VIVEKANANDHA DENTAL COLLEGE FOR

WOMEN
TIRUCHENGODE

DEPARTMENT OF ORTHODONTICS AND

DENTOFACIAL ORTHOPAEDICS

SEMINAR ON
CONCEPTS OF GROWTH AND DEVELOPMENT

Presented by

Dr.A.Sasirekha Head of Department

I st year MDS
26.07.2017
SYNOPSIS
1. Introduction
2. Definition
3. Pattern of growth
4. Mechanism of bone development
5. Mechanism of bone growth
6. Primary vs. Secondary cartilage
7. Growth movements
8. Enlow counterpart principle
9. Site vs. Center
10. Growth Rotation
11. Controlling factors in craniofacial growth
12. Gnomonic growth
13. Logarithmic growth of human mandible
14. Arcial growth of mandible
15. Theories of bone growth
16. Conclusion
17. References
INTRODUCTION

Craniofacial growth is a complex process, a thorough understanding of the principles

or concepts of growth will enable the dentist, orthodontist, pediatric dentist and oral
surgeon to meticulously plan the treatment and also to understand the normal
variations from abnormalities.

DEFINITION OF GROWTH
 Growth refers to increase in size - Todd
 Growth may be defined as the normal change in the amount of living
substance- Moyers
 Growth usually refers to an increase in size and number –Profitt
 Self multiplication of living tissue- Huxley
 Growth is defined as increase in size, change in facial proportion over time-
Krogman
 Any change in morphology which is within measurable parameter-Moss

Growth is quantitative i.e.., measurable aspects of biological life

Unit of growth is Inches per year /grams per day. GROWTH is always equal
to ENLARGEMENT. But in some instances there is a decrease in growth
size. e.g: thymus gland shrinks after puberty.

DEFINITION OF DEVELOPMENT

 Development means progression towards maturity - Todd

 Refers to naturally occurring unidirectional changes in life of an individual

from its existence as a single unit to its elaboration as a multifunctional unit

terminating in death- Moyer

GROWTH PATTERN
- Pattern refers to the way in which various parts of body are arranged in
proportional relationship. It represents set of proportional relationships not a
 single proportional relationship
CEPHALOCAUDAL GROWTH

SCAMMONS GROWTH GRADIENT

 Contributors to pattern are

 Cephalocaudal growth
 Scammon’s growth

CEPHALOCAUDAL GROWTH

Changes in overall body proportions – At 3 month of intrauterine

life the human fetus is almost 50% of the total body length. This for this
particular time is normal. At birth the trunk and limbs, which were
earlier rudimentary have growth false than the head and therefore the
proportion of head size to the rest of the body lengthen is 25-30%
eventually at adulthood the head size is just 13%.

Changes in proportions of craniofacial region. At birth the face

and jaws are relatively underdeveloped compared to their extent in adult.
There is much more growth of facial than cranial structures postnatally.
The mandible further away from brain tends to grow more and later than
the maxilla, which is closer. Cephalocaudal gradient of growth means
that there is all axis of increased growth extending from head towards
the feet.

SCAMMONS GROWTH GRADIENT

Not all tissue systems of the body grow at the same rate. Different
tissues and in term different organs grow at different sides. This process
is called ‘differential growth’.

- Neural tissue grows early completing their maturation by 6-7 years of

age.
- General body tissues, including muscle bone and viscera shows an ‘S’
shaped curve, with a definite slowing down of the rate of growth during
childhood and acceleration at puberty

- Lymphoid tissue proliferates far beyond the adult amount in late

childhood and then undergo involution at puberty or when genital
growth acceleration takes place

- Genital tissue secondary sexual characteristics begin to appear during

puberty and reaches peak by 2 years of age.

EFFECTS OF SCAMMON’S GROWTH IN FACIAL REGION

MANDIBLE

 It follows somatic growth pattern

 Growth occurs until about 18-20 yrs in male

MAXILLA

 Following neural growth pattern

 Growth ceases earlier
 Skeletal problems to be treated earlier to mandible, e.g. Ideal age for
giving reverse pull headgear is 6 yrs
VARIABILITY OF GROWTH
According to Moyer ,variability is the law of nature. No two individuals grow in
the same manner. It is very difficult to say whether an individual is within normal
range or at extremes of normal range or out of normal range. Variations can be
attributed to both genetic and environmental factors. Variations in the growth can be
expressed by statistics as range of differences found in a population containing
similar age, sex , socioeconomic background and race.
 CONCEPTS OF NORMALITY AND VARIABILITY
Normal refers to that which is usually expected ,ordinarily seen or typical.
Normality can be explained by the following ways; statistics , evolutionary ,
functional , esthetic, clinical.
MECHANISM OF BONE DEVELOPMENT
There are 2 Types Of Ossification

 Endochondral/Cartilagenous/Indirect Ossification
 Membranous/Intramembranous/Direct ossification
ENDOCHONDRAL BONE FORMATION:

 Differentiation of mesenchymal cells in to chondrocytes

 These Chondrocytes are enclosed by perichondral cells

 Within primary ossification center ,the chondrocytes hypertrophy

 small blood vessels from the perichondrium which carry undifferentiated

mesenchymal cells, gets converted to osteoblasts
INTRAMEMBRANOUS BONE FORMATION

 Undifferentiated cells in the connective tissue differentiate in to

osteoblasts

 Osteoblasts secrete Osteoid (fibrous bony matrix)

 Blood vessels are retained in close proximity to the bony trabeculae

 Osteoblasts get enclosed by their own deposits and become osteocytes

MECHANISM OF BONE GROWTH
Direct bone growth Deposition and resorption which causes
the cortical plate to drift

Displacement of entire bone Occurs due to growth of bone itself or

expansion of adjacent structures

TWEED GROWTH TRENDS

 Type A: Maxilla and mandible grow in unison both downwards and

forwards ; ANB shows no change since both maxilla and mandible grows
equally

 Type B: maxilla grows more rapidly than mandible ; ANB angle increases
  Type C: Mandible grows faster than maxilla ; ANB angle decreases

DEPOSITION AND RESORPTION

Bones grow by addition of new bone tissueon one side of the bony cortex and
taking it away from the other side.the surface towards the direction of progressive new
bone deposition. The surface away from undergoes resorption. The outside and inside
surfaces of bones are covered by irregular patterns called growth fields. It is composed
of various soft tissue osteogenic membranes/cartilages. Bone growth is influenced by
this soft tissue growth fields. All bones got both resorptive and depository fields.

ENDOSTEAL AND PERIOSTEAL GROWTH

Approximately half of cortical plate of the facial and cranial bones is formed by
the outer surface [Periosteum] and other half by inner surface [Endosteum].
Appositional layers of cortical bone can orginate entirely from the periosteum or the
endosteum. In some cases, the same cortex is composed of periosteal and endosteal
bone layers which are separated by reversal lines. This type of bone growth indicates
that there has been a change in the direction of growth at sometime. The Reversal
lines represents the interface between endosteally and periosteally produced bone
layers.

REMODELLING
Facial bones undergo resizing and reshaping simultaneous to bone
deposition and resorption.The reshaping of bone occurs not due to generalized
deposition and resorption. Bone shaping requires differential growth activity known as
remodeling. Remodeling is a part of growth process , provides regional changes in
shape , dimensions & proportions.
Deposition occurs on the side facing the direction of the growth
Resorption on surface facing away from the direction of growth

Cortical drift

TYPES OF REMODELLING

There are four kinds of remodeling in bone tissues; Biochemical remodelling :

Involves continuous deposition & removal of ions to maintain mineral homeostasis,

Growth remodelling : Constant replacement of bone during childhood, Haversion

remodelling: Secondary process of cortical reconstruction of bone as primarily

vascular bone is replaced, Pathological remodelling: Regeneration & reconstruction

of bone during and following pathology/trauma.

PRIMARY VS SECONDARY CARTILAGES

Primary
Derivatives of primordial cartilage
Chondroblasts divide& synthesize
intercellular matrix
Dividing chondroblasts are surrounded by Not surrounded by cartilaginous matrix
cartilaginous matrix
Cells arranged in columnar fashion
Not influenced by local environmental
factors e.g. epiphyseal cartilages,
synchondroses
Growth is interstitial. Hence 3
dimensional growth
Genetic pacemaker for growth
Secondary
Forms on a membranous bone
No intercellular matrix
arranged in Haphazard manner
Affected by external influences which
stimulate the growth of cartilage e.g.
Condylar cartilage
Only peripheral growth takes place
Contributes only to regional adaptive
growth

GROWTH MOVEMENTS
DRIFT AND DISPLACEMENT
Two kinds of growth movements , namely cortical drift and displacement are
seen. All bones have one common growth principle, that is drift , which is termed by
Enlow (1963). Drift is growth movement (relocation/shifting) of an enlarging of a
bone by the remodeling action of its osteogenic tissues, while displacement is Physical
movement of whole bone

DISPLACEMENT
Displacement is the movement of whole bone as a unit. It is a translatory
movement of the whole bone caused by the surrounding physical forces, and is the
second characteristic mechanism of skull growth. The entire bone is carried away
from its articular interfaces(sutures, synchondroses, condyle)with adjacent bones.
Displacement is of two types namely primary displacement and secondary
displacement.

PRIMARY DISPLACEMENT
It is the physical movement of the whole bone, as the bone grows and remodels by
resorption and apposition.
SECONDARY DISPLACEMENT
It is the movement of a whole bone caused by the separate enlargement of other
bones which may be nearby or quite distant.

PRIMARY DISPLACEMENT SECONDARY DISPLACEMENT

 Growth remodeling takes  Increase in size of middle

place to maintain contact, e.g. cranial fossa causes the maxilla to
 condyle grows upwards and be displaced anteriorly and
backwards to maintain contact inferiorly
with fossa as the mandible is
displaced downwards
 This is independent of the
growth and enlargement of
 Similarly maxilla is maxilla itself
displaced downwards and
forwards.to maintain contact bone
deposition takes place in upwards
and backwards direction

ENLOW’S V PRINCIPLE
The V principle is an important facial skeleton growth mechanism , since many
facial and cranial bones have ‘V’ configuration or ‘V’ shaped regions . The areas grow
by bone deposition on the inner side due to the concept of surface growth depending
on growth direction. Resorption takes place on the external surface of ‘V’ .the ‘V’
moves away from the tip and enlarges simultaneously. Thus an increase in size and
growth movement takes place in a unified process . hence it is called expanding V
principle. The movement of bone towards broad end of ‘V’.
Longitudinal section through the right and left coronoid process of mandible
reveals that the processes are enlarged durin growth. In accordance with the ‘V’
principle, bone is deposited on the lingual surfaces and resorbed from the opposing
buccal surfaces. The structures increases in height, the tips of coronoid process
diverge further and their bony bases converge.
ENLOW’S COUNTERPART PRINCIPLE:
According to Enlow , the growth activity in one region is invariably
accompanied by complementary growth in other regions. The complementary activity
is essential for maintaining functional and esthetic balance. Enlow poined out, both
the dimensions and alignment of the craniofacial components are important in
determining the overall facial balance.

Different counterparts or Growth equivalents:

Nasomaxillary complex elongation is the counter part for elongation of anterior

cranial fossa. Lengthening of spheno-occipital region is the growth equivalent of the
underlying pharyngeal region and the increasing length of ramus. Combined vertical
lengthening of the clivus and mandibular ramus is the growth equivalent of total
vertical nasomaxillary region. Maxilla and mandible corpus are mutual counterparts.
SITE VS CENTER- Baume

 Growth centers are places of endochondral ossification with tissue separating

force contributing to the increase in skeletal mass

 Growth site has been defined as a region of periosteal or sutural bone

formation and modeling resorption adaptive to environmental influences
Profitt defines growth site as merely a location at which growth occurs whereas center
is a location at which independent or genetically controlled growth occurs. All growth
centers are also sites, whereas all growth sites are not centers. Most of the theories of
growth are based on where the growth center is expressed. Examples of growth sites
include mandibular condyle, malillary tuberosity, synchondroses, sutures, alveolar
process, etc.

GROWTH SITE VS. GROWTH CENTER

Growth site Growth center/growth field

Is any location or place where growth
takes place
Is a region of periosteal or sutural bone
formation and remodeling resorption
adaptive to environment
Sites of growth when transplanted to
another area, does not continue to grow
Marked response to external influence
They do not cause growth of the whole
bone instead they are simply places where bone
exaggerated growth takes place
Is any location or place where genetically
controlled growth takes place
Are places of ossification with tissue
separating force
Centers of growth when transplanted to
another area continues to growth
Less response to external influence. More
response to functional needs
Cause growth of the major part of the

All growth sites are not growth centre All growth centres are growth sites

Theories of growth are not based on
growth site
Growth sites do not control the overall
growth of the bone
Various theories of growth are based on
the place where growth centre is
expressed
Growth Centre controls the overall
growth of the bone
William Profitt, Henry W.Fields, Jr.,David M.Sarver. Contemporary orthodontics -
2012 , 5th edition

GROWTH ROTATIONS
MANDIBULAR GROWTH ROTATIONS
BJORK’S (1969) Classification
Bjork has classified rotation of mandible into forward and backward rotations.
Forward rotation has three types and occurs in the following ways
Type I. In this type (the one that is usally considered) there is forward rotation about
centers in the joints which gives rise to a deep-bite, in which the lower dental arch is
pressed into the upper, resulting in underdevelopment of the anterior face height. The
cause may be occlusal imbalance due to loss of teeth or powerful muscular pressure.
This lowering of the bite may occur at any age.

Type II. Forward growth rotation of the mandible about a center located at the incisal
edges of the lower anterior teeth is due to the combination of marked development of
the posterior face height and normal increase in the anterior height.

Type III. In anomalous occlusion of the anterior teeth, the forward rotation of the
mandible with growth changes its character. In case of the large maxillary overjet or
mandibular overjet, the center of rotation no longer lies at the incisors but is displaced

BJORK’S (1969) Classification

backward in the dental arch, to the level of the premolars. In this type of rotation, the
anterior face height becomes underdeveloped when the posterior face height increases.
The dental arches are pressed into each other and basal deep-bite develops.

Backward roration of the mandible is less frequent than forward rotation and has been
examined by the implant method in considerably fewer subjects. Two types have been
recognized:

Type I. Here, the center of the backward rotation lies in the temporomendibular joints.
This is the case when the bite is raised by orthodontic means, by a change in the
intercuspation or by a bite-raising appliance, and results in an increase in the anterior
face height.

Type II. Backward rotation occurs about a center situated at the most distal occluding
molars.

Bjork has given seven structural signs of extreme growth rotation in relation to the
condylar growth direction. The seven signs are related to the following features:

1. Inclination of the condylar head

2. Curvature of the mandibular canal

3. Shape of the lower border of the mandible

4. Inclination of the symphysis

5. Interincisal angle

6. Interpremolar or intermolar angles and

7. Anterior lower face height

BJORK and SKEILLER’S METHOD

They divided the rotation into three components:

Total Rotation: The rotation of the mandibular corpus measured as a change in

inclination of an implant line in the mandibular corpus relative to the anterior cranial
base.
 Matrix Rotation: Rotation of the soft tissue matrix of the mandible relative to the
cranial base. The Sot tissue matrix is defined by the tangential mandibular line. The
matrix rotation has its centre at the condyles.

Intramatrix Rotation: Difference between total rotation and the matrix rotation is an
expression of the remodeling at he lower border of mandible. Identified by the change
in inclination of an implant or reference line. It has its centre somewhere in the
corpus.

SCHUDY’S concept of growth rotation

Schudy’s concept of growth rotation

Clockwise rotation Counterclockwise

Jaw bones or mandible grows downwards and backwards

Bone grows upwards and forwards

More posteriorgrowth and less anterior growthMore anterior growth and less posterior growth

Results in long face called as high angle cases Results in short face called as low angle cases
PROFITT CLASSIFICATION

CONTROLLING FACTORS IN CRANIOFACIAL GROWTH

VON LIMBORGH’S CLASSIFICATION
Factor
Intrinsic genetic factors
Local epigenetic factors(capsular
matrix)
General epigenetic factors
Local environmental factors(periosteal Local non-genetic influences from
matrix)
General environmental factors
Explanation
Genetic factors inherent to the
craniofacial skeletal tissues
Genetically determined influences
originating from adjacent structures
&spaces(brain, eyes)
Genetically determined influences
originating from distant structures(sex
hormones)
external environment(muscle force, local
external pressure)
General non-genetic influences
originating from the external
environment(oxygen supply ,food)
ENLOW AND MOYER’S CLASSIFICATION
NATURAL

 Genetic
 Function
 General body growth
 Neurotrophism
DISRUPTIVE FACTORS

 Orthodontics forces
 Surgery
 Malnutrition
 Malfunction
 Gross craniofacial anomalies
GOOSE AND APPLETON’S CLASSIFICATION

 Endocrinal factors
 Multifactorial inheritance
 Racial differences
 Nutrition
 Diseases
  Socioeconomic factors
 Secular trends

GNOMONIC GROWTH
Thompson analyzed the growth of certain sea shells. The chambered nautilus has two
fundamental characteristics:

 The shell grows in size but does not change its shape. Although the shell grows
asymmetrically, the original shape remains constant.

 The process of growth whereupon the addition of a figure or body leaves the
resultant figure or body similar to the original is called GNOMONIC GROWTH.
(Salentijin L, Moss ML: Morphological attributes of the logarithmic growth of the
human face:human growth. Acta Anat 78:185,1971)

The gnomonic growth can be described by a particular kind of curve called as the
LOGARITHMIC or EQUIANGULAR SPIRAL. The spiral is characterized by the
movement of a point away from the pole along the radius vector with a velocity
increasing as it’s distance from the pole. The spiral of the Nautilus has been fitted to a
precise formula:
ө =k log r.
Since the future growth of the animal will continue along that curve ,the spiral can be
generated at any time to reveal the final shape.

LOGARITHMIC GROWTH OF THE HUMAN MANDIBLE.

 Craniometric studies were performed by fixing small lead shots affixed to the
Foramen Ovale ,Mandibular foramen and Mental foramen of mandibles at various
stages of dentition. The lateral x-rays of these mandibles effectively outlined the
pathway of the Inferior alveolar nerve. Consequently ,it is possible to generate the
curve representing human mandibular growth at any time.

 The logarithmic spiral formulated

by Moss which coincides with the three
foramina of the inferior alveolar nerve
and which describes the path of
mandibular growth.

 As the bone increases in size, the

spiral itself does not change, instead the
mandible changes in position and base
appears to rotate along the spiral, moving
to a position where there is a less
curvature of spiral.
Moss ML,Salentijin L: the unitary logarithmic curve descriptive of human mandibular growth. Acta
Anat 78:532, 1971

ARCIAL GROWTH OF MANDIBLE

After Moss postulates of logarithmic spiral Rickett’s described arcial growth of

mandible.

Advantage: Arc of growth can be constructed for every individual depending on the
length of the core of the mandible.

A normal human mandible grows by superior- anterior apposition at the ramus on a

curve or arc which is a segment formed from a circle. The radius of this circle is
determined by using the distance from the mental protuberance (Pm) to a point at the
forking of the stress lines at the terminus of the oblique ridge on the medial side of the
ramus (Point Eva)
According to Ricketts, each individual generates his own unique arc.3 curves were
ultimately drawn:
CURVE A – Passes through DC -Xi and Pm .
CURVE B - Passes through tip of the coronoid process and Pm.
CURVE C – Passes through point Eva and Pm .
Xi point: It represents the geometric center of ramus.

DC point: It is the midpoint or the bisecting point of the condylar neck.

Point Eva, the confluence of stress lines on the medial surface of the ramus.
The curve created through Eva and Pm with Tr as represents the arc of mandibular
growth
(Tr/true radius it is the center of the arc. It is the intersection of arcs from Eva and PM
drawn with Eva-PM as the radius)

RICKETTS PREDICTION: The annual increase of 2.5mm when averaged over the
years of time. Growth was found to cease at 14.5 years for females and 19 for males.
This method, now, represents a convenient and fairly reliable method for mandibular
growth prediction.
(Ricketts RM: A principle of Archial growth of mandible AO 42:368, 1972)

THEORIES OF BONE GROWTH

The theories are based on the fact where the intrinsic genetic potential or growth
center is expressed.

 Bone remodeling theory

 Genetic theory
 Sutural hypothesis
 Cartilagenous theory
 Functional matrix theory
 Servo system theory
 Composite hypothesis by Von Limborgh
 Rate limiting ratchet hypothesis
 Growth relativity hypothesis

BONE REMODELLING THEORY- BRASH(1930)

Introduction to vital staining method by John
Hunter helped Brash to postulate this first
general theory the “bone remodelling theory”.
This theory concluded that Bone grows by
interstitial growth. The 3 Fundamental Tenets
of this theory are:

 Bone grows by only apposition at the

surfaces

 Growth of jaws takes place by deposition of bone at the posterior surfaces of

the maxilla and mandible, described as “Hunterian growth”

 Calvarium grows through bone deposition on the ectocranial surface of the

cranial vault and resorption of bone on the endocranial surface

THE GENETIC THEORY(A. Brodie – 1941)

The genetic theory simply stated that genes determine and control the whole
process of craniofacial growth. Gregor Mendel opened up the field of genetics.
 The field of genetics consist of two principle areas of interest:

 Transmission genetics
 Developmental and molecular genetics
Transmission Genetics is characterized by statistical approach. It explains only the
possible method of transmission. It is based on mendelian law and did not explain
about genes or its characteristics. Weisman, 19th century – the concept of “germ
plasm” – the determinant of traits that is transmitted from parents to offspring is
present in the cytoplasm of the gametes.
Developmental and Molecular Genetics
This field has undergone profound development following extensive research.

THE SUTURAL HYPOTHESIS/SUTURAL DOMINANCE THEORY

Sicher and Weinnman-1952. According to this theory Sutures , cartilages &
periosteum are responsible for facial growth and were assumes to be under intrinsic
genetic control
Essence of the theory
According to Sicher, sutures are the primary determinants of craniofacial growth.
The cranifacial skeleton enlarges due to expansile forces exerted by the sutures as they
separate.

Theory

He believed that the primary event in the sutural growth is the proliferation of the
connective tissues between the 2 bones. Proliferation of connective tissue creates the
space for appositional bone growth between the 2 bones
Mandibular growth takes place by growth of cartilage of mandibular condyle , which
pushes the mandible downward and forward. The various maxillary sutures produces
pushing of the bone which results in forward and downward movement of maxilla
Koski (1968) stated that there are two different views regarding the structure of
sutures.
 The first school of thought (Sicher & Weinnman) considers sutures as three
layered structure. It stated that the connective tissue between the two bones
plays the same role as the cartilage at the base of the skull and like epiphysis of
long bones.

 The second school of thought (Pritchard, Scott & Giris, 1956) sees the suture as
a five layer structure. Each bone at the suture has its own two layer periosteum
on both sides and the intervening fifth layer between these periosteal layers.
This layer plays a role in adjustment between the bones during growth.

EVIDENCES AGAINST SUTURAL THEORY

 Subcutaneous auto-transplantation of the zygomaticomaxillary suture in

guinea pigs has not found to grow (Watanabe M laskin)

 Extripation of facial structures has no appreciable effect on the dimentional of

the skeleton (Sarnat, 1963)

 Shape of sutures have been found to depend on functional stimulus (Moss &
Selentejin, 1969)

 Closure of suture appears to be extrinsically determined (Moss ML)

  Sutural growth can be halted by mechanical force by clips placed across sutures
(Leitunen, 1956)
CONCLUSION
Present evidences indicates sutures as adaptive growth sites. Sutural tissue have no
tissue separating force and they are not comparable to growth centers

SCOTT HYPOTHESIS /NASAL SEPTUM THEORY/NASOCAPSULAR

THEORY
Sutures are considered as merely passive & secondary & compensatory sites of bone
formation and growth. Scott felt that cartilagenous development was under tight
genetic control in prenatal growth and continue to dominate post natal growth also.

Discussion:
The cartilage is a pressure adapted tissue and expansion of cartilage provides the force
to displace maxilla downwards & forwards.
Two suture systems

 Posterior suture system lies behind maxilla and

seperates it from palatine, lateral mass of ethmoid,
lacrimal, zygomatic and vomer bones
 Ant. Suture system separates premaxilla, nasal & vomer bone

 2nd suture disappears during later part of fetal life

EVIDENCES SUPPORTING THE THEORY

 Extirpation of septal cartilage in growing rats resulted in deficient growth of

the snout(Sarnat,1966)

 Latham & Burstone (1966) concluded that nasal septum has a role in
determining anteroposterior growth of upper face

 Sarnat and Long undertook auto radiographic studies with thymidine to

determine the levels of proliferative activity of cartilage cells

 Koski after histological study of nasal septal cartilage found that there is
endochondral ossification taking place at septoethmoidal junction

EVIDENCES AGAINST THE THEORY

 Moss and Bloonberg(1968) found only slight deformity after extirpation of

septal cartilage, concluded that septal cartilage provides only mechanical
support for the nasal bones & is not a primary growth center.

 Moss stated that malformation in snout following excision of nasal septum is

due to trauma following surgery.
CONCLUSION
Nasal septal theory is still accepted as a reasonable explanation for craniofacial
growth. Nasal septum important for anteroposterior growth of face because of
endochondral growth process occurring at its posterior border

FUNCTIONAL MATRIX HYPOTHESIS (Melvin Moss-1960)

The functional matrix theory claims that the origin, growth, form, position and
maintenance of all skeletal tissues and organs are always secondary, compensatory
and obligatory responses to temporally and operationally prior events or processes that
occur in specifically related nonskeletal tissues, organs or functioning spaces
(functional matrices).

Theory

Moss states that ,”bones do not grow; bones are grown”. According to this hypothesis,
the head is a region within which certain functions occur and every function is carried
out by a functional cranial component. Each such component is composed of 2
parts.

 Functional matrix: all the soft tissues and spaces that perform a given function

 The skeletal unit: the bony structures that support the functional matrix
FUNCTIONAL MATRIX
The totality of the soft tissues associated with a single function. There are 2 distinct
types

 Periosteal matrix

 Capsular matrix

Periosteal matrix

 Influences the bone directly through the periosteum

 It acts by the process of bone deposition and resorption.
 eg: temporalis muscle, teeth, blood vessels, nerves, glands
 Periosteal matrices form the local environment factor which affect the growth.
 The influence of periosteal matrix is restricted to part of a bone, I.e. it affects the
“micro-skeletal unit”
Capsular matrix

 Capsular matrix includes the capsule that surrounds masses and spaces
 e.g., the neural mass is contained within the capsule of scalp, dura mater.
 Orbital mass is surrounded by the supporting tissues of eye.
 The oronasal-pharyngeal spaces are surrounded by variety of tissues that form
their capsule.

 Neurocranial capsular matrix is formed by the brain, leptomeninges and

cerebrospinal fluid.

 Orofacial capsular matrix pertains to functioning spaces and tissues in

 respiration, deglutition, etc.

 Capsular matrix forms the local epigenetic factor of which controls the growth
 There is genetically determined volumetric expansion of the capsular matrix.
 Volumetric expansion of the capsular matrix causes spatial translation of the
whole bone or macro-skeletal unit.

 Capsular matrix causes growth of the whole bone

SKELETAL UNIT
The totality of all the skeletal tissues associated with the one function is called a
skeletal unit. It’s of two types:

 Micro-skeletal unit

 Macro-skeletal unit

INTERACTIONS OF FUNCTIONAL MATRIX AND SKELETAL UNIT

PERIOSTEAL MATRIX MICRO-SKELETAL UNIT
Temporalis muscle Coronoid
Tooth Alveolar bone
Masseter & medial pterygoid Angle of mandible
CAPSULAR MATRIX MACRO- SKELETAL UNITS
Nasal mass Cranium
Eye mass Orbit
Orofacial capsule Core of mandible & maxilla

Periosteal matrix (teeth) Micro-skeletal unit

Capsular matrix
Macro-skeletal unit (jaws)
(dentofacial orthopaedics)

Clinical implications of functional matrix theory

 Orthodontic correction of malocclusion is done either by intraoral and or

extraoral appliances.

 Force applications by these applications tend to alter functional matrix.

 Alteration of periosteal functional matrix produces changes in micro-skeletal
unit

 Alteration of capsular functional matrix produces changes in macro-skeletal unit

NEUROTROPHISM

 Moss functional theory states that soft tissues regulate the skeletal growth
through functional stimuli.

 The process by which functional stimulus transmitted to the skeletal unit

 interface involves Neurotropism

 Neurotropism is a “non-impulsive, transmitive neurofunction involving

axioplasmic transport,providing for the long-term interactions between
neurons & innervated tissues which homeostatically regulate the morphological
, compositional and functional integrity of those tissues
Three types

 Neuroepithelial trophism
 Neurovisceral tropism
 Neuromuscular tropism
Orthodontic treatment that modifies functional matrix

 Rapid palatal expansion: this causes widening of the palatal sutures. It is a form
of orofacial orthopaedics.

 Repositioning maxillary segment in cleft patients: These procedures alter the

macro skeletal unit.

 Condylectomy: In ankylosis, condylectomy restores function and allows further

development of mandible.

 Upper anterior inclined planes: they hold the mandible to stimulate the growth
of condyle.

 Activator: to stimulate the growth of condyle.

 Functional regulator: stimulation of both periosteal matrix through lip pads,
buccal shields and capsular matrix by altering oropharyngeal spaces.
  Distraction osteogenesis
 Adjuncts used with fixed appliances like class II elastics, interarch coil springs,
Herbst appliances and extraoral appliances like headgear, facemask or chin
cups have direct effect on functional matrices, primarily because of alteration
of muscle and space.
The four components of functional matrix revisited by Melvin Moss:
1. The role of mechanotransduction

2. The role of an osseous connected cellular network

3. Genetics, epigenetics and causation

4. The epigenetic antithesis and the resolving synthesis

SERVO SYSTEM THEORY

 Put forward by petrovic

 It is based on cybernetic principles
 It states that everything affects everything & living organisms never operates in
an open loop mechanism

 In open loop mechanism, input/stimulus leads to a response. There is no

feedback or regulation

Closed loop mechanism

2 Types of closed loop system

 regulator: input is constant

 Servo system: Follow-up system, main input not constant but varies

ELEMENTS OF SERVOSYSTEM

 Command is a signal independently of the feedback system. E.g. growth

harmone, testosterone, oestrogen
 Reference input elements they establish relationship between command and
reference input which includes septal cartilage, septomaxillary ligament, labionarinay
muscles

 Reference input is a signal established as a standard of comparision - sagittal

position of maxilla

 The confrontation between the position of the upper & lower dental arch is the
comparator of the servo system

 Activity of the retrodiscal pad & lat. Pterygoid constitute the actuating signal

 Controlled system is between actuator & controlled variable. E.g. growth of

condylar cartilage through the retrodiscal pad stimulation

 Controlled variable is the output signal of the servo system. E.g. sagittal
position of mandible
EXPLANATION OF THEORY

 The influence of somatotrophic harmone on the growth of cartilages of nasal

septum, spheno-occipital synchondrosis follows the cybernetic form of command
pattern

 Growth in secondary cartilages like condyle corresponds to local

&environmental factors

 Upper dental arch is constantly changing reference input

 Lower arch constitutes the controlled variable

 Disturbance between the respective position of upper & lower arch, peripheral
comparator sends actuating signals through the stimulation of retrodiscal pad &
lat.pterygoid muscles

 This affects the output signal. The output signal is the final sagittal position of
mandible.

GROWTH RELATIVITY HYPOTHESIS(John C Voudouris 2000)

Growth relativity refers to its displaced condyle from actively relocating fossae.
John C Voudouris introduced this concept to explain the possible effect of functional
appliances on condyle and the resulting growth.

 Displacement of condyle

 Nonmuscular viscoelastic tissue stretch

 Force transduction beneath the fibrocartilage of the glenoid fossa and condyle
add new bone formation

Effect of three growth stimuli (displacement + viscoelasticity +transduction of

force): modification of growth occurs by a combination of all the three factors:
modification “first” occurs as a result of the action of anterior mandibular
displacement. “second” , the condoyle is affected by the posterior viscoelastic
tissues anchored between the glenoid fossa and “third”, displacement and
viscoelasticity further stimulate the normal condylar growth by transduction of
forces over the fibrocartilage cap of the condylar head. Voudouris & Kuftinec
compares this process to the light bulb analogy. The resultant increase in new
bone formation appears to radiate as multidirectional finger like processes
beneath the condoler fibro cartilage and significant appositional bone formation
is seen in the fossa.Growth relativity hypothesis is more specific to condyle
only when compared to functional matrix hypothesis.
CONCLUSION
Identifying the primary trigger mechanism for the growth of maxilla and mandible
will help the orthodontist to either simulate or retard the growth of maxilla and
mandible. This will prove to be the key for successful growth modification treatment
in skeletal malocclusions
REFERENCES

 Sridhar Premkumar ,Text book of craniofacial growth-2011, 1st edition.

 William Profitt, Henry W.Fields, Jr.,David M.Sarver. Contemporary

orthodontics-2012, 5th edition

 Graber,Rakosi, Petrovic -Functional appliances and dentofacial orthopaedics

 Ranley ,A synopsis of craniofacial growth

 Om Prakash Kharbanda ,Orthodontics diagnosis and management of

malocclusion and dentofacial deformities

 Salentijin L, Moss ML: Morphological attributes of the logarithmic growth of

the human face:human growth. Acta Anat 78:185,1971)

 Ricketts RM: A principle of Archial growth of mandible AO 42:368,1972