THEORIES OF

GROWTH
Department of Orthodontics
LEARNING OBJECTIVES

• To understand the different mechanisms of bone growth

• To understand the concept of different theories of bone growth
• To understand the contributions of different theories in the growth of
craniofacial region.
CONTENTS

• The Genetic "Theory”

• Sicher's Hypothesis (Sutural Dominance )
• Cartilaginous theory/Scott's Hypothesis (Nasal Septum)
• Moss' Hypothesis (Functional Matrix)
• Von Limborgh’s epigenetic Theory
 The Genetic "Theory"
The genetic theory simply said that genes determine all.

Mendel (1822-1884)- specific traits were passed between generations in a

particulate, discrete manner from both parents according to a set of mathematical
principals.

Carlson, David S. "Theories of craniofacial growth in the postgenomic era." Seminars in

Orthodontics. Vol. 11. No. 4. WB Saunders, 2005.
Handbook of Orthodontics by Robert E Moyers , 4th edition,1988
The field of genetics was characterized by two principal foci.

• Transmission genetics was based in the Mendelian Laws of Inheritance and was
characterized by a statistical approach that required no understanding of the nature
of genes or their expression. As a result, transmission genetics was of little help or
consequence for the study of development and growth.

• The second focus concerned the nature of the gene itself and the mechanisms of
gene action during development.

Carlson, David S. "Theories of craniofacial growth in the postgenomic era." Seminars in

Orthodontics. Vol. 11. No. 4. WB Saunders, 2005.
• Although called a theory it was more assumed than proven.

• The general assumptions were found to be flawed and hence there was
uneasiness with the all embracing aspects of the ‘theory.’

Handbook of Orthodontics by Robert E Moyers , 4th edition,1988

Sicher's Hypothesis (Sutural Dominance Theory)

• The sutural theory was largely the work of two anatomists, Joseph Weinmann
and Harry Sicher

• Primary event in sutural growth is the proliferation of the connective tissue

between the two bones.

Handbook of Orthodontics by Robert E Moyers , 4th edition,1988

• Replacement of the proliferating connective tissue was necessary for functional
maintenance of the bones.

• Sicher held sutures, cartilage, and periosteum all responsible for facial growth
and assumed all were under tight intrinsic genetic control.

Handbook of Orthodontics by Robert E Moyers , 4th edition,1988

Carlson, David S. "Theories of craniofacial growth in the postgenomic era." Seminars in
Orthodontics. Vol. 11. No. 4. WB Saunders, 2005.
A Textbook of Orthodontics ,T. D. FOSTER 3rd edition
• The sutural theory accounted for two major factors that were difficult to resolve
within the remodeling theory.

[Link] was consistent with the established fact that periosteal remodeling of bone is
under strong local influences by the functional environment, and thus is unlikely
to be under strong intrinsic, hereditary control.

[Link] sutural theory was consistent with the contemporary understanding of the
importance of cartilaginous structures and skeletal joints in the development and
postnatal growth of bones.

Handbook of Orthodontics by Robert E Moyers , 4th edition,1988

• The sutural theory also reinforced the concept that growth of the face and jaws
was essentially immutable.

• Sutures as well as the cartilages of the craniofacial skeleton were the locations
of centers of bone growth at which the inherited, immutable pattern of
craniofacial form and facial type, however determined, was expressed.

Handbook of Orthodontics by Robert E Moyers , 4th edition,1988

• According to this theory , growth at the sutures should occur largely
independent of the environment , and it would not be possible to change the
expression of growth at the sutures very much.

• However , it is clear that sutures are not primary determinants of craniofacial

growth

Contemporary Orthodontics, 4th Edition, William R. Proffit

• Two lines of evidence lead to this conclusion are

[Link] an area of the suture between two facial bones is transplanted to another
location the tissue does not continue to grow. This indicates a lack of innate
growth potential in the sutures.

[Link] can be seen that growth at sutures will respond to outside influences under a
number of circumstances

Contemporary Orthodontics, 4th Edition, William R. Proffit

Cartilaginous theory/Scott's Hypothesis
(Nasal Septum)

• According to Scott, cartilage continued to dominate the craniofacial growth

postnatally

• Within this theory, great emphasis was placed upon the role of cartilage in
producing the driving force of craniofacial growth

A Textbook of Orthodontics ,T. D. FOSTER 3rd edition

 Growth of mandible

• Imagining the mandible as the diaphysis of a long bone , bent into a horseshoe
with the epiphyses removed

• This made the cartilage a growth center and epiphyseal growth cartilage.

Contemporary Orthodontics, 4th Edition, William R. Proffit

 Growth of maxilla

• There is no cartilage in the maxilla itself, there is cartilage in the nasal septum,
and the nasomaxillary complex grows as a unit.

• Cartilage theory hypothesize that the cartilaginous nasal septum serves as a

pacemaker

• The cartilage is located so that its growth could easily lead to a downward and
forward translation of the maxilla.

Contemporary Orthodontics, 4th Edition, William R. Proffit

Contemporary Orthodontics, 4th Edition, William R. Proffit
Transplantation Result

Epiphyseal plate It will continue to grow in a new location or in

culture , indicating that these cartilages do
have innate growth potential

Spheno-occipital Also grows when transplanted but not as well

synchondrosis

Nasal septum Gave equivocal results : sometimes it grew,

sometimes it did not

Mandibular condyle Little or no growth was observe

Contemporary Orthodontics, 4th Edition, William R. Proffit

 Conclusion

Nasal septum may be important for the anteroposterior growth of the face

But it is not considered as an active contributor for vertical development of the

face

Contemporary Orthodontics, 4th Edition, William R. Proffit

Moss' Hypothesis (Functional Matrix)
• According to Moss, bone and cartilage lack growth determination and grow in
response to intrinsic growth of associated tissues termed as "functional
matrices.”

• Moss argues, the skeletal tissues grow only in response to soft-tissue growth and
the effect is a passive translation of skeletal components in space.

Carlson, David S. "Theories of craniofacial

growth in the postgenomic era." Seminars in
Orthodontics. Vol. 11. No. 4. WB Saunders,
• The functional matrix hypothesis explicitly claims that the origin, growth, and
maintenance of all skeletal tissue and organs are always secondary,
compensatory, and obligatory responses to temporally and operationally prior
events or processes that occur in specifically related nonskeletal tissues, organs,
or functioning spaces (functional ma- trices).

Moss, Melvin L. "Genetics, epigenetics, and

causation." American journal of orthodontics
80.4 (1981): 366-375.
The functional cranial component is composed of two parts:

functional • which actually carries out the

function
matrix

skeletal • whose biomechanical role it is to

protect, and/or support its specific
unit functional matrix.

Moss, Melvin L., and Letty Salentijn. "The primary

role of functional matrices in facial growth."
American journal of orthodontics 55.6 (1969): 566-
 Skeletal units
• May be composed of bone, cartilage, or tendinous tissues.

• The skeletal units can be

Micro skeletal units

Macro skeletal units

Moss, Melvin L., and Letty Salentijn.

"The primary role of functional matrices
in facial growth." American journal of
orthodontics 55.6 (1969): 566-577.
• Microskeletal untis

When a bone consists of a number of skeletal units, we call them micro skeletal
units.

• Macroskeletal units
When adjoining portions of a number of neighboring bones are united to function
as a single cranial component, we term this as a macro-skeletal unit.

Moss, Melvin L., and Letty Salentijn. "The primary role of

functional matrices in facial growth." American journal of
orthodontics 55.6 (1969): 566-577.
 Functional matrix

• The functional matrix includes muscles, glands, nerves, vessels, fat, teeth , etc.

• When this functional matrix grows or is moved, the related skeletal unit (the
alveolar bone) responds appropriately to this morphogenetically primary
demand.

Moss, Melvin L., and Letty Salentijn. "The primary role of

functional matrices in facial growth." American journal of
orthodontics 55.6 (1969): 566-577.
Types of Functional matrices

Periosteal matrix

Capsular matrix

Moss, Melvin L., and Letty Salentijn. "The primary role

of functional matrices in facial growth." American
journal of orthodontics 55.6 (1969): 566-577.
 Periosteal matrices

• The best example of periosteal matrix is the effect of the temporalis muscle on
the coronoid process

• The coronoid process does not grow first to provide a “platform” upon which the
temporalis muscle can then alter its functions.

Moss, Melvin L., and Letty Salentijn. "The primary role

of functional matrices in facial growth." American
journal of orthodontics 55.6 (1969): 566-577.
• Experimental removal of the mammalian temporalis muscle, or its denervation,
experimentally, postinfectively, or posttraumatically, invariably results in an
actual diminution of coronoid process size and shape or, indeed, in its total
disappearance

• Similarly, it is well established that functional hypertrophy or hyperactivity of the

temporalis muscle is productive of increased coronoid process size and also
alteration of its shape.

Moss, Melvin L., and Letty Salentijn.

"The primary role of functional matrices
in facial growth." American journal of
orthodontics 55.6 (1969): 566-577.
Moss, Melvin L., and Letty Salentijn. "The primary
role of functional matrices in facial growth."
American journal of orthodontics 55.6 (1969): 566-
• The total growth changes in all aspects of coronoid process form (size and shape)
are at all times a direct and compensatory response to the morphogenetically
and temporally prior demands of the temporalis muscle function.

• Muscles are excellent examples of periosteal functional matrices, they do not

comprise this entire category. Blood vessels, nerves, and glands produce
morphologic changes in their related skeletal units in a completely homologous
manner

Moss, Melvin L., and Letty Salentijn.

"The primary role of functional
matrices in facial growth." American
journal of orthodontics 55.6 (1969):
566-577.
 CAPSULAR MATRIX
• All the periosteal matrices and their skeletal units are organized in the form of
cranial capsules.

• the neural mass which consists

Neurocranial of the brain , leptomeninges
and cerebrospinal fluid

• the oronasopharyngeal
Orofacial functioning spaces
Color Atlas of Dental Medicine ,
Orthodontic diagnosis ; Thomas Rakosi ,
Irmtrud jonas , Thomas M. Graber
 Neurocranial capsule
• The composition of this capsule are the five layers of the scalp, the bone itself,
and the two-layer dura mater.

• The total neural mass volume which is morphogenetically significant,.

• The expansion of this capsular matrix volume is the primary event in the
expansion of the neurocranial capsule.

Moss, Melvin L., and Letty Salentijn. "The primary role

of functional matrices in facial growth." American
journal of orthodontics 55.6 (1969): 566-577.
• All of the included and enclosed functional cranial components( the periosteal
matrices and their microskeletal units) are passively and secondarily translated in
space.

Moss, Melvin L., and Letty Salentijn. "The primary role of

functional matrices in facial growth." American journal of
orthodontics 55.6 (1969): 566-577.
Orofacial matrices

• All functional cranial components of the facial skull arise, grow, and are
maintained within an orofacial (splanchnocranial) capsule

• This capsule surrounds and protects the oronasopharyngeal functioning spaces.

• It is the volumetric growth of these spaces which is the primary morphogenetic

event in facial skull growth.

Moss, Melvin L., and Letty Salentijn. "The primary role

of functional matrices in facial growth." American
journal of orthodontics 55.6 (1969): 566-577.
• The oral and pharyngeal regions have a primary function in maintaining a
patent airway.

• This is accomplished by a dynamic musculoskeletal postural balance

• which is termed the “airway-maintenance mechanism. ”

Moss, Melvin L., and Letty Salentijn.

"The primary role of functional
matrices in facial growth." American
journal of orthodontics 55.6 (1969):
• Post- natal development of the tongue is also integrally related to the acquisition
of an open masticatory cavity

• It is this expansion of available performance area which makes the anteriorward

elongation and greater motility of the tongue feasible and possible.

Moss, Melvin L., and Letty Salentijn. "The

primary role of functional matrices in facial
growth." American journal of orthodontics 55.6
(1969): 566-577.
 Mandibular growth

• Mandibular is a combination of the morphologic effects of both capsular and

periosteal matrices

• The enclosed and embedded macroskeletal unit (“mandible”) is passively and

secondarily translated in space.

Moss, Melvin L., and Letty Salentijn. "The primary role of

functional matrices in facial growth." American journal of
orthodontics 55.6 (1969): 566-577.
• The periosteal matrices related to the constituent mandibular microskeletal units
respond to this volumetric expansion.

• Such an alteration in their spatial position inevitably causes them to grow; that
is, causes changes in their functional demands.

• The sum of translation plus changes in form comprises the totality of mandibular
growth.

Moss, Melvin L., and Letty Salentijn. "The primary

role of functional matrices in facial growth."
American journal of orthodontics 55.6 (1969): 566-
Moss, Melvin L., and Letty Salentijn. "The primary
role of functional matrices in facial growth."
American journal of orthodontics 55.6 (1969): 566-
 Summary

Two basic types of matrices-periosteal and capsular.

Periosteal matrices act upon skeletal units by the process of osseous deposition and
resorption to alter the size and shape of their respective skeletal units.

Capsular matrices act upon the functional cranial components by altering the
volume of the capsules to bring about a passive translation of the cranial
components in space

Moss, Melvin L., and Letty Salentijn. "The primary role of

functional matrices in facial growth." American journal of
orthodontics 55.6 (1969): 566-577.
 Von Limborgh’s Hypothesis
• Intrinsic Genetic factors –
Genetic factors inherent to the skull tissues.

• Local Epigenetic factors –

Genetically determined but manifest their influence in an indirect way on
associated structures (brain, Eyes etc.).

Graber TM. Orthodontics Principles and practice ,3rd Edition

• General epigenetic Factors –
Genetically determined influences originating from distant structures (sex
hormones)

• Local Environmental Factors –

Local non genetic influences originating from the external environment (local
external pressure ,muscle forces)

• General Environment Factors -

General non genetic influences originating from external environment ( food,
oxygen supply).

Graber TM. Orthodontics Principles and practice ,3rd Edition

 Evidences against the theory

• This synthesis of parts from the three basic theories of craniofacial growth, while
representing a logical interpretation, does not answer all the questions

• The possible difference between control of appositional cartilaginous growth and

interstitial cartilaginous growth can be raised

Graber TM. Orthodontics Principles and practice ,3rd Edition

• Also, since neurocranium is completed quite early and thus provides a stable
base for continued membranous growth in other areas , a question is asked
concerning the influence of these membranous bones on the other membranous
bones which are still growing

Graber TM. Orthodontics Principles and practice ,3rd Edition

CONCLUSION

• UNDERSTANDING THE GROWTH PATTERN OF AN INDIVIDUAL HELPS

IN TREATMENT PLANNING.
Take home message:
• Sutural and Cartilagenous theory of growth can act as an adjunct in
the growth of the craniofacial region
• Functional matrix theory is the most widely accepted theory of
growth

Expected questions:

SAQ
1. Sutural Theory
2. Functional matrix theory of growth

LAQ
1. Describe in detail the theories of
growth
THANK YOU