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Growth and its role in orthodontic patient
Various concepts in growth and
Theories of growth and their description.

Theories of growth
It is fact that the growth is strongly
influenced by genetic factors, but it also can
be significantly affected by environment, in
the form of factors like nutritional status,
degree of physical activity, health or
illnesses etc.

Important theories

Genetic Theory. Brodie (1941)

Sutural Theory, by Sicher (1945)
Cartilagenous Theory, by Scott (1953)
Functional matrix Theory, by Moss (1962)

5.Neurotropism by, Moss (1971)

6. Servosystem Theory by, Petrovic (1982).
7. Functional matrix theory revisited
-Melvin Moss 1997

Genetic theory, Brodie 1941

The genetic theory simply implies that
genes determines all, i.e. all growth is
controlled by genetic influence and is
Although called a theory it was more
assumed than proves.

One can often conclude that all resemblance in

families are genetic. But such similarities like
facial expressions, mode of laughter may be
learned as a result of living together.
Undoubtly there are primary controls for
initiation and formation of facial structures. But
what we sometimes assume to be genetic may
be acquired and superimposed on genetic
foundation common to patients and progeny.

In addition to multiple genes there are the

effects of the environment on the product
of the genetic control during formation.
This was one of the earliest theories put
forward. Only some part of this theory is

Sichers Sutrual Theory:1955

According to Sicher the craniofacial growth
occurs at the sutures.
From the many studies using vital dyes he
deduced that, sutures are causing most of
the growth. If the sutural connective tissue
proliferates it creates the space for
appositional growth at the borders of the
two bones.

This connective tissue in sutures of both

the nasomaxillary complex and vault
produced forces which separates the
bones, just as syncondroses expanded
the cranial base and epiphyseal plates
lengthened long bones.

According to him, paired parallel sutures

that attach facial areas of the skull and the
cranial base region push the
nasomaxillary complex forwards to pace
its growth with that of the mandible.

Fig of synchondroses

Sicher believed that both the

condrocranium and the desmocranium
grow under rather strong genetic
He held sutures, cartilage and periosteum
all responsible for facial growth and
assumed all were under tight intrinsic
genetic control.

Growth, in his view , was the result of the

expression at all these sites of a genetic
program. The translation of maxilla,
therefore, was the result of pressure
created by growth of the sutures, so that
bones are pushed apart.

Rejection of Theory :
The theory has been largely rejected for the
reason, that the suture is essentially a tension
adapted tissue. The presence of any unusual
pressure on a suture triggers bone resorption,
not deposition. The sutural membrane can not
withstand any undue amount of compression
because pressure affects its vascular and
cellular components. It is believed that the
stimulus for sutural bone growth is the tension
produced by the displacement of that bone.

It is clear now that sutures, and the

periosteal tissues more generally, are
not primary determinants of the
craniofacial growth because :
When the area of suture between two facial
bone was transplanted to another location,
the tissue does not continue to grow. This
indicates lack of innate growth potential in

Growth takes place in untreated cases of

cleft palate even in the absence of suture.
Microcephaly and hydrocephaly raised.
Doubts about the intrinsic genetic stimulus
of the sutures

Thus sutures must be considered areas that

react not primary determinants. The sutures
of the maxilla are the sites of the growth and
not and not growth centers.

Scotts Cartilaginous Theory :

Scott assumed that the primary controlling
factors in craniofacial growth are found
only in the cartilage and the periostium,
and the sutures are secondary and
passive. He viewed that cartilaginous sites
throughout the skull as primary centers of

Cartilage is specifically adapted to certain

pressure-related growth sites, because it is
special tissue uniquely structured to provide
the capacity of growth in the field of
Cartilage is present in the epiphyseal plate of
long bones, in the synchondroses of the
cranial base, and the mandibular condyle,
where it provides linear growth by
endochondral proliferation.

The one way to visualize the mandible is

by imagining that, it is like diaphysis of a
long bone, so that there is cartilage
representing half an epiphyseal plate at
the ends, which represent the mandibular
condyles. Considering this, cartilage at the
mandibular condyle should act as a growth
center, behaving basically like epiphyseal
growth cartilage.


Although there is no cartilage in maxilla

itself, there is a cartilage in the nasal
septum, and the nasomaxillary complex
grows as a unit.
cartilaginous theory hypothesize that the
cartilaginous nasal septum serves as a
pacemaker for other aspects of the
maxillary growth.

the basis for the theory is that the

pressure-accompanying expansion of the
nasal septum provides a source for the
physical force that displaces the maxilla
anteriorly and inferiorly. If the sutures of
the maxilla served as a reactive, as they
seem to do,

then they would respond to this translation

by forming new bone when the sutures
were pulled apart from the forces from the
growing cartilage.

Two kinds of experiments have been

carried out to test the idea that cartilage
can serve as a true growth center :
Analysis of the results of transplanting

An evaluation of the effects on growth of

removing cartilage at an early age.

Transplantation experiments demonstrate

that not all skeletal cartilage acts the same
when transplanted. If a piece of a
epiphyseal plate of a long bone is
transplanted, it will continue to grow,
indicating that these cartilages do have
innate potential ,

cartilage from the spheno-occipital

synchondrosis of the cranial base also
grows when transplanted, but not as well.
transplanting cartilage from the nasal
septum give equivocal results : sometimes
it grew, sometimes it did not .

Experiments to test the effect of removing

cartilages are also informative. The
removal of the nasal septal cartilage from
young growing rabbits nose shows
considerable deficit in the growth of the
midface (Sarnat and McNamara 1976).
Ohyma in1969 did experimental study on
rats and supported scotts hypothesis

Fact against scott cartilaginous hypothesis

It is seen that in 75% to 80% of human

children who suffers from condylar fracture
resulting loss of the condyle does not
impede the mandibular growth.

In summary it appears the epiphyseal

cartilage, the cranial base synchondrosis,
and the nasal septal cartilage can and do
act as independently growing center.
Neither tranplantation nor the cartilage
removal experiment lend any support to
the idea that the cartilage of the condyle is
an important center.

It appears that growth of the condyle is

more analogue to growth of the sutures of
maxilla entirely reactive than to the
growth of the epiphyseal plate
At present the cartilaginous theory is still
accepted by no. of investigators, although
it is universally realized that, much more
needs to be understood.

Functional matrix theory-Melvin

The concept of functional matrix as
introduced by professor Melvin.L.Moss has
revitalised the studies of growth and
development and had established a rationale for
the orthodontic application of orthopaedic
forces . Proff. Moss has taken a quantum leap
with his functional matrix hypothesis to explain
growth and development-

Definition :
As in Am.j.orthodontics june 1969,vol
55,number 6. by Melvin.l Moss and Salentine
all responces of the osseous portions of skeletal
units to periosteal matrices are brought about
by the complimentary and interrelated process
of osseous deposition and resorption, the
resultant effect of this is to alter their size and
/or their shape.

Definition acc. to AJO vol july 1997 by

Melvin .L. Moss
The developmental origin of all cranial
skeletal elements (e.g., skeletal units) and
all their subsequent changes in size and
shape (e.g., form) and location, as well as
their maintenance in being, are always,
without exception, secondary,
compensatory, and mechanically obligatory
responses to the temporally and

operationally prior demands of their related

cephalic nonskeletal cells, tissues, organs,
and operational volumes (e.g., the
functional matrices).
this theory is based on functional cranial
component concept of Van Der Klaauw

Principles of functional matrix theory

Functional matrices are the primary
design mechanisms in craniofacial
growth, i.e functional matrices grows
and skeletal tissue responds.
Effects of genes are mainly exerted on
the functional matrices , rather than on
skeletal tissue themselves.

Changes in size, shape and location

are epigenetically ( i.e causally
related series of processes or
changes in external and internal
environment) related.
The interaction of both genomic and
epigenetic factors is required o
regulate or cause development

Functioning muscle influences

developmental changes in the form of
skeletal tissue to which they are
attached through muscle-bone

Functional cranial component

( tissues, organs, spaces, skeletal part )
skeletal unit
(bone, cartilage tendons

functional matrix


micro skeletal unit

macro skeletal unit


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

Skeletal unit :
All skeletal tissues associated with a
single function.
Micro skeletal unit: when bone is comprised of
several contiguous skeletal units, they are termed
micro skeletal unit.
Macro skeletal unit :when adjoining portions of a
number of bone are united to function as a single
cranial component.

Skeletal units may be composed

variably of bone, cartilage, or tendinous
To a variable extent, contiguous
microskeletal units are independent of
each other.

Eg, In the mandible we distinguish easily a

coronoid microskeletal unit related to the
functional demands of the temporalis
muscle; an angular microskeletal unit
related to the activity of both the masseter
and medial pterygoid muscles; an alveolar
unit related to the presence and position of
teeth; and a basal microskeletal unit related
to the inferior alveolar neurovascular triad

Functional matrix
The term functional matrix is by no means
equivalent to what is commonly understood as
"soft tissues," this is, muscles, glands, nerves,
vessels, fat, etc
Teeth as a functional matrix.
Teeth are also a functional matrix, :most
orthodontic therapy is based firmly 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 .

Periosteal matrices : these are muscles,

nerves, vessels, glands. They act directly on
their skeletal units; bringing about a
transformation in there size and shape by bone
deposition and resorption
Periosteal matrices act upon skeletal units in a
direct fashion by the processes of osseous
deposition and resorption (or of cartilaginous or
fibrous tissue multiplication).

Eg supporting periosteal matrix concept :

There exist considerable mutually
confirmatory data showing that
experimental removal of the mammalian
temporalis muscle or its denervation,
invariably results in an actual diminution of
coronoid process size and shape or,
indeed, in its total disappearance .
Similarly, it is well established that

functional hypertrophy or hyperactivity of

the temporalis muscle is productive of
increased coronoid process size and also
alteration of its shape.

Capsular matrix:
capsules is an envelope
which contains a series of functional
cranial components (skeletal units plus
their related functional matrices ) which,
as a whole, are sandwiched in between
two covering layers.

Capsular matrices act upon functional cranial

components as a whole in a secondary and
indirect manner.
Cause a passive translation of these cranial
components in space.
The growth of the facial skull is influenced by
volume and patency of these spaces.

Neurocranial capsule:
In neurocranial capsule , covering
consist of the skin and the dura mater.
The composition of this capsule in the
adult is easily stated; these are the socalled "five layers" of the scalp, then the
bone itself, and, finally, the two-layer dura

The neural skull does not grow first and

thus provide space for the secondary
expansion of the neural mass. Rather, the
expansion of the neural mass is the
primary event which causes the secondary
and compensatory growth of the neural

Orofacial matrices:
In the orofacial capsule the skin
and mucosa form the limiting layers.
All functional cranial components of the
facial skull arise, grow, and are maintained
within an orofacial (splanchnocranial)
capsule. This capsule surrounds and
protects the oronasopharyngeal
functioning spaces

The functional reality of the respiratory

and digestive systems is their patency,
and the volume of that patency is related
to the general metabolic demands of the
body as a whole.
The oronasopharyngeal functioning space
is particularly related to the relatively
dominant cranial respiratory functional
space volume.

Bosma concept 1969 Support for

capsular matrix:
Bosma believes that "a recent concept
is the development of head and neck
posture is about this pharyngeal airway"
and that the related functional cranial
components are so dynamically balanced
that this airway is maintained throughout
the range of motion of the head and neck.

The oral and pharyngeal "regions" are said

to have a primary function in maintaining a
patent airway. This is accomplished by a
dynamic musculo-skeletal postural balance
which is termed the Functional airwaymaintenance mechanism .
Cranial growth is a combination of the
morphogenetically primary activity of both
types of matrix.

Growth is accomplished by both spatial

translation and changes in form.
Conclusion :
Thus, the functional matrix concept, in
general, is established and valid, and it is
basic in helping us understand the complex
interrelationship that operate during facial

It is to be realized, however that this

principle is not intended to explain how the
growth control mechanism actually
functions. This concept describes
essentially what happens during growth; it
does not account for the regulatory
processes at the cellular and molecular
level that carry it out.

Experimental works supporting

functional matrix hypothesis
Koski -Makinen experimental study 1963-64 on
transplanted components of the mandibular
supported the functional matrix theory and did
not agree with sicher-weinmann hypothesis .
Sarnet and muchnic AJO1971 done
experimental study on skull of rhesus monkey to
see the changes after condylecomy.

Rankow and Moss Angle Orthodont. 1968

study of young female, who was subjected
to condylectomy following ankylosis.
other works were done by:
Irving and ronning 1962.
Gianelly and moorees in 1965.

Neurotrophism mechanism (Moss1971)

Neurotrophism is a non-impulse
transmitting neural function that involves
axoplasmic transport and provides for long
term interaction between neurons and
innervated tissues that homeostatically
regulates the morphological,
compositional and functional integrity of
those tissues.

Moss 1971 j.Dent .res talk about the neurotrophic

processes in oro facial growth and indicate three
general categories:
Neuro-epithelial trophism
Neuro-muscular trophism
Neuro-visceral trophism


3(l):14-29, May, 1989

There is evidence that vasoactive
intestinal peptide (VIP) and calcitonin
gene-related peptide(CGRP) elaborated
from sympathetic and parasympathetic
neurons may have a modulatory role.

Mechanisms involved in growth,
development, and maturation of tissues
sustained by neural cells would seem to
depend on chemical interactions.

Petrovics 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.

Cybernetic is an organized system that

operates through signals that transmit
Petrovic used a cybernetic model for the
physiologic phenomena involved in facial
In servo system the main input is not
constant but varies with time

According to this theory control of primary

cartilage takes a cybernetic form of a
command, whereas in contrast, control of
secondary cartilage (e.g. mandi condyle)
is comprised not only of a direct effect of
cell multiplication but also of indirect

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

( growth hormone, somatomedins, sex hormone, thyroxin )

In secondary cartilage

In primary cartilage
direct control

Indirect control Direct control

Septal cartilage

saggital positioning of maxilla

normal signal

Lateral pterygoid
muscle activity


deviation signal


Mandibular growth

This theory explains the mode of action of

the functional appliances directed at
The upper arch acts as a mould into which
the lower arch adjusts it self, such that
optimal occlusion is established.

Functional matrix hypothesis revisited 1997:1.The

role of mechanotransduction

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

FMH revisit presents seamless description

between several level of bone structure and
operation from genomic to organ level.
It does so by the inclusion of two
complementary concepts1) Mechanotransduction occurs
in single bone cells.
2) Bone cells are computational
elements that function multicellularly as a
connected cellular network.

Mechanosensing process enable a cell to
sense and to response to extrinsic loading
by using the process of mechanoreception
and mechanotransduction.
mechanoreception: transmits an extra
cellular physical stimulus into a receptor
cell, the mechanotransduction transforms
the stimulus into an intra cellular signal.

transducing or transforming the stimulus's
energetic and/or informational content into an
intracellular signal. Mechanotransduction is
one type of cellular signal transduction.
There are 2 mechanotransductive
process1) Ionic or electric
2) mechanical- through physical
continuity of the

transmembrane molecule

Extracellular collagen
intracellularly with cytoskeletal ACTIN
Nuclear membrane
Intranuclear process
Regulate genomic activity

Osseous mechanotransduction
Osseous mechanotransduction is unique in 4 ways1)Not cytologically specialized.
2) Evoke three adaptational responses
3)Osseous signal transmission is Aneural.
4)Evoked bone adaptational
response are confined with in each bone organ

Functional matrix hypothesis revisited 1997:

2. the role of an osseous connected cellular
Bone as an osseous connected cellular
network (CCN):
All bone cells, except osteoclasts, are
extensively interconnected by GAPjunction that form an osseous CCN.
Each osteocyte enclosed with in its
mineralized lacunae

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.

Loading of bone
stimulate initial cells
( loading exceeds

threshold value)

Intracellular signals generated

transmitted to intermediate or hidden
cells (osteocyte)
( when exceeds
threshold value)

transmission to final layer cells

Adaptive response

A skeletal CCN displays the following

attributesDevelopmentally: untrained
self-organized, self-adaptive and
epigenetically regulated system.
2) Operationally: stable,
dynamic system that exhibits oscillatory
behavior permitting feed back.
3)Structurally, an osseous
CCN is nonmodular.


Functional matrix hypothesis

revisited1997: 3. The genomic thesis
The initial version of the functional matrix
hypothesis claiming epigenetic control of
morphogenesis was based on macroscopic
(gross) experimental, comparative and
clinical data. Recently revised it now extends
hierarchically from gross to microscopic
(cellular & molecular) levels and identifies
some epigenetic mechanisms capable of
regulating genomic expression.

The epigenetic /genomic problem is a dichotomy

and dialectics is one analytical method for its
resolution. The method consists of the presentation
of two opposing views The genomic thesis

An epigenetic antithesis and a


The genomic thesis :

The genomic thesis holds that the genome from
the moment of fertilization, contains all the
information necessary to regulate (cause, control,
direct)--1)The intranuclear formation and transcription of

2) All (phenotypic) feature are ultimately

determined by the DNA sequence of the

Genomic thesis is denied because it is

both reductionist and molecular, that is
description of the causation (control,
regulation) of all hierarchically higher and
structurally more complex morphogenetic
processes are reduced to explanation of
mechanisms at the molecular (DNA) level.

The functional matrix hypothesis

revisited :4. The epigenetic antithesis
and the resolving synthesis
The epigenetic antithesis :
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.

Craniofacial epigenetics:
Broadly speaking, epigenetics refers to the entire
series of interaction among cells and cell products
which leads to morphogenesis and differentiation.
thus all cranial development is epigenetic.
In terms of clinical orthodontics, all therapy is
applied epigenetics and all appliances acts as
prosthetic functional matrices.
Clinical therapeutics includes a number of
epigenetic processes, whose processes of tissue
adaptation by both skeletal unit and functional

A 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
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.


A good knowledge of growth and development
helps us to know the etiology, diagnosis and
treatment planning of malocclusion and also
helps us to predict the prognosis of orthodontic
Growth modification by means of functional and
orthodontic appliance gives better response
before growth completion (best results during
growth spurts)
Orthognathic surgery gives best results if done
after completion of growth, so as to prevent


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