CONTENTS

INTRODUCTION
CYBERNETICS
COMPONENTS OF A SERVOSYSTEM
PRIMARY AND SECONDARY CARTILAGES
CONDYLAR CARTILAGE
CONTROL OF MAXILLARY GROWTH
CONTROL OF MANDIBULAR GROWTH
BIFURCATIONS
THREE LEVEL ARBORIZATION
MODE OF ACTION OF FUNCTIONAL APPLIANCES
CLINICAL IMPLICATIONS
DRAWBACKS
 INTRODUCTION

Last 20 years have seen an increasing awareness of the potential of

functional appliances as a valuable tool in the armamentarium of
orthodontists.

In late 1960’s Petrovic & co-workers produced first rigorous

demonstration that condylar cartilage’s growth rate & amount can be
modified by using appropriate functional & orthopedic appliances.
Later he employed the model of cybernetics & control theory to
describe craniofacial growth patterns & method of operation of
functional & orthopedic appliances.

Cybernetics is based on the communication of information. Any

cybernetically organized system operates through signals that
transmit information (which may be physical, chemical or
electromagnetic in nature). Any cybernetic system, when provided
an input (or stimulus), processes such an input and produces an
output. The output is related to the input by a transfer function. This
is similar to feeding numbers into a computer, and obtaining the sum
or product of the numbers. The calculations performed by the
computer, correspond to the transfer function.
ORIGIN :

The term “CYBERNETICS” (Greek kybernetes means steersman)

was coined by mathematician Norbert Wiener in 1948 to encompass
the entire field of control and communication theory, whether in the
machine or in the animal.

Cybernetics is concerned with scientific investigation of systematic

processes of a highly varied nature, including phenomenon such as
regulation, information processing, storage, adoption, self
organisation and strategic behaviour. It grew out of Shannon's
information theory – designed to optimise transmission of information
through communication channels and the feed back concept used in
engineering control systems. The concept of cybernetics and control
theory was put forth by Petrovic (1977) to describe craniofacial
growth mechanisms and the method of operation of functional and
orthopedic appliances.
 articular
Rept
iles
quadratus

Squamous

mammals
coronoid
m dentary condylar

angular

According to Symons, in mammalian embryo, the condylar cartilage

develops independently of the chondrocranium and the response of
the condylar cartilage growth to local factors may explain the
extraordinary success of the phylogenetically new mammalian joint
between the skull and the lower jaw. condylar cartilage growth is
integrated into an organised functional whole that has the form of a
servosystem and is able to modulate the lengthening of the condyle
so that the lower jaw adapts to the upper jaw during growth. In the
absence of such an adjustment the forces of occlusion would expose
the pdl structures to repeated trauma and loss of teeth. This
adjustment hence allows proper mastication and facilitates high
basic metabolism. 

What is CYBERNATICS ?

Cybernetics is the science that studies the abstract principles of

organization in complex systems. 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. As per petrovic (1977) It demonstrates qualitative and
quantitative relationship between observed and experimental
findings. Broader understanding of orthodontic problems , and action
of appliances. Cybernetics is the study of communication and
control within and between humans, machines, organizations
and society. The cybernetic theory postulates that everything
affects everything & therefore organized living systems never
operate in an open-loop manner. There is a dynamic motor control
 of receptor sensitivity, receptor orientation, stimulus selection &
sources of environmental stimuli .

Cybernetics Transfer of Information

Cybernetic system operates through signals that transmit

information. Signals may be Physical, Chemical, Electromagnetic.

Input Process Output

Cybernetic system
Input Output

Input Black Box Output

Orthodontic, Genetically determined & Correction of
Functional, cybernetically organized malocclusion &
& orthopedic biologic features of Intermax.
appliances Phenomena characterizing, malrelation
inducing, or controlling
spontaneous & appliance-
modulated growth relative
To the following:
• Max. lengthening &
• Widening
• Mandible lengthening
• Teeth movements

Physiological systems can be of the various types shown below:

Loops: The previous example shows an open loop. The Output does
not affect the input. In a closed loop system, a specific relation is
maintained between the input and output. Closed loops are
characterized by a feedback loop and a comparator. The input is fed
into a comparator which analyses the input and judges the degree to
which the transfer function needs to be carried out to obtain a certain
output. The output is fed back to the comparator (by a feed back
loop) and is analyzed as to its adequacy. If found to be inadequate,
the transfer function is carried out once again. The feed back loop
can have a positive or enhancing effect or a negative or attenuating
effect. Closed loops can be of two types:- A Regulator type of
closed loop is one which the input is constant. Any disturbance in the
input will cause the comparator to initiate a “regulatory feedback
system, which will restore the input to its normal state. An example
of this is the temperature regulation system of the body. Any change
in body temperature acts as the input into the comparator (the
hypothalamus), which causes an action (pilorection or shivering)
which ultimately brings the body temperature back to normal.
Open loop :
Output has no effect on the input

Closed loop :
relationship maintained between Input and out put and there will be
return of modified information. Input is constant . Any change of the
input will initiate a “regulatory process” which will restore the input to
its normal state .
The input is fed into a comparator which analyses the input and
judges the degree to which the transfer function needs to be carried
out to obtain a certain output.
The output is fed back to the comparator (through a feed back loop)
and is analyzed for its adequacy. If found inadequate, the transfer
function is carried out once again. The feed back loop can have a
positive or enhancing affect or a negative or attenuating affect.
A regulator type of closed loop is one in which the input is
constant. Any disturbance in the input will cause the comparator to
initiate a regulatory feedback system, which will restore the input to
its normal state.
Eg: The temperature regulation system of the body
Any change in body temperature acts as the input into the
comaparator (the hypothalamus), which causes an action
 (pilorection and shivering) which ultimately brings the body temp
back to normal.

Servosystem:

This the main input is constantly changing with time and the output is
constantly adjusted in accordance to the input.
Various Components of a Servo-System :
1) Command- A signal established independent of the servosystem,
and is not affected by the output of the system. Hence, as the name
suggests, it tells the system what is to be done.
2) Reference Input- The input into the servo-system (which is
brought about by the command). The command created a reference
input through the action of a reference input element. So the design
of the servo-system so far is –
3) Comparator (Peripheral) - The input is fed into the comparator
which is the component that analyses the reference input and judges
the performance of the system through performance judging
elements.
4) Central Comparator- The performance judging elements then
transmit a deviation signal to the central comparator which sends a
signal to various components – the actuator, the coupling system
and the controlled system (which will be discussed later). This
ultimately brings about an output (also known as the controlled
variable).
Therefore, the servo-system is:- Growth of the Face – As Explained
by the Servosystem Theory

Primary and secondary cartilage

1) Types of Cartilage – and influence of growth factors on them. 2)

Role of the lateral Pterygoid and retrodiscal pad in condylar growth.
Types of Cartilage:
a) Primary Cartilage The zone of growth is comprised of functional
chondroblasts, which divide, and synthesize a cartilaginous matrix.
Chondroblasts undergo maturation and are later transformed into
hypertrophied chondroblasts. Deeper in the cartilaginous matrix,
calcium is deposited and endochondral ossification begins.
b) Secondary Cartilage The zone of growth includes skeletoblasts
and perchondroblasts – cells that divide but do not synthesize a
cartilaginous matrix. Once the prechondroblasts mature into
chondroblasts, they become surrounded by cartilaginous matrix and
do not divide.

Primary cartilages are seen in:- 1) Epiphysial cartilages of long

bones 2) Cartilages of synchondroses of cranial bones 3) Nasal
septal cartilage 4) Lateral cartilaginous masses of ethmoid 5)
Cartilage between greater wings and body and sphenoid.
Secondary cartilages are seen in:- 1) Coronoid cartilage 2) Condylar
cartilage 3) Midpalatal suture cartilage 4) Post fracture callus.

According to studies carried out by Charlier, Petrovic and

Stutzmann on organ cultures, at the Strasbourg Laboratory of
Craniofacial Growth Mechanisms, France:-

Dividing chondroblasts (in primary cartilage) are more susceptible to

general extrinsic factors, especially growth hormone, somatomedin,
sex hormones and thyroxinel. The cartilage matrix surrounding the
mature chondroblasts isolates them from the effect of local factors.
Local Biomechanical factors (like functional appliances) can only
modify the direction of growth.
In the secondary cartilages, where prechondroblasts ate the dividing
cells, general and local extrinsic factors can affect the growth. The
amount of growth of these cartilages can be modulated by using
orthopedic appliance. Role of Lateral Pterygoid muscle and
retrodiscal pad on condylar growth. Lateral pterygoid muscle is
involved in 2 important aspects:- Blood Circulation b.
Biomechanic The blood supply to condylar cartilage is mainly from
the lateral pterygoid muscle and the retrodiscal pad. On surgical
excision of these 2 structures the growth rate of the condyle is
significantly diminished.
Biomechanical effects:-
Contraction of the lateral pterygoid muscle places the condyle in a
more anterior position. This causes a stretching of the retrodiscal
pad. Repeated contraction causes increases activity of the
retrodiscal pad, resulting in an increased blood supply and increases
washing away of metabolites, which tend to inhibit growth. Increase
in the blood supply increases the supply of nutritive factors as well
as growth factors such as stomatomedin, testosterone, and other
hormones. Rat experiments by Stutzmann and Petrovic have shown
that proper function of these two structures is essential for proper
mandibular growth. Growth of the Face The growth of the maxilla is
brought about by the release of hormones (esp. STH-Somatomedin).
These hormones have various direct and indirect effects which result
in the growth of the maxilla. Somatomedin induces growth of primary
and secondary cartilages (like the nasal cartilage, spheno-occipital
synchondrosis, lateral cartilaginous masses of ethmoid, cartilage
between the greater wings and body of the sphenoid) which results
in an outward and forward growth of the maxilla. Another important
action of somatomedin is the increase in the size of the tongue,
which also facilitates the outward and forward growth of the maxillary
dental arch. Once the maxilla increases in length and width, the
position of the maxillary dental arch is changed.

THE POSITION OF THE MAXILLARY DENTAL ARCH FORMS

THE REFERENCE INPUT OF THE SERVOSYSTEM. The release of
somatomedin represents the COMMAND (command to grow). The
hormone itself is the REFERENCE INPUT ELEMENT. The occlusion
between the upper and lower teeth forms the COMPARATOR.

Owing to the forward and outward growth of the maxilla there is an

obvious change in the relation of the teeth. What was originally a
cusp to fosse relationship becomes a cusp to cusp relationship.
Hence the PERIPHERAL COMPARATOR (occlusion) senses this
due to a chance in performance or the efficiency of mastication. Due
to improper mastication, there is increased force on the
periodontium, teeth, muscles and TMJ, which serve as the
PERFORMANCE ANALYSING ELEMENTS. The performance
analyzing elements send signals to the CENTRAL COMPARATOR
which is represented by the central nervous system. The CNS is
equipped with a SENSORY ENGRAM which is a record of ideal
tooth relations, and a record of the ideal muscular posture which can
help to attain proper mandibular position. Details on the development
and functioning of the sensory engram are given subsequently. The
CNS compares the present muscular position with the ideal
muscular position stored in the sensory engram. It then sends a
DEVIATION SIGNAL to correct this discrepancy. The deviation
signal is sent to an ACTUATOR which is represented by the motor
cortex. The actuator then sends an ACTUATING SIGNAL to the
COUPLING SYSTEM of the lateral pterygoid muscle and the
retrodiscal pad. The LPM positions the mandible forward and the
activity of the retrodiscal pad induces mandibular growth at the
condyle (THE CONTROLLED SYSTEM) The resultant output or
CONTROLLED SYSTEM is the forward growth of the mandible
which results in an ideal cusp to fossa dental relation. Growth at the
Posterior Border of the Mandible Once growth occurs at the condyle,
the posterior border of the mandible becomes more concave in
shape. This causes a negative piezoelectric effect to develop at the
posterior border of the mandible, and bone apposition results. At the
same time, the anterior border of the condylar process becomes
more convex, causing a subsequent positive piezoelectric current to
develop and a subsequent resorption of bone occurs. This accounts
for an increase in length of the mandible.

SOME OTHER TERMS RELATED TO A SERVOSYSTEM

Gain- Gain of a system is the output divided by the input

Gain = Output/ Input
If the gain is greater than 1, it indicates amplification caused by the
system. If it is less than 1, it indicates and attenuation.
Petrovic suggests that the gain is genetically determined, but can be
altered to an extent by hormonal influences.

Attractor- It is the final structural state that the system tries to attain.
i.e.:- Maximum interception.

Repeller- All the unstable states that the system tries to avoid. i.e.:-
cusp to cusp relation. Disturbance- Any input, other than the
reference input, which tends to have an effect of the output.
E.g. - Abnormal tooth positions or occlusal interferences can act as a
disturbance to the peripheral comparator.

The Sensory Engram The CNS serves as a central comparator for

the servosystem. The central comparator refers to what is known as
the SENSORY ENGRAM. The sensory engram is a collection of
feedback loops, which record the activity of the masticatory muscles
corresponding to a particular, habitual mandibular position. In other
words, the optimal functional blueprints recorded as the sensory
engram. As optimal function of the masticatory muscles develops,
the CNS develops feedback loops which, in effect, memorize‟ the
best muscle function. Once these feedback loops develop, the CNS
tends to operate along these pathways. The sensory engram
operates on the principle of OPTIMALITY OF FUNCTION. Any
particular muscle action or mandible position that gives the minimum
deviation signal is recorded in the sensory engram. This means that
when any new mandibular position is dictated to the patient, unless
the new position causes a smaller deviation signal than the ole
position, the CNS will tend to make the mandible relapse to its older
position, wherein the function was more ideal. An observation of
Jacobs‟ clearly demonstrates this. He observed that chain gang
prisoners need to alter the way in which they walk owing to the extra
weight they have to carry. Once the chains are removed, they retain
the altered walking pattern only for a short while, and later reverted
back to a normal gait. So when the restrictions are removed, the
optimal muscular pattern is readopted. Hence, once the sensory
engram is established, the CNS has a reference of optimal function,
towards which it strives to maintain all bodily functions.

Peripheral comparator, Catastrophe Theory and Bifurcations

The peripheral comparator is an important element in control of the
growth of the face (especially the mandible). Its functions can be
divided into 2 stages:- 1. When inter-cuspal relationships have not
yet developed (very young children) Since stable occlusion is not
established, the peripheral comparator is not established. Since
there is no stable occlusion, the reference engram is unable to
develop. Hence even though the other components of the
servosystem are operational, they cannot control growth of the
mandible in very young children, since the peripheral comparator is
not yet developed. Therefore mandibular growth is mainly genetically
influenced. This stage lasts foe a different amount of time in different
individuals, and can last indefinitely in case of anodontia. 2. The
second phase is the development of stable occlusion Sensory
engram begins forming Peripheral comparator can control
craniofacial growth. Another characteristic of the peripheral
comparator is the existence of DISCONTINUITIES. Between two
stable points (intercuspation) there is an area of instability (cusp to
cusp relation). So a stable phase can never be changes to another
stable phase without an unstable phase. This forms the basis of the
CATASTROPHE THEORY.

When the cuspal relation reaches the cusp to cusp relation, 2

possibilities can result.
This is known as a bifurcation.
The alteration in the occlusion can result in either of the types of cusp to fossa
relations. This brings us to the concept of OPTIMAL OCCLUSION (Class I)
which is always desired, and SUBOPTIMAL OCCLUSION (Class II and Class
III) which is not optimal, but stable none the less. So a Class II molar relation
will never spontaneously revert to a Class I As the teeth move into a cusp to
cusp relation, there is always a feedback system which rends to bring it back
to cusp to fossa relation.
 DISCONTIUITIES
As seen above are important points in control of cranio-facial growth, and
should always be taken into consideration during growth prediction, treatment
planning and decision making. As mentioned earlier, a given occlusal pattern
can be formed due to any number of causes. But once it is established, it
remains relatively stable, as any local changes are minimized by the regulatory
process. Another important aspect of discontinuities is that it explains how a
genotype may only partially influence the phenotype. The gene sequence only
codes a regulatory pattern. It is around these regulatory patterns that a
phenotype is expressed. This means that very small fluctuations taking place
around a bifurcation at a crucial time can lead to very different results.

Importance of Discontinuities
• Growth prediction , treatment planning , decision making
• Genome partially determines the phenome
• Supports mixed dentition therapy

Depending on the relationship of maxilla to mandible, the dentition as a whole

or in part (peripheral comparator may be located near molars or incisors,
sometimes near canines.) may be operating as a peripheral comparator of the
servo system.
In posterior rotating mandible - molars
In anterior rotating mandible - incisors and canines.
The action of the peripheral comparator is an important part of both orthodontic
and orthopedic treatment
Condylar cartilage

Adaptive to both extrinsic & local biomechanical & functional factors.

Condylar cartilage growth is integrated into an organized functional whole that

has form of Servosystem & able to modulate lengthening of condyle so that
lower jaw adapts to upper jaw during growth.

Specific features of condylar cartilage

1. Fibrous capsule -fibroblasts and type I collagen.

2. Zone of growth (mitotic compartment) –skeletoblasts and

prechondroblast type II, not surrounded by the cartilaginous matrix with
type I collagen.

3. Zone of maturation - functional and hypertrophied chondroblasts.

4. Zone of erosion.

5. Zone of endochondral ossification. 

Correlation between growth direction of condyle & sagittal distribution of

dividing cells in condylar cartilage

 Anatomic, microscopic and histologic studies have shown that the growth
direction of the condyle coincides in general, with the axis of individual
trabeculae, located just inferior to the central part of condylar cartilage.

Hence the condylar growth direction can be determined by measuring the main
axis of endochondral bone trabeculae in the condyle and the angle it forms
with the mandibular plane. A histologic & radioautographic study was made of
distribution of dividing cells in a sagittal section of condylar cartilage of juvenile
rats. Condylar cartilage divided into 4 equal sections from anterior to posterior
& cells counted. Each experimental group was subjected to specific
orthopedic treatment.
Results showed that both treatment with the postural hyperpropulsor & with the
growth hormone produced significant increase in growth rate of condylar
cartilage compared to control group (Charlier et al, 1968, 1969; Petrovic et al ,
1975). Condylar growth is not exclusively a result of the lengthening of pre-
existing endochondral bone trabeculae under condylar cartilage but also a
result of growth of bone trabeculae (mesenchymal cells) that are formed in
parallel & posteriorly oriented in condylar cartilage.

 
Stutzmann angle-

The angle formed between main axis of endochondral bone trabeculae in

condyle with mandibular plane as viewed on lateral cephalogram. In anterior
growth rotation there is closing of angle as seen in treatment with growth
hormone.

In posterior growth rotation there is opening of angle as seen in treatment with

postural hyperpropulsor
FACTORS AFFECTING CONDYLAR CARTILAGE GROWTH :

1. Lateral pterygoid muscle & retrodiscal pad tissue

2. Effect of hormones
3. Intrinsic regulation of condylar cartilage growth rate
4. c-AMP

Experimental studies on juvenile rats were carried out in which LPM were
resected.
The interruption of circulatory dependence on the blood supply originating
directly from LPM & indirectly through retrodiscal pad may contribute to
inhibited differentiation of skeletoblasts. It was observed that growth of
condylar cartilage & lengthening of mandible continued but significantly
decreased.

A “negative feed back signal” originates from the proximal part of the
chondroblastic zone and exerts a restraining effect on the prechondroblastic
multiplication rate. This concept can help explain the effects of some
orthopedic and orthodontic appliances and influence of a hormone such as
thyroxine. The earlier commencement of chondroblastic hyertrophy and the
subsequent decrease in the prechondroblastic division-restraining signal are
important intermediary steps in growth stimulating effects of class II elastics,
mandibular hyperpropulsar etc.

The acceleration of the chondroblastic maturation rate is similarly an

intermediary step for the growth rate stimulating effect of thyroxine.
(Stutzmann, Petrovic, 1975, 1979)

Failure of the Servosystem to Control Growth The peripheral comparator is the

most fragile component of the servosystem. Any problem in the dentition
(rampant caries, missing teeth, mutilated dentition) can cause an improper
functioning of the servosystem, as the occlusion cannot be established
properly. If there is a discrepancy between the rotation pattern and location of
the comparator (if anterior teeth form the comparator in posteriorly rotating
mandible, or the posterior teeth form the comparator in the anteriorly rotating
mandible) then the servosystem cannot fine tune the growth process of the
mandible to the maxilla.

According to the Servosystem theory The development of malocclusion can

be explained with the help of the following graph. For every unit of STH-
Somatomedin or testosterone that is released, the amount of maxillary growth
is less than that of the mandible.

The line Max. indicates the growth of the maxilla

(LPMmax) – Growth of the mandible with maximum activity of the LPM

(LPMmin) – Growth of the mandible with minimum activity of the LPM

(LPMnorm) – Growth of the mandible with normal activity of the LPM Under
normal circumstances, the hormonal level is around “N” and a good maxillo-
mandibular relation is maintained. As the hormonal level starts increasing
towards L2, the maxilla starts to grow, and the mandible grows at an even
faster rate. The action of the servosystem at this stage is to reduce the amount
of LPM activity, so that less mandibular growth occurs. So, a good maxillo-
mandibular relation is maintained. When hormonal levels reach L2, the LPM is at its

minimum activity. This is the maximum restraint on mandibular growth. Beyond

L2, the activity of the LPM can no longer control growth of the mandible
adequately enough and mandibular growth starts to exceed maxillary growth –
resulting in prognathism. The opposite happens when hormone levels fall
below L1. So within levels L1 to L2, a good maxillo – mandibular relation is
maintained. Outside these levels, malocclusions result. The relation between
the maxilla and mandible between the levels L1 & L2 are maintained by
contractile activity of the LPM, as controlled by the servosystem, as well as by
a change in the gonial angle.
 Control of maxillary growth
Increase in length of maxilla
Is caused by growth at the premaxillomaxillary and maxillopalatine sutures and
by subperiosteal deposition of bone in the anterior region.

Increase in width of maxilla

Is due to growth at the mid palatal suture and bone deposition along lateral
areas of alveolar ridge.

Mid palatal suture - secondary cartilage.

Mechanisms controlling growth of the upper jaw

STH-somatomedin, testosterone and estrogen play primary roles in extrinsic

control of post natal growth of the upper jaw.

They have direct and indirect effects.

Directeffects:
Represents almost the entire influence of the hormones on growth of spheno-
occipital synchondrosis and nasal septal cartilage.Small part of the effect of
hormones on growth of cranial sutures is direct. Effects the responsiveness of
preosteoblasts to regional and local factors, stimulating the skeletal cell
multiplication. In secondary cartilage - effect seen in multiplication and
responsiveness of prechondroblasts
Indirect effect:
Forward growth of nasal septal cartilage.

• Thrust effect
Septomaxillary ligament traction effect.
Labionarinary muscle traction effect.

Control of mandibular growth

The variation in direction and magnitude of condylar growth is partly a
quantitative response to changes in maxillary length. Variation in maxillary
growth can be induced through resection of nasal septal cartilage or
administration of growth hormone or testosterone or by orthopedic
appliances. As long as growth alteration does not exceed a certain limit,
no significant changes in sagittal relationship of dental arches occurs. The
physiologic adaptation of mandibular length to maxillary length occurs
through a variation in both growth rate and direction of growth of condylar
cartilage.

Growth hormone- somatomedin affects the lengthening of mandible

(through condylar growth) to a greater extent than its affects on the
lengthening of maxilla. If this hormonal effect remains within physiological
limits, the occlusion is not significantly altered, as concomitant reduction an
angle between ramus and corpus of mandible, decreases the length of the
mandible. The release of somatomedin represents the command
(command to grow).

Reference input elements are the nasal septal cartilage, septopremaxillary

frenum, labionariary muscles and premaxillary and maxillary bones. The
position of maxillary dental arch is constantly changing reference input of
the servosystem. Lower arch is controlled variable.
The “operation of confrontation” between the upper and lower dental arches
is the “ peripheral comparator” of the servosystem. Owing to the
forward and outward growth of maxilla, there is obvious change in relation
of the teeth. What was originally a cusp to fossae relationship becomes a
cusp to cusp relationship.

Hence the peripheral comparator (occlusion), senses this, due to change

in performance or efficiency of mastication. Due to improper mastication
there is increases force on periodontium, teeth, muscles and TMJ, which
serve as performance analysing elements. The performance analyzing
elements send signals to the central comparator (controller) represented
by the CNS.

The CNS is equipped with a SENSORY ENGRAM. The sensory engram is

a collection of feedback loops, which record the activity of masticatory
muscles corresponding to a particular habitual mandibular position. Any
particular muscle action or mandibular position that gives the minimal
deviation signal is recorded in the sensory engram. i. e. when any new
mandibular position is dictated to the patient, unless the newer position
causes a smaller deviation signal than the older position, the CNS will tend
to make the mandible relapse to its older position, where in function was
more ideal.
The CNS compares the present muscular position with the ideal position
stored in sensory engram and sends a deviation signal to an actuator-motor
cortex to correct this discrepency. The actuator then sends an actuating
signal to the coupling system of the lateral pterygoid muscle and retrodiscal
pad.

The LPM positions the mandible forward and the activity of retrodiscal pad
induces mandibular growth at the condyle.

The resultant output or controlled variable is the forward growth of mandible

which results in an ideal cusp to fossa relationship.

Once growth at the condyle occurs, the posterior border of the mandible
becomes more concave in shape, causing a negative piezoelectric effect to
develop at the posterior border of mandible and bone apposition occursAt
the same time anterior border becomes more convex, positive piezoelectric
current resorption of bone.

Thus length of mandible increases.

Action of Functional Appliances based on the Servosystem Theory

As it can be seen from the preceding graph, in a patient with retrognathism,

the LPM is at its maximum activity. Hence the mandible cannot be brought
forward any more and therefore retrognathism results. Two types of functional
appliances have been recognized according to their mode of action:-

1. Appliances like the activator, postural hyperpropulsor, Frankel appliance, Twin

block, Bionator etc.

Position mandible Increased activity of

Forward LPM and RDP

Stimulating effects on condylar cartilage growth is produced mainly during

appliance is worn .Less fatigable fibers are significant in LPM. LPM “helped
to contract more” by Functional appliances.

2. Appliances like the Herren &LSU activator, Harvold-Woodside activator,

Extra oral traction on the mandible, which position the mandible forward and
open it beyond the physiologic rest position. First Group When appliance is in
place, there is increased activity of the LPM and RDP due to the forward
positioning of the mandible. Studies by Oudet et al (1988) and Carlson et al
(1990) show that this increases the number of non fatigable fibers in the LPM.
This shows that the LPM is, in effect “helped to contract more” by the
functional appliance. Hence, the mandible grows forward by deposition of bone
at the condyle. Hence length and even direction of growth is altered. Also,
when the mandible is positioned forward, a cusp to cusp relation results. The
peripheral comparator interprets it as a forward movement of the maxilla (as
even that will result in a cusp to cusp relation). So, since the reference input
has been moved forward, the peripheral comparator sends a deviation signal
to the central comparator. Then the central comparator sends the actuating
signal to the actuator, and so on, ultimately resulting in growth of the mandible.
Position mandible forward , open in beyond rest position.

No increase in activity of LPM

• Herren (1953)

• Auf der Maur (1978)

No activity of LPM is seen when appliance is wornyet there was an increase in

growth by two effects ,during appliance is worn there reduced length LPM due
to forward positioning of mandible at that same time sensory engram is formed
for new positioning ,corollary to this poisition mandible moves more forward
position so that RDP is much more stimulated.

Before discussing how Class II elastics stimulate condylar growth, it is

important to understand the microscopic working of the cartilage. The mitotic
cells in the condylar cartilage are of 2 types:-

1. Precursor cells – pleuripotent, fibroblast like skeletoblasts which

differentiates into - 2. Prechondroblast – faster cell cycle & the main cell of the
mitotic component. The prechondroblasts mature into chondroblasts. It is seen
experimentally, that if chondroblasts are lost by resection or hypertrophy and
death, there is increased multiplication of prechondroblasts. This indicates that
there is a local control over multiplication of prechondroblasts, which originates
from the chondroblastic layer. And, the thicker the chondroblastic layer, the
more intense is this negative feedback signal. (Stutzmann & Petrovic 1982,
1990) Class II elastics, (and other functional appliances, but to a lesser extent)
cause increase in activity of the RDP and hence increase in the blood and
lymph supply to the condylar region. Hence nutrients and growth factors are
supplied and metabolites and growth inhibitors are washed away. In addition,
to increasing mitosis, this leads to an earlier start of the hypertrophy of
chondroblasts. Hence the previously mentioned negative feedback signal is
mitigated and increased growth at the condyle results. Also, cytoplasmic
junctions between skeletoblasts are reduced and hence transmission of
inhibitory factors also reduces. Skeletoblast mitotic rate increased and rate of
differentiation into prechondroblasts also increases. The second group of
appliances has a slightly different type of action:- The appliances in this group
tend to position the mandible forward as well as open it well beyond the
physiologic rest position. The mobility of the mandible is also reduced. No
increase or even a slight decrease in the activity of the LPM was seen when
these appliances were worn. Yet there was in increase in growth.

This can be explained as a 2 step process.

1. The time the appliance is worn, the forward positioning of the mandible
caused a reduction in the length of the LPM. At this time a new sensory
engram is formed for this position of the mandible.

2. When the appliance is not worn, the mouth functions according to this new
sensory engram. So the mandible is functioning in a more anterior position.
This increases the activity of the RDP, leading to earlier hypertrophy of
chondroblasts and in turn, increased multiplication of prechondroblasts.

Hence actual lengthening of the mandible takes place when appliance is not
worn. Also, the bite can be opened only to a particular limit. If it is opened
more than that, no growth is seen.
 Clinical Implications :
According to the principle of optimality of function, a condition which results in
maximum efficiency is one that is instilled into the brain. So, all orthodontic
treatment must strive to reach the optimal functional situation, or, if this is not
possible, the post treatment functional condition should be better than the
pretreatment condition. If this is established, the tendency for relapse is less.
A functional appliance should be removed only when growth is completed, or if
growth is not completed, it should achieve a good intercuspal relation (the
attractor). This ensures a stable result. If the treatment ends with the teeth in
poor occlusion (repeller), relapse is more likely to occur.
An understanding of how functional appliances affect the servosystem is
important to know how long the appliance is to be worn. The first group of
appliances should be worn full time. The second group of appliances should
be worn part time. 4) Proper function of the LPM – RDP is essential for growth.
This was shown by rat experiments by Petrovic and Stutzmann. Ideal
functioning of LPM-RDP not only increases the amount of growth of the
mandible, but also improved the response to functional appliances, as was
seen in breast fed versus gavage fed rats. This is important to know for
counseling purposes. 5) The sensory engram in children is poorly developed.
Hence younger children respond better to functional appliance therapy than
older children, and the results are more stable. 6) Hormonal activity is highest
at puberty, during the pubertal growth spurt. Since hormones are very
important for growth, one must take full advantage of the increased hormonal
activity if any growth modulation is required.
Drawbacks :

1) The theory places a lot of importance on the condyle as the growth centre.
Hence if the condylar cartilage is lost subsequent to a fracture, growth should
seize. But studies done in Scandinavia show that this does not happen.
2) The author places a lot of importance on the role of hormones in controlling
growth. In all probability, they do not have such a large role to play.

3) The peripheral comparator, the occlusion, itself, is unstable. Discrepencies

in the occlusion can easily be overcome by dentoalveolar changes, rather than
by growth of the mandible.

4) According to the theory, an end on relation is a repeller. Still, end on

relation of the molars and other teeth are often seen.

5) The theory does not explain the action of the reverse pull headgear
 THREE LEVEL ARBORIZATION

It is a morphogeneticic classification of human facial development.

ByLavergne and Petrovic(1983).

The first level based on the quantitative determination of the difference

between maxillary and mandibular sagittal growth.

The second level based on variations in the direction of mandibular and

maxillary growth, relates to growth inclinations and growth rotations of both
maxilla and mandible.

The third level, based on the occlusal relationship that functions as the
peripheral comparator of the Servosystem, has subdivisions representing
either an aggravation or a melioration of malocclusions resulting from the first
two arborizational levels.