GOOD AFTERNOON

Dr VAJRALA SASIDHAR,
FIRST YEAR POSTGRADUATE,
DEPARTMENT OF PEDIATRIC AND PREVENTIVE
DENTISTRY
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THEORIES AND FACTORS OF
GROWTH AND
DEVELOPMENT

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CONTENTS

INTRODUCTION
DEFINITIONS OF GROWTH AND DEVELOPMENT
GROWTH THEORIES
FACTORS AFFECTING THE GROWTH AND DEVELOPMENT
CONCLUSION
REFERENCES
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 THEORIES OF GROWTH FACTORS AFFECTING GROWTH AND
• BONE REMODELLING THEORY DEVELOPMENT
• GENETIC THEORY • HEREDITY AND GENETIC FACTOR
• SUTURAL DOMINANCE THEORY • SEX
• CARTILAGENOUS THEORY • NUTRITION
• FUNCTIONAL MATRIX THEORY • RACE
• FUNCTIONAL MATRIX REVISITED • ILLNESS
THEORY • SOCIO-ECONOMIC STATUS
• VANLIMBORGH’S THEORY • HORMONES
• ENLOW’S “V” PRINCIPLE • SECULAR TRENDS
• ENLOW’S COUNTERPART PRINCIPLE • CLIMATE AND SEASONAL EFFECTS
• NEUROTROPISM • EXERCISE
• SERVO SYSTEM THEORY • PSYCHOLOGICAL FACTORS
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INTRODUCTION

•The period of growth and development extends throughout the life cycle.
•Changes occur is from conception to the adolescence.
•Growth and development is a process where the person thinks normally, eventually & takes a

responsible place in society.

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 DEFINITIONS
GROWTH

• Change in any morphological parameter which is measurable. - Moss

• Growth refers to increase in size or number. - Proffit
• Quantitative aspect of biologic development per unit of time. - Moyer
• The entire series of anatomic and physiologic changes taking place between the beginning of prenatal
life and the close of senility. - Meredith
• Growth is an increase in size. - Todd

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DEVELOPMENT
• Development is progress towards maturity. - Todd
• Development refers to naturally occurring unidirectional changes in the life of an individual
from its existence as a single cell to its elaboration as a multifunctional unit terminating in
death. - Moyers

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THEORIES OF GROWTH AND DEVELOPMENT

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 BONE REMODELLING
THEORY (BRASH)

• First theory of cranio-facial growth

• It states that all cranio-facial skeletal growth occurs

exclusively by remodelling

• Selective addition and resorption of bone

• Growth of jaws takes place by deposition of bone at the

posterior surface of maxilla and mandible – HUNTERIAN
GROWTH.

• Calvarium - bone deposition on the ectocranial surface and

resorption of bone on endocranial surface.

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 GENETIC THEORY
(ALLAN BRODIE)
• This theory states that growth is preplanned and occurs only
by genes, which determine and controls the whole process of
cranio-facial growth

• Cranial differentiation is largely genetically determined

seems be challenged by the high degree of individuality of
certain parts of the cranium.

• But the mechanism of action by the genetic unit and the

mechanism by which the traits are transmitted were not
understood until recently.

• It is now clear that growth is not solely depended on genetics.

Environmental factors also plays major role in growth.

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 SUTURAL DOMINANCE THEORY
(SICHER AND WEINMANN)
• Sutures are the primary growth centers and are under
intrinsic genetic control, rest all factors are
secondary for cranio-facial growth.

• Cranio-facial skeleton enlarges due to the expansible

forces exerted by the sutures.

• Primary consideration of this theory is, proliferation

of the connective tissue and its replacement by bone
in the sutures.

• Paired parallel sutures that attach the facial areas to

skull & the cranial base region push the
nasomaxillary complex downward & forward
movement of maxilla in-order to pace its growth
with the mandible.
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EVIDENCES AGAINST THIS THEORY

• Sutures won’t have the necessary information for altering the growth because, TRABECULAR
PATTERN IN THE BONES at the sutures changes with age which indicates the changes in direction of
growth.
• SUTURES LACKS THE INNATE GROWTH POTENTIAL - When an area of the suture is transplanted
to another location, the transplanted tissue doesn’t continue to grow.
• Growth takes place even in the ABSENCE OF SUTURES. Example : Untreated cases of cleft palate.
• Many doubts raised about the intrinsic genetic stimulus of sutures in the cases of “MICROCEPHALY
AND HYDROCEPHALY”.
• Facial SUTURES EXTIRPATION has no perceptible effect on the dimensional skeleton growth.

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 CARTILAGENOUS
THEORY
(JAMES SCOTT)

• Scott hypothesis, which emphasizes that the intrinsic growth-

controlling factors are present in the cartilage and in the
periosteum, with the sutures being only secondary and dependent
on extrasutural influence.

• Cartilaginous parts of the skull must be recognized as primary

centers of growth, with the nasal septum being a major contributor
in maxillary growth perse.

• The role of septomaxillary ligament in growth of midface from

beginning of prenatal period till 3 or 4 years of life.

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EVIDENCES SUPPORTING THE
THEORY
• Histologic research validates the Scott’s hypothesis that both pressure and tension
have little effect on cartilaginous growth.

On the contrary, Intramembranous bone is immediately responsive.

This supports that sutural growth is secondary to synchondral growth.
• Extirpation of septal cartilage in growing rats resulted in deficient growth of snout.
• Nasal septum has role in determining anteroposterior growth of upper face.
• Deformity of snout after resection of nasal septum was the result of lack of growth.
• In cleft palate cases, where maxillary growth has been retarded by scarified
tissue, the nasal septum continues to grow and even bends on itself into the
characteristic ‘S’ shape. The inhibition of sutural growth is considered a
concomi tant lack of cartilage growth - no cartilage growth, no sutural growth,
no proliferation of connective tissue.

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EVIDENCES AGAINST THE THEORY
• Septal cartilage – mechanical support for nasal bones and not a primary growth center.

• Malformation in snout after excision of nasal septum is due to trauma following surgery.

Conclusion
• Nasal septum may be important for anteroposterior growth of face because of endochondral growth -
posterior border but it is not considered to be an active contributor for vertical development of face.

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 FUNCTIONAL MATRIX
HYPOTHESIS
(MELVIN MOSS)
Moss claims that the growth of the skeletal components, whether endochondral or intramembranous in
origin, is largely dependent on the growth of the functional matrices.

• Definition: Functional matrix hypothesis (FMH) claims that the origin, growth, and maintenance of all
skeletal tissues and organs are always secondary, compensatory, and obligatory responses to temporally
and operationally prior events, or processes that occur in specifically related non-skeletal tissues, organs, or
functioning spaces (functional Matrices).
Functional Cranial Component
“The head is a composite structure, operationally consisting of a number of relatively independent functions:
olfaction, respiration, vision, digestion, speech, audition, equilibration and neural integration. Each function
is carried out by a group of soft tissues which are supported and/or protected by related skeletal elements”.
It consists two sub-components : Skeletal unit and Functional matrix

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 FUNCTIONAL CRANIAL COMPONENT

SKELETAL UNIT FUNCTIONAL MATRIX

MACRO SKELETAL UNIT MICRO SKELETAL UNIT PERIOSTEAL MATRIX

CAPSULAR MATRIX
Maxilla, Mandible, Alveolar, Nasal, Palatal, Muscles, Glands, Nerves, Oro-cranial capsule,

Neurocranium. Coronoid, Condyloid. Blood vessels. Neuro-cranial capsule.

TRANSFORMATION

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TRANSLATION
 FUNCTIONAL
MATRIX
The functional matrix refers to all the soft tissues and spaces that perform a given function. There are two
types of functional matrices :
1. Periosteal matrix

2. Capsular matrix

• Periosteal matrix :- The ‘periosteal matrix’ corresponds to the immediate local environment. Periosteal
matrices are virtually self-defining. Examples of periosteal matrices include muscles, blood vessels, nerves,
teeth, etc. The effects of periosteal matrices are best exemplified by the effect of muscles upon the skeletal
units. Lack of contraction leads to atrophy of the bone. All periosteal matrices act homogeneously by
means of osseous deposition and resorption. The periosteal matrices stimulation causes growth of the
micro-skeletal units. They act to alter the size, shape of both of the bones.

• Capsular matrix :- The ‘capsular matrix’ is defined as the organs and spaces that occupy a broader
anatomical complex. The functional cranial components arise, grow and are maintained within a series of
capsules. Each capsule is an envelope that contains a series of functional cranial components, skeletal units
and their related functional matrices and is sandwiched between two covering layers. This limiting layer 19
consists of skin and dura mater in the neurocranial capsule and skin and mucosa in the orofacial capsule
SKELETAL UNIT
The skeletal unit refers to the bony structures which enable support to the functional matrix and these are essential or
permissive for that function. The skeletal unit does not refer to the individual bone directly, but to the function it
supports. There are two types of skeletal units:

1. Macro skeletal unit

2. Micro skeletal unit

• Macro skeletal unit :- They are made of the core of the maxilla, mandible and neurocranium. The capsular matrix
expansion causes the macro-skeletal unit to passively change the position. This process is called translational growth
of skeletal structures.

• Micro skeletal unit :- They are part of the bone whose growth is modulated by the periosteal matrices. Functional
variations in the periosteal matrices may be expressed within the micro-skeletal unit. The possible interaction
between the periosteal matrix and micro-skeletal unit includes temporalis–coronoid process, masseter, medial
pterygoid–gonial angle, and teeth–alveolar bone. The change in size and shape of micro-skeletal units occurs
independently of the changes in spatial position. Moss uses two terms for this : ‘transformation’ or ‘intraosseous
growth’.

The overall skeletal growth is a combination of changes in micro-skeletal and macro-skeletal units due to 20
stimulation of periosteal and capsular matrices, respectively. This total growth changes are termed ‘interosseous
growth’ by Moss.
 FUNCTIONAL MATRIX
HYPOTHESIS (REVISITED)

• Even though FMH gained popularity, it suffered from a major drawback. Moss was not able to explain
clearly the process by which the functional stimuli could get converted into a signal and affect changes
in bones. In his series of articles titled ‘Functional Matrix Hypothesis Revisited’, Moss tried to explain
the FMH in a more detailed and at microscopic level, and validate FMH. Moss tried to bridge the gap
between hierarchical constraints and explained the operation from genome to organ level by two
concepts:
1. Mechanotransduction occurring in single cells
2. Bone cells function multicellularly as a connected cellular network
(Osseousmechanotransduction).

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 Functional stimulus

Stimulation of vital cells

Mechanotransduction downward movement of Mechanoreception & transduction

signals to cells

Ionic & mechanical process

Intracellular activation of osteoblast and osteocyte

Through osseous connected cellular network

Upward movement of signal from cells tochange (OCNN)
bone form 22

Bone resorption results in alteration of form

“Mechanotransduction” is the process by which a mechanical stimulus is converted into a biologic
signal to affect a cellular response.

“Osseous mechano-transduction” translates the periosteal functional stimulus into a skeletal unit cell
signal by two skeletal cellular mechano-transductive processes namely ‘ionic’ and ‘mechanical’. The
ionic (or electrical) process involves the ionic transport through the plasma membrane of the bone cell
in some form. The possible ionic process includes stretch-activated ion channels, electromechanical,
electrokinetic, and electric field strengths. This is made possible because the bone is viewed as an
osseous connected cellular network (OCCN). The loaded tissue responds to the stimulus by the triad
of bone cell adaptation. The triad includes bone deposition and maintenance and bone resorption

Both osteoblasts and osteocytes are competent for intracellular stimulus reception and transduction

Conclusion
Moss concludes by saying that individually both genomic and epigenetic factors are necessary and
satisfactory causes. Both factors together are necessary and satisfactory causes for controlling
morphogenesis. Since epigenetic processes and its events are the immediate proximal cause of 23

development, they are considered as the primary agencies of development.

 VAN LIMBORGH’S THEORY

• A multi-factorial theory which has given a new view to the morphogenesis of skull was put forward
by Van Limborgh in 1970.

• This synthesis is essentially from the three basic theories of craniofacial growth. His theory is
conceptual, taking only the positive aspects of Scott's cartilaginous theory, sutural dominance theory
by Sichel' and Moss' functional matrix theory.

• The drawbacks of the above theories were left unanswered to a large extent. Thus in essential it is a
logical interpretation of the existing theories.

• VanLimborgh has suggested five factors that control growth. They are :
INTRINSIC GENETIC FACTORS
LOCAL EPIGENETIC FACTORS
GENERAL EPIGENETIC FACTORS
LOCAL ENVIRONMENTAL FACTORS
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GENERAL ENVIRONMENTAL FACTORS

Intrinsic genetic factors :- They are the genetic control of
the skeletal units themselves

Local epigenetic factors :- Bone growth is determined by

genetic control originating from adjacent structures like
brain, eyes, etc..,

General epigenetic factors :- They are genetic factors

determining growth from distant structures. Examples
are sex hormones, growth hormone, etc..,

Local environmental factors :- They are non-genetic

factors from local external environment. Examples are
habits, muscle force, etc..,

General environmental factors :- They are general non-

genetic influences such as nutrition, oxygen etc..,

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 ENLOW’S “V” PRINCIPLE

• Facial bones or parts of bone have a ‘V’ shaped pattern of growth.

• Growth movements and enlargement of the bones occur towards
the wide ends of the ‘V’ as a result of differential deposition and
selective resorption of bone.

• Bone deposition on the innerside of the wide end of the ‘V’ and
resorption on the outer surface.

• Deposition also takes place at the ends of the two arms of the ‘V’
resulting in growth movement towards the ends.

• ‘V’ pattern growth is seen in mandible, ends of long bone,

mandibular body, palate etc..,

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 ENLOW’S COUNTERPART
PRINCIPLE

• It states that the growth of any given facial or cranial part relates specifically to other structural and
geometric counterparts in the face and cranium.

• For balanced growth, each regional part and its particular counterpart enlarge to the same extent.

• There are regional relationships throughout the whole face and cranium. Some of them are :-

Nasomaxillary complex – Anterior cranial fossa

Horizontal pharyngeal space – Middle cranial fossa
Middle cranial fossa – Breadth of ramus
Maxillary arch – Mandibular arch
Bony maxilla – Corpus mandible
Maxillary tuberosity – Lingual tuberosity

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 NEUROTROPISM

• It is the nervous control of the skeletal growth by transmission of a substance through axon.
Definition :- Neurotropism “is a non-impulse transmittive neurofunction, involving axoplasmic transport,
providing for the longterm interactions between neurons and innervated tissues which homeostatically
regulate the morphological, compositional and functional integrity of those tissues”.
It is of three types. They are :-
1. Neuro - epithelial
2. Neuro – muscular
3. Neuro – visceral.

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 SERVO SYSTEM THEORY
(ALEXANDER PETROVIC)

• Petrovic using the language of cybernetics explained that the growth of various craniofacial regions is the
result of interaction of a series of causal change and feedback mechanisms.

• Based on a series of experiments, Petrovic and coworkers have formulated a cybernetic model for the control
of mandibular growth.

• Servosystem theory starts with the explanation of cybernetics. Weiner defines cybernetics as the science of
control and communication in the animal and machine.

• Cybernetics theory postulates that everything affects everything and, therefore, organized living systems
never operate in an open-loop manner.

• Open loop is a type of mechanism that has no feedback loop or comparator. The other type of feedback is
closed-loop mechanism.

• If a physiologic system is designed to maintain a specific correspondence between inputs and outputs, inspite
of disturbances, it is called closed-loop system. It is characterized by the presence of a feedback loop and
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comparator.

• Closed loop has two variations, namely, regulator and servo system.
• The regulator: The main input is a constant feature in this
system. The comparator detects disturbances and their effects. It
is a negative feedback system: disturbances cause changes that
tend to restore the normal state of the disturbed system to the
initial state.

• Feedback signal: It is the function of controlled variable that is

compared to the reference input. It is negative in regulator and
servosystem.

• The servosystem: It is also called follow-up system. The main

input is not a constant in this system but varies across time.

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Elements and organization of servosystem
theory

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CLINICAL SIGNIFICANCE :
It is difficult to explain the growth of most parts of the body with servosystem theory.
It is used to explain the growth of mandible following functional appliance therapy.
It is more useful as a research tool.

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FACTORS AFFECTING GROWTH &
DEVELOPMENT

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 HEREDITY AND GENETIC
FACTOR
 Heredity is the passing on of characteristics from parents to their
children. The heredity of a man and a woman determines that of
their children.

There seems to be considerable genetic influence on the

1. Size of parts
2. Rate of growth
3. Onset of growth
Genetic control influences the size of the organism.

Rate of growth depends on interaction between the genetic and

environmental factors. 35
 SEX

• Sex is determined in some countries at conception but it is not

practiced in India.
•After birth the male infants are longer and heavier than female
infants. Boys maintain this superiority until about 11 Years of age.
•Girls Mature earlier than boys, and are than taller on the average.
During the prepubertal stage of growth and development, boys are
again taller than girls.
•Bone development is more advanced in girls than in boys. Advance
in osseous development is also demonstrated by the earlier eruption
of permanent teeth in girls.

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 NUTRITION
• Sufficient intake of nutritional food is necessary for normal
growth.

• Malnutrition tends to cause deficient growth.

• During periods of rapid growth such as prenatal period,

infancy, puberty & adolescence need high amount of proteins
& calories are needed.

• Minerals such as calcium, phosphorus, fluorides etc., are

essential for teeth and bone growth; also vitamins A, D and C
participate in skeletal growth.

• Deficiency of such minerals, vitamins etc., in food leads to

defects in growth of bone/teeth.

• E.g. :- Vitamin-D deficiency-Rickets ; Vitamin-C deficiency-

Scurvy.
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 RACE

•Distinguishing characteristics called racial or subracial development

in prehistoric humans.
•As too height, too short, tall do examples exist among all the races
and subraces.
•This is again influenced by climate, nutrition and socioeconomical
status.
•For example, the timing of calcification and eruption of teeth occurs
almost a year earlier in Black population compared to their White
counterparts

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 ILLNESS

• The usual minor childhood illness ordinarily cannot be

shown to have much effect on physical growth.

• Chronic and debilitating illness can affect malocclusion

either as direct cause or as a result of its treatment.

• The effect of disease is similar to that of malnutrition. After

an illness, a catch up growth is possible to bring back the
child to normal growth when the illness is treated.

• E.g., Poliomyelitis - paralysis of orofacial muscle results in

malocclusion.

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 SOCIO-ECONOMIC STATUS

• Children in favorable socioeconomic conditions tend to

put on weight and grow in height more when compared
with unfavorable children.

• Parents in unfortunate financial circumstances, however

public health & health education programs are gradually
assisting such parents to provide better care for their
children.

• Role of nutrition plays a key role along with this factor.

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 HORMONES

• Hormone imbalances show effect on physical

growth.

• E.g.: Growth hormone (pituitary) deficiency

leads to retarded growth of skeletal tissue and
excess leads to acromegaly which causes
mandibular prognathism.

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 SECULAR TRENDS

• Changes in size and maturational status are notably

advancing between generations.

• The puberty age for the current generation girls is much

earlier compared to the previous generation.

• This is called as secular trends in growth.

• Though such facts are interesting to note, unfortunately

they still remain unexplained on scientific grounds

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 CLIMATIC AND SEASONAL EFFECTS

• The cold climate residents have a greater proportion of adipose

tissue.

• The climate influences the variations in the growth rates of

children and in the weights of new born babies.

• Climate changes are believed to have a minute direct effect on

the rate of growth.

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 EXERCISE

• Adequate exercise may be essential for the

development of motor skills for increase in the
muscle mass, for fitness and for general health
conditions.

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 PSYCHOLOGICAL FACTORS

•Emotionally deprived children may receive adequate nutrition but do

not gain weight as expected & are pale & unresponsive. If emotional
deprivation continues & loving care is not given over a period of time,
the children may have repeated illness, become emotionally ill, or die at
an early age.
•If the child is given the necessary care & love that promotes healthy
development, otherwise growth & development retardation may occur.

• When children experience stressful conditions it retards the growth

due to deficiency of growth hormone secretion.

• Removal of stressful condition tends to normal secretion and "catch-

up" growth is seen

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 CONCLUSION

• The need for learning growth theories and factors affecting the growth and
development because, the development of craniofacial growth is a
complicated phenomenon…. Where growth is irreversible in some cases such
as in terms of height / length of the body and in some cases growth is
reversible like weight of the body..
But growth is always directly proportional to increase in size and is
unidirectional

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REFERENCES

• TEXTBOOK OF ORTHODONTICS - SRIDHAR PREM KUMAR

• CONTEMPORARY ORTHODONTICS - WILLIAM R. PROFFIT
• TEXTBOOK OF ORTHODONTICS - S. GOWRI SHANKAR

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THANK YOU

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