Growth relativity hypothesis

-John voudouris, 2000

Growth relativity hypothesis

Hypothesis presented for the
mechanism of condylar-fossa growth
modification with propulsive
mandibular appliances, such as the
Herbst & Twin-block

Growth relativity hypothesis

Introduction
Extensive use of orthopaedic
appliances Herbst, Twin-block &
other auxiliaries
Why & How
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Growth relativity hypothesis

Normal C-GF growth
Condylar remodelling
Pathosis at the condyle . adaptation

Growth relativity hypothesis

Condylar modification
Genetic theory Genetic control

pre-natal
Effectiveness of orthopaedic appliances
on
condylar growth ?- Brodie
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Growth relativity hypothesis

cybernetic theory hyperactivity of LPM

anatomic research no significant

attachment of LPM to the condyle

other muscle & tendon attachments

deep masseter , temporalis - Rees
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Growth relativity hypothesis

Growth relativity hypothesis

Growth relativity hypothesis

LPM tendon anterior border of fibrous
capsule

Growth relativity hypothesis

Whetten & johnston LPM traction ..
Little effect on condylar growth

Permanently implanted longitudinal

muscle monitoring techniques
postural & functional LPM activity
Studies on humans-Auf der maur
-Pancherz
-Anchus pancherz

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Growth relativity hypothesis

Functional matrix hypothesis
influence of non-skeletal
tissues

Exact method of condylar growth

stimulation?

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Growth relativity hypothesis

Increased vertical dimension & decreased LPM activity

Condylar pull stress mandibular growth

Condylar compression -

C-GF modification
Graber & Joho

vertical dimension - postural masticatory muscle

activity EMG records by Storey et al
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Growth relativity hypothesis

Evidence of decreased muscle activity

use of propulsive orthopaedic appliances

Cause for growth modulation?

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Growth relativity hypothesis

Mandibular growth is a composite

of regional forces & functional agents
of growth control that interact in
response to specific extracondylar
activating signals Endow & Hans

Extrinsic signals basis of Growth

relativity theory
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Growth relativity hypothesis

Growth relativity growth that is relative
to the displaced condyles from actively
relocating glenoid fossa

Growth long term retention results

short term treatment outcomes
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Extension of Wolffs law

Growth relativity states that
with orthopaedically displaced condyle ,
the bone
architecture is influenced by the
neuromusculature & the
contiguous, non muscular , viscoelastic
tissues anchored
to the glenoid fossa & the altered dynamics of
the fluids

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Growth relativity hypothesis

3 main foundations
Displacement
Viscoelasticity
Referred force (transduction)
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Growth relativity hypothesis

Viscoelasticity
-applied to elastic tissues muscles
In G R it applies to all non calcified tissues
Elasticity of --retrodiskal tissues

--fibrous capsule
-- Synovial fluid flow
-- LPM perimycium
-- TMJ tendons & ligaments
-- Other soft tissues
-- Body fluids
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Growth relativity hypothesis

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Growth relativity hypothesis

Mandibular advancement(displacement)
Synovial fluid dynamics
Influx of nutrients

Engorged blood vessels

Stretch of non muscular viscoelastic tissues

transduction

New bone formation

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Growth restriction-glenoid fossa

GF - posteroinferior growth Bjork, Popovich
& Thompson
posteriorly directed viscoelastic tissues
effect condyle and GF
Reverse growth relocation anteroinferiorly
Class II correction
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Growth restriction-glenoid fossa

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Light bulb analogy of condylar

growth & retention

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Discussion
Epiphysis
Tissue separating forces

Vs

condyle

No significant tissue separating

forces

Ephiphyseal cartilages - little

Significant short term adaptation
short term adaptation potential potential

No fibrocartilagenous cap

Presence of fibrocartilagenous cap

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Epiphysis Vs condyle

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Epiphysis Vs condyle
Condyle dissimilar to epiphysis
functionally
anatomically
immunologically
chemically &
ontogenetically
condyle does not act like an
epiphysis during orthopaedic
treatment
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Retention relapse
Deactivation of modification due to
compression of retrodiskal tissues

Hence long term adaptation is not

clinically significant
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Retention relapse

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Retention relapse

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conclusion
No measurable long-term benefits for the
mandible are derived from the first phase of
functional appliance therapy in a two
phase
treatment.
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Future studies
Synovial fluid dynamics
Study conducted on primates using
full occlusal coverage herbst block &
twin block appliances hence
oppurtunity to use
cephalometric
histomorphometric
electromyographic methods
to investigate observed changes
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Clinical implications of
viscoelasticity
Dentoalveolar changes
AP & vertical changes differential
eruption
Transverse changes
Buccal segment intrusion & extrusion
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Bibliography
1.

Contemporary orthodontics
william R.Proffit ; 3rd edn

2.

Orthodontics Principles and practice T.M.Graber ; 3rd edn

3.

The primary role of functional matrices in

facial growth AJO-DO 1969 jun :(20-31)

4.

The doctrine of functional matricesAJO-DO 1969 july; 56:no.1

36

Bibliography
5.

Twenty years of functional cranial

analysis AJO-DO 1972 may;61:no.5
6. The role of functional matrix in
mandibular growth AJO-DO 1968
apr;38:no.2
7. The capsular matrix AJO-DO 1969
nov;56:no.5
8. Genetics , epigenetics and causationAJO-DO 1981 oct;(366-75)
37

Bibliography
The functional matrix hypothesis revisited
9. The role of mechanotransduction AJO-DO
1997 July;112:8-11
10. The role of an osseous connected cellular
network- AJO-DO 1997 Aug;112;221-26
11. The genomic thesis AJO DO 1997
Sep;112:338-42
12. The epigenetic antithesis and the resolving
synthesis AJO-DO 1997 oct;112:410-7
38

Bibliography
13.Factors affecting the growth of the midface
The functional matrix hypothesis :
reflections in a jaundiced eye Lysle
E.Johnston Jr
GROWTH RELATIVITY HYPOTHESIS
14. Improved clinical use of Twin-block and
Herbst as a result of viscoelastic tissue
forces on the condyle and fossa in treatment
and long term retention : Growth relativity
AJO-DO 2000 Mar;117:247-66

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