mental classification

2. M M House classification(1950)
• Class1 - Philosophical
• Class2 - Exacting
• Class3 - Hysterical
• Class4 - Indifferent
In 1950, House who contributed to science and prosthodontics' art development, devised a classification
system of patient’s psychological response to condition of being edentulous and denture.

3. M M House classification(1950)
• Class 1- Philosophical
• Reasonable, calm, and involved in the
treatment procedure at every step.
• Understand the treatment.
• Listen to the dentist’s advice and are willing
to follow the instruction.
• This type would follow dentist’s suggestion
about convert the old denture to a new
one.

4. M M House classification(1950)
• Class 2-Exacting mind
• This type has similar characteristic to philosophical mind,
yet the dentist need more attempts, patience, and
attention to patient of this type.
• These types are methodist, precise, strict, and often
make excessive demand.
• The patient may be in poor health condition and
desperately need for treatment, still they are not willing
to accept dentist’s suggestion on extract the untreatable
teeth and wear a denture.
• The patient with history of dental treatment
dissatisfaction often doubt dentist’s ability to design a
denture that can work functionally and aesthetically.
• Moreover, this patient often want a guarantee of the
treatment and demand more with no additional fee.
• However, once this patient satisfy with the treatment,
this patient can be clinician’s greatest supporter.

5. M M House classification(1950)
• Class3-Hysterical mind
• This type is emotionally unstable, easily happy
and easily anxious. This type have negative
attitude, lack of maintaining their oral health,
dentophobic, sometimes exacting but with
unfounded complaint, lack of effort to adapt
with denture, and have unrealistic expectation.
• Although they try to fit with denture, they often
fail to wear because they think his denture will
appear and function as natural teeth.
• The prognosis of treatment in this patient is
poor.

6. M M House classification(1950)
• Class4- Indifferent mind
• This patient is apathetic, uninterested, and
lack of motivation.
• This patient is more likely not concern
about their appearance and not motivated
to enjoy their meal.
• They can survive without denture. This
patient do not concern to the instruction,
no effort to cooperate with clinician, and
more likely to blame dentist regarding a
poor oral health of patient.
• The prognosis of this patient is doubtful or
bad.

7. Winkler Classification
The Hardy Elderly
Physically and psychologically ready, active in social and professional
life, and easily adapt to age change
The Senile Aged Syndrome
physically may be ill,disabled or aged
- psychologically and emotionally weak
- cannot cope with stress and vulnerable to ailments.
The Satisfied Old Denture Wearer
This type is satisfied with the old denture despite the severe problem.
They have adapted and happy with their old denture
Geriatric Patient who doesn’t Want Denture
This type is elderly patient who has been living with no teeth for years
and doesn’t have any desire to wear full denture and lack of
motivation.

8. Gamer Classification
• In 2003, Simon Gamer et al presented the expansion of House
classification including dentist’s attitude as defining factor of patient’s
attitude. Gamer classification is based on two factors, i.e:
• Patient’s engagement level to dentist and treatment procedure in a
continuum from totally engaged (++++) to disengaged (+)
Ideal patient
Submitter
Patient
Reluctant
Indifferent
Patient
Resistant Patient

9. Gamer Classification
1. Ideal patient
• Reasonably engaged i.e. (+ + +)
• Reasonably trusts the dentist i.e. (+ + +)
• May skeptically distrust also .
• Mature
• May ask questions and need satisfying answers
for the same from the dentist.
• May not be over suspicious or over accepting of
the dentist’s opinions.
• Similar to Philosophical type of patient in
House’s classification.

10. Gamer Classification
2. Submitter Patient
• Submitter patient are scored ++++ for involvement
and ++++ for willingness to trust dentist.
• They do not discriminate.
• Submitter do not have capacity to provide pure
informed consent because they submit everything
to dentist’s skill.
• Engages in the treatment completely.

11. Gamer Classification
3. Reluctant
• Engagement level is + +
• Trust for the treatment is ++
• Skeptic.
4. Indifferent Patient
• They are scored + for involvement and + for
willingness to trust dentist.
• They are often forced to come to dentist by their
relative and family.
• Minimal involvement.

12. Gamer Classification
5. Resistant Patient
• Engaged with treatment but with an adverse
mindset.
• Trust is very minimal or not there.
• Question or doubt if they receive help from
anyone in any situation.
• Instead of acknowledging or accepting, they
challenge the dentist.

14. House
classification
SOFT PALATE

17. Classification: Based on the
Angulation between Hard and
Soft Palate
Class I: Soft Palate is almost horizontal Class
II: Soft Palate turns downwards at
an angle of 450 from hard Palate Class III:
Soft Palate turns downwards
sharply at an angle of 750 from
hard Palate

18. Class I: Soft Palate is almost horizontal
Class II: Soft Palate turns downwards at an angle of
45 degrees from hard Palate
Class III: Soft Palate turns downwards sharply at an
angle of 75 degree to 90 degree from hard Palate

20. CLASS 1 : allows more than 5 mm of posterior palatal seal
area depending on the muscular activity of the soft palate.
Ideal retention
CLASS 2 : 1 to 5 mm of posterior palatal seal area depending
on the muscular activity of the soft palate. Good retention
CLASS 3 : 1 mm of posterior palatal seal area depending on
the muscular activity of the soft palate. Poor retention

21. POSTERIOR PALATAL SEAL AREA
• is an area between anterior and posterior vibrating lines found medially from
one tuberosity to another. It appears to be a cupid's bow / Butterfly shaped
• Boundaries of posterior palatal seal area encompasses:
- Maxillary tuberosity & hamular notch
• - Hard palate anterolaterally; the submucosal contains adipose tissue, and
posterolaterally; it contains displaceable glandular tissue.
- Soft palate is a movable, muscular fold, suspended from the posterior border
of the hard palate. It separates the nasopharynx from the oropharynx.

22. Anterior Vibrating Line

23. It is generally cupid bow-shaped,
How to record it :When the patient is instructed to say
“ah” with short vigorous bursts, or Ask the patient to
blow air gently through the nose with nostrils closed by
fingers.
Due to the projection of the posterior nasal spine, the
anterior vibrating line is not a straight line between both
hamular processes. The anterior vibrating line is always
on soft palatal tissues.
Anterior Vibrating Line

24. Posterior Vibrating Line

25. Posterior Vibrating Line
It is an imaginary line at the junction of aponeurosis of
the Tensor Veli Palatinae muscle and the muscular
portion of hard palate.
It presents the intersection of soft palate that shows
limited movement and the remainder soft palate that
shows marked movement.
Shape: It is usually straight and slight anterior
curvature

26. Relationship of Fovaea Palatinae to the vibrating line

28. Posterior Palatal Seal Area Depth

29. Posterior Palatal Seal Area Width

30. Establishment of Posterior Palatal Seal
CONVENTIONAL METHOD : Green stick
Fluid Wax stick: IOWA WAX/ CORRECTA WAX
SCRAPING THE CAST:

31. CLINICAL SIGNIFICANCE OF POSTERIOR PALATAL SEAL AREA
It increases retention of denture by atmospheric
pressure
It compensates for polymerization shrinkage when
scraps on the cast
It prevents air and food from getting under the
denture