臺灣博碩士論文加值系統

改善患者顏面美觀對矯正醫師是很重要的工作，顏面外觀是一個人最重要的特質之ㄧ，而且會影響社會人際關係，在矯正醫師的觀念中必須理解到除了牙齒的移動及適當的排列外，還要注意任何齒列的改變是否會引起不理想的顏面外觀改變。
在矯正治療中，標準的口內、外彩色照片以及X光片（側顱X光片和前後方頭顱片）是不可或缺的影像資料。各式各樣的軟組織評估方法也應運而生，然而，卻沒有任何一種方法是不需要硬組織解剖構造當作參考點的，或是只有單純軟組織的量測。除此之外，最重要的問題是要標準化這些影像是很困難的，主要的缺點是X光片的解析度和影像放大率的問題，事實上這些都有可能會造成實際軟組織的點位無法和X光片上的位置符合，這些無法避免的缺點都造成在評估分析治療成果上的困難。
到目前為止，二維側顱X光片仍然是評估矯正治療後顏面變化的主要方法，然而，事實上病人真正關心的是他們的正臉及四分之三側臉，鮮少關心他們的側臉是如何變化，在過去二十年的時間，三維影像的發展也漸漸應用在齒顎矯正領域上，藉由三維攝影儀器所擷取的資料稱為三維影像，經由電腦影像處理軟體將其呈現在二維的螢幕上，並可顯示影像的深度，深度的呈現即為三維影像的特色。
這篇研究著眼在矯正治療的第一步，黏著矯正器後下顏面的瞬時變化，並以三維立體方式做比較，以日本Minolta公司的VIVID 910非接觸式三維雷射掃描儀分別在每位患者黏著矯正器前後擷取顏面三維影像，所得到的資料以韓國INUS公司的逆向工程軟體Rapidform 2006做分析比較，發現黏著矯正器後的瞬時變化以嘴唇周圍及下巴區域最為明顯，並直接在重合的三維影像上做量測，但是結果發現此瞬時變化量卻與矯正器的厚度不一致！
臨床上藉由三維雷射掃描儀擷取顏面外觀是非常簡單且有效的工具，而且此三維影像能直接在處理軟體上做量測並能以任意方向角度呈現讓患者了解，相信在不久的將來，三維資料會漸形重要而且會慢慢取代今天所使用的傳統齒顎矯正資料！

Improving facial esthetics of our patients is of great importance to orthodontists. An individual’s facial appearance is one of their most obvious characteristics and has profound social significance. Tooth movement and proper positioning of the teeth to ensure favorable facial changes and to avoid unfavorable changes should be the goal in the orthodontist’s mind.
Standard color photographs and radiographic views (PA and cephalometric X-ray films) remain a principle adjunct to orthodontic care. Various methods of soft-tissue assessment have evolved; however, none of those method has been reported adequately enough to describe the face without depending upon anatomically variable intracranial landmarks as reference points or upon the facial soft tissues themselves. In addition, the most important problems are difficulties in standardizing these images. The main disadvantages are the poor resolution and the inconsistent magnification of the X-ray images and the fact that the landmarks identified on the soft tissue profile do not correspond with those identified from radiographic examination. These unavoidable disadvantages make it hard to analyze and compare the post-treatment outcomes directly.
At present, 2-dimensional (2D) assessments of lateral cephalograms is the main method to investigate the effects of orthodontic treatment on the face. However, patients tend to assess their appearance from either a frontal or a three-quarter profile view, rarely from the sagittal view as recorded in the 2D lateral cephalograms. Three-dimensional (3D) imaging has developed greatly in the last two decades and has been applied to orthodontic treatment. In 3D imaging, a set of anatomical data are collected using diagnostic imaging equipment, processed by a computer and displayed on a 2D monitor to give the illustration of depth. Depth perception causes the image to appear in 3D.
This study was to compare the 3D effects on the lower face immediate changes after the first step (direct bonding system, DBS) of orthodontic treatment. Laser scanner (Minolta VIVID 910) was used for capturing the facial images before and after DBS of each patient. The collected data were processed and compared with the Rapidforn 2006 (INUS Korea) reverse engineering software. The great immediate changes of the lower face after DBS were appeared over the peri-oral, chin area and could be measured by the variation directly from the superimposed images. But the immediate changes of the lower face after DBS were not in accordance with the thickness of the brackets.
The 3D laser scanning for capturing the facial profiles is a simple and effective tool clinically, because the 3D images can be measured directly from the processing software and easily showed the results of orthodontic treatment to patients. Application of 3D data is expected to increase significantly soon and might eventually replace many conventional orthodontic records which are in use today.

第一章 前言………………………………………………………….1
1. 研究背景………………………………………………………1
1.1 顏面美學的沿革…………………………………………..2
1.2美學的認知……………………..9
1.3 西洋人相學與中國面相學概述…………………………12
2. 近代顏面測量學與顏面美學的發展及研究……….……..…..15
2.1 側顱X光片在齒顎矯正中的應用………………….………16
2.2 人體測量學………………………………….……...…..…17
2.3 側顱X光片評估軟組織變化的方式……..……....……...…18
2.4 本校附設醫院齒顎矯正科評估軟組織變化之現狀............20
3.三維影像之原理及運用………….…………………22
3.1 顏面軟組織三維重建和測量的研究現狀…………….…...22
3.2 三維雷射掃描的簡介…………………..……………..…..28
3.3 三維雷射掃描測距原理…………….………………….….29
3.4 三維雷射掃描儀….…………..………………………..….31
3.5 三維影像資料處理的介紹……………………………..….33
3.6 三維影像掃描在牙醫學的應用………………………..….35
3.7 三維影像掃描在其他領域上的應用……………………...37
4. 齒顎矯正治療簡介……………………………………...……38
5. 研究目的………………………………………….…………..41
第二章 材料與方法…………………………….…………...............43
2.1 樣本的選取……………………….…….…………………..43
2.2 研究硬體……………………………….………….………..44
2.3 研究軟體…………………………….………………….…..44
2.4 研究步驟…………………………….…………….………..47
2.5 研究設計及掃描資料的處理……….……………….……...48
第三章 研究結果…………………………….…...…........................53
第四章 討論………………………………….……...........................57
4.1 研究標的…..………………….…….………………………57
4.2 研究儀器…………………….……………………….……..58
4.3 顏面變化的測量…………….………..……………….……59
4.4 顏面變化探討…………….………………………………...61
第五章 結論………………………….…………………...................68
第六章 未來展望…………………….……………………………...70
參考文獻……………………………….……………….....................71
作者簡歷……………………………….……………….....................75
授權書….………………………………………….............................76

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