优化颊廊比率:以三维、多层次的角度考量矫治效果

Optimizing the ratio of buccal gallery:a consideration on the therapeutic effect from a threedimensional and multi-level perspective

背景:正畸矫治不仅应改善静态侧貌形态和咬合关系,还应使患者的正面动态笑容具有美感。颊廊作为正面动态微笑美学最重要的评价指标之一,逐渐成为研究热点。目的:综述影响颊廊审美、大小的因素及颊廊大小对正畸微笑美学的影响,并进一步就正畸临床中如何更好地把握颊廊以创造微笑美进行归纳整理,同时对其未来发展前景进行展望,以期为临床治疗方案制定和疗效评价提供参考依据。方法:应用计算机遵循PRISMA指南检索中国知网、万方数据库、PubMed和Web of Science数据库收录的1999年7月至2020年10月的相关文献,中文检索词为“颊廊,正畸,微笑美学”,英文检索词为“buccal corridor spaces,orthodontic,smile aesthetics”,按照纳入与排除标准,最终选定51篇文献进行归纳总结。结果与结论:①现有的临床证据尚不足以证明拔牙矫治可影响患者的正面微笑美学;对于牙列拥挤非拔牙矫治病例,正畸医师可通过选择合适的自锁托槽矫治系统,以更好地协调牙弓宽度与颊面部软组织之间的关系,使矫治后患者微笑时显露适宜大小的颊廊,有效改善其面部正面微笑美学;②正畸矫治中,应追求“饱满的微笑”,正畸医师矫治时不仅应注重牙颌状况及静态侧貌形态,还应协调好颊廊与面部形态,将优化颊廊比率作为临床矫治方案设计和矫治的目标,从静态侧貌美学到动态正面美学,以三维、多层次的角度考量矫治效果。

BACKGROUND: Orthodontic treatment should not only improve the static profile and occlusal relationship, but also improve patient’s frontal smile aesthetics.As one of the most important evaluation indexes of positive dynamic smile aesthetics, buccal gallery has gradually become a research hotspot.OBJECTIVE: To review the factors that affect the aesthetics and size of the buccal space and the influence of the size of the buccal space on the aesthetics oforthodontic smile, and further summarize and sort out how to better grasp the buccal space to create the beauty of smile in orthodontic clinic, and prospect itsfuture development, so as to provide a theoretical basis for the diagnosis and treatment of dynamic smile in orthodontic clinic.METHODS: A computer-based search was conducted for the relevant literatures from July 1999 to October 2020 in CNKI, WanFang, PubMed and Web ofScience with the key words of “buccal corridor spaces, orthodontic, smile aesthetics”in Chinese and English, respectively. According to the inclusion andexclusion criteria, 51 articles were finally selected and summarized.RESULTS AND CONCLUSION: Existing clinical evidence is not enough to prove that tooth extraction can influence the patient’s frontal smile aesthetics. For nonextractioncases of crowded dentition, orthodontists can choose a suitable self-locking bracket correction system to better coordinate the relationship betweenthe width of the dental arch and the soft tissues of the buccal and facial area, making the patient show an appropriate size of the buccal gallery when smilingafter correction, and effectively improving the frontal smile aesthetics. In the orthodontic treatment, the “full smile” should be pursued. Orthodontists shouldcoordinate the buccal space and facial morphology, and take improving the buccal space as the goal of orthodontic design and treatment. From static profileaesthetics to dynamic positive aesthetics, the treatment effect is considered from three-dimensional and multi-level perspectives.