臨床牙醫師常見的Oral facial Pain，部分是由於頸椎的問題所導致，如果能夠精準地評估頸椎的問題，或能找出頭部及顏面疼痛的原因，有可能是由於頸椎錯導致的。我們透過頸椎軟組織的處理，能夠迅速有效改善病人的關節活動角度、神經功能、肌肉力量等陶時，也可以透過簡單的方式，排除頭部及顏面疼痛所導致的原因。

在矯正治療中，常受限於現有牙弓形態與小臼齒拔除等傳統觀念而使治療選擇趨於保守甚至受阻。然而，若能結合高品質的影像工具與精準診斷，跳脫制式化的治療流程，往往能開啟更具預測性與長期穩定性的解決方案。本演講主題「穿越牙弓之外：解鎖矯正的潛在挑戰」聚焦於如何以堅實的生物力學基礎為根本，策略性進行拔牙選擇以改善咬合與顏面美學。透過這些「非典型但科學合理」的治療選擇，重新思考治療順序、目標與患者預期，展現矯正醫師在面對複雜病例時整合診斷思維與治療技術的能力。

近年來隨著3D列印技術及電腦排牙軟體的進步，不管是在固定式的舌側矯正及活動式的透明牙套aligners在臨床治療上都有著很大的進步，筆者在臨床上使用這兩種治療方式的經驗，發現將兩種治療方式合併使用可以有效的縮短治療時間及增加治療效果的可預期性，是種很好的複合式治療方式，本次的演講將從以下的內容進行討論：1.舌側矯正的生物力學特點及其優缺點 2.透明牙套（Clear Aligner)之生物力學特性及其優缺點 3.Hybrid治療的特點及在臨床上使用的經驗分享。

The  temporomandibular  joint  (TMJ)  is  crucial  for  achieving  stable  and  predictable  outcomes  in  orthognathic  surgery  (OGS).  Preexisting  TMJ  pathologies  can  adversely   affect  results,  causing aesthetic dissatisfaction, functional  instability,  increased  risk  of  relapse,  and  persistent  pain.  Addressing  these  challenges  requires  the  incorporation  of  targeted  TMJ  treatment  prior  to  OGS.  By  prioritizing  TMJ  health  as  an  integral  component  of  a  comprehensive  treatment  plan,  clinicians  can  enhance  aesthetic  outcomes,  functional  stability,  and  long-term  success  in  this  complex  patient  population.

The periodontal aspects of orthodontics are reviewed with an emphasis on arch expansion and management of crowding in the lower anterior segment.

Gingival biotype (width of keratinized tissue) and bone morphotype (thickness of labial bone) are the critical diagnostic factors for prevention and treatment of gingival recession. Optimal post-treatment conditions are: 1. dentition positioned in the center of the alveolar ridge, 2. axial loading, 3. circumferential bone support 1–2mm below the cementoenamel junction (CEJ), and 4. alveolar bone at least 1mm thick on the labial and lingual surfaces of the root.

For non-extraction treatment of crowding, increasing arch width helps control labial tipping of the incisors. Recent animal studies reveal that very low archwire force (5cN or g-force), interacting with the resistance cheeks and lips, results in moment that produces buccal translation of molars and the alveolar process. These data help explain the mechanism of slow arch expansion with passive self-ligating (PSL) brackets and small diameter copper nickel titanium (CuNiTi) archwires.

Gingival grafts are not indicated for moderate recession problems related to poor alignment that can be corrected with orthodontics. Free gingival grafts can prevent further recession but combined soft tissue and bone grafts with enamel matrix derivative are required to restore the periodontium. Periodontal grafts can be performed before, during or after orthodontics.

Very low force is necessary for expansion of the alveolar process. Prospective surgical augmentation is indicated if tooth movement poses a significant risk for gingival recession. Prevention is preferred over surgical intervention.

在成人矯正治療中，為了獲取足夠的空間，可採用的策略包括：牙弓擴張，骨釘輔助的後移，拔除小臼齒。對於雙顎前突、嚴重暴牙或嚴重齒列擁擠者，常需透過拔除小臼齒來獲取空間，進行前牙內收、解除擁擠與改善咬合關係，同時有助於改善側貌及唇部閉合。然而，近年來部分學者關注，拔牙所造成的牙弓長度縮短與前牙後移，可能影響舌頭與軟顎的位置，進而改變上呼吸道的解剖結構，甚至增加阻塞性睡眠呼吸中止症的風險。

本報告將根據文獻回顧與實證醫學，探討拔牙矯正對上呼吸道結構的影響。2019年一項美國大型跨機構回溯性研究發現，拔除四顆小臼齒者與未拔牙者的OSA發生率差異不具統計意義。2021年的跨國系統性文獻回顧與統合分析亦指出，拔牙與非拔牙組在上呼吸道體積與最小截面面積之間並無顯著差異。長庚醫院於2023年針對非拔牙組、拔牙常態臉型組及拔牙高角長臉型組進行比較研究，結果顯示三組在治療前後的氣道前後徑及睡眠品質評估皆無顯著差異。

綜合實證結果，目前並無強而有力的證據證實成人拔牙矯正治療會顯著減少上呼吸道體積或提高睡眠呼吸中止症風險。然而，對於顱顏結構異常（如高角、長臉型、中顏面不足等）或原本就具高風險特徵之個案，矯正醫師仍應審慎評估氣道可能的變化，並與睡眠醫學專業團隊密切合作，提供個別化且安全的治療計畫，確保患者在兼顧美觀與健康的前提下，獲得最佳的治療成效。

This presentation examines the historical development and prospective trends of Taiwan’s orthodontic specialist certification system. Traditionally, the process comprised a written examination followed by an oral examination, in which candidates presented five self-prepared cases and one society-assigned case, both of which were required to pass.

In 2024, a major reform introduced a scenario-based oral examination into the assigned case component, designed to simulate real-world clinical decision-making and patient communication. Assessment topics may include etiology diagnosis, treatment planning, biomechanical principles, management of unexpected complications, patient communication, and medical ethics.

This change marks a paradigm shift from an outcome-oriented to a comprehensive competency-based approach, emphasizing real-time clinical judgment, problem-solving ability, and ethical decision-making, while reinforcing patient safety. The reform also aligns Taiwan’s system with global trends seen in international orthodontic board examinations.

Looking forward, the certification system is expected to incorporate digital case submission, cross-disciplinary clinical assessments, and periodic recertification to maintain professional excellence and ensure the highest standards of orthodontic care.

 There are three trends in the development of clear aligner treatment. They are “Hybrid Treatment”, “In-house Manufacturing” and “Direct Printing”. Hybrid aligner treatment is to combine with other tools or treatment modalities to improve the efficacy and efficiency. Through in-house manufacturing, the treatment progress becomes more flexible and adaptable. And direct printing technology is just the right solution to joint with hybrid treatment and in-house manufacturing perfectly.

    The key point of direct printed aligners is not just the simplified manufacturing process. The importance of this new technique is the material— “resin-based photopolymers”. 4D smart material is a special term in 3D printing technology, it refers to a material that not only can be fabricated into a 3D shape using additive manufacturing but also has the ability to change its properties, shape, or functionality over time when exposed to external stimuli. Therefore, we should have a different mindset when apply this new material to the direct printed aligners.

    There will be three parts to be introduced for my presentation:

1. DPA Design and Manufacturing workflows

2. 4D smart material: physical & mechanical properties, active memory polymer

3. Creative design, improved accuracy and efficiency in clinical applications