青少年面部组织与微笑相关数据的测量分析

目的：研究面部软硬组织与美的微笑的关系。方法：用数码相机拍摄60名个别正常黯的青少年面部正面像各数张（男30名,女30名）,由正畸医生和普通人用visual analog scale（VAS）评判美的微笑,用微笑网格软件测量微笑照片相关15项数据后经统计学处理。结果：1）经方差分析（F=7．415,P〈0．05）,显示正畸医生与普通人的微笑主观评分有统计学差异。2）经Pearson相关分析,正畸医生对美的微笑的主观评分高低与牙龈暴露量呈负相观（r=0．275,P〈0．05）,与上切牙暴露量呈正相观（r=0．209,P〈0．05）,与上下唇间隙呈负相观（r=0．40,P〈0．05）,普通人对美的微笑的主观评分高低与上切牙暴露量呈正相观（r=0．345,P〈0．05）。3）正畸医生对美的微笑主观评分的影响因素由大到小依次为：牙龈暴露量,上切牙暴露量,上下唇间隙,普通人对美的微笑主观评分的影响因素仅为上切牙暴露量。结论：1）正畸医生与普通人对美的微笑的审美观不一致,正畸临床诊治患者过程中,双方需加强沟通。2）上切牙暴露量是影响正畸医生与普通人对美的微笑主观评分的主要因素,提示正畸医生在诊治患者过程中应注意上切牙位置。     

青少年姿势位微笑与头影测量指标的相关分析

目的对比普通人与正畸医生对姿势位微笑的审美观异同，研究面部软硬组织与姿势位微笑的关系。方法用Canon EOS 50D数码照相机拍摄60名（男30名，女30名）个别正常胎的青少年面部正面照片数张，由正畸医生和普通人用视觉模拟尺度（VAS）评判美的微笑，并测量头颅侧位片的相关数据，最后经SPSS13．0统计软件进行统计学分析。结果1）正畸医生与普通人的微笑主观评分差异有统计学意义；2）正畸医生对姿势位微笑的主观评分高低与SNA角和SNB角呈负相关，与U1-L1角呈正相关；普通人对姿势位微笑的主观评分高低与MP角、PP—MP角和颏唇沟角呈正相关。结论1）正畸医生与普通人对姿势位微笑的审美观有差异，在正畸临床诊治患者的过程中，医患双方需加强沟通；2）正畸医生在诊治患者的过程中应关注患者面部侧貌的凸度及其面下1／3的协调美观。     

福建地区汉族人群对微笑美学参数喜好度的研究

目的    探讨微笑美学参数的改变对微笑美的影响,并研究福建地区汉族人群对微笑美学参数的喜好度,为临床诊疗提供参考。方法　选取1张美观协调的志愿者（福建医科大学口腔医学院本科生）微笑图像作为模板图像,通过调整颊隙率、侧切牙与中切牙宽度比值、上中切牙宽长比例和牙龈暴露量等微笑美学参数对模板图像进行修改,获得24张微笑图像,作为调查资料。选择2019年3—9月于福建医科大学附属口腔医院就诊的成年患者158例［男75例、女83例,年龄（29.8 ± 5.5）岁］作为调查对象,对24张微笑图像进行视觉模拟评分（visual analogue scale,VAS）,并对所获VAS评分进行Kruskal-Wallis检验和Mann-Whitney检验。结果　颊隙率为0 ~ 15%、侧切牙与中切牙宽度比值为62% ~ 87%、上中切牙宽长比例为80% ~ 95%,以及牙龈暴露量为-1 ~ 1 mm时,其VAS评分在相应微笑美学参数中相对较高（均P < 0.05）。结论    颊隙率、侧切牙与中切牙宽度比值、上中切牙宽长比例以及牙龈暴露量均可对微笑美产生显著影响。     

拔牙位点保存后与同期引导骨再生术种植红色美学效果临床比较

目的　评价美学区拔牙位点保存与同期行引导骨再生术（GBR）种植修复的红色美学效果。方法　随机选取2015年9月至2017年3月就诊于新疆医科大学第二附属医院口腔科美学区牙列缺损患者32例,以术式不同分组。A组14例,美学区拔牙位点保存后延期种植;B组18例,延期种植同期行GBR。上部结构修复完成后即刻和第6、9个月,由口腔修复医生和正畸医生对红色美学区进行红色美学指数评分（PES）,并由患者对主观满意度进行视觉模拟评分（VAS）。结果　在修复后即刻和第6、9个月,A组PES评分分别为（11.54 ± 0.69）、（12.57 ± 0.63）和（11.93 ± 0.60）分,VAS评分分别为（8.64 ± 0.50）、（9.79 ± 0.43）和（8.17 ± 0.61）分;B组PES评分分别为（10.17 ± 0.38）、（11.16 ± 0.46）和（11.02 ± 0.45）分,VAS评分分别为（7.22 ± 0.64）、（8.06 ± 0.64）和（8.28 ± 0.67）分。A组各时间点的PES评分和VAS评分均优于B组（均P＜0.05）,患者对红色美学效果满意度VAS评分与医生的PES评分明显相关（P＜0.05）。结论　美学区拔牙位点保存后种植修复的红色美学效果以及患者满意度优于同期行GBR的延期种植修复,患者满意度VAS评分与医生PES评分明显相关。     

应用3D数字化面部重建评估上颌尖牙垂直位置对微笑美学的影响

目的： 探讨上颌尖牙垂直位置改变对正面观和侧面观微笑美学的影响,寻找能被口腔医师和非专业人士接受的尖牙位置。方法： 选取一名志愿者,通过口内扫描和面部三维扫描,获取牙列和面部软组织图像并进行配准。在计算机辅助设计软件中,将上颌尖牙的垂直位置以0.5 mm为变量,自原始位置向牙合方1 mm和龈方1 mm进行数字化改变,重建三维虚拟数字化微笑面容。选取60名口腔医师和60名非专业人士,采用视觉模拟评分法,分别从正面和右侧45°对5个数字化微笑面容进行评分。将数值输入SPSS 20.0软件包,采用重复测量资料的方差分析比较2组间对数字化微笑面容的评分差异,采用秩和检验分析不同评价角度的评分差异。结果： 尖牙垂直位置改变对笑容评价有显著影响（P<0.05）,口腔医师和非专业人士对上颌尖牙垂直位置改变后微笑面容的美学评价存在显著差异（P<0.05）;评价角度不同,对微笑美学评价的差异无统计学意义（P>0.05）。结论： 尖牙牙尖相对侧切牙切缘于龈方0.5 mm时的笑容最美观,尖牙牙尖超过侧切牙切缘的笑容则不美观。临床上可参照所得数值,进行前牙美学设计。     

正畸医生与正畸患者对面部美学的评价及其差别

目的 通过Q分类法来调查正畸医生与正畸患者对面部美学的评价及其差别,同时调查男性与女性对面部美学的评价及其差别。 方法 将96例正畸完成后的患者（男、女各48例）临床照片由20名经验丰富的正畸医生（男7名,女13名）和25例正畸患者（男13例,女12例）用Q分类法进行评价。Kappa检验和McNemar检验用来评估正畸医生和正畸患者之间,以及男女之间对面部美学评价是否一致和其差别。 结果 在对男性面部美观调查中,正畸医师与正畸患者的评价具有较高的一致性,男性与女性的评价具有较高的一致性。在对女性面部美观调查中,正畸医师与正畸患者的评价的一致性较差,男性与女性评价的一致性也较差。 结论 正畸医师与正畸患者对面部美观的评价基本一致;男性与女性对面部美学的评价基本不一致。     

微笑时上颔前牙龈乳头暴露：笑线的临床研究

本研究的目的是对年龄为10～89岁的患者，在大笑时牙龈乳头的暴露（存在）或不暴露（缺失）情况进行量化评估。用单反数码相机对420名患者进行拍照并检查大笑时上颌前牙龈乳头的暴露情况。分别取得每位患者的正面像．右侧面像和左侧面像，共3张数码影像。由两名检查人员对影像数据进行分析．从而获得有无牙龈乳头暴露的基本情况。本研究发现420名患者中有380名患者（发生率为91％）．在大笑时牙龈乳头暴露。87％患者归类为低笑线型（n=303）．即微笑时暴露牙龈乳头。以10年为间隔的年龄组问存在差异．并且随着年龄的增长，存在牙龈乳头暴露量越多的趋势。动态微笑时牙龈乳头暴露应该得到重视．因为它出现在超过91％的老年患者和87％的低笑线患者中．是一种普遍和重要的美学元素．在患者微笑分析中可起到评估的作用。     

成人拔牙正畸矫治中骨密质松解术与尖牙快速移动对加速远中移动尖牙的效果分析

观察成人拔牙正畸矫治中应用骨密质松解术与尖牙快速移动装置的效果分析。方法 选取2015年9月～2017年7月本院收治错畸形患者64为研究对象,按照随机数字表法分为对照组和研究组各32例,对照组采用常规拔牙正畸矫治,研究组在拔牙正畸中采用骨密质松解术与尖牙快速移动装置进行矫治。观察两组尖牙远移到位时间、牙周情况、尖牙牙根吸收情况,比较两组并发症情况。结果 研究组尖牙远移到位时间显著短于对照组;治疗后3个月,两组牙龈指数（GI）、龈沟出血指数（SBI）和菌斑指数（PLI）均显著升高（P＜0.05）,研究组与对照组比较差异无统计学意义（P＞0.05）;尖牙远移到位后,研究组尖牙牙根吸收体积显著小于对照组（P＜0.05）;两组并发症发生率比较差异无统计学意义（P＞0.05）。结论 成人拔牙矫治中应用骨密质松解术与尖牙快速移动装置能加速尖牙的远中移动,且安全性较好。     

不同下唇上缘曲线对前牙微笑弧美观性的影响研究

目的:研究不同下唇上缘曲线形态在正畸结束患者中的分布比例及不同微笑弧曲度对V形和梯形下唇上缘曲线患者微笑美观性的影响.方法:纳入300名正畸矫治结束患者,统计不同下唇上缘曲线形态的分布比例;采用视觉模拟量表法形成不同上颌中切牙与侧切牙垂直距离及不同下唇上缘曲线的组合微笑图,由正畸医生、口腔修复医生和普通人对组合图片的美观性进行评价及比较.结果:圆缓形、V形和梯形下唇上缘曲线的患者比例分别是54.7％、23.3％和23.0％.对于V形下唇上缘曲线的患者,3组评价者均认为2 mm的上颌中切牙及侧切牙切缘垂直距离差的微笑是最美观的.对梯形下唇上缘曲线的患者,正畸医生和普通人选择曲度较平的微笑弧.结论:正畸医生在制定矫治方案时应充分考虑下唇上缘曲线形态对微笑弧美观性的影响,为患者制定个性化的微笑弧.对于V形下唇上缘曲线患者,不可随意压低其上颌前牙,微笑弧曲线可稍深一些,梯形下唇上缘曲线的患者微笑弧建议稍平一些.     

不同拔牙模式正畸矫治对成年女性牙弓宽度和软组织正貌的影响

目的：研究不同拔牙模式对安氏Ⅱ1错牙合成年女性治疗前后牙弓宽度和面部软组织正貌的影响。方法：将40例安氏Ⅱ1错牙合需拔牙矫治的成年女性患者随机分为两组。 A组拔除上颌2颗第一前磨牙,下颌拔除2颗第二前磨牙,B组拔除4颗第一前磨牙。分析比较两组病例治疗前后牙弓宽度和面部软组织正貌指标的变化。结果：正畸治疗后,组内比较显示两组病例上下颌尖牙间宽度均增加,上下颌第一磨牙间宽度均减小,差异有统计学意义（P＜0.05）;组间比较仅下颌尖牙和下颌第一磨牙间宽度变化有统计学意义（P＜0.05）,B组下颌尖牙宽度增加量大于A组,B组下颌第一磨牙牙弓宽度减小量小于A组。治疗前后比较,两组病例在面宽、口裂宽、下颌角间宽、容貌面长和鼻下颏下距的差异均无统计学意义（P＞0.05）。Pearson相关性分析显示牙弓宽度与软组织正貌指标之间无相关关系（P＞0.05）。结论：安氏Ⅱ1错牙合病例正畸矫治后成年女性软组织正貌的变化不受拔牙模式影响,不同拔牙模式仅影响矫治后牙弓宽度的变化。     

Effect of posterior gingival smile on the perception of smile esthetics

Objectives: To evaluate and compare the influence of posterior gummy smile on the perception of smile esthetics by orthodontists, general-dentists and laypersons. Study Design: A frontal photograph of a smile with normal gum exposure was chosen and manipulated digitally using Adobe Photoshop C3 to generate three further images with posterior gum exposure of 4, 6 and 8mm. These four images were assessed by the three evaluator groups: orthodontists (n=40), general-dentists (n=40) and laypersons (n=40). Both orthodontists and dentists had at least ten years professional experience and laypersons were aged between 40-50 years. The proportion of men to women was 20:20 in each group. Evaluators awarded a score to the smile esthetics of each image: 1=acceptable, 2=moderately acceptable, 3=unacceptable. Afterwards, each evaluator placed the four images in order of esthetic preference. Results: No significant differences (p>0.05) were detected between the three evaluator groups for the photo without posterior gummy smile. The perception of smile esthetics for a the 4mm posterior gummy smile (median for orthodontists=2, general-dentists= 1, laypersons=1), the 6mm (median for orthodontists=2, general-dentists=1, laypersons=1) and the 8mm (median for orthodontists=3, general-dentists=2, laypersons=2) was significantly different between orthodontists and the other two evaluator groups (p<0.0017). The three evaluator groups coincided in placing the image with the 6mm gum exposure in first place in order of esthetic preference. Conclusions: Posterior gummy smile influences the perception of smile esthetics more negatively among orthodontists than the rest of the groups. Key words:Aesthetics, gummy smile back, orthodontists, dentists, laypersons.     

正畸可控的笑容特征指标对微笑美的影响研究

目的 探讨各项正畸可控的笑容特征指标与微笑美的相关性。方法 选取男女微笑时面下1/3照片各1张,利用Photoshop依据各指标（切牙暴露量、露龈量、笑弧、颊廊、上颌牙合平面倾斜度及上切牙下唇间距）分别进行变动,选择200名大学生对其进行评价。数据输入Spss 19.0 统计软件包,将每项指标对应各图得分与该指标的变化进行等级资料Spearman相关分析。结果 男女笑容图的得分均与切牙暴露量、笑弧一致性成正相关（P<0.05）,与露龈量、颊廊面积、上颌牙合平面倾斜度、上切牙下唇间距成负相关（P<0.05）。结论 唇齿龈的相对位置对笑容的美观有显著影响,正畸过程中应注意调控。     

Smile esthetics: perception and comparison of treated and untreated smiles.

INTRODUCTION: Although orthodontic treatment is based primarily on occlusal relationships, greater attention is now paid to enhancing dentofacial characteristics to produce optimal facial esthetics. The purposes of this study were to compare smile esthetics among extraction and nonextraction patients and a control group, assess certain dentofacial characteristics in those groups, and discuss how these features relate to smile esthetics. METHODS: Panels of orthodontists, plastic surgeons, artists, general dentists, dental professionals, and parents used a 5-point scale to rate smiling photographs of 25 extraction, 25 nonextraction, and 25 untreated control subjects. Dentofacial characteristics of the 3 groups were obtained from lateral cephalometric analyses, direct biometric measurements, and frontal photographs. Smile esthetics and differences among the 3 groups were subjected to 1-way analysis of variance (ANOVA), and Pearson correlation coefficients were calculated to determine the relationship of the variables to the esthetic score. RESULTS: The mean esthetic scores for the extraction, nonextraction, and control groups were 3.15, 3.12, and 3.26, respectively. Visible dentition width relative to the smile width ratio and intercanine distance relative to smile width ratio were significantly different among the groups, with extraction patients showing a slightly wider dental arch relative to the soft tissue (P < .05). There was also a significant difference in the U1-SN angle among the groups (P < .05), and this variable showed a strong correlation with the esthetic score as did maxillary gingival display (P < .05). However, our study groups could not be differentiated in smile esthetics.     

The Role of the Posed Smile in Overall Facial Esthetics

Objective:To evaluate the role of the posed smile in overall facial esthetics, as determined by laypersons and orthodontists.Materials and Methods:Twenty orthodontists and 20 lay evaluators were asked to perform six Q-sorts on different photographs of 48 white female subjects. The six Q-sorts consisted of three different photographs for each of two time points (pre- and posttreatment), as follows: (1) smile-only, (2) face without the smile, and (3) face with the smile. The evaluators determined a split-line for attractive and unattractive images at the end of each Q-sort. The proportions of attractive patients were compared across Q-sorts using a Wilcoxon signed-rank test for paired data. The evaluators also ranked nine facial/dental characteristics at the completion of the six Q-sorts.Results:Evaluators found the pretreatment face without the smile to be significantly more attractive than the face with the smile or the smile-only photographs. Dissimilar results were seen posttreatment; there was not a significant difference between the three posttreatment photographs. The two panels agreed on the proportion of “attractive” subjects but differed on the attractiveness level of each individual subject.Conclusions:The presence of a malocclusion has a negative impact on facial attractiveness. Orthodontic correction of a malocclusion affects overall facial esthetics positively. Laypeople and orthodontists agree on what is attractive. Overall facial harmony is the most important characteristic used in deciding facial attractiveness.     

Effect of extraction of first four premolars on smile aesthetics

The objective of the present study was to assess smile aesthetics after orthodontic treatment in subjects with and without the extraction of four first premolars. Post-treatment coloured frontal photographs (4 × 6 inches) of 60 Pakistani subjects, 21 males and 39 females, aged between 15 and 30 years were assessed by one examiner. For 50 per cent (n = 30) of the patients, treatment included the extraction of four first premolars, whereas the other half were treated without extractions. Smile aesthetics were evaluated by a panel of 10 laypersons, five males and five females, aged between 20 and 30 years. Smile aesthetic parameters were measured using seven variables, and the ratios were calculated. An independent sample t-test was used to assess smile aesthetics. All seven variables namely smile width, smile height, visible dentition width, maxillary intercanine width, visible maxillary first molars, visible mandibular teeth, visible maxillary gingival margin, and the ratios between the above mentioned variables showed no detrimental effects following extraction of four first premolars on smile aesthetics.     

Attractiveness of variations in the smile arc and buccal corridor space as judged by orthodontists and laymen

OBJECTIVE: To evaluate changes in attractiveness on the basis of computerized variations of smile arcs and buccal corridors for male and female smiles judged by orthodontists and laypersons. MATERIALS AND METHODS: Using a visual analog scale in a Web-based survey, orthodontists and laypersons rated the attractiveness of nine digitally altered smile arc and buccal corridor variations of male and female smiles. The variations were accomplished in a clinically relevant manner and based on standards set by experienced orthodontists in a pilot web-based survey. RESULTS: The results indicate that both laypersons and orthodontists prefer smiles in which the smile arc parallels the lower lip and buccal corridors are minimal. Significantly lower attractiveness ratings were found for smiles with flat smile arcs and excessive buccal corridors. Flattening of the smile arc overwhelms the deleterious effects of excessive buccal corridors on attractiveness ratings. CONCLUSIONS: On the basis of the results of this study, care should be taken not to produce an excessively flat smile arc during orthodontic treatment.     

Extraction vs nonextraction: arch widths and smile esthetics

Dental casts of 30 patients treated with extraction and 30 patients without extraction of four first premolars were randomly selected to determine changes in arch width as a result of treatment. Arch widths were measured from the cusp tips of the canines, premolars, and molars. Posttreatment arch widths were also measured in the midline at a constant arch depth from the most labial surfaces of the incisors. Standardized frontal photographs of the face taken during smiling of 12 extraction- and 12 nonextraction-treated subjects were evaluated. Fifty laypersons judged the esthetics of the smiles. Intercanine width increased less than one mm in both groups, and there was no difference between the two groups. The interpremolar and intermolar distance in both arches decreased significantly from 0.53 to 0.95 mm in the extraction sample, whereas the interpremolar and intermolar widths increased significantly from 0.81 to 2.10 mm in the nonextraction sample. When arch widths of both groups were measured from the most labial surfaces of the teeth at a constant depth, the average arch width of both arches was significantly wider in the extraction sample (1.8 mm wider in the mandible and 1.7 mm wider in the maxilla). The mean esthetic score and the number of teeth displayed during a smile did not differ between the groups. The results indicate that arch width is not decreased at a constant arch depth because of extraction treatment, and smile esthetics are the same in both groups of patients.     

Canting of the occlusal plane: Perceptions of dental professionals and laypersons

Objectives: To determine if canting of the occlusal plane influences esthetic evaluation of the smile among orthodontists, dentists and laypersons. Study Design: A frontal photo of a smile with 0º occlusal plane canting in relation to the bipupillary plane was modified using Adobe Photoshop C3 (Adobe Systems Inc, San José, California) to generate two images with occlusal plane inclinations of 2º and 4º. The three images were evaluated esthetically by orthodontists (n=40) general dentists (n=40) and laypersons (n=40). Each image was awarded a score as follows: 1=esthetically acceptable; 2=moderately acceptable; 3=esthetically unacceptable. Evaluators also placed the three images in order in preference. Data were analyzed using the Kruskal-Wallis (p<0.05) and the Mann-Whitney tests, applying the Bonferroni Correction (p<0.016). Results: No significant differences (p> 0.05) were found between the three groups for 0º and 2º cants (median for orthodontists=1; general dentists=1; laypersons=1). Orthodontists (median score=3) made evaluations of the image with 4º occlusal plane that were significantly different from general dentists (median=2) and laypersons (median=2). All three groups put the 0º image in first place in order of esthetic acceptability, the 2º image in second place and the 4º image in third place. Orthodontists placed the 0º image in first place with significantly greater frequency (p<0.016) than laypersons. Conclusions: Occlusal plane canting of 0º and 2º were evaluated as esthetically acceptable by the three groups. The 4º occlusal plane cant was evaluated more negatively by orthodontists than by general dentists and laypersons. All three groups placed the 0º image in first place of esthetic acceptability, 2º in second place and 4º in third. Orthodontists put the 0º image in first place with significantly greater frequency than laypersons. Key words:Canting, perception, smile, orthodontics, dental esthetics.