【作者】 王艳；

【导师】 赖文莉；

【作者基本信息】 四川大学 ， 口腔临床医学， 2007， 硕士

【摘要】 正畸治疗中，错(牙合)畸形的矫治目标是平衡、美观和稳定，即错(牙合)畸形经治疗后，牙列、颌骨、软组织的形态和功能应协调美观。研究表明，改善颜貌美观是患者寻求正畸和／或正颌外科手术治疗的最主要目的之一，这对于成年患者尤为明显。近年来，随着患者对美观的要求提高，就诊人群中成年患者日益增多，三维颜貌分析在正畸临床诊断和治疗中占有愈加重要的地位。然而，因受传统Angle错(牙合)分类的影响，垂直向不调对颜貌美观影响的研究相对较少。因此，本研究的主要目的在于明确垂直向不调对国人侧貌美观的影响，以及垂直向不调与矢状向不调对侧貌美观影响的相对程度，并了解不同人群审美观的差异。方法：共有134人参与了本研究，126人完成了试验，其中成年患者27名，未成年患者家长25名，一般人群26名，正颌外科医生14名，正畸医生34名。以公认较美貌、牙骨性头影测量值基本在中国成人正常值范围，且无正畸、正颌外科治疗史的中国汉族成年男女头侧位片各一为初始图片。通过计算机图像处理技术改变图像的SNB角，得到ANB角分别为0°和6°的男女图片各2张，分别代表Ⅲ类和Ⅱ类骨面型之侧貌形态。再将上述图像的骨性下面高比按正常值的1个标准差(1SD)等量递增或递减，得到包括下面高比变化量在正常值的—4SD—+4SD范围内的男女各27张图片。最后将图片转换为剪影图并随机排列。图像处理过程中保持上面高、鼻及红唇缘外形不变。要求评分者根据图片美观程度进行评分，分值为1—9分，以9分代表最为美观，以1分代表美观性最差。2周后再由同一人群对男性图片再次评分，以评价评分结果的可重复性。结果：下面高比在正常值的1SD内者分值最高；下面高比较正常值减小4SD者分值最低。下面高比与正常值差异越大分值越低；但Ⅲ类骨面型男性图片的分值随下面高比的变化波动较小，且得分均较Ⅰ类和Ⅱ类骨面型男性图片更低。Ⅲ类骨面型对男性图片分值的负面影响最大，其次是下面高比的变化。5组人群的评分结果有统计学差异；但评分人群的性别和年龄对结果无显著性影响。综上所述，垂直向不调对国人侧貌美观有影响，垂直向比例与正常值差异越大，对侧貌美观的影响也越大。而且，垂直向不调对侧貌美观的影响还与矢状骨面型、性别等因素有关。Ⅰ类和Ⅱ类骨面型男性，垂直向比例减小者较增大者更美观；但对于女性和Ⅲ类骨面型男性则相反，即垂直向比例增大者较减小者更美观。Ⅲ类骨面型对男性侧貌美观的负面影响较垂直向不调更为明显；但Ⅱ类骨面型对男性侧貌美观的影响很小。目前暂不能确定垂直向不调与矢状向不调对女性侧貌美观影响的相对程度。个体审美观在一定程度上受专业背景的影响，但不受性别和年龄的影响。更多还原

【Abstract】 As known, the final goal of orthodontic treatment is to achieve a harmonious dentofacial complex with a good skeletal, dental, and soft tissue balance in function and esthetics. Self-perception of dentofacial attractiveness is an important chief complain for patients to seek orthodontic treatment, which is most evident in adult patients. Greater attention has been paid to three-dimensional facial analysis in recent years, along with the increased patients’ esthetic demand and the increased number of adult patients. The aim of this study was to define the influence of vertical discrepancy on Chinese male and female facial profile esthetics and the relative influence on attractiveness of vertical proportion and skeletal anteroposterior relation. And also, this research was designed to compare the inter-group differences in participants’ rating. Method: 134 subjects participated this study, but only 126 persons completed, comprising 27 adult patients, 25 adolescents’ parents and 26 laypersons, 14 oral surgeons, 34 orthodontists. The digitized lateral cephalometric radiographs of a Chinese man and a woman, each with a normal profile, a Class I molar relationship, and a Class I skeletal pattern, were used as the initial profiles. The profiles were modified to obtain 2 other images of each sex by artificially altering ANB value to 0°and 6°without any change to SNA angle and vertical height. Then 27 profiles of each sex were generated from the images mentioned above with lower vertical proportion increased or decreased by up to 4 standard deviations (SDs) from the Chinese norm. Finally they were manipulated to silhouette profiles and randomly arranged. The participants were asked to score each image using a 9 point numerical scale. The male profiles were rated once again after 2 weeks to assess the rating repeatability. Result: The images with lower anterior face height/total anterior face height (LAFH/TAFH) deviated within 1SD of the norm were rated the most attractive, while the images with LAFH/TAFH reduced by 4SDs from the normal were rated the least attractive. Attractiveness scores reduced as the vertical proportions diverged from the normal value (P＜0.05). However, the scores of the ClassⅢmale images demonstrated little differences while vertical proportion changed and they were generally lower than those of the ClassⅠandⅡ. The ClassⅢskeletal pattern had the most negative influence on the rating scores of male silhouettes, followed by vertical discrepancy. Significant differences were observed between the 5 groups’ average rating of the male and female profiles (P＜0.05). Sex or age of the participants was found to have no significant influence on the result.Based on these findings, vertical discrepancy had influence on the facial profile esthetics. Profile attractiveness reduced as the vertical proportions diverged from the normal value. For the ClassⅠandⅡmale profiles, images with reduced lower face proportions were considered to be more attractive than corresponding images with increased lower face proportions, while the opposite trend was found for the ClassⅢmale images and the female. The ClassⅢanteroposterior relation had the most negative influence on the male profile esthetics, followed by vertical discrepancy. But for the female, it was difficult to determine the relative influence of the vertical proportions and the anteroposterior relations in this study. Specialty of the participants was found, to some degree, to have influence on their esthetic standard.更多还原