MARIA DEL PILAR GONZALEZ

AGUSTIN GUETTE

UAH
UNIVERSITY
ANTONIO NARIÑO

INRODUCTION

ENLOW THEORY

In this seminar the growth model proposed by

Enlow will be described. We will use the
Enlow model to interpret bone modeling
patterns with the intention of determining the
mode of growth of the facial skeleton and jaw
 within the skull assembly.

Cayetana Martínez Maza. ONTOGENY AND PHYLOGENY OF BONE MODELING IN THE FACIAL SKELETON AND THE JAW OF HOMINOIDS: STUDY OF
THE NEANDERTHAL PHYLOGENETIC LINE FROM THE SAMPLES FROM ATAPUERCA-sh AND EL SIDRÓN. Madrid, 2007
 DONALD ENLOW

(January 22, 1927 – July 5, 2014)

biologist, paleontologist, anatomist and worked as

a geologist.

He knew how to read the meaning of the different

layers that exist on Earth and later applied it to
the study of the different histological sections
observed in the bones of the skull and face.
ENLOW THEORY

In the early 1960s, Dr. Donald Enlow synthesized a theoretical framework with which to
analyze the growth of the mammalian skull (Enlow, 1963, 1982). On this basis, he
proposed a growth model of the craniofacial complex of primates that constitutes the
José Chaqués Asensi and Andreu Puigdollers. Craniofacial growth according to Enlow. Rev Esp Orthod. 2015;45:179-
80
 basic reference for the analysis of craniofacial growth.

Cayetana Martínez Maza. ONTOGENY AND PHYLOGENY OF BONE MODELING IN THE FACIAL SKELETON AND THE JAW OF HOMINOIDS: STUDY OF
THE NEANDERTHAL PHYLOGENETIC LINE FROM THE SAMPLES FROM ATAPUERCA-sh AND EL SIDRÓN. Madrid, 2007
IX
 ENLOW THEORY

The model proposed by Enlow (Enlow, 1982 and Enlow & Hans, 1996) is based on a
reference system composed of the occlusal and posteromaxillary (PM) planes. This system
allows analyzing the different types of movements of the skull structures, cortical drift and
primary and secondary displacements.

Cortical drift : Primary offset Secondary offset

Cayetana Martínez Maza. ONTOGENY AND PHYLOGENY OF BONE MODELING IN THE FACIAL SKELETON AND THE JAW OF HOMINOIDS: STUDY OF
THE NEANDERTHAL PHYLOGENETIC LINE FROM THE SAMPLES FROM ATAPUERCA-sh AND EL SIDRÓN. Madrid, 2007
 ENLOW THEORY

A Enlow (1982) first establishes the different

relationships between the structures of the skull,
always taking as reference the posteromaxillary
and
Cavity

FLAT
OOLUSA

Figure 6.1. Schematic drawing showing the

con Traparts of the craniofacial system . The
vertical line is the posteromaxillary plane
 (PM) and the horizontal line is the occlusal
plane. Taken from Enlow (1982).
Cayetana Martínez Maza. ONTOGENY AND PHYLOGENY OF BONE MODELING IN THE FACIAL SKELETON AND JAW OF HOMINOIDS STUDY OF THE
NEANDERTHAL PHYLOGENETIC LINE FROM SAMPLES FROM ATAPUERCA-sh AND EL SIDRÓN. Madrid, 2007

ENLOW THEORY

It describes, from maxillary and mandibular histological sections, the behavior of

resorption and apposition in the different areas of the bone and the principles that
govern its growth. Reports the processes of remodeling, relocation, displacement,
counterparts, principle of the V, etc. He illustrates in detail all his work making it
understandable, he is continually cited when talking about craniofacial growth and
development.

Divided into 17 stages or

regional changes
ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages Aguila Juan, Donald
Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 1

actual elongation of bow

maxilla, is produced by a
continuous deposition of bone
in a backward direction on
the back face of the
N maxillary
tuberosity.

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 2

As bone is added to the

posterior surface of the
tuberosity, the entire maxilla
moves in an opposite anterior
direction.

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 3
4 The body of the mandible
lengthens to match maxillary
growth and achieves this by
remodeling conversion from
the ramus.

BRANC
H
BODY

ENLOW Donald H. Maxillofacial Growth, Editorial Interamerican - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, facial skull growth (orthodontics and orthopedics) book copy internet
provide body elongation. Bone growth occurs at the mandibular
condyle and along the posterior part of the ramus to the same
extent that the anterior part has undergone resorption.

REGIONAL CHANGE 4

subsequently for

Fig. 3-8

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 5
the mandibular ramus moves
progressively backwards
by a combination of
apposition and reabsorption
as the part does this
\ anterior branch is remodeled J

Fig. 3-9

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 5

Aguila Juan, Donald Enlow, facial skull growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 6
A The dimensions of M increase
the
middle
cranial
fossa, this
occurs
due to
resorption
on the

Fig? 3-11.

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 endocranial side and bone
accumulation on the external
part of the
\ floor of the skull
 REGIONAL CHANGE 7
A The entire maxillary region and
fossa D
cranial former are
displaced anteriorly due to
expansion of the middle cranial
fossa N.

Fig. 3-12

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 8
branch grows way
correspondent
from in the
equivalent dimensions to move
the mandibular arch forward to
the same extent.

Fig. 3-13. Fig. 3-14.

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 9
Simultaneously with the
growth process described
above, the entire jaw
undergoes a
displacement towa
rd
forward and down. This places
the mandibular arch in the
correct horizontal position
with respect to the maxillary
arch.

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 10
A The entire jaw moves M
in the sense prior to it
time growing backwards. The
magnitude of said anterior
displacement is equal to the
magnitude of posterior growth
of the ramus and condyle.

Fig. 3-16

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
The floor and anterior cranial
fossa and forehead grow by
accumulation on the exocranial
side and REGIONAL CHANGE 11
resorption
from the
endocranial
side.

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 12
A The vertical elongation of the M
nasomaxillary complex, as well
that its horizontal elongation
It is produced by deposit and
resorption and movement
displacement primary
directly linked
with its own enlargement

Fig. 3 18

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 12

The anterior portion of the upper bony

arch has a periosteal resorption surface,
since this area grows downward in a
straight line.

Fig. 3-19. (From Enlow, D. H. and S. Bang: Growth and

remodeling of the human maxilla. A.M. J. Orthodox. 51:446,
1965.)

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 growth in the various sutures of the jaw
where it makes contact with the other
bones above and behind it. in such
sutures bone is added as the entire jaw
is
REGIONAL CHANGE 13
N moves ingrowth
a lower vertical by
displacement
direction links with the

Fig. 3 21. Fig. 3 22

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 14
upper arch grows
down to level. Then the lower
teeth and alveolar bone grow
so
ascending to reach a
Complete non -
occlusion

Fig. 3-23.

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 15
While occur
movements
growth in teeththe
ascendants
lower and alveoli, of
remodeling
changes also occur in the area

alveolar of the incisors, the

mandibular and body
chin. the

Fig. 3-24.

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
A As the maxilla lengthens horizontally by
posterior growth, the malar region also
grows posteriorly through continuous
REGIONAL CHANGE 16
deposition of new bone on its posterior
side and resorption on its anterior side.

Fig. 3-25

ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
 REGIONAL CHANGE 17
4 At the same time that the entire maxillary
complex M moves in an anteroinferior
direction, its global size simultaneously
increases, the cheekbone is directed
forward and downward by
displacement
\ primary as it gets larger
CONCLUSION

• Enlow in his theory tells us that mandibular growth occurs through

zones of apposition and resorption of the mandible.

Fig. 3-27.
ENLOW Donald H. Maxillofacial growth, Editorial Interamericána - McGraw-Hill, 1992 - 575 pages
Aguila Juan, Donald Enlow, craniofacial growth (orthodontics and orthopedics) book copy internet
• Enlow in his theory also gives us two basic and classic principles of
growth:

• Remodeling as a phenomenon that modifies the shape of the bone

unit.
• The spatial displacement of each bone as a result of its own
remodeling
 CONCLUSION

• Each bone undergoes a primary displacement, due to its own

growth.

• The bones undergo secondary displacement due to the growth of

neighboring bones.

• In the same structure there are different intensities and rates of

growth, determined by the different moments of development .
 CONCLUSION

• Enlow mentions that in any facial or cranial bone, growth does not
occur due to the generalized and simple process of deposition of new
bone tissue.

• This theory highlights that the facial bones do not simply grow forward
and downward; during the development of the entire bone, many
directions of growth occur.
Mexican Dental Magazine eaauaa oe otdcg 0»8
VoL 16, No. 2 • Apr-June 2012

pO 88-97 ORIGINAL WORK

Study of craniofacial growth in patients with sequence

of Pierre Robin (SPR) not subjected to distraction osteogenesis
(DO)
Sfiiiiy of craniofacial growth in Pierre Robin sequence (PRS) patients not
subjected to osteogenic distraction (OD)
RP Escudero Canto/ M Yudovich Burak / M Aguilar Saavedra," F Ortiz Monasterio T

SUMMARY ABSTRACT

A study of craniofacial growth was carried out in patients with Pierre Rob n sequence We studied the craniofacial growth of patients with Pierre Robin's sequence {PRS) not
(PRS) and subjected to 05-theogenic distraction (DO), with the purpose of knowing the submitted to distraction on osteogenes is, in or der to learn the behavior of the
behavior of the partial compensatory growth of the maxillo-mandibular complex and compensatory part al growth of the maxlo-mandibular complex and to determine if its
determining If this growth is within the established cephalometric norms, the type of growth pattern is within the parameters of the known cephalometric norms. This is a
study was descriptive, open, observational and retrospective in 1 D patients with PRS descriptive, open, observational and retrospective study n 10 patients with PRS not
undergoing DO. The main researcher performed 220 cephalometric tracings on lateral submitted to OD. All examinations and mea surements were perfumed by the author,
skull x-rays, after calibration through the Kappa test. Including data from cetaometric with a previous calibration with the Kappa test. 220 trac ngs in lateral The behavior of
analyzes by Harvold, Ricketts. Riedel and Jarabak. The Man" Whitney U test was used the craniofacial growth showed a tendency to vertical excess At 4, 5, 6 and 12 years
with a significance level of p « 0.05. The growth behavior in patients without OD the growth was vertical while at 7 years a patient showed a trend to normality and at B
presents a tendency towards verticality . At 4, 5, 6 and 12 years the growth was years the growth was horizontal. The behavior of the maxillary growth lenses to vertical
vertical, while at 7 years a patient showed a tendency cia to normality and over the excess with supraocclusion and retrusion in 80% of the cases. The skeletal pattern that
years the growth was horizontal. The behavior of the maxilla in its growth was with a prevailed was of a class II that upsets the value of the facial depth (Po-Or/N-Pg) found
vertical tendency, manifesting with supraocclusion and retrusion in B0 % of cases . The under the n orm n the 1 D cases studied. Patients with PRS not submitted to OD, are
skeletal pairan that predominated class II fije, in The facial depth value (Po-OrN-Pg) below the patterns growth determined by the cephalo metric measurements of the
was altered BELOW the norm in the 10 cases studied. SPR patients not subjected to DO norm.
are even below the limits established by cephalometric standards.

Keywords: Pierre Robin sequence, craniofacial growth, cephalometry, distraction osteogen ca.
Key words: Pierre Robin's sequence, craniofacial growth, cephalometric traces, cephalometric measurements, distraction osteogenesis.
 STUDY OF CRANIOFACIAL GROWTH IN PATIENTS
WITH SEQUENCE OF PIERRE ROBIN (SPR) NOT SUBJECTED TO
OSTEOGENIC DISTRACTION (OD)

These results reaffirm the concepts of cre foundation and

craniofacial development dictated by Dr. Enlow, in which, any
repercussion of growth cannot be isolated and involves a pair
system tes and counterparts, which influenced by the growth
peaks and the functional matrix delimit the final growth model,
as Dr. Moss referred to it , the function describes the form.
 BIBLIOGRAPHY

1. ENLOW Donald H. Maxillofacial growth, McGraw-Hill Inter-American

Publishing House, 1992 -575 pages

2. Aguila Juan, Donald Enlow, facial skull growth (orthodontics and

orthopedics) book copy internet

3. Cayetana Martínez Maza. ONTOGENY AND PHYLOGENY OF BONE

MODELING IN THE FACIAL SKELETON AND THE JAW OF
HOMINOIDS: STUDY OF THE NEANDERTHAL PHYLOGENETIC LINE
FROM THE SAMPLES FROM ATAPUERCA-sh AND EL SIDRÓN.
Madrid, 2007

4. José Chaqués Asensi and Andreu Puigdollers. Craniofacial growth

according to Enlow. Rev Esp Orthod. 2015;45:179-80