Two theories of Growth: ENLOW’S ‘V’ PRINCIPLE AND ENLOW COUNTERPART

1. CONTENTS:
 INTRODUCTION
 DISPLACEMENT
 REMODELLING
 ENLOW’S ‘V’ PRINCIPLE
 ENLOW’S COUNTERPART PRINCIPLE
 CONCLUSION
 VON LIMBORGH’S THEORY
Presented by,
Dr. SOURABH DUTTA

2. INTRODUCTION
 Growth is the quantitative aspect of biologic
development and is measured in units of
increase per units of time, for instance, inches
per year or grams per day. -MOYERS
 Entire series of sequential anatomic and
physiological changes taking place from the
beginning of prenatal life to senility. -
MEREDITH

3. DISPLACEMENT
 It is described as the change in the position of
an object following the application of force.
Displacement of bones occurs with growth in two
ways:
 Primary Displacement of bone occurs due to
its growth, which causes it to move from its
original position. For example displacement of
chin anteriorly due to the increasing
mandibular length.
 Secondary displacement is an illustration of
growth at a location subsequent to actual
growth occurring in a distant part of skeletal

4. REMODELLING
 Remodelling is a process of progressive
adjustment of bones to maintain their shape,
proportions and size. Remodelling of bone occurs
at different sites concurrently with increase in
bone size.
 TYPES:
 Surface remodelling occurs on the surface of
bones and leads to changes in topography.
 Structural remodelling causes a change in the
inherent architecture of the bone and may lead to
change in the density and mechanical properties
of the bone.

5. ENLOW’S ‘V’ PRINCIPLE
 Enlow’s ‘v’ principle was given in 1982 by
DONALD H. ENLOW.
 It is the most useful and basic concept of
facial growth.
 According to the ‘V’ principle, bone deposition
occurs on inner side of ‘V’ while resorption
takes place on the outside surface which leads
to widening of the ‘V’ configuration; at the
same time the structure translates from its
original position and move towards the wide
end of the V.

6.  The ‘V’ principle is an important facial skeletal
growth mechanism, since many facial and
cranial bones have ‘V’ configuration or ‘V’
shaped regions.
 Thus an increase in size and growth
movement takes place in a unified process.
Hence it is also called as expanding ‘V’
principle.

10. 1. PALATAL REMODELLING:
 Growth of hard palate in the coronal section
shows resorption occurs on the
outer(nasal)surface and deposition on the
inner(palatal)surface. Progressive
remodelling, along with the growth at the mid
palatal suture, and the secondary
displacement due to growth of nasal bones,
increases the width of the palate and causes it
to descend vertically downwards.

12. 2. RAMUS TO CORPUS
REMODELLING:
 Growth of mandible also occurs in
concordance with the ‘V’ principle. When
viewed from above, the condyle and ramus
expand in a posterior and lateral direction due
to growth in the body, ramus and the condyle
itself. With growth there is progressive
relocation of the entire ramus in a posterior
direction. Resorption occurs on the anterior
edge with resultant lingual shift of the anterior
part of the ramus to become added to the
corpus.

14. ENLOW’S COUNTERPART
PRINCIPLE OF GROWTH.
 It states that growth of any given facial or
cranial part relates specifically to other
structural and geometric counterparts in
relation to it.
 There are many structures in craniofacial
skeleton that can be constructed as counter
parts. They are:
1. The nasomaxillary complex and the anterior
cranial fossa.
2. The middle cranial fossa and the width of
ramus.

15.  To illustrate the counterpart principle, a tripod
is used as an analogy.
 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 extended to exactly the
same length, the tripod retains geometric
balance and overall symmetry.

16.  If however, any one segment is not extended equal to
others, the leg as a whole is either shorter or longer,
although the remainder of all segments in that leg match
their respective counterparts.
 One can thus identify which particular segment is
different and determine the extent of imbalance.
 Fig1: all the segments ane equal to their respective
counterparts.
 Fig2: segment X is shorter in respect to Y so there is
retrusion of segment Z.
 Fig3: segment a, b, c are shorter in respect to there
segment counterparts in other legs. All theses regional
imbalances offset one another, so the total length of

18. STAGE 1:
 The overall length of the maxillary arch has
increased by the same amount that PTM
moves posteriorly.
 Bone has been deposited on the posterior-
facing cortical surface of maxillary tuberosity.
 Resorption occurs on the opposite side of
same cortical plate, which is the inside surface
of maxilla within the maxillary sinus

19. STAGE 2:
 Involves displacement, as the maxillary
tuberosity grows and lengthens posteriorly, the
whole maxilla is simultaneously carried
anteriorly.
 A protrusion of the forward part of the arch
now occurs, not because of the direct growth
in the forward part itself, but rather because of
the growth of the posterior region of the
maxilla as a whole bone is simultaneously
displaced anteriorly.

20. STAGE 3:
 The mandibular corpus(body) lengthens to
match the elongation of maxilla.
 The anterior part of ramus remodels
posteriorly, a relocation process that produces
corresponding elongation of corpus.
 A class 2 type of relationship still exists
between the maxillary and mandibular molars.

22. STAGE 4:
 The whole mandible is displaced anteriorly,
just as the maxilla becomes carried anteriorly,
while it simultaneously grows posteriorly.
 To do this, the condyle and the posterior part
of ramus remodel posteriorly.

23. STAGE 5:
 The corpus of the mandible elongates primarily in
posterior direction, just as the maxilla also
lengthens posteriorly.
 The whole ramus has moved posteriorly. The only
actual change in horizontal dimension involves the
mandibular corpus, which becomes longer.
 The anterior displacement of the whole mandible
equals the amount of anterior maxillary
displacement.
 The position of maxilla and mandible are now in
balance and class-I position of teeth has been
returned.

24. STAGE 6:
 The dimensions of the temporal lobes of the
cerebrum and middle cranial fossa have also
been increasing at the same time.
 This is done by resorption on the endocranial
side and deposition of bone on the ectocranial
side of the cranial floor.

26. STAGE 7:
 The maxillary tuberosity remains in constant
position on the vertical reference line as this
interface line moves forward.
 The forehead, anterior cranial fossa,
cheekbone, palate and maxillary arch all
undergo protrusive displacement in an anterior
direction.
 This is called secondary displacement.

27.  The floor of the middle cranial fossa is carried
forward as the temporal and frontal lobes of
the cerebrum growth increases.
 The nasomaxillary complex, suspended by
sutures from anterior cranial fossa and frontal
lobes, is thus carried anteriorly as the
combined frontal and temporal lobes
progressively expand.

29. STAGE 8:
 The expansion of the middle cranial fossa also
has the effect on the mandible. This too is
secondary type of displacement.
 The extent of displacement effect , is much
less than that of maxilla.
 The upper incisors show overjet and the
molars are in class-ll position.

31. STAGE 9:
 The horizontal extent of the middle cranial
fossa elongation is matched by the
corresponding extent of horizontal increase by
ramus.
 The horizontal dimensions of ramus equals
horizontal dimensions of middle cranial fossa.

33. STAGE 10:
 The oblique manner of condyle growth necessarily
produces an upward and backward projection of
condyle with a corresponding downward and
forward direction of the mandibular displacement.
 This results in further descend of mandibular arch
and separation of occlusion.
 The total extend of the vertical growth must match
the total vertical lengthening of nasomaxillary
complex.
 The molars have once again returned to Class-I
position and the upper incisors have no overjet.

35. STAGE 11:
 Nasal bones are displaced anteriorly.
 The posterior-anterior length of anterior cranial
fossa is now in balance with the extent of
horizontal lengthening of the structural
counterpart, the maxillary arch.

37. STAGE 12:
 The vertical lengthening of nasomaxillary
complex, as with the horizontal elongation is
brought about by:
1. Primary displacement movement
2. Growth by deposition and resorption.
 The combination of resorption on the superior
side of palate and deposition on the inferior
side produces downward remodelling
movement of whole palate.

39. STAGE 13:
 Maxilla is carried inferiorly by physical growth
forces of enclosing soft tissues.
 This is accompanied by bone deposition in
sutures responding to mutual growth signals
relating to both displacement and remodelling.
 The increment of bone growth in suture exactly
equals the amount of inferior displacement of
whole maxilla.
 This is the primary displacement.
 Vertical drift of the tooth occurs i.e., the movement
of the tooth by its own movement as bone is
added and resorbed on appropriate linning
surfaces in each socket.

41. STAGE 14:
 The maxillary arch has grown downwards.
 Now the mandibular teeth and alveolar bone
drift upward to attain full occlusion. This is
produced by superior drift of mandibular tooth,
together with the remodelling increase in the
height of alveolar bone.
 The extend of this upward movement plus that
of the downward growth movement by
maxillary arch equals the combined extent of
vertical remodelling by the ramus and middle
cranial fossa.

43. STAGE 15:
 The remodelling changes also occur in the incisor
alveolar region, the chin and the corpus of the
mandible.
 Lower incisors undergo lingual tipping for proper
overbite.
 The movement of teeth is accompanied by
resorption on the labial surface of the alveolar
region just above the chin and deposition on the
lingual side.
 Bone is progressively added to the external
surface of chin itself as well as the underside and
other external surfaces of corpus.

45. STAGE 16:
 The forward part of zygoma and malar region
of maxilla remodel.
 The malar area remodels posteriorly by
deposition on posterior side and resorption on
the anterior side.
 The front surface of whole cheek bone is thus
resorptive.
 The amount of deposition on posterior side,
exceeds resorption on anterior surface so that
the whole malar prominance is larger.

47. STAGE 17:
 The malar area is moved anteriorly and
inferiorly by primary displacement as it
enlarges.
 The cheek bone thus proportionately matches
the maxilla in…
1. The directions and amount of horizontal and
vertical remodeling relocation.
2. The directions and amount of primary
displacement.

48. CONCLUSION
 The final result is a craniofacial composite that
has essentially the same form and pattern
when the first stage was begun.
 Only the overall size has been altered.
 All the growth changes among the specific
parts and counterparts has been purposefully
balanced to give an understanding of the
meaning of ‘balanced growth’.

49. VON LIMBORGH’S THEORY
 Von Limborgh in 1970
 This theory is conceptual, taking only the
positive aspects of Scott’s cartilaginous
theory, sutural dominance theory by
Sicher and Moss, Functional matrix
theory.
 He suggested 6 factors that controls
growth.
 Van Limborgh lists the essentials of all
three hypothesis.

50. 6 factors that control growth
1. Growth of synchondrosis and endochondrial
growth is exclusively under the control of
intrinsic growth factors.
2. The intrinsic factors controlling
Intramembraneous growth i.e., growth at
sutures, periosteum growth to a larger extend
are general in nature.
3. Cartilaginous parts of the skull must be
considered as growth centres.

51. 4. Sutural growth is controlled by both
cartilaginous growth and growth of adjacent
structures in the head.
5. Periosteal growth to a large extend depends
on growth of adjacent structures.
6. Intramembraneous bone formation is
additionally influenced by local non- genetic
environmental factors inclusive of muscle
forces.

52. REFERENCES:
 CONTEMPORARY ORTHODONTICS
----BY WILLIAM R. PROFFIT.
 BOOK OF ORTHODONTICS
---- BY OM PRAKASH KHARBANDA.
 ESSENTIALS OF FACIAL GROWTH
---- BY ENLOW AND HANS.