Seminar on

Presented by
Dr Shan Mammen John
Servo in orthodontics?????
Orthodontist......

The craniofacial Biologist.......

 Craniofacial growth has been the ground for
research for several years, starting from Genetic
theory, Sutural theory, Cartilaginous theory,
Functional matrix theory, Van Limborg’s theory
and now the Cybernetic theory.
 The Servosystem is a part of the cybernetic
theory which describes the craniofacial growth
mechanism systematically and also explains the
functioning of the various appliance system
CYBERNETICS

The term cybernetics (Greek word

Kybernetes, meaning steersman) was
coined by the mathematician Norbert Weiner
in 1948 to encompass the entire field of
control and communication, be it in machine or
in animals.
Cybernetic and control theory
 Demonstrates the quantitative and qualitative relationship
between the observationally and experimentally collected
findings

Observation findings Experimental finding

Petrovic was the first to propose a cybernetic model

to account for the physiological phenomena involving
facial growth and functioning of the functional and
orthopeadic appliances
Warren McCulloch
Cybernetics is concerned with scientific
investigation of systemic processes such as
regulation, information processing,
information storage, adoption, self
organization, self reproduction and strategic
behavior.
 Cybernetics treats not things but ways of
behaving. It does not ask “What is this thing?”
but asks “What can it do?” and “What does it
do?”

The cyberneticians thus develop a

interdisciplinary language by which we may better
understand and modify our world – “the science
of effective organization”.
Cybernetic Features
Cybernetics provides useful research approach. Cybernetics
has brought new and beneficial concepts to the biologic and
biomedical sciences. Such as :-
-         Negative and positive feedback
-         Self regulation
-         Reference input
-         Open and closed loop
-         Regulation Vs Servo system
-         Gain (amplification/attenuation)
-         Systems and circuit analysis
 The cybernetic approach is in fact a major

breakthrough in the decision making process

and problem solving in scientific and clinical

orthodontics and dentofacial orthopedics.

Servo System Theory Of Craniofacial
Growth

In the late 1960s, Petrovic and co-workers

proved that the condylar cartilage’s growth

rate and amount CAN be modified using

appropriate functional and orthopedic

appliances.
 Research has also shown that the Lateral

Pterygoid Muscle (LPM) plays a regulating

role in the control of condylar cartilage’s

growth rate (Petrovic, Stutzman 1972).

 Again in 1976 Stutzmann et al proved that the

Retrodiscal pad also plays a very important

role in the lateral pterygoid muscle’s efforts to

control condylar growth.

Retrodiscal pad
 Partly a mediator of LPM as the blood supply is
through this muscle
 Surgical resection causes diminished rate of growth
of condylar cartilage and lengthening of mandible
 Blood circulating effect
 Biomechanic effect
 This finding was further investigated &

confirmed by McNamara et al in 1980s.

Biologic features of primary and secondary
cartilages
Primary Cartilage Secondary cartilage
 In primary cartilages (eg epiphyseal, spheno-
occipital synchondrosis, nasal septal),

 The chondroblasts divide and lay down intercellular

matrix.
 The cartilagenous matrix will isolate the dividing
chondroblasts from local factors.
 In the zone of growth there are functional
chondroblasts cells that divide and synthesize a
cartilagenous matrix.
 In secondary cartilages (eg : condylar, coronoid,
angular etc)

not surrounded by
 The Prechondroblasts are
cartilagenous matrix

 Since the secondary cartilage is not surrounded by the

cartilagenous matrix it is not isolated from the local factors.

Local extrinsic factors can modify the growth rate

of the secondary cartilage.
 Experiments conducted since

1968 have shown that orthopedic

appliances can modify the amount

and rate of growth of the condylar

cartilage
 Nature Of Cells Belonging To The Mitotic
Compartment Of Secondary Cartilage

 Experiments carried out (1976, 1982) show that the

secondary cartilage contains 2 kinds of cells –
Skeletoblast and Prechondroblast.
Skeletoblast
• It is a pleuripotential stem cell originating from the
embryonic mesenchymal cell.

• The maximum number of cell division can reach upto

60.

• The skeletoblast usually differentiates into osteoblast

but under specific conditions it may develop into a
Prechondroblast or an osteoclast.
 Embryonic mesenchymal cell

Skeletoblast
(pleuripotent stem cell)

Osteoblast Osteoclast
Prechondroblast
Prechondroblast –
 It originates from the skeletoblast.
 The prechondroblast is a differentiated cell, it
matures into secondary chondroblast.
 The maximum number of cell divisions is less
than 10.
 Prechondroblast multiplication is
controlled by general and local extrinsic
or intrinsic factors.
 Skeletoblast

Prechondroblast

Secondary Chondroblast
 Investigations have shown that there is a
continuous need for the prechondroblast to monitor
the size and shape of the condylar cartilage.
Local factors affecting the condylar
cartilage
Cytoplasmic junction
between the skeletoblasts
become quantitatively
reduced

Inhibitory intercellular
stimulations are reduced

Cell division rate

increases

Rate of differentiation of
skeletoblasts to
prechondroblasts increases
 Cybernetically organized biologic
features
INPUT BLACK BOX OUTPUT

o Maxillary
lengthening and Correction of
Orthodontic
widening, malocclusion
functional , and
and o mandibular intermaxillar
lengthening and y relation
orthopaedic
widening,
appliances
oTeeth movements
Classification of the loop systems

Physiologic systems

Closed loop system Open loop system

No comparator
Regulator Servosystem No feed back
system mechanism

constant Not a
constant
Input
 Command

Reference
x X input element

Constantly
changing reference
Coupling input
system Controlled
Output
system
Controlled variable
x
Comparator
Actuator

Performance Performance
Controller analyzing elements
Command
 Signal established independent of the feedback system
 Affects the behavior of the control system without being
affected by the consequences
 Eg. Growth hormones,testosterone, and estrogen
COMMAND

REFERENCE INPUT
ELEMENT
AMPLIFIER
OPUTPUT REFERENCE
INPUT

CONTROLLED
ACTUATOR COMPARATOR
SYSTEM

CONTROLLER PERFORMANCE

PERFORMANCE
ANALYSING
ELEMENTS
Reference input constantly changing variable
 Signal established as a standard of comparison
 Independent of the feedback mechanism
 Sagittal position of the maxilla

COMMAND

REFERENCE INPUT ELEMENT

AMPLIFIER REFERENCE
OPUTPUT INPUT

CONTROLLED
ACTUATOR COMPARATOR
SYSTEM

CONTROLLER PERFORMANCE

PERFORMANCE
ANALYSING
ELEMENTS
Reference input element
COMMAND

REFERENCE INPUT
ELEMENT
AMPLIFIER
OPUTPUT REFERENCE
INPUT

CONTROLLED
ACTUATOR COMPARATOR
SYSTEM

CONTROLLER PERFORMANCE

PERFORMANCE
ANALYSING
ELEMENTS

 Between the command and the reference input

 Septal cartilage, septopremaxillary frenum, labionarinari
muscle and premaxillary and maxillary bone
Comparator

Central comparator Peripheral comparator

Repetitive Detects the

posturing of the disturbances in
mandible periphery

Sensory engram Periodontal receptors

Performance and the performance
analysing elements
COMMAND

REFERENCE INPUT ELEMENT

AMPLIFIER
OPUTPUT REFERENCE
INPUT

CONTROLLED
ACTUATOR COMPARATOR
SYSTEM

CONTROLLER
PERFORMANC
E

PERFORMANCE
ANALYSING
ELEMENTS
The controller and the actuating signal
 The central nervous system
 Controls the activity of the lateral pterygoid muscle and
the retrodiscal pad
 The A.signal is the response of muscle and the
retrodiscal pad COMMAND

REFERENCE INPUT
ELEMENT

AMPLIFIER
OPUTPUT

CONTROLLED
ACTUATOR COMPARATOR
SYSTEM

CONTROLLER PERFORMANCE

PERFORMANCE
ANALYSING
ELEMENTS
Retrodiscal pad
 Partly a mediator of LPM as the blood supply is through
this muscle
 Surgical resection causes diminished rate of growth of
condylar cartilage and lengthening of mandible
 Blood circulating effect
 Biomechanic effect
Retrodiscal pad

1st Action Metabolic pump

Anabolic Catabolic

STH, testosterone, estrogen The prechondroblast

in low doses, insulin, multiplication restraining
prostaglandin F2, mitogenic signal, cyclic adenosine
peptides. monophosphate (camp)
prostaglandin E2.

These iterative changes are responsible for the

supplementary growth of the condylar cartilage produced
by functional appliances.
2nd Action

The biomechanic effect of the

retrodiscal pad is responsible for the

posterior rotation and

supplementary lengthening of the

mandible because of increased bone

opposition at the posterior border of

the ramus.
 The posterior rotation occurs due to the piezoelectric
effect because of which there will be more of bone
remodeling. Negative electric charges accumulate at the
posterior border of the ramus which is concave. The
tendency for that part of the bone is to become flat. So
there will be bone deposition at the posterior border thus
giving a posterior rotation of the condyle.
Controlled system
 Is the final outcome of the system
 The sagittal position of the mandible

COMMAND

REFERENCE INPUT
ELEMENT
AMPLIFIER
OPUTPUT REFERENCE
INPUT

CONTROLLED
ACTUATOR COMPARATOR
SYSTEM

CONTROLLER PERFORMANCE

PERFORMANCE
ANALYSING
ELEMENTS
The Attractor
 Structurally stable steady state in a dynamic system
 Full interdigitation of the teeth be it class I, Class II or
Class III, with cusp to fossa relationship thus eliminating
 The servosystem strives to achieve this stable form
The Repeller
 Unstable equilibrium state
 Cusp to cusp type of occlusal relationship
 The comparator detects this deviation signal and tries to
achieve the cusp to fossa relationship through the
servosystem
 Command

Reference
x X input element

Constantly
changing reference
Coupling input
system Controlled
Output
system
Controlled variable
x
Comparator
Actuator

Performance Performance
Controller analyzing elements
Upper jaw
growth
control by
STH
Control of the maxillary growth

Direct effect Indirect effect

STH -
stomatomedin

Spheno occipital synchondrosis Forward

Nasal septal cartilage growth of Outward
Lateral masses of ethmoid septal
Body and greater wing of sphenoid cartilage growth
Forward growth of septal cartilage
Thrust effect

Anterior extremity of the

nasal septal cartilage

Spreads laterally in
antero inferior direction

Penentrates into the

premaxillary bone

Thrust
effect

Premaxillomaxillary Maxillopalatine
suture suture
 Traction Effect
 Septopremaxillary ligament traction

Growth of the nasal

septal cartilage
Traction effect on the
premaxillary bone through
the Septopremaxillary
ligament
 Traction of the labionarinari muscle
 Traction of the premaxillary bone through this muscle
 Biomechanic promotion of the forward growth of the upper jaw
 Absence of labial muscle attachment on the nasal septum –
cleftlip- bone deformation
Outward growth
Outward growth of the lateral cartilaginous
masses of the ethmoid and the cartilage
between the body and greater wings of
sphenoid

Produces a lateralization of the right and left

alveolar ridges

Stimulates the growth of the midpalatal suture

Outward growth of the

maxilla
Cybernetic Model For Growth of Mandible
Mode of Action of Functional Appliances
Functional appliances
Increased contraction
of LPM Supplementary
lengthening of
Iterative activity of the the mandible
retrodiscal pad

In growth stimulating factors Additional subperiosteal

ossification of the posterior
Enhancement of local mediators border of mandible
Reduction of local regulators
Additional growth of
Change in the condylar condylar cartilage
trabecular orientation
Postural hyperpropulsor
Upper dental arch in a more Reduction in
anterior position anatomic
repositioning of
the mandible
Confrontation
between arches
Reduced intensity
of the deviated
Deviated signal signal

Reduced by fwd posturing Supplementary

of mandible lengthening of mandible

Contractile activity
of LPM
Class II elastics
 No increase in the contractile activity
 Action through the retrodiscal pad
 Intrinsic regulation of the prechondroblasts multiplication

Functional prechondroblast

Restriction of the
prechondroblast multiplication

stimulated growth rate

 Biologic activator for stimulating effect of class II
elastics seem to be retrodiscal pad and its role as a
metabolic pump
Herren Activator Effect similar to class II elastics
 Two step effects
When the appliance is
worn
Reduced length of the
muscle as the mandible is
positioned forward
No stimulating effect on
the condylar cartilage
When the appliance is not
worn
The retrodiscal pad is
more stimulated
Early onset of hypertrophy
of the prechondroblasts
Growth rate of condylar
cartilage is increased
Chin cap therapy
 The number of dividing cells in the condylar cartilage is
decreased
 Vertical growth direction and closing of the Stutzmann
angle
 Decrease in the length of the mandible
 Complete immobilization and the use of chin cap induces
the greatest decrease in the growth rate of condylar
cartilage and the lengthening of the mandible
Occlusal development
First phase Second phase

Morphogenetic process First phase coincides with

leading to stable occlusion
occlusion to serve as the
Stable occlusal
development capable of
serving as a peripheral
comparator is not achieved
Creation of an engram is
not possible
the establishment of the
peripheral comparator
Thus the creation of an
engram
Minimizes the possible
deviation to achieve
stable occlusal
adjustment
Conclusion
 The treatment of dentofacial malrelations requires
considerable insight into the modalities of craniofacial
growth which is adequately understood only with a
knowledge of mechanisms controlling it,so far the
cybernetic language has been the best tool to render
accurately the intricacy and complexity of the
craniofacial growth and means to influence it clinically