ENLOW'S PRINCIPLE

PRESENTED BY :-
DR. ANKITA SETHI
MDS 1st YEAR
DEPARTMENT OF ORTHODONTICS &
DENTOFACIAL ORTHOPEDICS
CONTENTS
• Introduction
• Remodelling & Relocation
• Primary displacement
• Secondary displacement
• Enlow's expanding 'v' principle
• Enlow's counterpart principle
• Regional Changes I-XVII
• Conclusion
• Growth and development is a morphogenic
process working towards a composite state
of aggregate structural and functional
balance among all of the multiple, regional
growing and changing hard and soft tissue
parts.
• Bone grows by adding new
bone tissue on one side of a
bony cortex and taking it away
from the other side.

• The surface facing toward the

direction of progressive growth
receives new bone deposition.

• The surface facing away

undergoes resorption.This
complete process is termed as
‘drift’.

• It produces a direct growth

movement of any given area of
bone.
• The outside and inside surfaces of a bone are
completely blanketed with a mosaic like pattern of
“growth fields”

• As one might presume that the outside surface

i.e. the periosteal surface of the bone must be
completely depository but that is not the case
about half of it is resorptive in nature.

• So if a given periosteal area has a resorptive type

of field,the opposite endosteal bone has
depository type of field and vice versa and this is
what causes the growth of the bone.
• Bone produced by the
covering membrane
(periosteal bone)
constitutes about half
of the cortical tissue
present and the rest
half is laid down by
the lining
membrane(endosteal
bone)
• The operation of the growth fields covering
and lining the bone is actually carried out
by osteogenic membranes and other
surrounding tissues rather than the hard
part of the bone.

• The growth is not programmed inside the

calcified part of the bone instead the
blueprint for design, construction and
growth of bone lies in the muscles, tongue,
lips, cheek, integument, mucosa,
connective tissue, nerves, vessels all of
which together provide information signals
that pace a bones development.
• All the resorptive and depository fields do
not grow at the same rate some grow faster
and some slower.

• During remodeling the extent of bone

deposition usually slightly exceeds that of
resorption so that regional part of the bone
gradually enlarge and the cortical plates
thicken as they remodel.
REMODELING AND RELOCATION

• Remodeling is a basic part of the growth process.

• The reason why the bone must remodel during

growth is because its regional parts become
moved; this calls for sequential remodeling
changes in the shape and size of each region.

• The ramus for example moves progressively

posteriorly by a combination of deposition and
resorption and as it does so the anterior part of
the ramus becomes remodeled into a new
addition for the mandibular corpus.
• This produces growth elongation
of the corpus, this progressive
and, sequential movement of the
component parts as the bone
enlarges is termed ‘relocation’

• Relocation is the basis of bone

remodeling, the whole ramus is
thus relocated posteriorly and
the posterior part of the
lengthening corpus becomes
relocated into an area previously
occupied by the ramus.
Structural remodeling of what
used to be the ramus into what
then becomes a new part of the
corpus and corpus enlarges.
PRIMARY DISPLACEMENT
• As bone enlarges, it is
simultaenously carried away
from the other bones in direct
contact with it. This creates a
space within which the bony
enlargement takes place.The
process termed as primary
displacement.

• As bone grows by surface

deposition it is simultaenously
displaced in opposite direction.
• For eg. The nasomaxillary complex is in contact
with the floor of the cranium the whole maxillary
complex is displaced downward and forward by
the expansive force caused by the growth of the
tissues in the midfacial region. This then triggers
new bone formation at various sutural contacts
surfaces between the nasomaxillary composite
and the cranial floor.

• Displacement thus preceeds downward and

forward growth by bone deposition that
simultaenously takes place in opposite direction
i.e. upward and downward direction (toward the
cranial floor)
SECONDARY DISPLACEMENT
• Secondary displacement is the
movement of the bone caused by the
separate enlargement of other bones.

• For eg. Increase in the size of the

bones that comprise the mid cranial
fossa results in the marked
displacement of the whole maxillary
complex anteriorly and inferiorly

• This is quite independent of the growth

and development of the maxilla itself
ENLOW'S EXPANDING
'V' PRINCIPLE
• The most useful and basic concept in facial
growth is the expanding “V”
principle.

• Many facial & cranial bones have this V

shaped configuration.

• Therefore Prof. Enlow has tried to explain

the growth of these bones in the shape of
“V” by the “V” principle.

• According to this principle there is bone

deposition inside of this “V” and bone
resorption on the outside which leads to the
increase or expansion of the “V”.
• The direction of the expansion is toward the
wide end of the ‘V’.

• Thus, a simultananeous growth movement

and enlargement occurs by additions of
bone on the inside with removal from
outside.
• The diameter of the A is
reduced because the
broad part of the bone is
relocated to position B

• This remodeling change

converts a wider part into
a more narrow part, as
both become sequentially
relocated by the V
principle

• Periosteal resorption and

endosteal deposition of
bone tissue brings about
this.
IN CASE OF ZYGOMATIC BONE
• The zygomatic bone moves and
enlarges laterally and inferiorly as the
entire face, brain and the cranium
expand into space formerly occupied
by the zygomatic arch.

• It does this by progressive deposition

on the lateral facing and downward
facing periosteal and endosteal
surfaces with resorption from the
opposite surfaces.

• The right and the left zygomatic arches

thus grow out and away as the rest of
the head enlarges between them.

• The arches also grow in size to

accommodate the muscles attached to
them.
IN CASE OF PALATAL BONE
THE 'V' PRINCIPLE

• The surfaces inside the V are depository

and surfaces outside are resorptory i.e.half
of the bone tissue that is endosteal (inner
side of V) in origin is depository ,and other
half that is periosteal (outer side of the V) is
resorptory.
ENLOW'S COUNTERPART
PRICIPLE
• It states, that the growth of any given facial or
cranial parts relates specifically to other structural
and geometric counterparts in the face and
cranium.

• These are regional relationships through out the

whole face and cranium.

• If each regional part and its particular

counterparts enlarge to the same extent balanced
growth between them is the outcome

• Imbalances are produced by differences in

respective amounts or directions of growth
between parts and counterparts.
• The counterpart principle can be illustrated by
an expandable photographic tripod.

• The tripod has a series of telescoping

segments in each leg; the length of each
segment matches the length of its counterpart
segments in the other two legs.

• If all the segments are extented to exactly the

same length,the tripod retains geometric
balance and overall symmetry.

• Similarly if any one segment is not extended

equally to other legs it will lead to imbalancing
of the tripod.
DEVELOPMENTAL SEQUENCES

• This is a short summary of the overall pattern of

combined remodeling and displacement
movements representing the essence of the "big
picture".

• The multiple growth process in all the various

parts of the face and cranium are described
separately as individual "regions" or "stages."

• Keep in mind that these growth processes take

place simultaneously.
REGIONAL CHANGE I
• The horizontal lengthening of the bony maxillary
arch is produced by growth at the maxillary
tuberosity.
• This is represented by the backward movement
of the ptm.
• Bone has been deposited on the posterior facing
cortical surface of the maxillary tuberosity.
• Resorption occurs on the opposite direction of the
same cortical plate,which is the inside of the
maxilla within the maxillary sinus.
• It is depository field in which the backward facing
periosteal surface of the tuberosity recieves continuous
deposits of new bone as long as growth in this part of the
face continuous.

• Because the posterior surface of the maxillary tuberosity

points towards the direction of arch elongation,this is a
particular surface that is depository.

• The arch also widens and the lateral surface is similarly

depository.

• The endosteal surface is resorptory,the cortex thus drifts

progressively posteriorly and also to a lesser extent
laterally.
REGIONAL CHANGE II
• The second stage describes about the
displacement between the counterparts i.e.
as the maxillary tuberosity grows and
lengthens posteriorly,the whole maxilla is
simultaneously carried anteriorly

• The amount of this forward displacement

directly compliments the posterior
lengthening displacement
REGIONAL CHANGE III
• The counterparts of the maxillary arch are many
the nasomaxillary complex,anterior cranial
fossa,palate,and the corpus of the mandible.

• In this stage the corpus is discussed.

• The mandible is composed of two major units the

corpus and the ramus and each should be
considered separately.

• The corpus lengthens to match the growth of the

maxilla and does this by remodeling conversion
from the ramus.
• The anterior part of the ramus grows
posteriorly,a relocation process that
produces the corresponding elongation of
the corpus.

• The mandibular arch increases by an

amount that equals the growth of the
maxillary arch and both elongate in the
posterior direction
REGIONAL CHANGE IV
• In this stage further posterior lengthening of the
mandible takes place.

• To do this the condyle and the posterior ramus

grow posteriorly.

• This returns the horizontal dimension of the

ramus to the same breadth as the first stage.

• The amount of anterior ramus resorption is

equaled by the amount of posterior ramus
resorption.
REGIONAL CHANGE V
• The whole mandible is displaced anteriorly
as to the same amount as the ramus has
been relocated posteriorly.

• This is a type of primary displacement as

the whole of bone itself is bringing up the
changes.
The changes that take place for growth of mandible
are:

 The corpus elongates in posterior direction

 Ramus is also relocated posteriorly

 Anterior displacement of the whole mandible

equals the amount of posterior displacement.

 The obliquely upward and backward direction of

ramus growth must also lengthen its vertical
dimension in order to provide horizontal
enlargement .
REGIONAL CHANGE VI

• The dimensions of the middle cranial fossa

also keeps increasing at the same time

• This is done by the resorption of the

endocranial side and the deposition at the
ectocranial side of the cranial floor.
REGIONAL CHANGE VII
• All the cranial and the facial parts lying anterior to
the middle cranial fossa become displaced in
forward direction.

• The forehead, anterior cranial fossa, cheek,

palate,and maxillary arch all undergo protrusive
displacement in the anterior direction.

• This is secondary type of displacement.

• The anterior cranial fossa and the nasomaxillary

complex is pushed forward as the interface
between the frontal and the temporal lobes of
becomes separated.
REGIONAL CHANGE VIII
• The expansion of the middle cranial fossa
also brings about changes in mandible.

• This is a also secondary displacement but

the displacement effect is much less as
compared to maxilla.

• This because much of the middle cranial

fossa growth occurs in front of the condyle
in between the condyle and tuberosity.
• Thus the amount of maxillary
protrusiveness far exceeds mandibular
protrusive displacement caused by the
middle cranial fossa.

• That is why the sella nasion should not be

used to represent the upper face or anterior
cranial base as the SN comparison is
invalid because dissimilar effective spans
are being compared as SN itself does not
represent any anatomically meaningful
dimension either for the upper face or the
cranial base.
REGIONAL CHANGE IX
• Ramus is the structural counterpart of the middle cranial
fossa and the pharygeal space.

• The skeletal function of the ramus is to fill the span of

pharengeal space and the middle cranial fossa in order to
place the mandible is proper anatomic relation to the
maxilla.

• The horizontal extent of the middle cranial fossa elongation

is matched to the coressponding horizontal increase in the
length of the ramus.

• If we recall stage iv ramus was associated with remodeling

changes associated with corpus and actual breadth was not
 REGIONAL CHANGE X
• The entire mandible is displaced anteriorly at the
same time as it grow posteriorly.

• The amount of anterior displacement equals:

 The extent of posterior ramus and condylar growth.

 The amount middle cranial fossa enlargement
anterior to mandibular condyle.
 The extent of resultant anterior maxillary
displacement.
 REGIONAL CHANGE XI
• The floor of the Anterior cranial fossa and the forehead
grow by deposition on the ectocranial side with
resorption at the endocranial side.

• The nasal bone are displaced anteriorly.

• The posterior anterior length of the cranial fossa is now in

balance with its counterpart that is the maxillary arch. The
facial area increases horizontally to an extent that it matches
the growth of anterior cranial fossa.

• The facial area increases to an extent that it matches the

growth of anterior cranial fossa above and the maxillary arch
and the palate below.
 REGIONAL CHANGE XII
• The vertical lengthening of the nasomaxillary
complex as its horizontal lengthening is brought by:-

 Growth by deposition and resorption.

 Primary displacement
 The combination of resorption on the superior
side(nasal) of the palate and deposition on the
inferior side(oral) produces downward growth of the
whole palate.
 This relocates it inferiorly,a process that provides for
the vertical enlargement of the overlying nasal
 REGIONAL CHANGE XIII
• Vertical growth by displacement is associated with growth at
various sutures of the maxilla where it contacts the other
separate bones above and behind it.

• Bone is added to these sutures and the whole maxilla is

displaced inferiorly.

• The addition of new sutural bone does not move the maxilla
downward it is infact done due to other physical growth forces.

• For eg. the downward movement of palate and maxillary arch

is due to sutural bone deposition and primary displacement.
 REGIONAL CHANGE XIV
• The maxillary arch has grown downward now the
mandibular arch grows superiorly in order to get the
teeth into proper occlusion.

• This is done with corresponding increase in the

height of the alveolar bone.

• One should remember the extent to which the

maxillary teeth show inferior drift is much more than
the superior drift of the mandibular teeth.

• Therefore very less growth is available to work with in

major orthodontic movements of the mandibular teeth
as compared to maxillary teeth.
REGIONAL CHANGE XV
• As the changes are occuring at the alveolar
sockets at the same time changes are occuring at
the incisor region chin and the corpus.

• Lower incisor undergo lingual tipping so that the

upper incisors overlap the upper teeth and thus
proper overbite is achieved.

• The movement of the lower teeth is accompanied

by resorption of the alveolar bone on the outside
just above the chin.
REGIONAL CHANGE XVI
• The forward part of the Zygoma and the Malar
region of the maxilla grow in conjunction to the
maxillary complex.

• Vertical length of the orbital rim increases by

sutural deposits at the frontozygomatic suture.
The zygomatic bone also enlarges considerably
by bone deposition along the inferior edge.

• The zygomatic arch grows by bone deposition on

the lateral surface, together with resorption from
the medial side within the temporal fossa.
REGIONAL CHANGE XVII

The zygoma propotionally matches the

maxilla in:

Directions and amount of horizontal and

vertical growth

Direction and amount of primary

displacement.
CONCLUSION

• The growth changes among the specific

parts and counterparts have been
purposefully balanced to give an
understanding of the meaning of balanced
growth and to provide a basis for analyzing
imbalanced growth changes
REFERENCES

• Essentials of Facial Growth, Donald

H.Enlow, Mark G. Hans

• Contemporary Orthodontics, 5th

edition,W.Proffit