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This document presents classification systems for complete edentulism, partial edentulism, and completely dentate patients. For complete edentulism, it describes 4 classes based on factors like residual bone height, ridge morphology, muscle attachments, and occlusal relationships. Partial edentulism classes are determined by location/extent of edentulous areas, abutment conditions, occlusion, and residual ridges. Completely dentate classes consider tooth condition and occlusal scheme, with higher classes requiring more extensive pre-prosthetic therapy.
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- 1. PROSTHODONTIC DIAGNOSTIC INDEX PRESENTED BY: PRAMOD CHAHAR
- 2. PROSTHODONTIC DIAGNOSTIC INDEX Completeedentulism Partial edentulism Complete dentate
- 3. CLASSIFICATION SYSTEM FOR COMPLETEEDENTULISM • Developed by American college of prosthodontics • Published in 1999 in Journal of Prosthetic dentistry • By McGarry et al • Review of prosthodontic literature was done • 89 variables identified
- 4. • The datacollected via this questionnaire were formatted into a new survey instrument that differentiated variables into four subclasses: Physical findings Prosthetic history Pharmaceutical history Systemic disease evaluation
- 5. The variables inthese four subclasses were further evaluated to determine their importance in relation to: Educational requirement Clinical responsibility Clinical technique modification Clinical and laboratory time requirement Overall clinical significance
- 6. • The subcommitteeestablished a ranking of individual variables. Subsequently, a classification system was developed based on the most objective variables • Four categories were defined ranging from Class I to Class IV – Class I patient: an uncomplicated clinical situation – Class IV patient: the most complex and higher-risk situation
- 7. PROSTHODONTIC DIAGNOSTIC INDEX COMPLETEEDENTULISM CHECKLIST Bone Height-Mandibular Residual ridge morphology of maxilla Muscle attachments in mandible Maxillomandibular relationship Conditions Requiring Pre-prosthetic Surgery Limited Inter-arch Space Tongue anatomy Modifiers
- 9. BONE HEIGHT • Chronicprogressive, irreversible and disabling process probably of multifactorial origin. Type I :(most favourable): residual bone height of 21 mm or greater Type II: bone height of 16 to 20 mm Type III: bone height of 11 to 15 mm Type IV: bone height of 10 mm or less
- 10. RESIDUAL RIDGE MORPHOLOGY: MAXILLA TypeA (most favourable) Vestibular depth and palatal morphology that resists vertical and horizontal movement Sufficient tuberosity definition Hamular notch is well defined to establish the posterior extension Absence of tori or exostoses
- 11. Type B Lossof buccal vestibule Palatal vault morphology resists vertical and horizontal movement of the denture base. Tuberosity and hamular notch are poorly defined. Maxillary palatal tori and/or lateral exostoses do not affect the posterior extension of the denture base.
- 12. Type C Lossof labial vestibule Palatal vault morphology offers minimal resistance. Maxillary palatal tori and/or lateral exostoses do not affect the posterior extension Hyperplastic, mobile anterior ridge offers minimum support and stability Reduction of the post malar space by the coronoid process during mandibular opening and/or excursive movements.
- 13. • Type D Loss of labial and buccal vestibules. Palatal vault morphology : No resistance. Maxillary palatal tori and/or lateral exostoses: interferes Hyperplastic, redundant anterior ridge. Prominent anterior nasal spine.
- 14. Muscle Attachments: Mandible •Type A (most favourable) Attached mucosal base without undue muscular impingement during normal function in all regions. • Type B Attached mucosal base in all regions except labial Mentalis muscle attachment near crest of alveolar vestibule ridge. • Type C Attached mucosa in all regions except anterior labial and lingual vestibules-canine to canine.
- 15. • Type D Attached mucosal base only in the posterior lingual region. Mucosal base in all other regions is detached. • Type E No attached mucosa in any region.
- 16. MAXILLO-MANDIBULAR RELATIONSHIP • ClassI (most favorable): Tooth position that has normal articulation Teeth supported by the residual ridge. • Class II: Maxillomandibular relation requires Tooth position outside the normal ridge relation (excessive overlap) • Class III: Maxillomandibular relation requires Tooth position outside the normal ridge relation to attain aesthetics, phonetics, and articulation (cross bite)
- 17. CONDITIONS REQUIRING PREPROSTHETIC SURGERY •Any situation requiring pre-prosthetic surgery are considered in class 3 and class 4 of classification system • Class III Minor soft/hard tissue surgical procedure Implant placement without graft • Class IV Implant with bone-graft complex Hard tissue augmentation Correction of dentofacial deformity Major soft tissue revision
- 18. LIMITED INTERARCH SPACE •Class III 18-20 mm • Class IV Surgical correction required
- 19. TONGUE ANATOMY • ClassIII Large and occludes interdental space • Class IV Hyperactive with retracted position
- 20. CLASS I Residualbone height of 21 mm or greater. Residual ridge morphology resists horizontal and vertical movement Location of muscle attachments that are conducive to denture base stability and retention. Class I maxillomandibular relationship.
- 21. CLASS II Residualbone height of 16 to 20 mm Residual ridge morphology that resists horizontal and vertical movement Location of muscle attachments with limited influence on denture base stability and retention Class I maxillomandibular relationship. Minor modifiers, psychosocial considerations, mild systemic disease with oral manifestation
- 22. CLASS III Residualalveolar bone height of 11 to 15 mm Residual ridge morphology has minimum influence to resist horizontal or vertical movement Location of muscle attachments with moderate influence on denture base stability and retention. Class I, II, or III maxillomandibular relationship Minor pre-prosthetic surgery is required Limited inter-arch space (18-20 mm) TMD symptoms present Hyperactive gag reflex
- 23. CLASS IV Residualvertical bone height of 10 mm or less Residual ridge offers no resistance to horizontal or vertical movement Muscle attachment location have significant influence on denture base stability and retention Class I, II, or III maxillomandibular relationships. Major conditions requiring pre-prosthetic surgery Insufficient interarch space with surgical correction Maxillo-mandibular ataxia (incoordination). Hyperactive gag reflex managed with medication Hyperactivity of tongue associated with a retracted tongue position
- 24. CLASSIFICATION SYSTEM FOR PARTIALEDENTULISM Partial edentulism is defined as the absence of some but not all of the natural teeth in a dental arch The quality of the supporting structures contributes to the overall condition and is considered in the diagnostic levels of the classification system. PARTIALLY EDENTULOUS patients exhibit a wide range of physical variations and health conditions.
- 25. DIAGNOSTIC CRITERIA Location and extent ofthe edentulous area Condition of abutments Occlusion Residual ridge characteris tics
- 27. CRITERIA 1: LOCATIONAND EXTENT OF THE EDENTULOUS AREA(S) Any anterior maxillary : max 2 incisors are missing Any anterior mandibular max 4 incisors are missing Any posterior maxillary or mandibular edentulous area that does not exceed 2 premolars or 1 premolar and 1 molar. A. Ideal or minimally compromised edentulous area
- 28. Any anterior maxillaryedentulous area that does not exceed 2 incisors Any anterior mandibular edentulous area that does not exceed 4 incisors Any posterior maxillary or mandibular edentulous area that does not exceed 2 premolars, or 1 premolar and 1 molar A missing maxillary or mandibular canine. B. Moderately compromised edentulous area
- 29. Any posterior maxillaryor mandibular edentulous area greater than 3 teeth or 2 molars Any edentulous areas including anterior and posterior areas of 3 or more teeth. C. Substantially compromised edentulous area
- 30. Any edentulous areaor combination of edentulous areas requiring a high level of patient compliance. D. Severely compromised edentulous area
- 31. CRITERIA 2: ABUTMENTCONDITIONS A. Ideal or minimally compromised abutment conditions No pre-prosthetic therapy is indicated. B. Moderately compromised abutment condition Abutments in 1 or 2 sextants have insufficient tooth structure Abutments in 1 or 2 sextants require localized adjunctive therapy
- 32. C. Substantially compromised abutment condition Abutmentsin 3 sextants have insufficient tooth structure. Abutments in 3 sextants require more substantial localized adjunctive therapy D. Severely compromised abutment condition Abutments in 4 or more sextants have insufficient tooth structure. Abutments in 4 or more sextants require extensive adjunctive therapy. Abutments have guarded prognoses
- 33. CRITERIA 3: OCCLUSION •No pre-prosthetic therapy required • Class I molar and jaw relationships A. Ideal or minimally compromised occlusal characteristics • Occlusion requires localized adjunctive therapy • Class I molar and jaw relationships B. Moderately compromised occlusal characteristics
- 34. • Occlusion isre-established without change in the vertical dimension. • Class II molar and jaw relationships C. Substantially compromised occlusal characteristics • Occlusion is re-established, with changes in the vertical dimension. • Class II division 2 and Class III molar and jaw relationships D. Severely compromised occlusal characteristics
- 35. CRITERIA 4: RESIDUALRIDGE CHARACTERISTICS The criteria published for the Classification System for Complete Edentulism are used to categorize any edentulous span present in the partially edentulous patient
- 36. CLASS I Thelocation and extent of the edentulous area are ideal or minimally compromised Adequate physiologic support of the abutments. The abutment condition: no need for pre- prosthetic therapy. The occlusion : no need for pre-prosthetic therapy Maxillomandibular relationship: Class I molar and jaw relationships. Residual ridge morphology conforms to the Class I complete edentulism description.
- 37. CLASS II Thelocation and extent of the edentulous area are moderately compromised Condition of the abutments is moderately compromised Occlusion is moderately compromised Maxillomandibular relationship: Class I molar and jaw relationships. Residual ridge morphology conforms to the Class II complete edentulism description. .
- 38. CLASS IIICLASS III The location and extent of the edentulous areas are substantially compromised: The abutments is moderately compromised: less no: of teeth and requires adjunctive therapy Occlusion is substantially compromised Requires reestablishment of occlusal scheme without change in the vertical dimension
- 39. Maxillomandibular relationship: ClassII molar and jaw relationships. Residual ridge morphology conforms to the Class III complete edentulism description
- 40. CLASS IV • Thelocation and extent of the edentulous areas results in severe occlusal compromise • Abutments are severely compromised: Abutments in 4 or more sextants require extensive localized adjunctive therapy. Occlusion is severely compromised with reestablishment of the occlusion with a change in the occlusal vertical dimension Maxillomandibular relationship: class II division 2 or Class III molar and jaw relationships. Residual ridge morphology conforms to the class IV complete edentulism description.
- 41. CLASSIFICATION SYSTEM FORTHE COMPLETELY DENTATE PATIENT • A completely dentate patient is defined as an individual with an intact continuous permanent dentition with no missing teeth or roots excluding
- 42.
- 43. CRITERIA 1. TOOTHCONDITION A. Ideal or minimally compromised tooth condition No localized adjunctive therapy required. B. Moderately compromised tooth condition Insufficient tooth structure to retain or support in 1 sextant. Pathology that affects the coronal morphology of 4 or more teeth in a sextant. Pathology may occur in 2 sextants and may be present in opposing arches. Teeth require localized adjunctive therapy for a single tooth or in a single sextant.
- 44. Insufficient tooth structureto retain or support in 2 sextants. Pathology affecting the coronal morphology of 4 or more teeth in 3–5 sextants. Pathology may occur in 3 sextants in the same arch and/or in opposing arches. Teeth require localized adjunctive therapy in 2 sextants. C. Substantially compromised tooth condition
- 45. Tooth condition—insufficient tooth structurein 3 or more sextants Pathology affecting the coronal morphology of 4 or more teeth in all sextants. Teeth requiring localized adjunctive therapy in 3 or more sextants D. Severely compromised tooth condition
- 46. CRITERIA 2. OCCLUSALSCHEME No pre-prosthetic therapy required. Ideal or minimally compromised occlusal scheme. Intact anterior guidance. Occlusal scheme requires localized adjunctive therapy. Moderately compromised occlusal scheme Major therapy required to maintain entire occlusal scheme without any change in the occlusal vertical dimension. Substantially compromised occlusal scheme Major therapy required to re-establish entire occlusal scheme including any necessary changes in the occlusal vertical dimension. Severely compromised occlusal scheme
- 47. CLASSIFICATION OF COMPLETELY DENTATEPATIENT CLASS I • Characterized by an ideal or minimally compromised tooth condition and occlusal scheme. Ideal or minimally compromised tooth condition • No localized adjunctive therapy required. • Pathology affecting the coronal morphology of 3 or fewer teeth in a sextant. Ideal or minimally compromised occlusal scheme • No pre-prosthetic therapy required. Contiguous, intact dental arches
- 48. CLASS II • Moderatelycompromised tooth condition Tooth condition insufficient tooth structure available to retain or support in 1 sextant. • Moderately compromised occlusal scheme Intact anterior guidance Occlusal scheme requires localized adjunctive therapy.
- 49. CLASS III Substantially compromisedtooth condition requiring localized adjunctive therapy in multiple sextants Substantially compromised occlusal scheme requires major therapy to maintain occlusal scheme without change in vertical dimension
- 50. CLASS IV • Severelycompromised tooth condition Tooth condition—insufficient tooth structure Teeth require localized adjunctive therapy in 3 or more sextants • Severely compromised occlusal scheme Major therapy required to re-establish occlusion with changes vertical dimension Other characteristics of the Class IV patient may include :Severe manifestations of local or systemic disease
- 51. GUIDELINES FOR THEUSE OF THE CLASSIFICATION SYSTEM Those instances in which a patient’s diagnostic criteria overlap 2 or more classes, the patient is assigned to the more complex class. Consideration of future treatment procedures must not influence the choice of diagnostic level. Initial adjunctive therapy may change the original classification level. Classification may need to be reassessed after existing restorations are removed.
- 52. Aesthetic concernsor challenges raise the classification by 1 or more levels in Class I and II patients. The presence of temporomandibular disorders (TMD) symptoms raises the classification by 1 or more levels in Class I and II patients. Patients who fail to conform to the definition of completely dentate should be classified using the classification system for partial edentulism
- 53. POTENTIAL BENEFITS OF CLASSIFICATIONSYSTEM Improved intra-operator consistency Improved professional communication Insurance reimbursement commensurate with complexity of care An objective method for patient screening in dental education Standardized criteria for outcomes assessment and research Improved diagnostic consistency A simplified, organized aid in the decision-making process relating to referral.
- 54.
- 55. REFERENCES 1. McGarry TJ,Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH. Classification system for complete edentulism. Journal of Prosthodontics. 1999 Mar 1;8(1):27-39. 2. McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH, Arbree NS. Classification system for partial edentulism. Journal of Prosthodontics. 2002 Sep 1;11(3):181-93. 3. McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH, Guichet GN. Classification system for the completely dentate patient. Journal of Prosthodontics. 2004 Jun 1;13(2):73-82. 4. GPT 9
Editor's Notes
- #2 Correct classification of any situation is very imp for coreect diagnosis, to formulate correct treatment plan and to asses the treatment outome
- #3 Three dif class systems have been given in pdi for completely edentulous patients , partial and completely dentate patients
- #4 Developed by American college of prosthodontics based on diagnostic findings Review of prosthodontic literature was done and a questionnaire was prepared by which 89 variables were identified and a questionare was made.
- #5 On the basis of data collected from this questionarre , these variables were differentiated into 4 subclasses
- #6 Educational requirement: What additional clinical skill or knowledge is necessary to manage this variable? Clinical responsibility: Is ths variable most significant to the patient, practitioner, or the dental laboratory technician? Clinical technique modification: ?$'ill this variable require a change in conventional five-step technique, and could this variable have a significant effect on patient satisfaction? Clinical and labomtory time requirement: Will this variable require additional time by the practitioner, clinical staff, and/or the dental laboratory technician? Overall clinical significance: Will this variable require advanced education to manage?
- #7 After avaluation of these variables ranking of individual varibles was established and 4 categories were defibed
- #10 At the present time, the importance of various cofactors is unknown.”
- #11 The classification system continues on a logical progression, describing the effects of residual ridge morphology and the influence of musculature on a maxillary denture Anterior labial and posterior buccal Vestibular depth that resists vertical and horizontal movement of the denture base
- #12 Tuberosity and hamular notch are poorly defined, compromising delineation of the posterior extension of the denture base.
- #13 Palatal vault morphology offers minimal resistance to vertical and horizontal movement of the denture base
- #14 Maxillary palatal tori and/or lateral exostoses intcrfere with the posterior border of the denture. with the posterior border of the denture.
- #15 The effects of muscle attachment and location are most important to the function of mandibular denture
- #17 The classification of the maxillomandibular relationship characterizes the position of the artificial teeth in relation to the residual ridge and/or to opposing dentition Class 2 (eg, anterior or posterior tooth position is not supported by the residual ridge; anterior vertical and/or horizontal overlap exceeds the principles of fully balanced ar ticulation). Tooth position outside the normal ridge relation to attain esthetics, phonetics, and articulation Class III: Maxillomandibular relation requires tooth position outside the normal ridge relation to attain esthetics, phonetics, and articulation (ie crossbite-anterior or posterior tooth position is not supported by the residual ridge).
- #21 This classification level characterizes the stage of ederitulism that is most apt to be successfully treated with complete dentures using conventional prosthodontic techniques measured at the least vertical height of the mandible on a panoramic radiograp of the denture base; Type A maxilla.
- #22 This classification level distinguishes itself by the continued physical degradation of the denture supporting anatomy, and, in addition, is characterized by the early onset of systemic disease interactions, patient management, and/or lifestyle considerations measured at the least vertical height of the mandible on a panoramic radiograph.
- #23 This classification level is characterized by the need for surgical revision of supporting structures to allow for adequate prosthodontic function
- #24 This classification level depicts the most debilitated edentulous condition. Surgical reconstruction is almost always indicated but cannot always be accomplished because of the patient's health, preferences, dental history, and financial considerations
- #25 To address this problem, the American College of Prosthodontists (ACP) Subcommittee on Prosthodontic Classification was formed in consistent with the existing classification system for complete edentulism
- #32 Abutments in 1 or 2 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations. Abutments in 1 or 2 sextants require localized adjunctive therapy (ie, periodontal, endodontic, or orthodontic procedures).
- #33 to retain or support intracoronal or extracoronal restorations (ie, periodontal, endodontic, or orthodontic procedures).
- #34 therapy eg, enameloplasty on premature occlusal contacts).
- #37 This class is characterized by ideal or minimal compromise in the location and extent of edentulous area
- #38 This class is characterized by ideal or minimal compromise in the location and extent of edentulous area
- #41 This class is characterized by severely compromised location and extent of edentulous areas with guarded prognosis, abutments requiring extensive therapy, occlusion characteristics requiring reestablishment of the occlusion with a change in the occlusal vertical dimension, and residual ridge conditions.
- #46 Retain or support resorations
- #48 No preprosthetic therapy required. Contiguous, intact dental arches.
- #52 Characterized by severely compromised tooth conditions requiring extensive therapy and/or reestablishment of occlusal scheme with change in the occlusal vertical dimension