国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (6): 810-820.doi: 10.7518/gjkq.2026147

• 专家笔谈 • 上一篇    

Andrews六要素在正颌外科方案设计中的应用探索

刘思颖(),高洁()   

  1. 口腔疾病国家临床医学研究中心 口颌系统重建与再生全国重点实验室 陕西省口腔疾病临床医学研究中心 空军军医大学口腔医院正畸科 西安 710032
  • 收稿日期:2026-07-07 修回日期:2026-09-24 出版日期:2026-11-01 发布日期:2026-10-29
  • 通讯作者: 高洁
  • 作者简介:刘思颖，空军军医大学口腔医院正畸科副教授、副主任医师，硕士研究生导师。从事颌面组织发育与再生的基础研究，以及面部美学与正颌外科手术设计方面的临床应用研究。临床专长为青少年错畸形的矫治及成人正畸正颌联合治疗。现任中华口腔医学会口腔正畸专业委员会委员，中华口腔医学会口腔颌面创伤及正颌外科专业委员会青年委员，陕西省口腔医学会口腔正畸专业委员会常务委员，陕西省口腔医学会数字化口腔医学专业委员会委员，Tweed中国中心教官。发表论文28篇，其中被SCI数据库收录17篇。主持国家自然科学基金2项、省部级课题3项、空军医疗机构临床新技术1项、其他课题5项。获美国正畸医师协会（CDABO）年度最佳病例报告奖，获陕西省高校青年教师教学竞赛一等奖、中华口腔医学会全国口腔院校青年教师授课技能比赛一等奖、陕西省高等教育教学成果一等奖、陕西省本科优秀教学案例、空军军医大学教学标兵团队负责人。获国家实用新型专利1项，主编专著1部、副主编副主译专著3部，参编专著4部、译著3部。|刘思颖，副主任医师、副教授，博士，Email：mylsdr@ sina.com|高洁，空军军医大学口腔医院正畸科副教授、副主任医师。临床擅长数字化正畸治疗，隐形-多学科联合治疗等。主持各类基金6项；发表SCI数据库收录论文18篇，核心期刊收录论文5篇；编著正畸专著8本；授权专利5项，其中2项已转化。获第八届中国医疗器械创新创业大赛3项奖项，陕西省科技创新大赛三等奖。研究方向主要为数字化技术在正畸临床中的应用，正畸面部软组织变化，视觉理解与感知人工智能在正畸中的应用等。开发的儿童腺样体早期筛查预防系统“军大儿童呼吸小卫士”发布于微信小程序端。
  • 基金资助:
    空军军医大学第三附属医院科技发展基金(2024JZ014);空军军医大学第三附属医院临床新技术“快响课题”项目(LXKX26-205)

Exploration of the application of Andrews’ six elements in orthognathic surgery planning

Siying Liu(),Jie Gao()   

  1. National Clinical Research Center for Oral Diseases, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Shaanxi Clinical Research Center for Oral Diseases, Dept. of Orthodontics, Hospital of Stomatology, the Fourth Military Medical University, Xi'an 710032, China
  • Received:2026-07-07 Revised:2026-09-24 Online:2026-11-01 Published:2026-10-29
  • Contact: Jie Gao
  • Supported by:
    Science and Technology Development Fund of the Third Hospital Affiliated to Air Force Medical University(2024JZ014);Clinical New Technology “Rapid Response Project” Funding Program of the Third Hospital Affiliated to Air Force Medical University(LXKX26-205)

RichHTML

5

PDF (PC)

16

摘要：

正颌外科方案设计关键在于颌骨空间位置的精准定位。传统头影测量分析方法存在参考指标繁杂、经验依赖性强、以“平均脸”为目标等局限。Andrews口颌面协调六要素以个体面部软组织标志为参照，为颌骨个性化定位提供了新思路。本文基于笔者团队前期研究成果与临床实践经验，综述了六要素的理论框架，并探索性地提出了一套应用Andrews六要素设计正颌外科方案的参考流程，该流程将手术设计的核心聚焦于上中切牙FA点-目标前界线（UFA-GALL）距离，步骤明确、参考系简单，有望在一定程度上辅助减少经验依赖与误差累积。然而，该方法应用于中国人群时仍面临若干问题：前额定点及头位校正存在主观性，影响GALL线可重复性；人种差异导致GALL线相对靠前，需进行数据修正；要素Ⅰ对术前正畸去代偿提出更高要求；六要素基于二维诊断，缺乏正面及动态评价指标。未来应增加前瞻性研究验证其设计有效性，并推动六要素的三维化扩展、跨人种数据优化及智能化辅助，以期为正颌外科方案设计提供新的参考工具。

关键词: Andrews六要素, 正颌外科, 方案设计, 目标前界线, 去代偿

Abstract:

The core of orthognathic surgery planning lies in the precise spatial positioning of the jawbones. Traditional cephalometric analysis methods are limited by complex reference indices, heavy reliance on clinical experience, and a focus on achieving an “average facial morphology.” Andrews’ six elements of orofacial harmony, which take indivi-dual facial soft tissue landmarks as references, provide a novel approach for personalized jawbone positioning. This work reviews the theoretical framework of Andrews’ six elements on the basis of previous research and clinical experience and proposes an exploratory reference workflow for orthognathic surgery planning using Andrews’ six elements. This workflow centers surgical design on the upper facial-axis-goal anterior limit line (UFA-GALL) distance, featuring clear steps and a simplified reference system that can assist in reducing experience-dependent bias and cumulative errors. However, the following challenges remain when applying this method to the Chinese population: 1) The subjectivity in frontal bone landmarking and head position correction compromises the reproducibility of the GALL line; 2) Ethnic differences lead to a relatively anteriorly positioned GALL line, necessitating population-specific data correction; 3) Element Ⅰ imposes high requirements for preoperative orthodontic decompensation; and 4) rooted in 2D diagnosis, the six elements lack frontal and dynamic evaluation metrics. Future research should include prospective studies to validate the design efficacy. Efforts should be directed to promoting the 3D expansion of the six elements, cross-ethnic data optimization, and intelligent auxiliary tools, with the aim of providing a novel reference tool for orthognathic surgery planning. Its effectiveness remains to be validated by further prospective studies.

Key words: Andrews’ six elements, orthognathic surgery, surgical planning, goal anterior limit line, dental decompensation

中图分类号: 

  • R783.5

图 1

Andrews要素Ⅰ定义的上下颌中切牙的理想位置FOP：功能平面（functional occlusal plane）。理想的切牙位置：在头颅侧位片上，上中切牙牙冠唇面具有+7°转矩，且阻抗中心应位于牙槽骨的唇侧1/3处（即上中切牙阻抗中心至唇侧牙槽骨表面的垂直距离为X，同时距舌侧牙槽骨表面的垂直距离为2倍的X）；下中切牙牙冠唇面具有-1°转矩，根尖应位于牙槽骨中央（即下中切牙根尖距唇、舌侧牙槽骨表面的垂直距离相等，均为Y）。满足以上条件，即可认为上下颌中切牙直立于牙槽骨基骨中央并具有合适的转矩。"

表 1

主要解剖标志点名称及定义"

标志点名称定义
发际点（trichion，Tr）前额和头皮的交界点，即解剖前额的最上点
眉间点（glabella，Gl）侧面观软组织眉弓最凸点
额上点（superion，Su）临床前额的最上点，在直形前额上与发际点Tr重合，在圆形前额上指额部侧面上与面部的关系较与头皮更密切的一点；在角形前额上为角形的转折点
临床前额中点（forehead facial-axis point，FFA）侧面观临床前额的中点，在直形前额中，就是Tr和Gl的中点；在角形和圆形前额中，则是Su和Gl的中点
鼻下点（subnasale，Sn）鼻小柱与上唇的转折点
上口点（stomion supe-rius， Stoms）上唇下缘最低点
软组织颏下点（menton of soft tissue，Mes）软组织颏部最下点
软组织下颌角点（go-nion of soft tissue，Gos）软组织上相应的下颌角点
软组织耳点（porion of soft tissue，Ps）软组织外耳道最上缘点
上中切牙FA点（UFA）上中切牙临床冠唇面长轴上龈向中点
下中切牙FA点（LFA）下中切牙临床冠唇面长轴上龈向中点
颏前点（pogonion，Pog）硬组织颏部最前点

表 2

主要参考平面/测量平面名称及定义"

参考平面/测量平面名称定义
额平面（forehead plane，FP）在直形前额中，就是Tr和Gl的连线；在角形和圆形前额中，则是Su和Gl的连线
FALL（forehead anterior limit line）经过FFA点的铅垂线
GALL（goal anterior li-mit line）与FALL平行，当FP与FALL的夹角≤7°，此线与FALL重叠；当FP与FALL的夹角>7°，此线位于FALL前方，每增大1°，此线靠前0.5 mm，但最前不超过Gl（除非患者要求）
功能平面（functional occlusal plane，FOP）均分后牙咬合接触点的平面
PALL（pogonion's anterior limit line）过LFA点，垂直于FOP的假想平面

图 2

Andrews定义的3种临床前额形态及前额解剖标志点定位示意图A：直形前额；B：圆形前额；C：角形前额。"

图 3

使用Andrews六要素设计正颌外科方案的流程示意图A：描记与定点；B：定位GALL线；C：沿平面移动上颌骨；D：垂直向移动上颌骨；E：旋转平面；F：移动下颌骨及颏部；G：调整前下面高与后面高；H：重新描绘软组织外形。蓝色：术前；灰色：移动中；红色：模拟术后。"

[1] 王旭东, 魏弘朴, 李彪. 从“经验外科”到“精准外科”：精准正颌外科体系的建立与临床应用[J]. 华西口腔医学杂志, 2023, 41(5): 491-501.
Wang XD, Wei HP, Li B. From “Empirical Surgery” to “Precision Surgery”: establishment and clinical application of precision orthognathic surgery system[J]. West China J Stomatol, 2023, 41(5): 491-501.
[2] Posnick JC, Makan S, Bostock D, et al. Primary maxillary deficiency dentofacial deformities: occlusion and facial esthetic surgical outcomes[J]. J Oral Maxillofac Surg, 2018, 76(9): 1966-1982.
[3] Li JTW, Leung YY. Digital diagnostics and treatment planning for orthognathic surgery[J]. Aust Dent J, 2025, 70(S1): S82-S92.
[4] Bench RW. The visual treatment objective: ortho-dontic's most effective treatment planning tool[J]. Proc Found Orthod Res, 1971: 165-194.
[5] 闫佳恕, 李彪, 王旭东. 数字化正颌外科技术在临床实践中面临的挑战[J]. 口腔疾病防治, 2024, 32(5): 395-400.
Yan JS, Li B, Wang XD. Challenges of computer-assisted orthognathic surgery in clinical application[J]. J Prev Treat Stomatol Dis, 2024, 32(5): 395-400.
[6] Peck S, Peck L. Selected aspects of the art and science of facial esthetics[J]. Semin Orthod, 1995, 1(2): 105-126.
[7] Oh HS, Korn EL, Zhang XY, et al. Correlations between cephalometric and photographic measurements of facial attractiveness in Chinese and US patients after orthodontic treatment[J]. Am J Orthod Dentofacial Orthop, 2009, 136(6): 762.e1-762.e14.
[8] Andrews LF. The six keys to normal occlusion[J]. Am J Orthod, 1972, 62(3): 296-309.
[9] Andrews LF. The 6-elements orthodontic philosophy: treatment goals, classification, and rules for treating[J]. Am J Orthod Dentofacial Orthop, 2015, 148(6): 883-887.
[10] Andrews WA, Andrews LF. The six elements or-thodontic philosophy: goals, diagnosis, classification, and treatment[M]. Meridian: Dental Press, 2025.
[11] 张珂, 白丁. Andrews口颌面协调六要素在侧貌美学中的应用[J]. 国际口腔医学杂志, 2010, 37(2): 236-239.
Zhang K, Bai D. Application of Andrews' six elements of orofacial harmony in profile esthetics[J]. Int J Stomatol, 2010, 37(2): 236-239.
[12] Lundström A, Lundström F, Lebret LM, et al. Natural head position and natural head orientation: basic considerations in cephalometric analysis and research[J]. Eur J Orthod, 1995, 17(2): 111-120.
[13] Lo LJ, Weng JL, Ho CT, et al. Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism[J]. PLoS One, 2018, 13(8): e0200589.
[14] San Miguel Moragas J, Oth O, Büttner M, et al. A systematic review on soft-to-hard tissue ratios in orthognathic surgery part Ⅱ: chin procedures[J]. J Cranio Maxillofac Surg, 2015, 43(8): 1530-1540.
[15] Knoops PGM, Borghi A, Breakey RWF, et al. Three-dimensional soft tissue prediction in orthognathic surgery: a clinical comparison of Dolphin, ProPlan CMF, and probabilistic finite element modelling[J]. Int J Oral Maxillofac Surg, 2019, 48(4): 511-518.
[16] Dammling C, Powell K, Repasky T, et al. Validation of Andrews analysis in the virtual environment[J]. J Oral Maxillofac Surg, 2023, 81(8): 979-987.
[17] Resnick CM, Daniels KM, Vlahos M. Does Andrews facial analysis predict esthetic sagittal maxillary position[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2018, 125(4): 376-381.
[18] Resnick CM, Kim S, Yorlets RR, et al. Evaluation of Andrews' analysis as a predictor of ideal sagittal maxillary positioning in orthognathic surgery[J]. J Oral Maxillofac Surg, 2018, 76(10): 2169-2176.
[19] 王策. 应用Andrews六要素要素Ⅱ评估骨性Ⅱ类患者上下颌骨矢状向位置特征的研究[D]. 沈阳: 中国医科大学, 2022.
Wang C. Study on the application of Andrews six element Ⅱ to evaluate the sagittal positional characte-ristics of the upper and lower jaws in patients with skeletal class Ⅱ[D]. Shenyang: China Medical University, 2022.
[20] 杨妍, 梁源, 金钫, 等. 中国骨性错𬌗畸形人群基于眉间点确定上颌理想前界线的可行性研究[J]. 中华口腔正畸学杂志, 2025, 32(3): 146-150.
Yang Y, Liang Y, Jin F, et al. Feasibility of using the glabella to determine the ideal sagittal position of the maxilla in Chinese patients with skeletal malocclusion[J]. Chin J Orthod, 2025, 32(3): 146-150.
[21] Miao P, Gao J, Lu ZY, et al. Cone beam computed tomography imaging of sagittal positions of the mandibular prominence and maxillary central incisors in adult Chinese Han men as an aesthetic profile determinant[J]. Medicine, 2020, 99(43): e22778.
[22] Perrett DI, May KA, Yoshikawa S. Facial shape and judgements of female attractiveness[J]. Nature, 1994, 368(6468): 239-242.
[23] 杨妍, 曹猛, 刘思颖, 等. 中国汉族正常𬌗人群GALL线与眉间点矢状向关系的研究[J]. 中华口腔正畸学杂志, 2017, 24(3): 128-132.
Yang Y, Cao M, Liu SY, et al. The relationship between GALL Line and glabella in sagittal direction of Han Chinese with individual normal occlusion[J]. Chin J Orthod, 2017, 24(3): 128-132.
[24] Sandoval C, Díaz A, Manríquez G. Relationship between craniocervical posture and skeletal class: a statistical multivariate approach for studying Class Ⅱ and Class Ⅲ malocclusions[J]. Cranio, 2021, 39(2): 133-140.
[25] Slaimayeh AAS. 自然头位下头影测量稳定参考平面研究[D]. 成都: 四川大学, 2021.
Slaimayeh AAS. Study on stable reference plane of cephalometric measurement under natural head position[D]. Chengdu: Sichuan University, 2021.
[26] Andrews WA. AP relationship of the maxillary central incisors to the forehead in adult white females[J]. Angle Orthod, 2008, 78(4): 662-669.
[27] 王晓婷, 林立. Andrews六要素与上颌矢状向定位的研究进展[J]. 中华口腔正畸学杂志, 2024, 31(3): 148-152.
Wang XT, Lin L. Research proceeding of Andrews' six elements and the sagittal position of maxilla[J]. Chin J Orthod, 2024, 31(3): 148-152.
[28] Bertot AA, Dammling CW, Souccar NM, et al. A cross-sectional study examining Andrews' analysis in Caucasian and African American subjects[J]. J Oral Maxillofac Surg, 2024, 82(12): 1528-1536.
[29] Farkas LG, Katic MJ, Forrest CR. International anthropometric study of facial morphology in various ethnic groups/races[J]. J Craniofac Surg, 2005, 16(4): 615-646.
[30] Suhk J, Park J, Nguyen AH. Nasal analysis and ana-tomy: anthropometric proportional assessment in asians-aesthetic balance from forehead to chin, part Ⅰ[J]. Semin Plast Surg, 2015, 29(4): 219-225.
[31] 何冰. 广东地区正常𬌗人群Andrews侧貌分析研究[D]. 广州: 南方医科大学, 2013.
He B. Andrews lateral facial analysis study on normal occlusion population in Guangdong region[D]. Guangzhou: Southern Medical University, 2013.
[32] He DQ, Gu Y, Sun YN. Evaluation of aesthetic anteroposterior position of maxillary incisors in patients with extraction treatment using facial refe-rence lines[J]. J Int Med Res, 2019, 47(7): 2951-2960.
[33] Zou BS, Zhou Y, Lowe AA, et al. Changes in anteroposterior position and inclination of the maxillary incisors after surgical-orthodontic treatment of ske-letal class Ⅲ malocclusions[J]. J Cranio Maxillofac Surg, 2015, 43(10): 1986-1993.
[34] An JS, Jeong W, Sonnesen L, et al. Effects of presurgical mandibular incisor decompensation on long-term outcomes of Class Ⅲ surgical orthodontic treatment[J]. J Clin Med, 2021, 10(13): 2870.
[35] Seker ED, Sunal Akturk E, Yilmaz HN, et al. Occlusal plane rotation and orthodontic decompensation: influence on the outcome of surgical correction of Class Ⅲ malocclusion[J]. J Orofac Orthop, 2023, 84(6): 373-383.
[36] Liang YQ, Zhang RC, Wang S, et al. Evaluation of a safe decompensation range for mandibular incisors during presurgical orthodontic treatment for severe skeletal Class Ⅲ malocclusion: a cone-beam computed tomography study[J]. Am J Orthod Dentofacial Orthop, 2026, 169(4): 440-457.e2.
[37] 贺红. 正畸牙移动中牙周界限的探讨[J]. 中华口腔医学杂志, 2021, 56(10): 966-970.
He H. Periodontal limits of orthodontic tooth movement[J]. Chin J Stomatol, 2021, 56(10): 966-970.
[1] 于世宾,张勉,冯志宏,董岩,姜华,刘洪臣,李鸿波,谢理哲,尹德强,刘洋. 老年人修复的咬合设计策略——一些共识性的意见和一种数字化新方法[J]. 国际口腔医学杂志, 2026, 53(4): 451-464.
[2] 李沛然,毕瑞野,王旻,王瑞宇,刘尧,姜楠,曹品银,祝颂松. 上颌Le Fort Ⅰ前徙术与前份根尖下截骨后退术术后软组织变化的比较研究[J]. 国际口腔医学杂志, 2023, 50(3): 293-301.
[3] 罗恩. 人工智能正颌外科的探索与临床初步应用[J]. 国际口腔医学杂志, 2022, 49(2): 125-131.
[4] 王立冬,马文,付帅,张长彬,崔庆赢,梁燕,黎明. 不同方法制作正颌手术数字化牙合板的研究及精确性分析[J]. 国际口腔医学杂志, 2021, 48(2): 156-164.
[5] 王涛. 外科优先序列治疗——正颌外科的发展热点之一及其误区[J]. 国际口腔医学杂志, 2020, 47(5): 497-505.
[6] 戴智, 侯敏, 张春香. 渐进性髁突吸收致下颌后缩正颌外科的治疗进展[J]. 国际口腔医学杂志, 2017, 44(3): 359-362.
[7] 谭俭琴 唐正龙. 手术优先治疗牙颌面畸形的研究进展[J]. 国际口腔医学杂志, 2016, 43(1): 99-.
[8] 曹俊综述 唐恩溢审校. 正颌手术后咀嚼肌改变的研究进展[J]. 国际口腔医学杂志, 2010, 37(02): 210-210～213.
[9] 张恒,施斌,. 特殊颌关系患者种植修复的临床进展[J]. 国际口腔医学杂志, 2007, 34(02): 127-130.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!