29/08/2026
對於骨性戽斗的情況，有些患者會透過拔牙矯正，以牙齒移動來調整咬合，
這類治療方式稱為「掩飾性矯正」 （Camouflage Orthodontics） 。
但牙齒與顎骨是不同層面的問題。
當齒列逐漸調整到理想關係，原本的上下顎骨比例、臉型或左右不對稱，仍需要依個別情況進一步評估。
這次分享的，就是一位曾接受拔牙矯正，後續再進行正顎手術的案例。
這位年輕女性初期於外院接受拔除四顆第一小臼齒的單純牙齒矯正。當療程接近尾聲時，雖然齒列已勉強達到 Class I，也就是上下牙齒的前後關係接近正常，但原本骨性戽斗的外觀特徵仍然存在。
從臉型來看，可以觀察到中臉較凹、臉型偏長；下顎向右偏斜，也伴隨牙齒中線向右偏移。
咬合方面，則仍有上下前牙咬合偏淺的情況。
這些骨架與咬合的差異，也反映在笑容上：微笑曲線較平、嘴角下垂，動態微笑時左右嘴型也明顯不對稱。
因此，這次要處理的不只是牙齒排列，而是從上下顎位置、咬合、臉型比例與微笑線條進行整體規劃。
#做過拔牙矯正，正顎可以怎麼規劃呢？
針對這類已接受過拔牙代償、又面臨二次矯正難題的情況，
謝明吉醫師透過3D電腦斷層影像分析與數位手術模擬（VSP）進行評估。
這次採取單純正顎手術（Surgery-Only Orthognathic Surgery）
不再進行第二次術前齒列矯正，而是直接從骨骼位置進行調整。
手術主要從兩個方向規劃：
1.調整戽斗，也重新建立上下顎與咬合關係
這次進行雙顎正顎手術，將上顎向前調整，增加原本較凹陷的中臉支撐；下顎則進行旋轉、後退與左右對稱校正，處理原本戽斗及下顎偏斜的問題。
但正顎的規劃不只是單純「把下巴往後退」。
手術也加入咬合平面的順時針旋轉，增加笑起來時上排前牙露出的比例，重新調整原本較平的微笑曲線（Smile arc），以及靜態時嘴角下垂的情況。
同時重新校正牙齒中線，並在手術中設定適當的上下前牙水平距離（Overjet），為前牙咬合與導引建立更穩定的基礎。
2.正顎＋削骨手術，臉型輪廓一起規劃
針對原本臉型較寬、下半臉偏長的特徵，透過顴骨、下顎與下巴不同部位的調整
進一步修飾臉部寬度與下半臉比例，讓整體輪廓線條更加流暢。
#術後沒有再進行第二次齒列矯正
這也是這個案例很特別的地方。
患者在正顎手術後沒有再進行第二次齒列矯正，主觀感受到咬合穩定度與咀嚼功能較術前提升；從術後恢復紀錄中，也可以觀察到臉型比例朝向更加緊緻、立體與平衡的方向改變。
這個案例也讓我們看到，矯正與正顎不是二選一，而是彼此相輔相成。
透過矯正與正顎在不同階段的配合，不只幫助調整牙齒與咬合，也能進一步調整骨架位置與臉型比例，讓整體輪廓更加協調柔順。
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For patients with skeletal Class III malocclusion, some may undergo orthodontic treatment with tooth extraction to adjust the occlusion. This type of treatment is known as camouflage orthodontics.
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However, dental alignment and skeletal jaw relationships are different aspects of treatment.
Even when the teeth have gradually been aligned into an ideal relationship, the underlying maxillomandibular proportions, facial profile, or facial asymmetry may still require further evaluation based on the individual case.
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This case features a patient who previously underwent extraction-based camouflage orthodontics and later proceeded with orthognathic surgery.
The young female patient initially received orthodontic treatment at another clinic, which involved the extraction of all four first premolars. As treatment approached completion, her dentition had just managed to achieve a Class I relationship, meaning the anteroposterior relationship between the upper and lower teeth was close to normal. However, the underlying skeletal Class III facial characteristics remained.
From a facial perspective, midface deficiency and a relatively long facial profile were still present. The mandible deviated to the right, accompanied by a rightward deviation of the dental midline.
In terms of occlusion, her anterior bite remained relatively shallow.
These skeletal and occlusal discrepancies were also reflected in her smile: the smile arc was relatively flat, the corners of her mouth turned downward at rest, and noticeable asymmetry was present during dynamic smiling.
Therefore, the goal was not simply to address tooth alignment, but to develop a comprehensive plan incorporating maxillary and mandibular position, occlusion, facial proportions, and smile aesthetics.
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📌After extraction-based orthodontic treatment, how can orthognathic surgery be planned?
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For cases like this—where previous extraction-based dental compensation has already been performed and secondary orthodontic treatment presents additional challenges—Dr. Adrian Hsieh conducted a detailed evaluation using 3D CT imaging and Virtual Surgical Planning (VSP).
A Surgery-Only Orthognathic Surgery approach was selected for this case.
Rather than undergoing a second round of preoperative orthodontic treatment, the plan proceeded directly with skeletal repositioning.
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The surgical plan focused on two main directions:
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1. Correcting the skeletal Class III relationship while re-establishing overall maxillomandibular and occlusal relationships
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A two-jaw orthognathic surgery was performed. The maxilla was advanced to provide greater support to the deficient midface, while the mandible underwent rotation, setback, and asymmetry correction to address the original mandibular prognathism and lateral deviation.
However, orthognathic planning is not simply about “moving the lower jaw backward.”
The surgical plan also incorporated clockwise rotation of the occlusal plane to increase upper incisor display during smiling, while addressing the flat smile arc and the downward appearance of the mouth corners at rest.
At the same time, the dental midline was realigned, and an appropriate overjet was set during surgery to establish a more stable foundation for anterior occlusion and guidance.
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2. Combining orthognathic surgery with facial bone contouring to refine overall facial shape
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To address her original wider facial shape and relatively long lower face, targeted adjustments were made to different anatomical areas, including the zygoma (cheekbones), mandibular angle, and chin.
These procedures further refined her facial width and lower facial proportions, creating smoother overall facial contours.
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📌No second round of orthodontic treatment after surgery
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This is one of the distinctive aspects of this case.
Following orthognathic surgery, the patient did not undergo a second round of orthodontic treatment. Subjectively, she reported improved bite stability and masticatory function compared with before surgery. Her postoperative recovery records also show changes in facial proportions toward a more compact, defined, and balanced appearance.
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This case demonstrates that orthodontic treatment and orthognathic surgery are not an either-or choice—they can complement each other.
By coordinating orthodontic treatment and orthognathic surgery at different stages, treatment can not only help improve dental alignment and occlusion, but also address skeletal positioning and facial proportions, contributing to a more harmonious and naturally balanced facial contour.
#正顎手術 #骨性戽斗 #掩飾性矯正 #拔牙矯正 #雙顎手術 #功能性正顎 #削骨手術 #顴骨縮小 #下顎骨修整 #顏面不對稱 #咬合不正 #牙齒矯正 #風華聯合診所 #謝明吉醫師
