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

Anterior aesthetic restoration with ultrathin porcelain veneers on asymmetric faces assisted by a four⁃dimen⁃sional smile design:a case report and literature review

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。

Objective To explore the application effect of a four⁃dimensional smile design as the leading and facial streamline as the reference system in the aesthetic restoration of anterior teeth.Methods A case of scattered space in anterior teeth was treated with a four⁃dimensional smile design and digital aesthetic restoration with ultrathin porcelain veneer.The digital information of the patients was obtained through oral and facial scanning,and a four⁃dimensional smile design and prediction were carried out.After the treatment plan was jointly determined by doctors and patients,minimally invasive abutment preparation was carried out,and ultrathin porcelain veneer was made and bonded in place.After the operation,the esthetic degree and marginal fit were observed and reexamined one year after the repair.Re⁃sults The edges of the ultrathin ceramic veneers were naturally tight,and the color was coordinated,with satisfying pink and white esthetics.The face was more harmonious and natural when smiling.One year after the restoration,the fa⁃cial aesthetics were wonderful,the abutment teeth and periodontal tissues were healthy,and the patients were satisfied.The results of the literature review showed that the fitting of temporal facial scanning and intraoral scanning data can ac⁃curately predict four⁃dimensional smile aesthetics,simulate the real state of the dynamic smile and pronunciation pro⁃cess,and combine it with facial streamlines to design a natural and coordinated personalized smile for patients with asymmetric faces.However,for patients with occlusal changes,unstable occlusion or temporomandibular joint disorder,it is necessary to add data fitting,such as electronic facial arch and cone beam CT,to more accurately simulate postop⁃erative mandibular movement.Conclusion With a four⁃dimensional smile design as the leading and facial streamline as the reference system,the whole process digital design assisted the restoration of asymmetric anterior teeth with ultra⁃thin porcelain veneer and had a good effect.The postoperative smiling of patients is harmonious and beautiful,which is in line with the expected effect.Patient participation and satisfaction are high;thus,this method is worthy of clinical promotion.