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中华口腔医学研究杂志(电子版) ›› 2025, Vol. 19 ›› Issue (05) : 293 -299. doi: 10.3877/cma.j.issn.1674-1366.2025.05.002

专家笔谈

构建虚拟患者实现美学与功能的""谐统一
胥春()   
  1. 上海交通大学医学院附属第九人民医院口腔修复科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海 200011
  • 收稿日期:2025-06-28 出版日期:2025-10-01
  • 通信作者: 胥春

Constructing virtual patients to achieve the harmonious unity of aesthetics and function

Chun Xu()   

  1. Department of Prosthodontics, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai 200011, China
  • Received:2025-06-28 Published:2025-10-01
  • Corresponding author: Chun Xu
  • Supported by:
    National Natural Science Foundation of China(82071157); Original Exploration Project of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(JYYC002); Clinical Research Program of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ202409)
引用本文:

胥春. 构建虚拟患者实现美学与功能的""谐统一[J/OL]. 中华口腔医学研究杂志(电子版), 2025, 19(05): 293-299.

Chun Xu. Constructing virtual patients to achieve the harmonious unity of aesthetics and function[J/OL]. Chinese Journal of Stomatological Research(Electronic Edition), 2025, 19(05): 293-299.

美学区牙列对于咀嚼、发音和美观等功能至关重要,传统的美学修复技术基于诊断蜡型制作诊断饰面或临时修复体来呈现治疗效果,需要医师、技师和患者三方配合,花费时间较多。随着数字化技术的发展,"虚拟患者"技术应运而生。借助静态虚拟患者技术,避免了传统技术中印模制取时可能带来的不适、诊断蜡型在运输过程中可能的损坏、患者对设计不满意时的反复修改和复诊等问题,有效提高了患者的满意度。在静态虚拟患者的基础上加入下颌运动轨迹数据和面部动态数据,可以获得更适合患者的前牙舌面、切端及唇面的形态和位置,减少临床调操作时间和难度,降低干扰、创伤、崩瓷和修复体脱落等风险,提高修复的美学和咬合功能效果。目前,虚拟患者技术所需设备数量多,成本高,精度、文件格式不统一,操作技术敏感性高,配准流程复杂等,使其使用受到一定限制。未来如能开发出一站式完成虚拟患者所需数据的采集技术,并基于人工智能技术自动完成多源数据的配准,将进一步推动虚拟患者技术的普及。

The dentition in the aesthetic area is crucial for functions such as chewing, pronunciation, and aesthetics. Traditional aesthetic restoration techniques are based on diagnostic wax-up to create diagnostic mock-ups or temporary restorations to present therapeutic outcomes, which requires the cooperation of dentists, technicians, and patients, and takes a considerable amount of time. With the development of digital technology, the "virtual patient" technology has emerged. With the aid of the static virtual patient technique, possible problems, such as discomfort during impression in traditional techniques, damage to diagnostic wax-up during transportation, and repeated modifications and visits when patients are dissatisfied with the design, have been avoided, and patient satisfaction is effectively improved. By attaching mandibular movement trajectory data and facial dynamic data, the morphology and position of the incisor edge and lingual and labial surfaces of the anterior teeth are more suitable for the patients. This reduces the time and difficulty of occlusal adjustment in the clinic, lowers the risks of occlusal interference, occlusal trauma, porcelain breaking, or restoration detachment, and improves the aesthetic and occlusal function of the restorations. Nowadays, the virtual patient technology requires a large number of devices with high costs, inconsistent accuracy, and file formats, high technical sensitivity, and sophisticated registration processes, etc. Its application is still subject to certain limitations. If the collection of data required for virtual patients can be completed on a single device, and the function of automatically registering multi-source data can be accomplished with artificial intelligence technology in the future, it will greatly popularize the technology for virtual patients.

图1 美学修复效果不佳的修复体 A:切牙平面歪斜;B:调磨烤瓷冠上的干扰点后,造成金属底冠暴露。
图2 构建虚拟患者进行修复体设计的流程图
图3 患者静态面部数据的获取 A:面部扫描仪;B:闭口时静态面部数据,C:微笑时静态面部数据;D:大笑时静态面部数据。
图4 动态虚拟患者下颌运动轨迹记录及结果 A:使用上颌叉和硅橡胶记录上颌牙列相对于颅底和颞下颌关节的位置;B:下颌叉固定于下颌牙列唇颊面;C:将超声发射头安装于下颌叉上,记录下颌的位置和运动轨迹;D:软件记录、输出的患者下颌运动轨迹相关参数。
图5 畸形影响下颌运动轨迹分析仪数据记录 A:深覆患者口内正面像;B:上颌前牙咬至下颌叉,干扰上、下颌牙列咬合。
图6 直接法配准牙列形态数据和面部形态数据 A:上牙列形态数据;B:配准后的上牙列及面部形态数据。
图7 牙列形态数据与锥形束CT(CBCT)数据配准
图8 下颌运动轨迹数据与静态数据配准 A:上颌叉与口内扫描仪(IOS)获取的牙列数据配准;B:虚拟面弓转移上架;C:前伸;D:右侧侧方;E:左侧侧方;F:后退。
[1]
骆小平,钱冬冬,袁宇,等.前牙全瓷美学修复中值得注意的事项[J].华西口腔医学杂志201331(2):113-117. DOI:10.7518/hxkq.2013.02.001.
[2]
赵铱民,周永胜,陈吉华.口腔修复学[M]. 8版.北京:人民卫生出版社,2020.
[3]
李韬,龙慧,孙炜,等.数字化微笑设计在上颌前牙牙列缺损美学修复中的可行性分析[J].中国美容医学202534(8):155-158. DOI:10.15909/j.cnki.cn61-1347/r.006983.
[4]
高雨童,撒悦,杨静文.动态虚拟患者技术在口腔修复领域的应用进展[J].中华口腔医学杂志202459(3):267-273. DOI:10.3760/cma.j.cn112144-20230729-00046.
[5]
刘伟才.多模态数据融合技术在口颌系统功能评估中的应用[J].口腔医学202242(1):14-19. DOI:10.13591/j.cnki.kqyx.2022.01.003.
[6]
孙欣荣,冯玥,刘伟才.多模态数据融合的可视化技术在咬合重建中的应用[J].华西口腔医学杂志202240(4):468-475. DOI:10.7518/hxkq.2022.04.015.
[7]
Lepidi LGalli MMastrangelo F,et al. Virtual articulators and virtual mounting procedures:Where do we stand?[J]. J Prosthodont202130(1):24-35. DOI:10.1111/JOPR.13240.
[8]
Yuan YLiu QYang S,et al. Four-dimensional superimposition techniques to compose dental dynamic virtual patients:A systematic review[J]. J Funct Biomater202314(1):33. DOI:10.3390/jfb14010033.
[9]
沈颉飞.口腔修复诊疗中构建虚拟患者的机遇与挑战[J].华西口腔医学杂志202442(1):1-11. DOI:10.7518/hxkq.2024.2023317.
[10]
Piao XYPark JMKim H,et al. Evaluation of different registration methods and dental restorations on the registration duration and accuracy of cone beam computed tomography data and intraoral scans:A retrospective clinical study[J]. Clin Oral Investig202226(9):5763-5771. DOI:10.1007/S00784-022-04533-7.
[11]
杜启翠,李敏,陈红.数字化口内扫描法和传统硅橡胶印模法在牙隐裂根管治疗后全冠修复中的临床疗效比较[J].临床医学研究与实践202510(24):38-41. DOI:10.19347/j.cnki.2096-1413.202524010.
[12]
刘劭晨,李红霞,郭航,等.研究数字化口内扫描技术与传统硅橡胶精细印模技术在临床前牙瓷贴面修复中的应用效果[J].现代医学与健康研究电子杂志20226(8):28-32.
[13]
Shadid RSadaqah N. Accuracy of virtual static articulation:A systematic review[J]. Int J Prosthodont202235(5):627-646. DOI:10.11607/IJP.7407.
[14]
Morsy NEl Kateb M. Accuracy of intraoral scanners for static virtual articulation:A systematic review and Meta-analysis of multiple outcomes[J]. J Prosthet Dent2024132(3):546-552. DOI:10.1016/j.prosdent.2022.09.005.
[15]
Waldecker MRues SBehnisch R,et al. Effect of scan-path length on the scanning accuracy of completely dentate and partially edentulous maxillae[J]. J Prosthet Dent2024131(1):146-154. DOI:10.1016/j.prosdent.2022.02.016.
[16]
Piedra-Cascón WAdhikari RRÖzcan M,et al. Accuracy assessment(trueness and precision)of a confocal based intraoral scanner under twelve different ambient lighting conditions[J]. J Dent2023134:104530. DOI:10.1016/j.jdent.2023.104530.
[17]
黄翠,刘峰,满毅,等.口内数字印模技术[J].实用口腔医学杂志202339(6):689-695. DOI:10.3969/j.issn.1001-3733.2023.06.001.
[18]
Anh JWPark JMChun YS,et al. A comparison of the precision of three-dimensional images acquired by 2 digital intraoral scanners:Effects of tooth irregularity and scanning direction[J]. Korean J Orthod201646(1):3-12. DOI:10.4041/KJOD.2016.46.1.3.
[19]
曹悦,陈俊锴,赵一姣,等.口内三维扫描技术临床应用精度的研究进展[J].中华口腔医学杂志202055(3):201-205. DOI:10.3760/cma.j.issn.1002-0098.2020.03.012.
[20]
Reich SYatmaz BRaith S. Do "cut out-rescan" procedures have an impact on the accuracy of intraoral digital scans?[J]. J Prosthet Dent2021125(1):89-94. DOI:10.1016/J.PROSDENT.2019.11.018.
[21]
Chen YZhai ZLi H,et al. Influence of liquid on the tooth surface on the accuracy of intraoral scanners:An in vitro study[J]. J Prosthodont202231(1):59-64. DOI:10.1111/JOPR.13358.
[22]
郑钰莹.影响口内扫描咬合关系记录精度的相关因素研究[D].西安:中国人民解放军空军军医大学,2025.
[23]
Revilla-León MGómez-Polo MBarmak AB,et al. Influence of occlusal collision corrections completed by two intraoral scanners or a dental design program on the accuracy of the maxillomandibular relationship[J]. J Prosthet Dent2024132(1):191-203. DOI:10.1016/j.prosdent.2023.05.015.
[24]
Beck FLettner SZupancic Cepic L,et al. Comparison of virtual intersection and occlusal contacts between intraoral and laboratory scans:An in-vivo study[J]. J Clin Med202312(3):996. DOI:10.3390/JCM12030996.
[25]
杨琪,刘晓秋.面部扫描仪在口腔医学中的应用[J].口腔医学研究202238(4):316-319. DOI:10.13701/j.cnki.kqyxyj.2022.04.005.
[26]
Bohner LGamba DDHanisch M,et al. Accuracy of digital technologies for the scanning of facial,skeletal,and intraoral tissues:A systematic review[J]. J Prosthet Dent2019121(2):246-251. DOI:10.1016/j.prosdent.2018.01.015.
[27]
Amornvit PSanohkan S. The accuracy of digital face scans obtained from 3D scanners:An in vitro study[J]. Int J Environ Res Public Health201916(24):5061. DOI:10.3390/ijerph16245061.
[28]
Yang SRevilla-León MWei C,et al. Accuracy(trueness and precision)of 3-dimensional virtual patients:An in vitro investigation of different facial scanners and digital integration techniques[J]. J Dent2025154:105567. DOI:10.1016/j.jdent.2025.105567.
[29]
Lawand GTohme HAzevedo L,et al. Techniques and accuracy for aligning facial and intraoral digital scans to integrate a 3-dimensional virtual patient:A systematic review[J]. J Prosthet Dent2025:S0022-3913(25)00357-9. DOI:10.1016/j.prosdent.2025.04.017.
[30]
Biun JDudhia RArora H. The in-vitro accuracy of fiducial marker-based versus markerless registration of an intraoral scan with a cone-beam computed tomography scan in the presence of restoration artifact[J]. Clin Oral Implants Res202334(11):1257-1266. DOI:10.1111/clr.14166.
[31]
Hamilton ASingh AFriedland B,et al. The impact of cone beam computer tomography field of view on the precision of digital intra-oral scan registration for static computer-assisted implant surgery:A CBCT analysis[J]. Clin Oral Implants Res202233(12):1273-1281. DOI:10.1111/clr.14009.
[32]
Tian SDai NLi L,et al. Three-dimensional mandibular motion trajectory-tracking system based on BP neural network[J]. Math Biosci Eng202017(5):5709-5726. DOI:10.3934/MBE.2020307.
[33]
Farook THRashid FAlam MK,et al. Variables influencing the device-dependent approaches in digitally analysing jaw movement:A systematic review[J]. Clin Oral Investig202327(2):489-504. DOI:10.1007/S00784-022-04835-w.
[34]
Zhong YZhu YJiang T,et al. A novel study on alar mobility of HAN female by 3dMD dynamic surface imaging system[J]. Aesthetic Plast Surg202246(1):364-372. DOI:10.1007/S00266-021-02386-1.
[35]
Ortensi LFisichella MLOrtensi M,et al. A comparison of accuracy between three different facial detection systems for prosthodontic esthetic preview:A single-blinded in vitro study[J]. Minerva Dent Oral Sci202271(4):199-205. DOI:10.23736/S2724-6329.21.04595-2.
[36]
Solaberrieta EGarmendia AMinguez R,et al. Virtual facebow technique[J]. J Prosthetic Dent2015114(6):751-755. DOI:10.1016/J.PROSDENT.2015.06.012.
[37]
Al Hamad KQAyyad JQAl-Rashdan BA,et al. Trueness and precision of facial scan and virtual patient representation workflow[J]. J Prosthodont202534(7):703-711. DOI:10.1111/JOPR.14024.
[38]
马丽娅,巢家瑞,刘飞,等.基于下颌运动轨迹与虚拟架运动参数模拟调的对比研究[J].华西口腔医学杂志202341(3):254-259. DOI:10.7518/hxkq.2023.2022452.
[39]
Lam WYHsung RTChoi WW,et al. A 2-part facebow for CAD-CAM dentistry[J]. J Prosthet Dent2016116(6):843-847. DOI:10.1016/j.prosdent.2016.05.013.
[40]
Park JHHwang CJChoi YJ,et al. Registration of digital dental models and cone-beam computed tomography images using 3-dimensional planning software:Comparison of the accuracy according to scanning methods and software[J]. Am J Orthod Dentofacial Orthop2020157(6):843-851. DOI:10.1016/j.ajodo.2019.12.013.
[41]
Mangano CLuongo FMigliario M,et al. Combining intraoral scans,cone beam computed tomography and Face scans:The virtual patient[J]. J Craniofac Surg201829(8):2241-2246. DOI:10.1097/SCS.0000000000004485.
[42]
叶红强,柳玉树,王冠博,等.三维数字化仿真设计与实现技术在前牙美学修复中的应用[J].中华口腔医学杂志202055(10):729-736. DOI:10.3760/cma.j.cn112144-20200712-00412.
[43]
Li QBi MYang K,et al. The creation of a virtual dental patient with dynamic occlusion and its application in esthetic dentistry [J]. J Prosthet Dent2021126(1):14-18. DOI:10.1016/J.PROSDENT.2020.08.026.
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