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Therories of Growth

Guided by:
Dr. Basanta K. Shrestha,
Assoc. Prof and Head,

Presented by:Dr.
Rajesh Gyawali,
Resident

gyawalirajesh@gmail.com

Orthodontics and Dentofacial Orthopedics Unit


Faculty of Dentistry,
Institute of Medicine(IOM), Kathmandu

Introduction
Theories with changing paradigm

Genetic Theory

Sutural Theory

Cartilageneous Theory

Functional Matrix Theory

Servosystem Therory

Enlows expanding V principle

Enlows counterpart principle

Neurotrophic process in oro-facial


growth

Revolution in develpmental molecular


biology

Growth in orthodontics ?
How does growth occur ?
Many theories are proposed.

Paradigm 1
Paradigm 1

Paradigm 1

Paradigm 2
Paradigm 2
Paradigm 2

Normal science Scientific revolution Normal science

Genes determine all.


Growth is controlled by genetic influences
and is pre programmed.
More assumed than proven.
"perhaps this part is genetically controlled
while that is not"

Brash in 1930.
Bone grows by deposition
at one surface and
resorption at another.
Exclusively by bone remodelling.
Sutures and cartilage no role.

By Weinmann and Sicher.

Intrinsic, genetically regulated, primary


growth of bone occurs in suture.

Expansive proliferative growth


at sutural connective tissue

Forces the bones away


from each other

Increase in volume
of skull

Evidence against sutural theory


Area of the suture transplanted to another
location no growth.
Growth at sutures will respond to outside
influence Facial bones mechanically pulled apart at
the sutures, new bone will fill in,
If a suture is compressed, growth at that
site will be impeded.

James H. Scott in 1950.

Nasal septum is most active and important for


craniofacial skeletal growth late prenatally and
early postnatally
Nasal septum is most active and important for
craniofacial skeletal growth late prenatally and
early postnatally

Transplantation of cartilage to other site

Nasal septal cartilage,


Epiphyseal cartilage
Cartilage from spheno-occipital synchondrosis
grew at another site.
Except the

Condylar cartilage

Effect on growth on removing cartilage at early age:

Experiments
on animals

Arguments:-

Reduced
growth of
midface
Effects of surgery
Interference with blood supply

Removal of nasal septum after injury at age 8

Melvin MossFunctional Matrix Theory

Genomic
paradigm
Growth is immutable
and predetermined
Orthodontic treatment
limited to tooth
movements only

Functional
paradigm
Growth can be
modified by function

Use of functional
orthopedic appliances
to modify growth

By Melvin Moss in 1960.


Origin, form, position, growth and maintenance
of all skeletal tissues and organs are always
secondary, compensatory and necessary responses
to chronologically and morphologically prior
events or processes that occur in specifically
related non- skeletal tissues, organs or functional
spaces.

Bone grows in direct response to its extrinsic


environment
Bones do not grow, bones are grown
Functional cranial component
Skeletal Unit
Macroskeletal
unit

Microskeletal
unit

Functional Matrix

Capsular
Matrix

Periosteal
Matrix

Functional matrix hypothesis


of craniofacial growth.

By Alexandre Petrovic.
The hormonally regulated growth of the
midface and anterior cranial base, which
provides a constantly changing reference
input via the occlusion,

The rate-limiting effect of this midfacial


growth on the growth of the mandible.

Hormonal
factor

Muscle
functions

CNS

Condylar
growth

Maxillary
growth

Occlusal
deviation

Propioceptors:
Periodontium-TMJ

Multifactorial theory
Combined Functional Matrix Theory
Sutural Theory
Genetic Theory

5 Factors Intrinsic genetic factor


Local epigenetic factor

General epigenetic factor


Local environmental factor

General environmental factor

V shaped pattern of growth


Deposition occurs on the inner side of
the wide ends of the V
Resorption on the outer
surface

Growth of one part relates specifically to other


structural and geometric counterparts in the face
and cranium.
Regional part and its particular counterpart
enlarge to the same extent, balanced growth
occurs.

The different parts and their counterparts are :


Nasomaxillary complex anterior cranial fossa.
Horizontal dimension of the pharyngeal
space -middle cranial fossa.
Middle cranial fossa - breadth of the ramus.
Maxillary - mandibular dental arch.
Bony maxilla - corpus of the mandible.
Maxillary tuberosity - lingual tuberosity.

Network of nerves (all kinds, motor as well as


sensory) as links for feedback interrelationships
Pathways for stimuli that can trigger certain bone
and soft tissue remodeling responses
Transport of neurosecretory material along nerve
tracts or by an exoplasmic streaming within the
neuron

New discoveries relating to the role of neural


crest cells and regulatory genetic factors
Homeobox gene (conserved sequence of DNA)
Encodes for transciption factors
and signaling molecules
Regulates expression of other
genes during development

Lateral border of the


crest of neuroectoderm

Neural crest
cells

Neural crest cells


highly pluripotent
important role in the development of head
migrate extensively throughout the embryo

forms of craniofacial bones, cartilages and


connective tissues.

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