THEORIES

OF
GROWTH

SUBMITTED TO:-
HEAD OF DEPARTMENT
OF PEDODONTICS
DR: RITU J INDAL
SUBMITTED BY :-
MANPREET SINGH
B.D.S FINAL PROF:
ROLL NO. 36


GROWTH THEORIES

Introduction

To explain the craniofacial growth certain theories have been
proposed independently but all of them depend on the following
terms :

Site location at which growth occurs

Center location at which independent (genetically controlled)
growth occurs

All centers of growth are also sites of growth but not all sites of
growth are centers of growth .

Craniofacial Growth Determination Theories

1. Bone Theory
Bone is the primary determinant of skeletal growth .
Periosteum is the locus of genetic control expression .

2. Cartilage Theory
Cartilage is the primary determinant of skeletal growth .
Bone is the secondary passive determinant of skeletal growth .
Cartilage is the locus of genetic control expression and bone responds
passively to growth of cartilage .

3. Soft Tissue Matrix Theory
Soft Tissue Matrix where skeletal elements is primary determinant of
growth .

Bone and Cartilage are secondary determinants of growth .

Now, combination of second and third theories is believed to be the true
theory .

DIFFERENT THEORIES ARE :

1. Brodies Theory / Genetic Theory/ Site vs. Center Growth Theory

2. Scote theory / Cartilaginous theory

3. Sicher theory / Sutural dominance theory /sutural theory of growth

4. Enlow & bangs V principle .

5. Moss theory / Functional matrix theory / Moss functional theory /
Functional matrix hypothesis .

6. Petrovics theory /Servo system theory


7. Van limborghs theory / multifactorial theory


8. Neurotrophism .

Brodies Theory / Genetic Theory / Site vs. Center Growth
Theory

COINED BY : BRODIE
COINED IN : before 1950

ACCORDING TO THIS THEORY :
Craniofacial development is due to growth centers under
strict genetic control.

1. Sutures are centers of growth and bones are sites of growth
respectively .
2. Bones are pushed apart and cause growth of cranium.
3. Genes are determinants of growth .
4. The inheritance that does take place is polygenic in nature .

Evidence
Growth of long bones.
Epiphyseal plates of long bones have the ability to grow under
conditions
of mechanical loading.
The predisposition of an individual to class three malocclusion .



Limitations

Sutures are growth sites.

Sutures are adaptive and compensatory growth mechanisms.

Sutures respond to mild tension forces by surface deposition of
bone thereby enabling bones of the face and skull to adapt.

Spheno-Occipital Synchondrosis has growth directing capacity.

Mandible Condyles are regarded as growth sites and not centers.

Condylar cartilage is secondary, fibrous-type cartilage and not
primary, growth-plate type cartilage .

Condylar cartilage is capable of intrinsic growth but cannot generate
tissue separating forces similar to epiphyseal plates


Conclusions

Sutures are growth sites and not centers.

Mandible Condyles are growth sites and not centers.

2.CARTILAGENOUS THEORY :

COINED BY : Scote

COINED IN : 1953

ACCORDING TO THIS THEORY :


1. Intrinsic growth controlling factors present only in cartilage & in
periosteum so both of these act as growth centers .

2. He claimed that growth in the sutures was secondary & entirely
dependent on the growth of the cartilage & adjacent soft tissues .

3. Scott explain the coordinated growth that has been observerd within the
skull, & b/w the skull & soft tissues .
e.g. In mandible :

1. The condylar cartilage of mandible is pacemaker for growth of the mandible & the
remodelling of the ramus & others surface .

2. Mandible growth has been explained that condyles act as the diaphysis of a long bone
with growth occurring at both the ends but recent studies have proven that the growth
at the condyle is mostly reactive & not of primary nature.


In maxilla :

1. The nasal septum cartilage serves as pacemaker for other aspects of maxillary growth so
maxillary growth can be explained due to the translation of nasomaxillary complex as a
unit.

2. It appear that epiphysial cartilage & the cranial base synchondrosis can & do act as
independent growth centers ,as can the nasal septum but not the condyle is an
important center .




3. Sichers Theory / Sutural Dominance Theory

COINED BY : SICHER

COINED IN : 1955


ACCORDING TO THIS THEORY :


All bone forming element or osteogenic tissue (cartilage , sutures &
periosteum ) are the growth centers. The sutural connective tissue
proliferates & creates space for bone apposition e.g., sutures are
primary growth centers for skull bones.


Bone growth is independent except for minor remodeling caused by
local environmental factors such as muscular forces.





LIMITATIONS :

1.Lack of growth in sutures transplantation .

2.Growth occur in cleft palate cases .

4. Guiding of bone growth is influenced by epigenetic factors.

5. Extirpation of facial sutures has no appreciable effect on the
dimensional growth of the facial skeleton.

6. Shape of the sutures is dependent on functional stimuli.

7. Closure of sutures is extrinsically determined.

8. Sutural growth can be halted by mechanical forces.

9. Cannot explain change in size of cranium in hydrocephaly and
microcephaly.


Conclusion

Sutures are growth sites and not growth centers.
4. ENLOW AND BANGS V
PRINCIPLE :

COINED BY :Enlow & bang

COINED IN : 1956


ACCORDING TO THIS THEORY :


Bone deposition occurs on the inner surface of V whereas resorption
occurs on the outer surface . This principle is used to described the
growth of facial , cranial & long bones .


5. MOSS FUNCTIONAL THEORY :

COINED BY : MELVIN MOSS

COINED IN : 1960 & Reintroduced by Moss and Salentiin 1962 .

ACCORDING TO THIS THEORY :

1. No direct genetic influences on the size , shape or position of skeletal
tissue (remodeling) & they are independent of each other .

2. It says all genetic & skeletogenic activity is depend upon embryonic
FUNCTIONAL MATRICS .

3. Bone respond to metrics in a passive manner & does not have any
primary growth potential.




FUNCTIONAL MATRIX :

DEFINITION :

soft tissue & space that completely perform a particular function guiding the
size, shape & position of the skeletal tissues which supports the matrix .

(or)

The totality of soft tissues associated with a single function is termed as
functional matrix .



FUNCTIONAL CRANIAL COMPONENT:

DEFINITION :

The tissues, organs,spaces & skeletal parts necessary to carry out a given function
were termed collectively a functional cranial component .






. 1. PERIOSTEL MATRIX :
consist of those tissue that influences the bone directly through the periosteum . It
affects the microskeletal unit i.e. only a part of one bone e.g. temporalis muscle
acting on coronoid process .

2. CAPSULAR MATRIX :
consist of masses & spaces that are surrounded by skeletal unit .e.g. brain mass
surrounded by calvarium , it affects the macroskeletal unit (calvarium ) i.e. saveral
bones are simultaneously affected .


- On the basis of relation to transformative & translative growth ,the soft
tissues of functional matrix is classified as :


SKELETAL UNIT :

the totality of all the skeletal element associated with a single function
is termed a skeletal unit .



Moss explain the observation as diverse as :

1. The diminution in size of the coronoid process subsequent to
experimental denervation of the temporalis muscle .

2. The excessive growth of the cranial vault in cases of hydrocephalus

3. The shrinkage of the alveolar process after the tooth removal .





Discussion

1. Soft tissues surrounding skeleton are primary centers of growth.

2. Bones and cartilages are secondary centers of growth and sites of
growth.

3. Increase in the size of brain causes separation of cranial bones at
sutures. This space is filled with new bone passively which causes an
increase in the size of cranium.

4. In Microcephaly i.e. small brain size, cranium size is reduced.

5. In Hydrocephaly i.e. increased CSF, brain size is reduced, cranium size is
increased.

6. Increase in size of eye causes increase in size of orbital cavity.

7. Increase in size of nasal cavity causes increase in size of maxilla.

8. Increase in size of oral cavity causes increase in size of mandible

Conclusions

Growth of craniofacial skeleton is partially a response to
functional needs of soft tissues.
6. SERVOSYSTEM THEORY :

COINED BY : Petrovic and Charlier & supported by Stutzmann .

COINED IN : 1970 .

ACCORDING TO THIS CONCEPT :


PRIMARY CARTILAGE ( epiphyseal cartilages of the long bones , cartilages of
the nasal septum and sphenooccipital synchondrosis , lateral cartilaginous
masses of ethmoid , cartilage b/w the body & the greater wings of sphenoid ,
etc.) takes a cybernetic form of command in which growth occur by
differentiation of chondroblast , can be modified with factors which affect the
direction only & not the amount of growth.


SECONDARY CARTILAGE ( condylar ,coronoid & angular cartilages of the
mandible , cartilages of the mid palatal suture , some other craniofacial sutures
, & the provisional callus during bone fracture repair , &rib growth cartilages )
has not only direct but also some indirect effect on the cell multiplication effect
.





1. It explain the mode of action of the functional appliances directed at the
condyle .


2. The upper arch acts as a mould into which the lower arch adjust itself , such
that optimal occlusion is established .


3. It also says that the growth of the maxilla occur from a combination of
growth at sutures & direct remodeling of the bone surface .


4. The maxilla translates downwards & forwards as the face grows .


5. The growth of the mandible occur by both endochondral ossifications at
the condyle & resorptions of bone at the surfaces .
7. VAN LIMBORGS THEORY :

COINED BY : Van limborg

COINED IN: 1972


ACCORDING TO THIS THEORY :


1. The embryologic origin of the component of the skull determine the kind of
growth that occur there .

2. The cartilaginous base ,nasal capsule & the otic capsule are sites of
endochondral ossification & are known as the chondrocranium .

3. All the bones arising from these cartilage precursor have for varying degree of
time the capability of interstitial expansion while they are growing.

4. Direct deposition of bone in the fibrous membrane i.e. intra membranous
ossification forms the desmocranium (calvarium , middle face & mandible ) .

FACTOR CONTROLLING SKELETAL MORPHPGENESIS ARE :

1. INTRINSIC GENETIC FACTORS
2. LOCAL EPIGENETIC FACTORS
3. GENERAL EPIGENIC FACTORS
4. LOCAL ENVIRONMENTAL FACTORS
5. GENERAL ENVIRONMENTAL FACTORS

This explain the interaction b/w the genetic & environmental factors . Environment
for the bone (muscle & soft tissues ) is in turn dependent on the growth &
function of the soft tissues .

The growth of muscle & soft tissues has a genetic component .

Even if there is genetic disposition it is polygenic , multifactorial in nature , thus
precluding any facial dimensions of children from the study of their parents .


8. NEUROTROPHISM (1976) :

It includes epithelial visceral & muscular component & this says that the
nerve impulse involving axoplasmic transport has direct growth potential
.


It also have an indirect effect on the osteogenic growth by influencing
soft tissues growth but the effect of these reported to be negligible .
REFERENCES :

BOOKS :

SHOBHA TANDON ( textbook of pedodontics 2
nd
edition )

GURKEERAT SINGH ( textbook of orthodontics 2
nd
edition )

S.G. DAMLE ( textbook of pediatric dentistry )

INTERNET SOURCES :

www. Growth theories ppt. com
www. Dental spaces . Com