GOOD MORNING

THEORIES OF GROWTH

UNDER THE ABLE GUIDANCE OF :

DR. RAKESH KOUL (PROF. &
H.O.D.)
DR. RAM AUTAR (PROF.)
DR. SHANTANU KHATTRI (PROF.)
DR. MADHVI BHARDWAJ (PROF.)
DR. VIJAYTA YADAV (READER)
Presented by:
Sana Mahtab (JR 1)
Department of
Orthodontics and
Dentofacial Orthopaedics
 GROWTH CENTRE VERSUS GROWTH
SITE
• A site of growth is merely a location at which growth occurs, whereas
a centre of growth is a location at which independent growth occurs.
• All centres of growth also are sites, but the reverse is not true.
• Initially, the sutures between the membranous bones of the cranium
and jaws were considered growth centres. If this theory were correct,
growth at sutures should occur largely independent of environmental
influences.

But it was later seen that growth at sutures does respond to external
stimuli. Hence, sutures are sites of growth and not the centres of
growth.
 THEORIES OF GROWTH

• Brash’s remodeling theory

• Genetic theory
• Sicher’s theory of sutural growth dominance
• Scott’s theory of cartilaginous growth dominance
• Functional matrix theory
• Petrovic’s servosystem theory
• Functional matrix theory: revisited
 BRASH’S REMODELING
THEORY
James Couper Brash proposed that bone grow only by
surface remodeling.

• he proved in animal experiments on pigs that resorption

takes place on the anterior surface of the ramus and bone
addition on the posterior border of the ramus.

• The mandible grows by extension of all its borders in all

directions except the coronoid process.
The main tenets of this theory as summarised by
Carlson are:

• growth of the jaws is characterised by

deposition of bone at the posterior surfaces of
the maxilla and mandible, sometimes described
as Hunterian growth of the jaws

• calvarial growth occurs via deposition of

bone on the ectocranial surface of the cranial
vault and resorption of bone endocranially at its
surfaces.

The theory underestimates or totally ignores the

role of sutures and cartilages of the craniofacial
skeleton in the growth of bone.
 GENETIC THEORY: BRODIE(1941)
• All growth is controlled by genetic influence and is pre-planned.
• The basic control of growth, both in magnitude and timing, is located
in the genes.
• The potential for growth is genetic.
• The actual outcome of growth depends on the interaction between
the genetic potential and environmental influences.
• Studies of twins have shown that body size, body shape, deposition
of fat, and patterns of growth are all more under genetic control than
under environmental control.
• Heredity controls both the end result and rate of progress toward the
end result
7
Factors in support of genetic theory

• Genetic factors play the most important role in early bone development.
This was demonstrated by transplantation of cartilaginous bone models
from the very early embryo into various sites both in vivo and in vitro.

• Such transplants have the capacity to develop for a short time into
miniature replicas of adult bone even in environment devoid of nervous,
circulatory and gross mechanical influences.

• Genetic factors affecting general size and form of the final skeleton is
clearly shown in many familial developmental anomalies.
 SICHER’S THEORY OF SUTURAL
GROWTH DOMINANCE

He stated that all bone forming elements like sutures ,cartilages and periosteum
are growth centers like the epiphysis of the long bone and were responsible for
causing most of the growth.
Sicher called this theory as the sutural dominance theory because he believed that
the primary event in sutural growth is proliferation of the connective tissue between
the two bones.
• Sicher’s theory came from evidence he gathered by observing the staining of
bones of animals fed on madder (contains Alizarin), which gets incorporated in
developing bones and causes intrinsic staining. He concluded that sutures were
causing the growth since they were the sites of active staining.
According to Sicher, the sutures are the primary determinants of
craniofacial growth. The craniofacial skeleton enlarges due to expansible
forces exerted by the sutures as they separate.
According to Sicher sutures
important in growth of upper jaw
are:

• Suture between frontal

process of maxilla and frontal
bone
• Suture between zygomatic
bona and maxilla
• Suture between pyramidal
process of palatine bone and
pterygoid process of
sphenoid bone.
• According to Sicher the primary event in craniofacial growth was proliferation of the
connective tissue between bones that caused them to grow and elongate.

• Proliferation of the sutural connective tissue creates the space for appositional bone
growth between the borders of two bones.

• Increase in the size of the cranial vault takes place via primary growth of the bone at the
sutures, which forces the bones of the vault away from each other.

• Growth of the midface takes place via intrinsically determined sutural expansion of the
circummaxillary suture system, which forces the midface downward and forward.

• Mandibular growth takes place via intrinsically determined growth of the cartilage of the
mandibular condyle, which pushes the mandible downward and forward.

• It was believed that the stimulus for bone growth is tension produced by the
displacement of the bones.
In 1968, Koski further gave two concepts of growth at sutures :

1. Three-layer theory (Sicher and Weinmann) whereby the intermediate

connective tissue between the sutures proliferates which makes the bone grow.

It stated that the connective tissue

between the two bones plays the same
role as the cartilage at the bases of the
skull and like epiphysis of the long bone.

There is spreading of sutures due to

proliferation of middle layer of the sutural tissue.

According to this concept tissue separating

force exists in the suture itself.
2. Five-layer theory (Pritchard,
Scott and Girgis,1956)

Whereby the ends of bone at

sutures have a two layered
periosteum, where the primary
bone growth takes place. The
intermediate connective tissue
allows adjustments for the
bony growth.
SHORTCOMINGS OF SUTURAL THEORY
• Trabecular pattern in the bones at the suture change with age, indicating the changes in the
direction of growth it cannot be accepted that suture will have the necessary information for
altering growth.

• Sutures & periosteal tissues lack innate growth potential.

• Extirpation of facial sutures has no appreciation effects on the dimensional growth of the
skeleton.

• Sutural growth can be halted by mechanical forces like clips placed across the sutures.

• Growth at sutures responds to outside influences, as compression and tension.

e.g. If cranial or facial bones are pulled apart at sutures, new bone fills in and if suture is
compressed the growth will be impeded. Sutures are thus areas that react and not the
primary determinants. Thus sutures are growth sites, not growth centres.

• Growth take place even in untreated cases of cleft palate even in the absence of sutures.
 CARTILAGINOUS
THEORY
In the early 1950’s James H. Scott proposed an alternative view, which is regarded as the
second major hypothesis, on the nature of craniofacial growth.

• He assumed that intrinsic, growth-controlling factors were present only in the cartilage and
in the periosteum.
• He claimed that growth in the sutures was secondary and entirely dependent on the growth
of the cartilage and adjacent soft tissues.
• He argued that growth of the nasal cartilage was the primary factor determining the growth
and displacement of the mid-face forward and that it was under strong genetic control.
• It became clear eventually that "centres," such as the facial sutures, cannot actually drive
the nasomaxillary complex into downward and forward displacement. This is because a
suture is a traction-adapted (not a "pushing" and pressure-adapted) type of tissue.
• Because cartilage is a more pressure-tolerant tissue than the vascular-sensitive
sutures, it presumably has the developmental capacity to expansively push the whole
nasomaxillary complex downward and forward.

• With this thought, Scott's famous nasal septum theory was born and the premise for the
idea was quite reasonable.

• It basically developed from the criticisms of the "sutural theory“ described previously.

• Cartilage is specifically adapted to certain pressure-related growth sites, as mentioned

before, because it is a special tissue uniquely structured to provide the capacity for
growth in a field of compression.

• Cartilage is present in the epiphyseal plates of long bones, in the Synchondrosis of the
cranial base, and in the mandibular condyle, where it relates in each case to linear
growth by endochondral proliferation. Whereas the cartilaginous nasal septum itself
contributes only a small amount of actual endochondral growth.
• The basis for the “nasal septal theory” is that the pressure-
accommodating expansion of the cartilage in the nasal septum
provides a source for the physical force that displaces (pushes)
the whole maxilla anteriorly and inferiorly.

• This sets up fields of tension in all the maxillary sutures.

• The bones then secondarily, but virtually simultaneously, enlarge

at their sutures in response to the tension created by the
displacement process.
EXPERIMENTAL STUDIES
Two kinds of experiments have been carried out to test the idea that cartilage can serve as
growth centre:

1. Transplantation experiments-
These experiments demonstrate that not all skeletal cartilage acts the same when
transplanted.

2. Experiments to test the effect of removing the cartilage-

The goal of this experiment was to know if removing a cartilaginous area stops or
diminishes growth
Effect of removing nasal septum in a man at the age of 8years, after an
injury showing midface deficiency
Growth on the basis of Scott’s theory :

Growth of the Cranial Base:

• The changes in the cranial base occur primarily as a

result of endochondral growth through a system of
Synchondroses.
• Prenatally, the cranial base has a series of
synchondroses within and between the ethmoid,
sphenoid, and occipital bones.
• This arrangement allows for a rapid increase in the
length of the cranial base early in life to accommodate
the growing brain.
• e.g. growth of the cartilage of the spheno-occipital
synchondrosis increases the anteroposterior dimension
of the skull base.
Growth of the cartilaginous nasal septum and
maxilla:

• Scott suggested that the primary cartilage

present in the nasal septum is the primary
mechanism responsible for the growth of the
nasomaxillary complex.

• Nasomaxillary complex grows as unit and the

cartilaginous nasal septum serves as a
pacemaker for maxillary growth.

• The cartilage leads to the downward and forward

translation of the maxilla.
Growth of the mandibular condylar
cartilage :

• The mandible is like the diaphysis of a long bone

bent into a horse- shoe shape with epiphysis
removed so that there is cartilage constituting
half an epiphyseal plate at the ends which are
represented by condyles.

• Scott asserted that the cartilage of the

mandibular condyles behaves similarly to cranial
base and nasal septal cartilages, and directly
determines the growth of the mandible as its
“pushes” the mandible downward and forward.
Thank you