正畸治疗与软组织侧貌

咬合与面部美学紧密相关,通过正畸治疗可以改变软组织侧貌,对软组织形态的考虑也会影响正畸医师的矫治设计。作者从软组织侧貌的评价方法、种族差异、生长发育以及与正畸拔牙几方面进行综述。     

正畸矫正目标之美学观念

上一讲我向大家介绍了Dr．Roth的正略功能猪概念，这一讲主要向大家介绍目前在美国正畸界声望颇高的Dr．Kokich的正畸美学新概念。如果说好的希功能是正崎医师能为患者提供的最主要的健康服务，美观却是患者寻求正畸治疗的主要目的。关于侧貌的美观，不同种族有不同的审美观，这里不再重复，本讲主要介绍一些具有共性的正面观牙齿和牙龈位置的美学问题。尽管排齐牙齿是口腔美学的主要部分，但随着牙体修复学、正颌外科、牙周等学科的发展，正崎的美学目标已不仅仅是侧貌美观十牙齿排列整齐了。下面介绍与正畸治疗相关的几个牙齿排列的美学…     

软组织侧貌的美学指标

软组织侧貌的美学指标王云，许天民正畸治疗对侧貌的影响已逐渐为正畸界及患者所重视。而软硬组织形态学表明不能以硬组织结构简单地类推覆盖在其上的软组织，且软组织侧貌并不随着牙列的改善而发生完全一致的改观，因此正畸治疗中不能仅以、颌的分析来预测软组织侧貌的改...     

面部侧貌美学指标临床应用

目的：用５项美学指标评价错牙合治疗前后变化及研究相关的硬组织测量指标在治疗前后如何变化。方法：以２０例成人安氏Ⅰ类双颌前突错牙合正畸治疗前后及对照组５６例正常牙合为资料，进行Ｘ线头影测量。结果：通过正畸治疗许多美学指标及相关的硬组织测量指标都产生了变化。结论：正畸治疗可使侧貌明显改善，但有一定限度。     

唇突度的变化对侧貌美观的审美评价

目的研究唇突度侧貌对审美的影响差异。方法拍摄软硬组织测量值都在正常值范围内的1例男性和女性的侧貌照片。使用图像处理技术改变唇突度,使唇突度各增加2 mm、4 mm、6 mm,再各减少2 mm、4 mm、6 mm,加上原图,男性和女性照片各有7张。请41位正畸医生、43位整形医生、41位正畸患者家长、86位正畸治疗患者和41未曾接触正畸知识的成年人即普通大众进行美学评分。组间比较使用秩和检验,两两比较使用LSD检验方法。结果男性和女性原图得分最高,唇部明显前突的侧貌(c+6)得分最低。正畸医生组对男性唇部前突(c+4)的评分显著低于其他组(P=0.01),同时患者组评分显著低于患者家长组评分(P=0.02)。与异性相比,男性对唇部中度前突(c+4)的侧貌评分更高(P=0.04),而女性对唇部轻度内收(c-2)的侧貌评分更高(P=0.03)。中年组比青年组和少年组对女性侧貌(c-4)的评分更高(P=0.02)。结论正畸医生对唇突度的审美更苛刻,而患者比其家长的审美也更苛刻。女性更加偏爱唇部后缩的侧貌,中年人对侧貌审美最宽容。     

口腔正畸与颌面部美学

口腔正畸是一门基于美学的临床应用学科，通过调整牙齿移动以及颌骨关系来协调鼻唇颏的相互关系。正畸医生需要在术前对患者的面部软组织正貌和侧貌进行充分的分析，了解可能存在的颌面部对称性、水平向、垂直向问题，可能的影响因素（增龄性变化和代偿性变化对面部形态的影响）以及在牙齿正畸时给颌面部形态带来的变化，以引导矫治方案的设计与正畸治疗的实施，有效提高正畸临床的效果，本文将以正畸医生视角对指导正畸方案设计的美学评价作一综述。     

骨性Ⅱ类成年患者不同治疗方式下的侧貌审美评价

目的:评价骨性Ⅱ类上颌前突下颌后缩成年患者不同治疗方式下的侧貌美观.方法:选取1例骨性Ⅱ类上颌前突下颌后缩正畸代偿治疗后的成年女性作为研究对象,拍摄头颅侧位片和侧貌像,运用Photoshop软件模拟得到正畸代偿治疗结合不同前移程度的颏成形手术及正畸-正颌联合治疗的侧貌图共6张,由专业和非专业人员对其评分,采用SPSS22.0软件包对数据进行单因素方差分析及SNK检验.结果:正畸-正颌联合治疗最为美观,正畸代偿治疗结合颏成形手术治疗颏部前移4 mm时次之,前移8 mm时美观程度较正畸代偿治疗差.结论:正畸-正颌联合治疗仍为骨性Ⅱ类上颌前突下颌后缩患者改善侧貌美观的最佳治疗方式.颏成形手术作为一种正畸代偿治疗后的辅助治疗手段,可在一定程度上提高面部的协调及美观,但美学效果不能与正畸-正颌联合治疗相媲美.     

下颌前突畸形手术前后正畸治疗的临床研究

目的:总结下颌前突畸形下颌升支矢状劈开截骨手术前后的正畸治疗,为术后软组织侧貌的预测提供临床数据。方法:介绍术前术后正畸内容,及X线测量分析。结果:正颌手术后侧貌改观明显,正畸使之有稳定的关系。结论:正颌手术前后正畸具有重要的临床意义,术前软组织侧貌的预测为手术提供可靠的依据。     

正畸治疗对软组织侧貌的影响

在寻求牙列整齐的正畸患者中,也存在一部分对面容有需求的患者。另一方面,正畸医师在制定治疗计划时,软组织侧貌的考虑也会影响矫治设计。本文就软组织侧貌的评价方式、各种正畸手段如功能性矫治器、拔牙矫治等对软组织侧貌的影响以及研究进展进行综述。     

正畸正颌联合治疗骨性Ⅲ类错(牙合)畸形侧貌软硬组织变化及相关性分析

目的:测量骨性Ⅲ类错(牙合)畸形正畸正颌联合治疗前后侧貌软硬组织变化及相关性分析,评估正畸正颌联合治疗的美学效果,为更好地预测术后美学性数值提供研究支持。方法:选择32例严重的骨性Ⅲ类错(牙合)畸形患者,并在正畸治疗前、后拍摄CBCT。通过CBCT获得精确的头影侧位片,选择头影测量标记点,测量侧貌相关的角度、厚度、距离。对侧貌相关的角度、软组织厚度进行配对t检验,并对软硬组织的矢状面距离变化进行Pearson相关分析。结果:鼻唇角、颏唇角、下颌平面与SN前下交角、下中切牙长轴与SN后下交角差异显著(P<0.05),上中切牙长轴与SN后下交角差异无统计学意义(P>0.05)。LL’处软组织厚度、Bs处软组织厚度增加,差异有统计学意义(P<0.05),Sn处软组织厚度、UL’处软组织厚度、Pos处软组织厚度差异无统计学意义(P>0.05)。软/硬组织对应点:鼻下点/A点、上唇缘点/上中切牙点、下唇缘点/下中切牙点、颏唇沟点/B点、软组织颏前点/颏前点、软组织颏顶点/颏顶点的矢状向距离变化显著相关,相关系数分别为0.69、0.59、0.73、0.85、0.90、0.97。结论:骨性Ⅲ类错(牙合)畸形患者正畸正颌手术治疗后,侧貌美观明显改善。相关性分析显示,术后颏部位置预测性佳,唇位置预测性差,下颌比上颌更具有可预测性。     

Répercussion de l’orthodontie sur l’esthétique faciale de l’adulte

The aim of this study is to investigate the impact of orthodontic treatment on facial esthetics in adults using soft tissue esthetic analysis in combination with Tweed Merrifield cephalometric analysis. The key lies in labial posture changes at smile and profile level which will enhance the patient's facial appearance. The problem of facial esthetics is just as crucial as occlusal function and will determine both the orthodontic treatment and the mechanics used in the adult patient.     

A therapeutic concept for the combined orthodontic surgical correction of angle Class II deformities with short-face syndrome: Surgical lengthening of the lower face

In today's society not only facial esthetics have become important, but also the information on ways to correct adult orthodontic problems is readily available. Subsequently, increasing number of adults seek orthodontic treatment merely to change their facial appearance. In general, these adult patients exhibit such a severe skeletal deformity that it is noticeable even by non-experts. The nature of these adult deformities is such that the only promising treatment is the combined orthodontic-surgical approach. A stable and functional occlusion with a physiologic position for the condyle is the common goal of orthodontic treatment. In patients with skeletal deformities, however, improvement of facial esthetics takes paramount importance. They judge the success of treatment by extraoral appearance. Accordingly, the clinician must assess both the dental and facial appearance, and then inform the patient of different treatment possibilities. In this scenario, patient's input into the decision making process is critical for a mutually satisfactory result. This clinical report describes a concept of systematic approach to treatment of Class II deformities with skeletal deep bite and short lower face (short-face syndrome). This approach emphasizes the soft tissue analysis.     

A therapeutic concept for the combined orthodontic surgical correction of angle Class II deformities with short‐face syndrome: Surgical lengthening of the lower face

In today's society not only facial esthetics have become important, but also the information on ways to correct adult orthodontic problems is readily available. Subsequently, increasing number of adults seek orthodontic treatment merely to change their facial appearance. In general, these adult patients exhibit such a severe skeletal deformity that it is noticeable even by non‐experts. The nature of these adult deformities is such that the only promising treatment is the combined orthodontic‐surgical approach. A stable and functional occlusion with a physiologic position for the condyle is the common goal of orthodontic treatment. In patients with skeletal deformities, however, improvement of facial esthetics takes paramount importance. They judge the success of treatment by extraoral appearance. Accordingly, the clinician must assess both the dental and facial appearance, and then inform the patient of different treatment possibilities. In this scenario, patient's input into the decision making process is critical for a mutually satisfactory result. This clinical report describes a concept of systematic approach to treatment of Class II deformities with skeletal deep bite and short lower face (short‐face syndrome). This approach emphasizes the soft tissue analysis.     

A therapeutic concept for the combined orthodontic surgical correction of angle Class II deformities with short-face syndrome: Surgical lengthening of the lower face

In today's society not only facial esthetics have become important, but also the information on ways to correct adult orthodontic problems is readily available. Subsequently, increasing number of adults seek orthodontic treatment merely to change their facial appearance. In general, these adult patients exhibit such a severe skeletal deformity that it is noticeable even by non-experts. The nature of these adult deformities is such that the only promising treatment is the combined orthodontic-surgical approach. A stable and functional occlusion with a physiologic position for the condyle is the common goal of orthodontic treatment. In patients with skeletal deformities, however, improvement of facial esthetics takes paramount importance. They judge the success of treatment by extraoral appearance. Accordingly, the clinician must assess both the dental and facial appearance, and then inform the patient of different treatment possibilities. In this scenario, patient's input into the decision making process is critical for a mutually satisfactory result. This clinical report describes a concept of systematic approach to treatment of Class II deformities with skeletal deep bite and short lower face (short-face syndrome). This approach emphasizes the soft tissue analysis.     

Orthodontic treatment of a patient with Lowe syndrome

This article describes the orthodontic treatment of a patient with Lowe syndrome. The objective of the treatment was to improve the patient's dental relationships and consequently his quality of life. This was achieved by maxillary expansion and extraction of the mandibular central incisors and maxillary deciduous canines. The teeth were aligned and leveled with a fixed orthodontic appliance. Satisfactory results were obtained at the end of treatment, with substantial improvement in dental esthetics, occlusal function, and facial profile.     

Correlation between objective and subjective evaluation of profile in bimaxillary protrusion patients after orthodontic treatment

Objective:To correlate the objective cephalometric measurements with subjective facial esthetics in patients with bimaxillary protrusion.Materials and Methods:The sample consisted of 60 Asian-Chinese patients with bimaxillary protrusion who met the inclusion criteria. The facial esthetics of posttreatment profile and the change of profile on standardized lateral photographs were rated by a panel of 10 orthodontists and a panel of 10 lay persons with bimaxillary protrusion. All of the pretreatment and posttreatment cephalograms were digitized and traced. Twenty-five cephalometric measurements were constructed and analyzed. Correlations between the subjective facial esthetic scores and each cephalometric measurement were evaluated.Results:The cephalometric measurements correlated with the facial esthetic scores of posttreatment profile given by the orthodontist and the lay persons were basically the same. For the evaluation of posttreatment profile in bimaxillary protrusion patients, the upper and lower lip to E-line, upper and lower incisor tip to AP plane, Pg-NB distance, mentolabial angle, and sulcus depth correlated significantly with the esthetic score. For the evaluation of profile change during orthodontic treatment, retraction of upper incisor relative to AP plane or the perpendicular line through sella (line Y), change of upper incisor inclination, change of mentolabial sulcus depth, and retraction of lips relative to E-line were correlated positively with the esthetic value.Conclusions:Cephalometric measurements of lip position, incisor position, and chin morphology were key parameters correlated to facial esthetics.     

Soft-tissue profile changes concurrent with the orthodontic treatment

Anthropologists have shown that the external covering made up of integument, adipose tissue, connective tissue, and muscle does not always distribute itself in a uniform, orderly manner. There are great variations in the amount and distribution of these soft-tissue elements. Therefore, a facial profile analysis that is limited to measurements on the hard skeletal structure would not appear to conform to the standards of accuracy if an assessment of the soft-tissue profile were required. The purpose of this investigation is to provide an understanding of the changes which occur in the soft-tissue profile during the orthodontic treatment concurrent with normal growth and development. At the present time, it is not possible to devise a set rule for differentiating a desireable from an undesireable soft-tissue facial profile. However, this should not prohibit the presentation of some reference material as an aid in the diagnosis and practice of orthodontics. In many instances evaluations of facial esthetics seem to be singularly influenced by the orthodontist's concept of a pleasing face. At present, the accomplishment of soft-tissue profile changes by dental movement is limited so it is very important to rely on proper timing of the orthodontic treatment through the pubertal growth period to achieve optimal profile changes.     

Orthodontic-surgical treatment of Class III malocclusion with mandibular asymmetry

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone discrepancy may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 15 years and 1 month with Class III skeletal malocclusion, having narrow maxilla, posterior open bite on the left side, anterior crossbite and unilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the maxillary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patient's final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.     

Multilingual bracket treatment combined with orthognathic surgery in a skeletal Class III patient with facial asymmetry

A case report is presented on a female adult with a Class III mandibular protrusion. Resolution of her dentoskeletal problem required a combination of comprehensive multibonded orthodontic mechanotherapy and orthognathic surgery. The patient preferred a multilingual bracket appliance because of esthetics. Both surgical and orthodontic treatment were quite successful in the correction of the facial profile and occlusion. Both psychological and esthetic satisfaction were achieved.     

Outcome of orthognathic surgery in Chinese patients. A subjective and objective evaluation

OBJECTIVE: To evaluate the outcome of orthognathic surgery by objective cephalometric measurement of posttreatment soft-tissue profile and by subjective evaluation of profile esthetics by laypersons and clinicians. MATERIALS AND METHODS: The sample consisted of 30 Chinese patients who had completed combined orthodontic and orthognathic surgical treatment. The posttreatment cephalograms of these patients were analyzed with respect to profile convexity, facial height, and lip contours and these were compared to the previously established esthetic norms. Line drawings of the soft-tissue profile were displayed to a panel comprising six laypersons and six clinicians who scored the esthetics of each profile using a 7-point scale. RESULTS: Complete normalization of cephalometric soft-tissue variables was not achieved with orthognathic surgery in most patients, with four of the six soft-tissue cephalometric measurements showing significant differences compared to the esthetic norms. There were good correlations in the esthetic scores between laypersons and clinicians, even though clinicians tend to rate the profiles more favorably. Facial convexity and facial height did not significantly influence the subjective scores of both the laypersons and clinicians. Lower lip protrusion was the only cephalometric variable that significantly influenced clinicians' assessment of profile esthetics (P<.01). CONCLUSIONS: Profile convexity and lower facial height proportion had little influence on both lay and professional perception of profile esthetics. Lower lip position is the only cephalometric variable that significantly influenced clinicians' assessment of profile esthetics.