Growth Relativity Hypothesis

Growth relativity hypothesis
-John voudouris, 2000

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

Introduction
Extensive use of orthopaedic
appliances Herbst, Twin-block &
other auxiliaries
Why & How
3

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

Condylar modification
Genetic theory Genetic control
pre-natal
Effectiveness of orthopaedic appliances
on
condylar growth ?- Brodie
5

cybernetic theory hyperactivity of LPM
anatomic research no significant

attachment of LPM to the condyle
other muscle & tendon attachments

deep masseter , temporalis - Rees
6

LPM tendon anterior border of fibrous
capsule

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
10

Functional matrix hypothesis
influence of non-skeletal
tissues
Exact method of condylar growth

stimulation?
11

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
12
Evidence of decreased muscle activity

use of propulsive orthopaedic appliances
Cause for growth modulation?

13
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
14

Growth relativity growth that is relative
to the displaced condyles from actively
relocating glenoid fossa
Growth long term retention results

short term treatment outcomes
15
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
16

3 main foundations
Displacement
Viscoelasticity
Referred force (transduction)
17

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
18
19
20

Mandibular advancement(displacement)
Synovial fluid dynamics
Influx of nutrients
Engorged blood vessels
Stretch of non muscular viscoelastic tissues

transduction
New bone formation

21
22
23
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
24
Growth restriction-glenoid fossa
25
Light bulb analogy of condylar

growth & retention
26
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
27
Epiphysis Vs condyle
28
Epiphysis Vs condyle
Condyle dissimilar to epiphysis
functionally
anatomically
immunologically
chemically &
ontogenetically
condyle does not act like an
epiphysis during orthopaedic
treatment
29
Retention relapse
Deactivation of modification due to
compression of retrodiskal tissues
Hence long term adaptation is not

clinically significant
30
Retention relapse
31
Retention relapse
32
conclusion
No measurable long-term benefits for the
mandible are derived from the first phase of
functional appliance therapy in a two
phase
treatment.
33
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
34
Clinical implications of
viscoelasticity
Dentoalveolar changes
AP & vertical changes differential
eruption
Transverse changes
Buccal segment intrusion & extrusion
35
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
39

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Growth relativity hypothesis

-John voudouris, 2000