《实用口腔医学杂志》稿约

近年来,随着计算机技术的飞速发展,数字化设计技术凭借精准、高效等特点,已经越来越多的应用到口腔修复各领域,并且有望在未来实现口腔修复的完全数字化.该文将简要介绍数字化设计技术在固定和可摘义齿修复领域的应用,阐述其技术原理和设计流程;总结了常见的口腔修复数字化设计软件的分类,并概述3D数字微笑设计的工作流程.     

数码微笑设计在前牙美学修复中的应用

随着生活水平的不断提高,人们对美的追求越来越高。前牙美学修复要求功能性好、美观、个性化。为达到医患满意的修复效果,修复前的美学设计尤为重要。数码微笑设计（digital smile design,DSD）技术是目前比较前沿的美学修复设计手段,可以增强医患沟通、医技沟通及医医沟通。文章就DSD技术在前牙美学修复中的应用做一综述。     

数字化虚拟仿真设计在口腔美学修复中的应用和研究进展

口腔美学修复中,修复后的美学效果是患者术前关注的重点,也是医患沟通的重要内容。随着口内扫描、面部扫描、数字化设计、数控切削和三维打印等技术的发展和联合应用,数字化技术逐步应用于口腔美学修复前的虚拟仿真设计,模拟修复后的美学修复效果,并用于医患、医技沟通,最后将患者满意的设计效果转移至最终修复体上,以提高患者对美学修复的满意度。本文对数字化虚拟仿真设计在口腔美学修复中的应用展开综述,分析其研究现状、不足以及发展方向,以期为临床诊疗提供参考。     

四维微笑设计辅助非对称面型前牙超薄瓷贴面修复前牙区散在间隙1例及文献复习

目的探讨以四维微笑设计为主导、以面部流线为参考体系的全程数字化设计在前牙美学修复中的应用效果。方法对1例前牙区散在间隙患者进行四维微笑设计,辅助行超薄瓷贴面数字化美学修复。通过口内和面部扫描获得患者数字化信息,进行四维微笑设计和预测,进行2次美学预告,医患共同确定治疗方案后,进行微创基牙预备,制作超薄瓷贴面,就位后粘接。术后观察美观度、边缘密合度,于修复完成后1年复查。结果超薄瓷贴面边缘密合,颜色过渡自然,红白美学效果好,微笑时面部协调,1年后随访,颜面整体美学佳,基牙、牙周组织健康,患者满意。文献复习结果表明,时序性面部扫描与口内扫描数据拟合可以准确地进行四维微笑美学预测,模拟动态微笑及发音过程的真实状态,结合面部流线,为非对称面型患者设计出自然协调的个性化微笑;然而对于咬合改变、咬合不稳定或颞下颌关节紊乱患者,需增加电子面弓、锥形束CT等数据拟合,更加准确地模拟患者术后的下颌运动。结论以四维微笑设计为主导、以面部流线为参考体系的全程数字化设计,辅助非对称面型前牙超薄瓷贴面的修复前牙散在间隙的效果良好,患者术后微笑协调美观,符合预期效果;患者参与度、满意度高,值得临床推广。     

前牙复合树脂修复的美学设计——牙外伤修复（一）

牙外伤导致牙体缺损为口腔临床常见问题。前牙区牙体缺损不仅妨碍口腔正常的咬合功能，更严重影响牙体外观，影响人们的自身形象．因此．通过牙体美学修复治疗设计．捕捉、复制与表达牙体色、形、质的变化，再现与重建自然和谐地微笑．是美学牙科至关重要的课题。本文通过应用复合树脂对1例前牙外伤导致的牙体缺损进行美学修复设计．力求从医患交流、口腔微笑分析．牙体比色．牙体预备、粘结修复中酸蚀、粘结、充填等重要环节，修复体抛光．牙表面纹理表现，牙外形调整以及患者术后口腔教育等方面进行临床分析与说明，并对临床设计要点、牙体预备路径、修复操作细节及临床经验进行归纳总结。     

3D打印在口腔美学修复中的应用

3D打印技术可完成结构复杂物体的打印,在口腔修复领域已有一定应用,未来有望替代大部分传统修复技术。在口腔美学修复中如何保证分析设计阶段初设的轮廓外形与颜色等与患者得到的最终修复体一致,一直是困扰口腔医师和技师的难题。3D打印的蜡型、树脂冠桥等可用于美学修复的美学分析和设计结果的输出预告,一对一地传递并指导最终修复体的设计和制作。3D打印的目标修复体导板（TRSguide）既为美学修复制定了可预览的修复蓝图,让口腔医师和技师能检测患者重建的口腔功能和美学的相关信息;又能指导实施符合牙体保存和活髓保护理念的理想牙预备,做到真正的全程精准与微创。这些新的数字化技术进展使得美学修复焕然一新。本文对3D打印在口腔美学修复中的应用进行介绍。     

动态虚拟患者技术在口腔修复领域的应用进展

随着面部扫描、口内扫描、虚拟面弓、下颌运动轨迹记录等技术在口腔修复领域的发展及应用, 动态虚拟患者技术逐渐被应用于口腔修复的术前分析、美学诊断、治疗设计及修复体制作, 并成为近年的研究热点。本文从口腔动静态数据获取、动态口腔虚拟患者的构建、动态口腔虚拟患者的应用优势等方面对动态虚拟患者技术在口腔修复领域中的应用和研究展开综述, 以期为相关数字化技术的临床应用提供参考。     

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本文着重介绍应用复合树脂对临床不同类型牙体美容缺陷进行美学修复的临床设计方案、洞斜面设计、牙体美学分层修复颜色设计理念与方法,并结合临床病例对修复过程中重要环节如口腔微笑分析、牙体比色、牙体预备、酸蚀、粘接、牙体修复、抛光修整等操作步骤及临床要点进行归纳、总结。旨在为临床医生合理应用复合树脂进行牙体修复,获得良好美学效果提供借鉴和帮助,以期共同努力提高复合树脂牙体美学修复水平。     

计算机辅助规划设计助力精准种植与长期稳定

随着影像技术及计算机技术的不断发展,口腔种植医疗也正经历一场数字化革命,发展为包括数字化信息采集、计算机辅助虚拟三维种植手术规划、数字化引导种植外科和数字化修复等多种数字化技术在内的综合诊疗方式,数字化的临床程序使得种植诊疗更加规范、种植修复实施更加精准,必将极大降低了种植修复并发症的发生,提升种植修复长期稳定的功能与美学效果.笔者将围绕数字化信息采集、种植修复前美学分析、种植外科辅助规划、种植体支持的修复体设计等计算机辅助种植规划与设计方面进行概述.     

美学区牙冠延长术同期应用上皮下结缔组织移植术联合冠修复改善粉白美学效果的初步探索（附1例报告）

和谐、迷人的微笑是口腔美学治疗追求的目标，发生于上颌前部牙弓美学区的唇齿龈关系不调及粉白美学缺陷都可能影响整体的微笑美学效果。牙齿被动萌出不足导致的露龈笑是常见的微笑美学缺陷之一，美学区牙冠延长术可以行之有效地重建牙龈外形；而上颌美学区牙周表型偏薄，如伴有唇侧软组织轮廓塌陷，不仅损害粉色美学效果，也增加了发生根面透色、牙龈退缩等并发症的风险。如何重建牙龈外形、改善唇齿龈关系，同时恢复协调的软组织轮廓，改善牙周表型，是临床粉色美学治疗的难点。本文展示了1例上前牙美学区露龈笑伴有唇侧软组织轮廓塌陷的美学分析及临床诊治过程，详细介绍了美学区牙冠延长术同期实施上皮下结缔组织移植术的手术过程，联合冠修复重建协调的粉白美学，并采用数字化模型进行多维度的分析评价，最终获得了良好的美学效果。     

正畸微笑美学的影响因素及研究进展

一个完美自信的微笑可以大大提升个人的魅力。微笑美学已成为患者寻求正畸治疗的主要原因,而且是正畸医生的治疗目标。正畸医生有必要了解面部美学和当前社会对面部吸引力的偏好。正畸医生了解微笑美学的指标,可以用于指导临床操作,从而达到最佳的治疗效果。该文归纳了笑线、笑弧、颊廊、牙齿、牙龈等影响微笑美学的因素并从微笑的微观美学和迷你美学两方面作一综述。     

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.     

数字化冠延长导板在前牙美学修复中的应用效果评价

目的: 评价三维数字化微笑设计（three-dimensional digital smile design,3D-DSD）联合双定位冠延长导板在前牙美学修复中的临床效果。方法: 选择需行上前牙美学牙冠延长术和全冠修复的患者20例,随机分为实验组和对照组,每组10例。实验组进行3D-DSD,3D打印双定位冠延长导板,指导美学牙冠延长术,术后3个月进行全冠修复。对照组采用传统美学牙冠延长术和全冠修复。术前、术后3个月、术后6个月进行粉白美学指数（pink esthetic score/white esthetic score,PES/WES）评估,术后6个月、7个月采用视觉模拟评分法（visual analogue scales,VAS）进行2次患者满意度评价,对2次VAS结果进行可重复性评价,并对术后6个月PES/WES评分和整体满意度进行相关性分析。采用SPSS 23.0软件包对数据进行统计学分析。结果: 2组患者术后3个月、术后6个月PES/WES评分均高于术前（P<0.05）。组间比较结果显示,术后3个月PES、术后6个月PES和WES,实验组显著高于对照组（P<0.05）。满意度调查结果显示,2次VAS结果的组内相关系数为0.956（P<0.05）;实验组牙冠长宽比例、微笑曲线、个性特征、患者参与度和整体满意度均优于对照组（P<0.05）。术后6个月PES和WES评分与整体满意度均呈正相关（r_S1=0.905,P<0.001;r_S2=0.460,P=0.041）。结论: 3D数字化微笑设计联合双定位冠延长导板指导前牙美学牙冠延长术和修复治疗,可提高治疗后粉白美学效果及患者满意度。     

Successful and stable orthodontic camouflage of a mandibular asymmetry with sliding jigs

The purpose of this paper is to present and discuss a simple and low-cost clinical approach to correct an asymmetric skeletal Class III combined to an extensive dental open bite that significantly compromised the occlusal function and smile aesthetics of an adult male patient. The patient did not accept the idealistic surgical-orthodontic treatment option, neither the use of temporary anchorage devices to facilitate the camouflage of the asymmetrical skeletal Class III/open bite. Therefore, a very simple and inexpensive biomechanical approach using sliding jigs in the mandibular arch was implemented as the compensatory treatment of the malocclusion. Although minor enhancements in facial aesthetics were obtained, the occlusal function and dental aesthetics were significantly improved. Furthermore, the patient was very satisfied with his new smile appearance. Some advantages of this treatment option included the small invasiveness and the remarkably low financial costs involved. Moreover, the final results fulfilled all realistic treatment objectives and the patient’s expectations. Results remained stable 5 years post-treatment demonstrating that excellent results can be obtained when simple and low cost, but well-controlled mechanics are conducted.     

颊旁间隙对微笑美影响的研究进展

日常生活中,人们往往更关注正面微笑,正面微笑是个性、自信和魅力的体现。作为面部美学评价指标之一的颊旁间隙近年来受到了极大关注。该文就颊旁间隙对微笑美影响的研究进展做一综述,并探讨了在正畸临床中如何更好地把握颊旁间隙创造微笑美。     

Smile aesthetics

The aim of this article is to outline some of the factors practitioners should take into consideration when planning optimal smile aesthetics. The components of the smile that will be discussed include the smile arc, incisor/gingival display, smile width, gingival aesthetics, tooth proportionality/symmetry, contacts/connectors/embrasures and the dental midlines. CLINICAL RELEVANCE: A systematic evaluation of the components of the smile when planning treatment will help to improve smile aesthetics and produce greater patient and dentist satisfaction.     

牙列中线偏斜的审美研究进展

面部对称是容貌美观的重要影响因素。在微笑美学的研究中,牙列中线与面中线的一致性与微笑审美评价结果密切相关,直接影响患者微笑的美观程度。由于牙列中线偏斜在普通人群中发生率较高,因此,牙列中线与面中线不一致常作为患者就诊的主诉,同时也是正畸医生在制定治疗计划时需要特殊考虑的一个临床诊断指标和矫治目标。本文将对牙列中线偏斜的流行病学情况、病因学分类、诊断与治疗方法及其对微笑审美的影响作一综述,以期指导临床操作。     

Perception of oral and maxillofacial surgeons,orthodontists and laypersons in relation to the harmony of the smile

ObjectiveHarmony is one of the main objectives in surgical and orthodontic treatment and this harmony must be present in the smile, as well as in the face. The aim of the present study was to assess the perceptions of professionals and laypersons in relation to the harmony of the smile of patients with or without vertical maxillary alterations.Materials and methodsSixty observers (oral and maxillofacial surgeons, orthodontists and laypersons) reported the degree of harmony of six smiles using an objective questionnaire and the participants indicated if there was a need for corrective surgery or not. The classification of observers was recorded on a Likert scale from 1 to 5. Mixed regression was used to determine differences between the three groups.ResultsStatistically significant differences were found only for the harmony of the smile between the oral and maxillofacial surgeons and laypersons, with laypersons being more critical when assessing the smile. There was no statistical difference between the other groups for the harmony of the smile or the indication of corrective surgery. The patterns of greater or lesser harmony determined by observers during the smile were similar to those found in the literature as the ideal standard in relation to vertical maxillary positioning.ConclusionsLaypersons had a tendency to be more critical in relation to facial harmony than surgeons, although no statistical differences were found in the other groups in relation to the harmony of the smile or indication for the corrective surgery. In addition, the patterns of greater or lesser harmony of the smile determined by the participants were similar to those found in the literature as the ideal standard in relation to vertical maxillary positioning. Overall, the present study demonstrates that adequate interaction between surgeons, orthodontists and laypersons is essential in order to achieve facial harmony with orthodontic and/or surgical treatment.Clinical relevanceOpinion of specialists and laypersons about the smile in relation to the vertical positioning of the maxilla.