2025中国专家共识：正畸治疗中牙釉质脱矿的预防和治疗（英文）解读

Interpretationof2025ChineseExpertConsensusonPreventionandTreatmentofEnamelDemineralizationinOrthodonticTreatment

1.BackgroundoftheConsensus

Enameldemineralization,commonlypresentedaswhitespotlesions(WSLs),isthemostprevalentadverseeventduringfixedorthodontictreatment.Withthegrowingpublicdemandfororthodonticcorrection,theincidenceofWSLsduringorthodontictreatmenthasremainedbetween15%and80%,whichseriouslydamagespatients'oralhealthandpostoperativeaestheticoutcomes.Before2025,therewasnounifiedstandardizedclinicalspecificationforthepreventionandmanagementofenameldemineralizationinorthodontictreatmentinChina.The2025ChineseExpertConsensus,officiallypublishedinChineseJournalofOrthodontics,integratesthelatestevidence-basedmedicalevidenceanddomesticclinicalpracticeexperience,anditsEnglishversionfurtherpromotestheexchangeofChineseorthodonticexperiencewiththeinternationalcommunity.ThisinterpretationsortsoutthecorepointsoftheEnglishversionoftheconsensustohelpcliniciansquicklygrasptheclinicalspecifications.

2.CoreDefinitionandEpidemiologicalConsensus

Theconsensusclearlydefinesorthodontic-relatedenameldemineralizationassubsurfaceenamelminerallosscausedbyacidificationofcariogenicbiofilmaroundorthodonticappliances,whichisanearlystageofcariesthatcanbereversedwitheffectiveintervention.Intermsofepidemiology,theconsensusupdateslocalizedChinesedata:theincidenceofWSLsinChinesepatientsafter6monthsoffixedorthodontictreatmentisabout38.6%,andhigh-riskgroupsincludeadolescents,patientswithpoororalhygiene,patientswithorthodontictreatmentlastingmorethan2years,andclearaligneruserswhodonotcomplywithwearingandcleaningrequirements.Differentfrompreviousforeigndata,theconsensuspointsoutthattheincidenceofdemineralizationinChineseadolescentorthodonticpatientsisslightlyhigherthanthatinEuropeanandAmericanpopulations,mainlyduetodifferencesinsugarintakefrequencyandoralhealthawareness,whichisalocalizedcharacteristicconclusionuniquetothisconsensus.

3.CorePreventionRecommendationsforEnamelDemineralization

Theconsensusdividespreventionstrategiesintothreelevels:generalprevention,targetedpreventionforhigh-riskgroups,andin-processintervention,whichisclearerthanpreviousclassifications.Thecorerecommendationsareasfollows:

Dailyoralhygienemanagement:Theconsensusrecommendsthatorthodonticpatientsusefluoridetoothpaste,withafluorideconcentrationof1000-1500ppmforchildrenand1450-1500ppmforadults.Forfixedappliancepatients,interdentalbrushesandspecialorthodonticflossarerecommendedtocleantheareaaroundbrackets,andcleaningaftereachmealismandatory.Forclearalignerusers,itisemphasizedthatalignersshouldbecleaneddailywithneutralsoap,anddisinfectionwithhigh-concentrationalcoholorhotwaterisprohibitedtoavoiddeformationandbacterialaccumulation.

Professionalfluorideintervention:Formediumandhigh-riskpatients,theconsensusrecommendsprofessionaltopicalfluorideapplicationevery3months,includingfluoridevarnish,fluoridefoam,etc.Itisclearlypointedoutthatfluoridevarnishhasbetterbiocompatibilityandanti-demineralizationeffectthanotherfluoridepreparations,anddoesnotaffectthebondingstrengthofbrackets,soitisthefirst-choiceclinicalpreparation.

Applianceoptimization:Theconsensusrecommendsself-ligatingbracketswithsmoothersurfacesforpatientsathighriskofdemineralization,whichcanreducebiofilmadhesion.Forpatientswithextremelypoororalhygiene,long-termfixedappliancesarenotrecommended,andremovableappliancesorstagedcorrectioncanbeselectedtoreducetherisk.

4.CoreTreatmentRecommendationsforEstablishedEnamelDemineralization

Accordingtothescopeanddepthofdemineralization,theconsensusformulateshierarchicaltreatmentrecommendationswithstrongeroperability:

Earlysuperficialdemineralization(noaestheticcomplaints):Remineralizationtherapyisthefirstchoice,achievedbydailyuseofhigh-concentrationfluoridetoothpastecombinedwithregularprofessionalfluorideapplication.Theconsensusrecommends1.23%acidulatedphosphatefluoridegelor5%sodiumfluoridevarnishforremineralization,andtheeffectiveratecanreachmorethan70%after6monthsofintervention.

WSLswithobviousaestheticcomplaints:Forlesionswithadepthoflessthan1mm,minimallyinvasivemicro-abrasioncombinedwithremineralizationorresininfiltrationtherapyisrecommended.TheconsensuspointsoutthatresininfiltrationhasabetteraestheticeffectforearlyWSLs,witha5-yearretentionrateofmorethan85%,whichissuperiortotraditionalfillingtherapy.Forlesionswithadepthofmorethan1mmoraccompaniedbyobviouscariescavities,compositeresinfillingoradhesiverestorationisrecommended.

Severedemineralizationinvolvingpulp:Theconsensusrecommendsendodontictreatmentfollowedbyaestheticrestoration,whichconformstothegeneralprincipleofcariestreatment,butemphasizesthatthetimingofaestheticrestorationshouldbearrangedafterthecompletionoforthodontictreatmenttoavoidaffectingtoothmovement.

5.ClinicalEnlightenmentandSignificanceoftheConsensus

The2025ChineseExpertConsensusisthefirstdomesticspecializedconsensusfocusingonenameldemineralizationinorthodontictreatment.ItsEnglishversionprovidesavaluablereferenceforEastAsia