Cybernetic

Cybernetic Theory
Theory
of
of
Craniofacial
Craniofacial Growth
Growth
 Petrovic 1977

• Demonstrate qualitative and quantitative

relationship between observed and experimental
findings.

• Broader understanding of orthodontic problems,

and action of appliances

• Familiarity of orthodontists with cybernetics

Cybernetics Transfer of Information

• Cybernetic systems operate through transfer of

information

• Physical, Chemical, Electromagnetic

Input Process Output

Cybernetic
Input Output
System
Transfer Function
 Physiological cybernetic systems

Open loop Closed loop

Peripheral
Regulator Comparator
Central

Positive
Servosystem Feedback
Negative
 Open Loop

Output has no affect on the input

 Closed Loop

Relationship maintained between input and output

Input Comparator Transfer function

Feedback Output
Loop
 Regulation Type of Closed Loop

Input is constant
Any change of the input will initiate a “regulatory
process”

Input Comparator Transfer function

Regulation of input
Servosystem Type of Closed Loop
 Components of a Servosystem

Reference Input Elements

COMMAND Reference Input

Actuator, Coupling System, COMPARATOR

Controlled System Output
(Controlled Variable) Performance
Analyzing
Elements

Central Comparator Performance

(sensory engram) Deviation Signal
Growth of the Face

According to the

Servosystem Theory
 Types of Cartilage
Primary
 Types of Cartilage
Secondary
Primary Cartilage:
Epiphysis, Synchondrosis, Nasal Septum, Ethmoid

Sphenoid

Secondary Cartilage:

Condyle, Coronoid, Mid Palatal Suture,

Fracture Callus
Factors influencing Primary Secondary
Growth Cartilage Cartilage
Hormones Yes Yes

Local Factors No (Chondroblasts Yes (Pre-

surrounded by matrix) chondroblasts not
surrounded by matrix)
Orthopaedic Only Direction Direction and
appliances Amount

Charlier, Petrovic, Stutzmann

Strasburg, France
Role of Lateral Pterygoid and Retrodiscal Pad

•Blood Supply

•Bio-mechanic
 Relationship Between Lateral Pterygoid,
Retrodiscal Pad and Condyle

MENISCUS
LPM
RDP
 Stutzmann and Petrovic

Proper function of Lateral Pterygoid and

retrodicsal pad:

• Excision of Lateral Pterygoid

• Reduced function of the Retrodiscal pad
(Rat experiments)
 The Face as a Servosystem

Input – Maxillary dental arch

Output – Adjustment of the position of mandibular

dental arch
 Growth of the maxilla

Growth in Growth in
Length Width
 Traction
Growth in Length:
Septo- Induction Growth of
Premaxillary Pre
ligament Maxillary
Growth of extremity
Nasal Septum
Biomechanical
Labio narinary
Muscles
Anterior shift Growth of
Release of Thrust Premaxillo-
STH Of premaxillary
bones Maxillary
Somatomedin suture
Protrusion of
Upper Incisors
Increased size
Thrust Growth of
Of Tongue
Maxillo
Protrusion of
Palatine
Lower Incisors
suture

Direct Action
 Growth in Width: Growth of
Transverse inter Pre
Separation of Maxillary
Growth of premaxillae suture
Lateral cartilaginous
masses of Ethmoid Outward growth
Of maxillary
bones Transverse
Seperation of Growth of
Release of Horizontal mid
STH Growth of cartilage Maxilla and Palatine
Somatomedin B/w greater wings Palatine plates suture
& body of sphenoid
Outward shift of
Alveolus and
molars Outward
Increased size
Of Tongue Appositional
Bone
growth

Direct effect
 The Face as a Servosystem

Release of Hormones Position of Maxillary

Hormones (Command) Dental arch (Ref Input)

LPM & RDP Growth at condyle OCCLUSION

(Comparator)
(Coupling system) (Controlled System) Output
Periodontium,
Actuating Teeth
signal
Musculature
Actuator (Motor Cortex) Joint

Brain Mastication
(sensory engram) Deviation Signal (Performance)
Growth at the Posterior Border of the Ramus
 Other Terms Related to a Servosystem

Gain = Output
Input
Enhancement (Gain>1) Attenuatation (Gain <1)

1. STH – Somatomedin 1. Large amounts of

TESTOSTERONE
2. Small amounts of 2. Small or large amounts of
TESTOSTERONE OESTROGEN
3. Very small amounts of 3. Large amounts of
OESTROGEN CORTISONE
Attractor Cusp to fossa relation

Repeller Cusp to cusp relation

Disturbances Abnormal tooth position

Occlusal interferences
Arthritis
Muscle Inflammation
Periodontitis, Pulpitis
 Peripheral Comparator
Before development of Occlusion:-
•Sensory engram not developed
•Servosystem does not operate
•Genetic influence on mandibular
growth
•Anodontia

After Development of Occlusion:-

•Sensory engram forms
•Peripheral comparator controls
growth
 Failure of Servosystem to Control Growth

• Peripheral comparator faulty – Caries,

Mutilated dentition.

•Discrepancy between rotation pattern (Anterior

or Posterior) and location of comparator.
 Discontinuities

Stable Unstable Stable

Catastrophe Theory
Bifurcation
Catastrophe Theory
 Importance of Discontinuities

•Growth prediction , treatment planning , decision making

•Stability of occlusion after it is established

•Genotype does not directly influence the phenotype

Height of
Bifurcation

OR
 The Sensory Engram

• Collection of feedback loops

• Blueprint of ideal muscular function/position

• CNS tends to operate along these feedback loops

 Optimality of Function

•Minimum deviation signal

•CNS always tries to revert back to optimal position

•Observation of Chain gang prisoners by Jacobs (1968)

Development of Skeletal Malocclusion

According to the Servosystem Theory

For every unit of Growth hormone released,

the amount of growth in the maxilla is less than

in the mandible.
Increase in length

LPM(max)

LPM(norm)

LPM(min)

MAX

Retrognathism Prognathism

Hormone levels
L1 N L2
Action of Functional
Appliances
 Two Types of Functional Appliances:

) Activator, Postural hyperpropulsor, Frankel

appliance, Twin block, Bionator, Class II Elastics(?)

) Herren activator, LSU activator, Harvold-Woodside

activator, Extra oral traction on the mandible.
FIRST GROUP:

Position mandible Increased activity of

Forward LPM and RDP

Less fatigable fibres in LPM

•Oudet et al (1988)
•Carlson et al (1990)

LPM “helped to contract more” by

Functional appliances.
 CELLULAR LEVEL

1. Precursor
Skeletoblast –
pleuripotent,
fibroblast like.
2. Prechondroblast –
faster cell cycle,
matures into
Chondroblast
 Chondroblasts lost Increased
(hypertrophy, surgically removed) multiplication of
prechondroblasts

Local control over multiplication of

prechondroblasts
Originates from chondroblastic layer
•Stutzmann and Petrovic
(1982, 1990)
Functional appliances (especially Class II elastics)

Increased activity of RDP

Increased nutrients and growth factors supplied

and inhibitors removed.

Increased mitoses and earlier hypertrophy of

chondroblasts.
Reduced negative feedback
signal reaching
prechondroblasts

Increased growth at the

condyle
Cytoplasmic junctions between skeletoblasts reduce.

Transmission of inhibitory factors reduce.

Increased mitotic rate and rate of differentiation into

prechondroblasts.
SECOND GROUP:

Position mandible forward , open in beyond rest

position.

No increase in activity of LPM

•Herren (1953)
•Auf der Maur (1978)

Yet there was an increase in growth

wo steps:

) While appliance is worn:-

Forward position
Reduction of length of LPM
New sensory engram

) While appliance is not worn:-

New sensory engram
Functioning in anterior position
Increased activity of RDP
Action of first group while appliance is worn

Action of second while appliance is not worn

group
 CLINICAL IMPLICATIONS

1) Principle of optimality of function :-

Less relapse tendency if post orthodontic

treatment muscular activity produces a lower

deviation signal.
2) Removal of functional appliance – when growth
is complete.

3) If removed when growth not complete – Proper

intercuspation.
4) Understanding of when, and for how long a

particular functional appliance should be worn.

First group – Full time

Second group – Part time

5) Proper functioning of LPM and RDP important for
growth – Proper parent counseling.

6) Sensory engram poorly developed in younger

children.

7) Utilization of high hormonal activity at puberty.

 Drawbacks

Lot of importance on condyle:

Fracture?

Peripheral comparator (occlusion)

discrepancies may be overcome by Dentoalveolar
changes.
Occurrence of Class II end on relation is seen often?

Action of reverse pull headgear on maxilla

(primary cartilage)
 References
Dentofacial Orthopedics with Functional
Appliances
Graber, Rakosi, Petrovic

Craniofacial Growth Series – Monograph 23

(Craniofacial Growth Theory and Orthodontic Treatment –
Edited by Carlson)
Treatment objectives and case retention:
Cybernetic and myometric considerations
R.M. Jacobs Am J Orthod, 58:552-564, 1970

Grant’s Atlas of Anatomy