinicians.
2 Principal factors1-The hormonally regulated growth of the midface &
anterior cranial base which provides a constantly changing
reference input via the occlusion.
2) The rate limiting effect of this mid-facial growth on the
growth of mandible.

Various Components of a Servo-System:Command- A signal established independent of the servosystem, and is not affected by
the output of the system. Hence, it tells the system what is to be done.
Reference Input -The input into the servo-system (which is brought about by the
command).
The command created a reference input through the action of a reference input element.

Comparator (Peripheral) - The input is fed into the comparator which is the component
that analyses the reference input and judges the performance of the system through
performance judging elements.
Central Comparator- The performance transmit a deviation signal to the central
comparator which sends a signal to various components the actuator, the coupling system
and the controlled system This ultimately brings about an output.

The Servosystem is:Reference Input Elements

COMMAND

Actuator, Coupling
System,
Controlled System

Central Comparator
(sensory engram)

Reference Input
COMPARATOR
Output
(Controlled
Variable)

Deviation Signal

Performanc
e
Analyzing
Elements

Performance

TRANSFER FUNCTIONS
Any cybernetic system, when provided an input (or
stimulus, processes ,produces an output. The output is
related to the input by a transfer function

OT
INPUT PROCESS

OUTPUT

INPUT

PROCESS

ORTHODONTIC,FUNCTIONAL,
ORTHOPEDIC APPLIANCE

MAXILLA LENGTHTHENING AND

WIDENING
MANDIBLE LENGTHENING,TEETH
MOVEMENTS

CORRECTION OF MALOCCLUSION
OUTPUT

Growth of the Face According to

the
Servosystem Theory
Depends on :
1) Types of cartilage and the influence of growth factors on them,
2) Role of the lateral pterygoid and retrodiscal pad in condylar
growth.
Types of cartilage:
a) Primary cartilage
b) Secondary cartilage

Primary cartilages are seen in:

1) Epiphyseal cartilages of long bones
2) Cartilages of synchondroses of long bones
3) Nasal septal cartilages
4) Lateral cartilaginous masses of ethmoid
5) Cartilage between greater wings and body of sphenoid.
Secondary cartilages are seen in:
6) Coronoid cartilage
7) Condylar cartilage
8) Midpalatal suture cartilage

FACE AS A SERVO SYTEM

Input

Output

Maxillary
dental arch

Growth in
length
Growth
in
width

Adjustment of the
position of mandibular
dental arch

Growth in Length:
growth
of
Nasal
Septum

Traction
SeptoPremaxillar Inductio
y
n
ligament

Labial
Muscles

Release of
STH

Thrust

Somatomedi
n

Thrust

Increased
size
Of
Tongue

Direct Action

Protrusion
of
Upper
Incisors
Thrust
Protrusio
n of
Lower
Incisors

Growth of
Pre
Maxillary
extremity

Biomechanic
alPost-ant
shift
of
premaxillary
bones

Growth of
Pre
Maxillary
Suture,

Growth of
Maxillo
Palatine
suture

Growth in
Width

Growth of
Lateral cartilaginous
masses of Ethmoid

Releas
e of
STH
Somat
omedi
n

Growth of cartilage
B/w greater wings
& body of sphenoid

Increased size
Of Tongue

Outward
growth
Of
maxillary
bones

Outward
shift of
Alveolus
and
molars

Transvers
e
Separatio
n of
premaxilla
e
Transverse
Seperation
of
Horizontal
Maxilla and
Palatine
plates

Growth
of
mid
Palatine
suture

Outward
Apposition
al
Bone
growth

Action of Functional Appliances based on the Servosystem

Theory

Two categories of functional appliances :1.Appliances like the activator, class II elastics, Frankel appliance,
Twin block, Bionator etc.
2.Appliances like the Herren &LSU activator - Extra oral traction
on the mandible, which position the mandible forward and open it
beyond the physiologic rest position.

*FirstGroup
When appliance is in place, there is increased activity of the LPM
and RDP due to the forward positioning of the mandible.
Hence, the mandible grows forward by deposition of bone at the
condyle, thus length and even direction of growth is altered.

SecondGroup:
Theappliancesinthisgrouptendtopositionthemandible
forwardaswellasopenitwellbeyondthephysiologicrest
position.
Noincreaseorevenaslightdecreaseintheactivityofthe
LPMwasseenwhentheseapplianceswereworn.Yetthere
wasinincreaseingrowth.

This can be explained as a 2 step process.

1) The time the appliance is worn, the forward positioning of the
mandible caused a reduction in the length of the LPM.
At this time a new sensory engram is formed for this position of
the mandible.
2) When the appliance is not worn, the mouth functions according
to this new sensory engram. So the mandible is functioning in a
more anterior position.
This increases the activity of the RDP, leading to hypertrophy of
chondroblasts.

Hence actual lengthening of the mandible takes

place when appliance is not worn.

FUNCTIONAL APPLIANCE
INCREASED CONTRACTILE ACTIVITY OF THE LPM
INTENSIFICATION OF THE REPETITIVE ACTIVITY OF
RETRODISCAL PAD
INCREASE IN GROWTH STIMULATING FACTORS
CONDYLAR CARTILAGE CHANGES
LENGTHENING OF MANDIBLE

CLINICAL IMPLICATIONS
1.All orthodontic treatment must strive to reach the optimal
functional situation,if not post treatment condition should be
better than pretreatment condition,tendency for relapse is less.
2.A functional appliance should be removed only when growth is
completed,if not should achieve good intercuspal relation,ensures
stable result.
3.Proper functioning of LPM and RDP is important for growth
4. Utilization of high hormonal activity at puberty.
5.understanding of how functional appliances affect the servosystem
is important to know how long the appliance is to be worn.
6.Younger children respond better to functional appliance - results
more stable

Drawbacks
The theory places a lot of importance on the condyle as the growth
centre. Hence if the condylar cartilage is lost subsequent to a fracture,
growth should seize.
Lot of importance is placed on the role of hormones in controlling
growth. In all probability, they do not have such a large role to play.
The peripheral comparator, the occlusion, itself, is unstable.
Discrepancies in the occlusion can easily be overcome by
dentoalveolar changes, rather than by growth of the mandible.
According to the theory, an end on relation is a repeller. Still, end on
relation of the molars and other teeth are often seen.
The theory does not explain the action of the reverse pull headgear.

8.Remodelling theory:
GIVEN BY JC BRASH IN 1930
Brash provided the foundation for the development of the first general
theory of craniofacial growth.
First bone is deeply stained through out by giving madder
continuously from birth for sufficient time. Then it is
omitted for any period during which growth of bone is to
be determined.
The research by Brash provided the foundation for
development of first theory of craniofacial growth - the
remodeling theory.

Principal tenets of remodeling

theory
*Bone grows only appositionally at surfaces,
*bone does not grow grow interstitially through mitotic
activity of osteocytes.
*Growth of jaws is characterized by deposition of bone
at posterior surface of maxilla and
mandible,sometimes described as Hunterian growth
of jaws.
*Calvarial growth occurs via deposition of bone on
ectocranial side and resorption endocranially.

According to this theory all of the craniofacial skeletal

growth occurs mainly by bone remodelling selective
addition and removal of bone at surfaces.

Schematic Representation Of The

Remodeling Theory Of Craniofacial Growth
Using The Cranial Vault As A Model

INCONSISTEN
created doubt about the role of unique
* This theory
CY
structures like sutures, cranial base synchondrosis
and mandibular condylar cartilage.

* The doubt was that if these sites are not essential for
normal craniofacial growth then why they were
present at all ?

Enlows V principle
One of the basic concepts in facial growth is the "V" principle.
Many facial and cranial bones, or parts of bones, have a V-shaped
configuration.

Deposition also takes place at the end of two arms of the V resulting in
growth movement towards the ends.

Enlows counterpart principle

The growth of any facial and cranial part relates to other structural counter part
in the face and cranium.
-If the regional part and its particular counter part enlarge to some extent,
balanced growth occur.
-Imbalance occur when differences in amounts or directions of growth between
parts and counter part is seen.

Different parts and their counterparts

* Nasomaxillary complex- anterior cranial
fossa
* Middlecranial fossa and ramus breadth are
counterparts
* Maxillary and mandibular archescounterparts
* Bony maxilla and corpus of mandible
* Max tuberosity- lingual tuberosity

conclusion
Majorly influenced by embryological and less by
genetics, craniofacial growth & development,
malocclusion & treatment concepts were known till
now taking advantage of that dentists are now well
positioned to enter a new era of genetics and
molecular biology through the incorporation of the
principles of developmental molecular genetics into
treatment of developing malocclusion and growth
related jaw discrepancies in a new way

References:

Proffit W.R.: Contemporary Orthodontics. 5th Edition

Textbook Of Orthodontics- Samir E. Bishara

Enlow D.H.: Handbook Of Facial Growth.

3nd Edition.1990, W. B.

Saunders Company

Graber Petrovik Rakosi : Scientific Concepts & Validation Of

Functional Appliances

Rahul Raman Doshi And Amol Somaji Patil. A Role Of Genes In

Craniofacial Growth . Iioabj; Vol. 3; Issue 2; 2012: 1936

VIRGILIO F. Ferrario, Chiarella Sforza, Graziano Serrao, Veronica Ciusa,

Claudia Dellavia. Growth And Aging Of Facial Soft Tissues: A
Computerized Three-dimensional Mesh Diagram Analysis. Clinical
Anatomy 16:420433 (2003)

Melvin L. Moss. The functional matrix hypothesis of

mechanotransduction 1997American Journal ofOrthodontics and

* Sanjay Gupta , Patnaik. V . V. Gopichand, Subhash Kaushal , Sudha Chhabra

,Vipin Garsa. CRANIAL ANTHROPOMETRY IN 600 NORTH INDIAN ADULTS. Int J

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* Clinical othrodontics: current concepts, goals and mechanics. Ashok karad.
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* V.Venkatesh
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* D. Verma ,T.Peltomki ,A.Hunter. Predicting vertical growth of the
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