GENERAL CONCEPTS OF

GROWTH &DEVELOPMENT
Presented By –Dr. ANURAG KUMAR
JRI
Department of Orthodontics
&Dentofacial Orthopedics
CONTENTS
 Introduction
 Definition of growth and development
 Concept of development
 Basic concept of growth
 Types of growth data
 Methods of collecting growth data
 Methods of studying growth
 Mechanism of bone formation
 Nature of skeletal growth
 Theories of growth
 Importance of growth and development to an orthodontist
 Conclusion
 References
INTRODUCTION
 Human beings keep changing. During their lives, they
change in size, appearance and psychological make up.
The way they change differs from individual to
individual. But the fundamental underlying patterns of
growth and development remain more or less the same
and take place in an orderly way.
DEFINITION OF GROWTH
o “Growth usually refers to an increase in size and
number” – Proffit
o “The Self multiplication of living substance”-
J.X.Huxley
o “Change in any morphological parameter which is
measurable”- Moss
o “Growth refers to increase in size”– Todd
o “Growth is physiochemical process by which an
organism becomes larger” – J.A.Salzman
o “Increase in size, change in proportion and progressive
complexity” – Krogman
o “Entire series of sequential anatomic and physiologic
changes taking place from the beginning of prenatal
life to senility”-Meridith
o “Quantitative aspect of biologic development per unit
of time” - Moyers
DEFINITION OF DEVELOPMENT
o “Development connotes a maturational process
involving progressive differentiation at the
cellular and tissue levels” – Enlow

o“Development refers to all naturally occurring,

progressive, unidirectional, sequential changes
in life of an individual from its elaboration as a
multifunctional unit terminating to death” –
Moyers
“Development is a progress towards maturity” –
Todd
“Development is the sequence of changes from
fertilization to maturity” – J.A.Salzman
“Development is in complexity” - Proffit
 Moss states that"Development can be
considered as a continuum of causally related
events from the fertilization of ovum
onwards". Development includes all the
changes in life
CONCEPT OF DEVELOPMENT
 Development = Growth + Differentiation
+Translocation + Maturation
 Differentiation means change in quality. It

is the change from generalized cells or tissues

to more specialized kinds during development.
 Translocation means change in position.for
example translocation of chin point downward
and forward is far more than any growth at
chin itself.
 Maturation - “It is the emergence of
personal characteristics and behavioral
phenomenon through growth processes.” It is
used to express the qualitative changes which
occur with aging.
Correlation between growth and
development
GROWTH DEVELOPMENT

• Anatomic • Physiological
phenomenon phenomenon
• Quantitative in • behavioral in nature
nature
 Factors Affecting Growth
 Heredity-genetic have influence on the size of parts, rate of
growth and onset of growth.

 Sex- sex is very important factor which influence growth and

development. There is lot of difference in growth between girls
and boys.

 Nutrition- growth is directly related with nutrition. The human

body requires an adequate supply of nutrition for its normal
growth.

 Illness- prolonged and debilitating illness however can have a

marked effect on all aspects of growth.

 Race- in American blacks, calcification and eruption of teeth

occurs almost a years earlier than their white counterparts.
 Socio-economic status-children brought up in
affluent and favorable socio-economic conditions
show earlier onset of growth events.

 Secular Trends- changes in size and maturation in

a large population can be shown to occur with
time. For example, fifteen year old boys are
approximately 5inches taller than the same age
group 50 years back.

 Hormones- Hormones are considered to be a

growth supporting substance. These hormones are
capable of raising or lowering the activity level of
the body or some organs of the body.
BASIC CONCEPTS OF GROWTH
 Pattern
- Cephalocaudal gradient of growth
- Differential Growth

 Variability

 Timing
PATTERN
 Pattern in growth represents proportionality. Usually a
complex set of proportions rather than just a single
proportional relationship. It refers not just to a set of
proportional relationships at a point in time, but to the
change in these proportional relationships over time.
 In other words, the physical arrangement of the body at

any one time is a pattern of spatially proportioned parts

CEPHALOCAUDAL GRADIENT OF GROWTH
 There is an axis of increased growth extending from the head towards the
feet
o Changes in proportion of head and face, at birth the
face and jaws are relatively underdeveloped compared
with their extent in adult life.
o As a result there is much more growth of facial than
cranial structures postnatally.
DIFFERENTIAL GROWTH
 Different organs grow at different rates, to different
amount and at different times.

 Scammon’s curve of growth- Richard Scammon has

given classical curves to explain the growth pattern by
cross-sectional studies.
SCAMMON’S CURVES OF
GROWTH
 Lymphoid
 Neural
 General

(muscle, bone
and viscera)
 Genital
VARIABILITY
 A second important concept in the study of growth is
variability. According to MOYERS variability is the
law of nature.
 No two individuals grow in the same manner

 Variation can be attributed to both genetic and

environmental factors
 It can be difficulty but clinically very important to
decide whether an individual is merely at the extreme
of the normal variation or falls outside the normal
range
 CONCEPT OF NORMALITY
 Normality refers to that which is usually expected, is
ordinarily seen or typical. – Moyers.
 Normality may not necessarily be ideal.
 This can be done by using “growth charts.”
 While ideal denotes the central tendency for the group,

normal refers to a range. Normality must not be equated with

ideal or desired nor it is appropriate as a goal of treatment of
an individual.
It is more appropriate to put forth VARIABILITY as
deviation from usual pattern and express it in a quantitative
manner and this can be done with the help of GROWTH
CHARTS
APPLICATION OF GROWTH
CHARTS
 Location of an individual relative to the group can be
established.

 Can be used to follow a child over time and note for

any unexpected change in growth pattern.
TIMING
 Timing variations arises because the biologic
clocks of different individuals are set differently.

 One of the factors for variability in growth.

 Itis influenced by: genetics, sex related

differences, physique related, environmental
influences.
GROWTH SPURTS
 Woodside in 1969 coined the word growth spurts.

 Defined as periods of sudden growth acceleration.

 Physiologicalalteration in hormonal secretion is

believed to be the cause of such accelerated growth.

 Thegrowth spurts occur earlier in girls compared to

boys.
 The following are the timings of growth spurt

a) Just before birth

b) 1 year after birth

c) Mixed dentition growth spurt(BOYS 8-

11years),GIRLS-(7-9 years)

d) Pre- pubertal growth spurt BOYS 14-16 years

of age, GIRLS – 11-13 years of age.
Timing of puberty
 There is a great deal of individual variation,
but puberty and the adolescent growth spurt
occur on the average nearly two years earlier
in girls than in boys.

 Why this occurs is not known, but the timing of

puberty is a highly heritable trait. When it occurs
has an important impact on the timing of
orthodontic treatment, which must be done earlier
in girls than in boys to take advantage of the
adolescent growth spurt.
 Adolescence in girls can be divided into three
stages, based on the extent of sexual
development . In boys, four stages in development
can be correlated with the curve of general body
growth at adolescence.
METHODS OF COLLECTING
GROWTH DATA
 Longitudinal studies

 Cross sectional studies

 Semi-longitudinal studies
LONGITUDINAL STUDIES
The observation and measurements pertaining to growth are made on
a person or a group of persons at regular intervals over a prolonged
period of time.
It highlights individual variations, particularly variations caused by
timing effects.

Advantages
 Variability in development.
 Serial comparison .

Disadvantages
 Time consuming.
 Expensive.
 Sample loss.
CROSS SECTIONAL STUDIES

Measurement of different individuals or different

samples and studied at different periods.
ADVANTAGES
 Quicker .
 Less costly.
 Statistical treatment of data made easier.
 Repeated studies are possible easily.

DISADVANTAGES
 Variation among individuals cannot be studied.
METHODS FOR STUDYING
GROWTH
According to Proffit, there are two basic approaches to studying
physical growth.

Measurement Approaches
 Craniometry

 Anthropometry

 Cephalometric Radiology

 Three - Dimensional Imaging

Experimental Approaches
 Vital Staining

 Radioisotopes

 Implant Radiography
MEASUREMENT APPROACHES
 Craniometry
 Anthropometry
 Cephalometric Radiology
 Three dimensional Imaging(CT,CBCT)
CRANIOMETRY
Advantages
 Precise measurements can be made.
 Gives information of extinct populations.
 Tells us about their growth pattern.

Disadvantages
 All growth data must be cross sectional.
 The same individual can be measured at only one point

in time.
 ANTHROPOMETRY
Anthropo means human
Metry means measurement.

Measurement of skeletal dimensions on living individuals.

Advantage
 Produces longitudinal data.

Disadvantage
 Variation in soft tissue thickness gives different results.
CEPHALOMETRIC RADIOGRAPHY
 “Cephalic” pertains to head and “Metry” means
measurement.
 Serial Radiography is possible.

Advantages
 Direct measurement of bony skeletal dimensions.
 Allows follow up of the same individual over time.

Disadvantages
 Precise orientation of head, precise control of magnification.
THREE DIMENSIONAL IMAGING
 New information now is being obtained with the application
of 3-D imaging techniques. Computed axial tomography (CAT
or, more commonly, computed tomography [CT]) allows 3-D
reconstructions of the cranium and face
 Recently, cone beam computed tomography (CBCT) rather
than axial CT has been applied to scans of the head and face.
This significantly reduces both the radiation dose and the cost.
 CBCT allows scans of patients with radiation exposure that is
much closer to the dose from cephalograms. Superimposition
of 3-D images is much more difficult than the
superimpositions used with 2-D cephalometric radiographs,
but methods have been developed to address this
Computed tomography (CT) scans are the best way to determine the details of skeletal
deformities. These views of a 9-year-old girl (A) with severe hemifacial microsomia
(and previous surgical treatment to build up the affected side of the mandible) illustrate
that CT scans can show both skin contours and bony relationships from any aspect.
Color can be added to different structures to make it easier to visualize them (B), and
surface layers can be made transparent (as in [C] to [F]) to reveal the skeletal structures
beneath. Views of this type greatly facilitate surgical treatment planning. (Courtesy Dr.
L. Cevidanes.)
VITAL STAINING
 Dyes that stain mineralizing tissues (or occasionally,
soft tissues) are injected into an animal. These dyes
remain in the bones and teeth and can be detected
later after death. This method was originated by the
great English anatomist John Hunter in the 18th
century. Hunter observed that the bones of pigs that
occasionally were fed textile waste were often stained
in an interesting way. He discovered that the active
agent was a dye called alizarin, which still is used for
vital staining studies.
Other dyes used are:
 Acid Alizarin Blue
 Trypon Blue
 Procion
 Lead Acetate
 Tetracycline
Vital staining aids in studying:
 Site of bone growth, the direction and amount of growth.
 The timing and relative duration of growth at different

sites.

Advantages
 After one injection of the dye, several red lines may be

found in several areas of active calcification bone.

Disadvantages
 Vital staining will give incomplete data on the pattern of

bone formation.
RADIOISOTOPES
 Radioisotopes of certain elements or compounds are
often used as in vivo markers. These radioisotopes
can later be detected by tracking down the
radioactivity they emit.

◦ Technetium 99
◦ Calcium 45
◦ Potassium 32
IMPLANT RADIOGRAPHY
 Developed by Arne Bjork and co-workers in 1969 at
Royal Dental College, Denmark
 Method of implanting tiny bits of tantalum or

biologically inert alloys into growing bone. These serve

as radiographic reference points for serial radiographic
analysis.
 They are around 1.5mm in length and 0.5in diameter.
NATURE OF SKELETAL
GROWTH
At the cellular level, there are only three possibilities for
growth.

 Hypertrophy :- increase in the size of cells.

 Hyperplasia :- increase in the number of cells.

 Extracellular material :- secreted by cells.

Interstitial Growth and Appositional
Growth
 Growth of soft tissues occurs by a combination of
Hyperplasia and Hypertrophy , and processes go
on everywhere within the tissue , and the result is
Interstitial growth(it occurs at all points within the
tissue). It is characteristics of nearly all soft
tissues and of uncalcified cartilage within the
skeletal system
 Direct addition of new bone to the surface of

existing bone and does occur through the activity

of periosteum is Direct or Appositional growth. It
increases the diameter of bone.
MECHANISMS OF BONE
FORMATION
◦ Endochondral Bone formation
◦ Intramembranous Bone formation

 Mechanism of bone growth

◦ Remodeling
◦ Drift
◦ Displacement

 Other terminologies related to growth

◦ Growth fields
◦ Growth sites
◦ Growth centers
Endochondral bone formation
 Bone formation is preceded by formation of a
cartilaginous model which is subsequently
replaced by bone.
INTRAMEMBRANOUS BONE FORMATION
Here bone formation is not preceded by formation of a
cartilaginous model. Instead bone is laid down directly in a
fibrous membrane. This type of bone formation occurs in
the cranial vault and both the jaws.

Development of the mandible begins as a condensation of

mesenchyme just lateral to Meckel’s cartilage and proceed
entirely by Intramembranous ossification.
DEPOSITION AND RESORPTION
 About one-half the total amount of cortical bone is
periosteal in origin and the other half is endosteal. If
endosteal surface is resorptive then periosteal surface
would be depository.
The surface that faces toward the direction of movement
is depository (+). The opposite surface, facing away
from the growth direction, is resorptive (-).
GROWTH FIELDS
 The outside and inside surfaces of a bone are blanketed
by a mosaic pattern of soft tissues, osteogenic
membranes or cartilages called as growth fields.

 These when altered are capable of producing an

alteration in the growth of the particular bone.
GROWTH SITES
It is merely a location at which growth occurs. E.g.
mandibular condyle, maxillary tuberosity, sutures and the
alveolar process.

 Growth does not occur just at such special growth

sites, the entire bone participates.
GROWTH CENTERS
 Location at which independent (genetically controlled)
growth occurs.
 Site of endochondral ossification with tissue-separating

force, contributing to the increase of skeletal mass.

 E.g. epiphyseal plates of long bones, nasal septal

cartilage.
 Force, energy or motor for a bone resides primarily

within its growth center.

 All growth centers are sites but reverse is not true..
REMODELING
 It is the differential growth activity involving
simultaneous deposition and resorption on all the inner
and outer surfaces of the bone.
 It is required for bone shaping .
 It maintains the form of a whole bone while providing

for its enlargement at the same time.

 The progressive, sequential movement of component

parts as a bone enlarges is termed relocation.

Remodeling in bone tissues are of four types
 Biochemical remodeling:- continuous deposition and

removal of ions to maintain mineral homeostasis.

 Haversian remodeling:-the secondary process of

cortical reconstruction as primary vascular bone is

replaced.
 Pathologic remodeling:-the regeneration and

reconstruction of bone during and following pathology

or trauma.
 Growth remodeling:- the constant replacement of bone

during childhood.
 Theramus moves
posteriorly by the
combination of
deposition and
resorption.

 So the anterior part of the

ramus gets remodeled
into a new shape and
position.
FUNCTIONS OF REMODELING
 Progressively change the size of whole bone.
 Sequentially relocate each component of the whole bone.
 Progressively change the shape of the bone to accommodate
its various functions.
 Progressive fitting of all the separate bones to each other and
to their contiguous, growing, functioning soft tissues.
 DRIFT
 It is remodeling process
and a combination of
deposition and
resorption.
 The implant becomes

relocated from one side

of the cortex to the
other, not because of its
own movement, but
because of the drift
of the bone around it.
DISPLACEMENT
 It is a physical movement of a whole bone and occurs
while the bone simultaneously remodels by resorption
and deposition. It can be of two types:

 Primary Displacement

 Secondary Displacement
Primary Secondary
displacement displacement
Enlow’s V principle of growth

Enlow noted that many craniofacial bones, or

their parts, have a V-shaped configuration
(funnel-shaped in three dimensions). He pointed
out that these bones grew by the addition of
bone on the inside of the V with removal of bone
from the outside. This concept of bone growth is
called the V principle of Enlow.
According to this principle, bone deposition
occurs on the inner side of the V while
resorption takes place on the outside surface,
which leads to widening of the V configuration;
at the same time, the structure translates from
its original position and moves towards the
wide end of the V.
 THEORIES OF GROWTH
 Remodeling theory-J.C.Brash(1930)
 Genetic Theory- Brodie(1941)
 Cartilaginous Theory- James Scott (1953)
 Sutural Dominance Theory- Sicher(1955)
 Functional Matrix Theory- Melvin Moss (1962)
 Van Limborgh’s Composite Theory- Van

Limborgh(1970)
 Neurotrophism -Moss(1971)
 Servosystem Theory- Petrovic (1982)
 Functional Matrix Theory Revisited-Melvin

Moss(1977)
 REMODELLING THEORY(1930)
 Put forwarded by J.C.Brash in1930.
 The three fundamental tenets of this theory are-

-Bone grows only by surface remodelling.

-Growth of jaw takes place by deposition of bone at the posterior

surfaces of the maxilla and mandible. This is 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.
 Schematic representation of the remodelling theory
of craniofacial growth using the cranial vault as a model.
Increase in the size of the cranial vault occurs by adding bone via
periosteal deposition on the outer, ectocranial surface and resorption of
bone on the inner, endocranial surface of the vault. The growth of the
jaws takes place principally via deposition of bone on the posterior
surface of the maxillary complex and mandibular ramus. Sutures and
cartilages play no role in the growth of the craniofacial complex.
Reproduced with permission from Carlson
THE GENETIC THEORY(1941)
 Earliest theory put forwarded by Brodie in 1941.
 It states that all growth is controlled by genetic

influence and is pre planned.

 Genes are primary controls for initiation and formation

of facial structures.
 Intrinsic genetic information necessary for the

differentiation of cranial cartilages and bones is

supplied by neural crest cells.
CARTILAGINOUS THEORY(1953)
 James H Scott assumed that intrinsic growth
controlling factors are present in the cartilage and in
the periosteum.
 Sutures are secondary and dependent on extrasutural

influence.
 Cartilaginous part of skull must be recognized as

primary centers of growth.

 It suggests that genetic control is expressed in the

cartilage, while bone responds passively to being

displaced.
 Transplantation experiments demonstrate that not all
skeletal cartilage act the same when transplanted.

 Transplantation of the nasal septal cartilage and

epiphyseal cartilage of long bones shows significant
growth. This indicates the innate growth potential of
the cartilage.

Shortcomings of Scott’s Theory

 Transplantation experiments have revealed that
condyle has no innate growth potential. It is a growth
site and not a growth center.
SUTURAL DOMINANCE
THEORY(1955)
 Introduced by Sicher in 1955 .
 Primary event in sutural growth is the connective tissue
proliferation between the two bones.
 The connective tissue in sutures of both the nasomaxillary
complex and vault produce forces which separated the bones.
 The theory held sutures, cartilage and periosteum, all
responsible for facial growth and assumed all were under
tight intrinsic genetic control.
 Compressive forces applied across sutures reduce bone
deposition and induce bone resorption. Tensional forces
increase bone deposition.
Increase in the size of the cranial vault takes place via primary growth of bone at the sutures, which forces
the bones of the vault away from each other. The growth of the midface takes place via intrinsically
determined sutural expansion of the circummaxillary suture system, which forces the midface to descend
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. Reproduced with
permission from Carlson
Shortcomings of Sutural Theory :
 Sutures & periosteal tissues lack innate growth
potential, proved by transplanting a suture.
 Growth at sutures respond to outside influences, as
compression and tension.
 Sutures are thus areas that react- not primary
determinants.
 Thus sutures are growth sites, not growth centers.

 Microcephaly and hydrocephaly raised doubts about

the intrinsic genetic stimulus of sutures.
FUNCTIONAL MATRIX HYPOTHESIS

 Dr.Melvin Moss,
Originator of the
functional matrix
hypothesis.
FUNCTIONAL MATRIX
THEORY(1962)
 It was put forward by Melvin L. Moss 1962.

 Melvin L. Moss stressed that osseous growth of skull is entirely

secondary. (Based on functional cranial component theory of
Van Der Klaauw-1952).

 It claims that the origin, form, position, growth and maintenance

of all skeletal tissues and organs are always secondary,
compensatory and obligatory responses to temporarily and
operationally prior events or processes that occur specifically
related non skeletal tissues, organs or functioning spaces.
 It claims or attempts to comprehend the relationship
between form and function.

 Moss claimed that the growth of skeletal components,

is largely dependent on the growth of functional
matrices.

 Every function is completely carried out by a

functional cranial component
 FUNCTIONAL CRANIAL COMPONENT

Functional Matrices Skeletal unit

Periosteal Capsular Micro Macro

Examples presented by Moss has evidence to support
the functional matrix theory.

◦ The diminution in size of the coronoid process subsequent

to experimental denervation of the temporalis muscle.

◦ There is shrinkage of alveolar process subsequent to tooth

removal.

 Drawback OF FMH- No clarification on as to how

functional needs are transmitted to tissues
VAN LIMBORGH’S
THEORY(1970)
 It was put forwarded by Van Limborgh in 1970.

 It is a theory that unifies all the factors contributing to

growth, namely the genetic, the epigenetic and the
environmental factors.
Van Limborgh's had these views that controls growth:
1. Intrinsic control of growth at synchondrosis.
2. Intrinsic control of sutural growth is less.
3. Synchondrosis is a growth centre.
4. Sutural growth controlled in part by growth of cranial
base.
5. Periosteal bone growth (vault) controlled
epigenetically by adjacent structures.
6. Growth of cranial vault also controlled by local
environmental factors (muscle forces inclusive).
 NEUROTROPHISM THEORY(1971)
 Introduced by Moss in 1971.

 It is a non impulsive transmittive neurofunction involving

axoplasmic transport providing for the long term
interaction between neurons and innervated tissue which
homeostatically regulate the morphological,
compositional and functional integrity of those tissues.
 Moss classifies neurotrophism into three types –

- Neuromuscular
- Neuroepithelial
- Neurovisceral
Neuroepithelial Trophism
 epithelial mitosis and synthesis are
neurotrophically controlled.

For example, presence of taste buds is dependent

upon an intact innervation. The nerves are not
only important for the sensation of taste but they
also have a neutrophilic effect in sustaining
healthy growth of the taste buds and nearby
epithelial tissues. If they are de-innervated, they
become atrophic and so also the nearby epithelial
cells
Neuromuscular Trophism
 Moss states that genetic control cannot reside
solely in the functional matrices alone and
there is neurotropically regulated homeostatic
control of the genome.
 Moss also believes that similar neurotrophic

mechanism exists for capsular matrix which

passively regulate the functional cranial
component.
 Neurovisceral Trophism

 In the orofacial region ,salivary gland is partially

tropically regulated. Increase or decrease of mature
salivary gland, under neurotrophic influence have
been experimentally demonstrated.
 Shortcoming of Neurotrophism
theory
 Moss was not able to clearly explain the process
by which the functional stimuli could get converted
into signal and affect changes in bone.
 Servosystem theory(1970)
 Alexandre Petrovic proposed a cybernetic model known as
the servosystem theory.
 Cybernetics was originally defined as the science of

automatic control and communication in both animals and

machines. It indicated that control depended on a flow of
information and that the laws governing control were
universal
 It is concerned not so much with what systems consist
of, but how they function.
 Cybernetics focuses on how systems use information,

models, and control actions to steer towards and

maintain their goals, while counteracting various
disturbances.
 According to this theory control of primary cartilages

takes a cybernetic form of a "command" whereas, in

contrast, control of secondary cartilage is comprised
not only of a direct effect on cell multiplication but also
of indirect effects.
Primary Cartilage
 Primary cartilage develops from the primary

embryonic structures.
 They have intrinsic growth potential.
 They contains chondroblasts that divide and secrete

cartilaginous matrix.
 The cartilaginous matrix surrounds the chondroblasts.
 They are pressure tolerant, noncalcified, flexible,

nonvascular and does not require a nutrient

membrane covering for survival.
E.g. epiphyseal cartilage of long bones, nasal septal
cartilage etc.
According to the servosystem concept
 influence of the STH-somatomedin hormone on

growth of primary cartilage follow cybernetic form of

a‘command’ not influenced by local feedback loops.
 In this case the effect of local biomechanics factors is

reduced to modulation of the direction of growth with

no effect on amount of growth.
Secondary Cartilage
 Secondary cartilages does not develop from the

primary embryonic structures.

 Does not have intrinsic growth potential.
 They contains prechondroblasts that do not divide

but secrete cartilaginous matrix.

 The prechondroblasts are not surrounded by

cartilaginous matrix.
 They are local mesenchymal cartilage formations,

primarily associated with membrane bones.

 E.g. Condylar, coronoid and angular cartilages of the

mandible, etc.
Servosystem theory of craniofacial growth, with
emphasis on the growth of the mandible.
Functional matrix revisited(1977)
◦ Genetic and epigenetic
◦ Functional matrix revisited I – The role of
mechanotransduction
◦ Functional matrix revisited II – The role of an osseous
connected cellular network (CCN)
◦ Functional matrix revisited III – The genomic thesis
◦ Functional matrix revisited IV – The epigenetic
antithesis and the resolving synthesis
◦ Resolving synthesis between genetic and epigenetic
factors.
IMPORTANCE OF GROWTH AND
DEVELOPMENT TO AN ORTHODONTIST
 As an orthodontists we should have the concepts of
when, where, why and how the facial growth occurs. It
is necessary to have an understanding of both the
pattern of normal growth and the mechanism that
underlie it and deviation from normal pattern.

 Understanding of how and where the growth occurs,

direction of growth and how much growth potential is
remaining and when growth will express itself.
 How the above factors can be modified by the operator
for the benefit of the patient and to achieve the optimal
results in the potential of each individual person.
CONCLUSION
 No single theory is comprehensive. All theories have
their positive & negative aspects. There is no conflict
among theories. Conflicts are among individuals. A
composite theory can better address the phenomenon of
craniofacial ontogenesis. Cranial growth is a
combination of both spatial translation and
transformation. As new concepts, hypothesis & theories
emerges, it may change the picture of craniofacial
development. As new concepts, hypothesis & theories
emerges, it may change the picture of craniofacial
development.
 Since much of our knowledge is still on the level of the
working hypothesis, our synthesis of concepts is really
a current “ state of affairs” report and undoubtedly will
be altered with ongoing research in the field.
REFERENCES
1. T.M.Graber: Orthodontics Principles And Practice 3 rd edition,
1988; 38-48
2. Proffit: Contemporary Orthodontics 4th edition, 2007 ; 27-41,
47-56
3. Moyers: Handbook of Orthodontics 4 th edition, 1988; 6-17,
44-53

4. Krogman: Principles of Human Growth, 22-30

5. Enlow, Hans: Essentials of Facial Growth 1st edition 1996; 18-
38
6. Meng H ,R Nanda: Growth changes in the nasal profile from 7-
8 yrs AJO 1988:94; 4; 317-326
7. S Bishara: Longitudinal changes in 3 normal facial types:
AJO1985:88; 6; 466-502
8. Melvin L. Moss: The functional matrix hypothesis revisited. 1. The role
of mechanotransduction; AJO-DO 1997: 112; 1; 8-11
THANK YOU