[Expert consensus on the "Four-Level and Dual-Axis" comprehensive diagnostic and therapeutic system for prosthetic rehabilitation of oral diseases].

内容摘要

Traditionally, prosthodontics has adhered to a clinical diagnosis and treatment model centered on "tooth defects, partial edentulism, and complete edentulism", which show insufficient alignment with the modern "biopsychosocial" medical model. The demand of high-quality medical services continues to increase with the nation's growing prosperity and the continuous extension of average life expectancy. Facing these heightened medical demands, particularly the challenges of oral frailty and multimorbidity in an aging society, the traditional diagnostic and therapeutic system for prosthodontics increasingly reveals limitations, including insufficient information coverage, obscuring the underlying etio-logy, the neglect of individual psychological needs, and a lack of holistic consideration for multimorbidity. This consensus proposes the "Four-Level and Dual-Axis" comprehensive diagnostic and therapeutic system for prosthetic rehabilitation of oral diseases to address these bottlenecks in disciplinary development. This system classifies the diagnostic scope from micro to macro into four functional levels of "tooth-pulp", "dentition-occlusion", "occlusion-temporomandibular joint", and "maxillofacial-systemic" emphasizing the pathological cascade reactions between levels and a bidirectional diagnostic logic. Simultaneously, it introduces a subjective-objective dual-axis assessment model comprising "individual psychology and prosthetic needs (axis A)" and "etiology and patho-anatomical diagnosis (axis B)," achieving an integration of medical rationality and humanistic care. By reconstructing diagnostic logic and implementing standardized sequential treatment pathways, this consensus aims to facilitate the continuous transition of prosthodontics toward the "biopsychosocial" medical model, shifting from a "prosthesis-centered" approach to a "patient-centered and disease-focused" model of precision personalized prosthetic rehabilitation. 一直以来口腔修复学遵循以“牙体缺损、牙列缺损、牙列缺失”为核心的临床诊疗模式，与现代医学的“生物-心理-社会”模式的契合度不足。随着国家的富强和百姓平均寿命的持续延长，高质量医疗服务的需求日益高涨。而面对更好更高的医疗需求，尤其是社会老龄化带来的口腔衰弱与多病共存等的挑战，传统口腔修复诊疗体系已日益显现出信息涵盖量低、掩盖病因本质、忽视个性心理及缺乏共病思维等局限性。为了解决学科发展堵点，本共识提出“四层双轴”口腔疾病修复重建诊疗体系，将诊疗视野由微观至宏观分为“牙体-牙髓”“牙列-咬合”“-颞下颌关节”“颌面-全身系统”4个功能层级，强调层级间的病损级联反应与双向诊疗逻辑;同时引入“个性心理-修复需求（轴A）”与“病因-病理解剖诊断（轴B）”的主客观双轴评估模式，实现医学理性与人文关怀的融合。通过重构诊断逻辑并推行标准化序列治疗路径，旨在推动口腔修复学持续向“生物-心理-社会”医学模式转化，并从以修复体为中心，向实现以患者口腔疾病为中心的精准个性化修复重建治疗转型。.