classification RPD.pptx

CLASSIFICATION OF PARTIALLY
EDENTULOUS ARCHES

 Prime purpose : To enable dentist to clearly
communicate to a listener
 An aid in learning of the fundamentals of design

 To formulate a good treatment plan
 To anticipate the difficulties common to occur for that
particular design
 To communicate with a professional about a case
 Standardization of work principle

 Allow visualization of type of partially edentulous arches
that is being considered
 Allow differentiation between tooth supported and tooth-
tissue supported partial dentures
 Serve as a guide to the type of design to be used
 Be universally accepted

 Cummer
 Kennedy’s
 Applegate-Kennedy
 Bailyn
 Neurohr
 Mauk
 Friedman
 Godfrey
 Skinner
 Austin and Lidge
 Craddock
 Wild
 Watt et al
 Costa
 Osborne and Lammie
 Beckett
 Swenson
 ACP classification
 ICK classification

KENNEDY’S CLASSIFICATION
 Most widely used method of classification
 Proposed in 1923 by Dr. Edward Kennedy of New York
 It is based on the relationship of the edentulous spaces to the
abutment teeth

Class I - Bilateral edentulous
areas located posterior to the
remaining natural teeth
Class II - Unilateral
edentulous area located
posterior to the remaining
natural teeth
Class III - Unilateral
edentulous area with natural
teeth both anterior and
posterior to it
Class IV - Single, bilateral
edentulous area located
anterior to the remaining
natural teeth

APPLEGATE KENNEDY’S SYSTEM
 It is a modification of the Kennedy’s system
 It takes into consideration the capabilities of the teeth,
which bound the spaces to serve as abutments for the
prosthesis

Dr. O.C Applegate (1960) later attempted to expand the
Kennedy system by adding class V and VI
Class V : Edentulous area bounded anteriorly and posteriorly by
the natural teeth but in which the anterior abutment (the lateral
incisor) is not suitable for the support
Class VI : An edentulous situation in which the teeth adjacent to
the space are capable of total support of the required prosthesis

Applegate also provided the following 8 rules to govern the
application of the Kennedy system:
Rule 1-
Classification should follow rather than precede extractions that
might alter the original classification
Rule 2-
If the third molar is missing and not to be replaced it is not
considered in the classification
Rule 3-
If the third molar is present and is to be used as an abutment, it is
considered in the classification
APPLEGATE’S RULES

Rule 4 -
If the missing second molar is not to be replaced that is the
opposing second molar is also missing, it not considered in
the classification
Rule 5 –
The most posterior edentulous area or areas always
determines the classification
Rule 6 –
Edentulous areas other than those determining the
classification are referred to as the modification spaces and
are designated by their number

Rule 7 –
The extent of the modification is not considered, only the number
of additional edentulous areas are considered
Rule 8 –
There can be no modification areas in class IV arches

CUMMER’S CLASSIFICATION SYSTEM
 Proposed By Cummer in 1920
 Cummer stated “ for working purposes all the cases may be
made to fall into 4 simple classes, which have as their basis
the choice of number and position of the direct retainer”

Class I – Diagonal : 2 diagonally opposite teeth are chosen as
abutment teeth for the attachment of direct retainer
Class II – Diametric: 2 diametrically opposite teeth are chosen as
abutment teeth for the attachment of the direct retainers

Class III – Unilateral : one or more teeth on the same side are
chosen as abutment teeth for the attachment of the direct
retainers
Class IV – Multilateral : Three or more teeth are chosen as
abutment teeth for the attachment of the direct retainers

BAILYN’S SYSTEM
 Based on whether the prosthesis is tooth borne, tissue borne
or a combination of the two:
 Bailyn divided all R.P.Ds into-
 A : Anterior restorations : Saddle area anterior to the 1st
bicuspids
 P : Posterior restorations : Saddle area posterior to the
cuspids

Subdivided as:
Class I : Bounded saddle (not more
than 3 teeth missing)
Eg: P.I
Class II : Free end saddle (no distal
abutment)
Eg: P.II
Class III : Bounded saddle (more
than 3 teeth missing)
Eg P.III

Class A.III :
•Edentulous space anterior to the 1st
bicuspid
•Bounded saddle (more than three
teeth missing)
Class A.I. P.II –
•Edentulous area anterior to the first
bicuspid and not more than 3 teeth
missing
•other edentulous space being
posterior to the cuspid with only one
tooth available as an abutment

Class P.I P.II – Both the edentulous spaces are posterior to the
cuspids
• One with only one tooth for anchorage
• Other with two available teeth separated by a distance of less
than three teeth

NEUROHR’S CLASSIFICATION
 Proposed in 1939, this classification is based on the
support derived
 It is not commonly used due to its complexity
 Many of his denture designs did not match his principles
of classification

Class I : Tooth bearing
Teeth posterior to all spans, and when there are not more than
four teeth missing in any space

There are two possible variation in this class -
Variation 1 : Missing posteriors predominate
a. Posteriors missing, anteriors in place
b. Posteriors missing, some anteriors missing

Variation 2 : Missing anteriors predominate
a) Anteriors missing, posteriors present
b) Anteriors missing, some posteriors missing

Class II : Tooth-and-tissue bearing
No teeth posterior to one or more spans
• More than 4 teeth (which include a canine) in one or more
spans

Class II is further subdivided into divisions with
variation under each
Division 1: When there are no teeth posterior
to 1 or more span
a. Posteriors missing, anteriors in place
a. None
b. Anteriors missing, some posteriors missing

Division 2: when there are teeth posterior in all
spans, but when there are more than 4 teeth in
any one or more spans.
a. None
• Anteriors missing, posteriors in place
• Anteriors missing, some posteriors missing
CLASS III : Tissue bearing complete dentures

MAUK’S SYSTEM
 Class I – Bilateral posterior spaces
and teeth remaining in a segment in
the anterior region
 Class II – Bilateral posterior spaces
and one or more teeth at the posterior
end of one space
Based on number, length and position of the spaces and
number and position of the remaining teeth

Class III - Bilateral posterior spaces
and one or more teeth at the
posterior end of both spaces
Class IV – Unilateral posterior space
with or without teeth at the posterior
end of the space. Opposing arch is
unbroken

Class V – It has an anterior space
only. Posterior part of the arch is
unbroken on either side
Class VI – Has irregular spaces
around the arch. The missing teeth
are single or in groups

WILD’S CLASSIFICATION
 Proposed simple and self explanatory
classification
 Class I : Interruption of the dental arch
(i.e bounded)
 Class II : Shortening of the dental arch
(i.e free end)
 Class III : combination of I & II

GODFREY’S SYSTEM (1951)
 Based on the location and the extent of the edentulous spaces
 Class A – Tooth borne denture bases in the anterior part of the
mouth
 It may be an unbroken 5 - tooth space; a broken 5-tooth space;
or an unbroken 4-tooth space

Class B – Mucosa borne denture
base area in anterior of the mouth
Unbroken six tooth space; an
unbroken 5-tooth space; a broken 5-
tooth space
Class C – Tooth borne denture base
in the posterior part of the mouth
Unbroken 3-tooth space; a broken
3-tooth space; an unbroken 2-tooth
space; a broken 2-tooth space

Class D – Class D has mucosa borne denture bases in the
posterior part of the mouth
It may be an unbroken 4 – tooth space or a 3 tooth; 2 tooth or
single tooth space

FRIEDMAN’S CLASSIFICATION
Introduced ‘ABC’ classification in 1953. According to this
classification -
 A: Anterior
 B: Bounded posterior
 C: Cantilever

BECKETT AND WILSON CLASSIFICATION
 Beckett and Wilson based their ideas on Bailyn’s
classification(1928)
 Based on proportionate amount of support provided by
the teeth and tissues
Beckett S L, The influence of saddle classification on the design of partial removable
restorartions, J Prosthet Dent, 1953;3(4): 506-16

Class I : Bounded saddle. Abutment
teeth qualified to support the denture.
Mucosa is not used for support
Class II : Free end
a. Tooth and tissue borne
b. Tissue borne

Class III : Bounded saddle. Abutment teeth not so qualified to
support the denture as described in class I.
Wilson in 1957 elaborated the classification as follows:
• Mandibular Kennedy’s class III should be treated as class I
• Maxillary Kennedy’s class III should be treated as class I or III

CRADDOCK’S CLASSIFICATION
 In 1954
 Class I – Saddle supported on
both sides by substantial
abutment teeth
 Class II – Vertical biting forces
applied to denture resisted entirely
by soft tissue
 Class III – Tooth supported at only
1 end of the saddle

AUSTIN AND LIDGE CLASSIFICATION
 In 1957
 Describes the position of teeth
Class A: Missing anteriors
 A1 : Missing anteriors on one side
 A2 : Missing anteriors on both sides
 A B1: Missing anteriors with bilateral construction

Class P : Missing posteriors
P1 – Missing posteriors on one side
P2 – Missing posteriors on both sides
P B1 : Posterior missing on both sides
(distal extension)

Class AP : Missing anteriors
and posteriors
AP1 – Missing anteriors and
posteriors on one side
AP2 – Missing anteriors and
posteriors on both sides

SKINNER’S SYSTEM
 This system was based on the relationship of the abutment
teeth to the supporting residual alveolar ridge
 He said that the value of RPD is directly related to quantity
and the degree of support, which it receives, from the
abutment teeth and residual ridge
Skinner C N, A Classification of removable partial dentures based upon the principles
of anatomy and physiology; J Prosthet Dent,1959;9(2):240-46

Class I – Abutment teeth are located
both anterior and posterior to the
denture bases, spaces may be
unilateral or bilateral
Class II – All teeth are posterior to the
denture base. It may be unilateral or
bilateral

Class III – All the abutment teeth are anterior to denture base
and may occur unilaterally or bilaterally
Class IV – Denture bases are located both anterior and posterior
to the remaining teeth. They may be unilateral or bilateral
Class V – Abutment teeth are unilateral in relation to denture
base

SWENSON’S CLASSIFICATION
 The 4 primary classes represent only slight modification
of the Kennedy’s system
 Class I – Its an arch with one free end denture base

Class II – It is an arch with 2 free end denture base
Class III – It is an arch with edentulous space posteriorly on one or
both the sides but with teeth present anteriorly or posteriorly to
each space
Class IV – It is an arch with anteriorly edentulous space and with 5
or more anterior teeth missing

Subdivision –
• A : Anterior
• P : Posterior
• AP : Anterior and posterior
Class II A – It is basic class II with an anterior space
Class IV P – Basic class IV with posterior space

TERKLA AND LANEY MODIFICATION (1963)
Combined Kennedy’s and Swenson’s classification
Kennedy’s class II = Swenson’s class I
Kennedy’s Class I = Swenson’s Class II

WATT ET AL CLASSIFICATION
 Proposed the classification in 1958. It was based on the
type of support derived
 Entirely tooth borne : Entire denture rests on the abutment
teeth

Entirely tissue borne : Entire denture rests on soft tissue
Partially tooth borne and partially tissue borne : These dentures
rest on both teeth and the tissues

OSBORNE AND LAMMIE’S CLASSIFICATION
 Proposed in 1974. It is similar to Watt et al’s classification
 Class I : Mucosa borne
 Class II : Tooth borne
 Class III : combination of Mucosa – borne and tooth borne

COSTA’S CLASSIFICATION
 This system developed in 1974 was based on
describing rather than classifying partially dentulous
arches
Costa E, A simplified system for identifying partially edentulous dental arches, J Prosthet Dent
1974;32(6):639-45

• Anterior : Edentulous space
located in the anterior part of
dental arch
• Lateral : Edentulous space
bounded both mesially and distally
by remaining teeth
• Terminal : Edentulous space not
bounded distally by remaining
teeth

PROSTHODONTIC DIAGNOSTIC INDEX
The American College of Prosthodontists (ACP) has
developed a classification system for partial edentulism
based on diagnostic findings
McGarry T H, Classsification system for partial edentulism, J prosthodont, 2002;11:181-193

THIS PARTIALLY EDENTULOUS CLASSIFICATION SYSTEM
OFFERS THE FOLLOWING POTENTIAL BENEFITS
 Improved intra-operator consistency
 Improved professional communication
 An objective method for patient screening in dental education
 Standardized criteria for outcome assessment and research
 Improved diagnostic consistency
 Simplified, organized aid in the decision to refer a patient
McGarry T H, Classsification system for partial edentulism, J prosthodont, 2002;11:181-193

CLASSIFICATION SYSTEM FOR THE PARTIALLY
EDENTULOUS PATIENT
DIAGNOSTIC CRITERIA
1. Location and extent of the edentulous area(s)
2. Condition of the abutment teeth
3. Occlusal scheme
4. Residual ridge

CRITERIA 1
LOCATION AND EXTENT OF
EDENTULOUS AREA(S)

IDEAL OR MINIMALLY COMPROMISED
EDENTULOUS AREA
The edentulous span is confined to a
single arch and one of the following:
 Any anterior maxillary span that
does not exceed 2 missing incisors
 Any anterior mandibular span that
does not exceed 4 missing incisors
 Any posterior maxillary or
mandibular span that does not
exceed 2 premolars or 1 premolar
and 1 molar

MODERATELY COMPROMISED EDENTULOUS AREA
The edentulous span is in both arches and
one of the following:
 Any anterior maxillary span that does
not exceed 2 missing incisors
 Any anterior mandibular span that does
not exceed 4 missing incisors
 Any posterior maxillary or mandibular
span that does not exceed 2 premolars
or 1 premolar and 1 molar
 The maxillary or mandibular canine is
missing

SUBSTANTIALLY COMPROMISED
EDENTULOUS AREA
 Any posterior maxillary or mandibular span that is greater than
3 missing teeth or 2 molars
 Any edentulous span including anterior and posterior areas of 3
or more missing teeth

SEVERELY COMPROMISED EDENTULOUS AREA
 Any edentulous area or combination of edentulous areas
requiring a high level of patient compliance

CRITERIA 2
ABUTMENT TEETH CONDITION

IDEAL OR MINIMALLY COMPROMISED
ABUTMENT TEETH CONDITION
No pre-prosthetic therapy is indicated

MODERATELY COMPROMISED ABUTMENT TEETH
CONDITION
Abutment Condition:
Insufficient tooth structure to retain or support intra-coronal
restorations – in one or two sextants
Abutments require localized adjunctive therapy, i.e.,
periodontal, endodontic or orthodontic procedures in one or
two sextants

Abutment condition
Insufficient tooth structure to retain or support intracoronal or
extracoronal restorations - three or more sextants
Abutments require extensive adjunctive therapy, i.e.,
periodontal, endodontic or orthodontic procedures - in three or
more sextants
SUBSTANTIALLY COMPROMISED ABUTMENT
TEETH CONDITION

SEVERELY COMPROMISED ABUTMENT TEETH
CONDITION
Abutments have a guarded prognosis

IDEAL OR MINIMALLY COMPROMISED OCCLUSAL
SCHEME
 No preprosthetic therapy required
 Class I molar and jaw relationships

MODERATELY COMPROMISED OCCLUSAL SCHEME
 Occlusal scheme requires localized adjunctive therapy (e.g.
enameloplasty on premature occlusal contacts)
 Class I molar and jaw relationships

SUBSTANTIALLY COMPROMISED OCCLUSAL
SCHEME
 Entire occlusal scheme requires reestablishment but
without any change in the vertical dimension
of occlusion
 Class II molar and jaw relationships

SEVERELY COMPROMISED OCCLUSAL
SCHEME
 Entire occlusal scheme requires reestablishment with
changes in the vertical dimension of occlusion
 Class II Division 2 and Class III molar and jaw
relationships

The criteria published for the Classification
System for complete edentulism are used to
categorize any edentulous span present in the
partially edentulous patient

CLASSIFICATION SYSTEM FOR
PARTIAL EDENTULISM

Class I
Location and extent
of edentulous area
Condition of the
abutments
Occlusion
Residual ridge
characteristics
Ideal or minimal compromise
Ideal or minimally compromised no
need for pre prosthetic treatment
Ideal or minimally compromised
class I molar and jaw relation
Class I ridge

Class II
Location and extent
of edentulous area
Condition of the
abutments
Occlusion
Residual ridge
characteristics
One or both arches edentulous
Extent anterior maxillary not exceeding 2 I,
anterior mandibular not exceeding 4 I and any
posterior span not exceeding 2 PM or 1 PM and 1
M or any missing canine
Abutment moderately compromised
Insufficient tooth structure for support
Localized adjunctive therapy required
Localized adjunctive therapy required
Class I molar relationship
Residual ridge: class II

Class III
Location and extent
of edentulous area
Condition of the
abutments
Occlusion
Residual ridge
characteristics
Present in one or both arches
Posterior are greater than 3 teeth or 2 molars
anterior and posterior areas of 3 or more teeth
If 3 sextants have insufficient tooth structure
Localized adjunctive therapy
Abutments have a fair prognosis
Requires reestablishment of the entire occlusal
scheme without accompanying change in the
OVD.
Class II molar
Class III residual ridge

Class IV
Location and extent
of edentulous area
Condition of the
abutments
Occlusion
Residual ridge
characteristics
Extensive and in both arches
Acquired or congenital maxillofacial defects
included
In 4 or more sextants, have insufficient
tooth structure and require extensive
localized adjunctive therapy
Re-establishment of entire occlusal
scheme including changes in OVD
required.
Class II div 2 or class III molar
Class IV ridge

GUIDELINES FOR THE USE OF
THE CLASSIFICATION SYSTEM FOR PARTIAL
EDENTULISM

 Consideration of future treatment procedures must not
influence the decision as to which diagnostic level to place
the patient in
 Initial pre-prosthetic treatment and/or adjunctive therapy
can change the initial classification level. The classification
may need to be reassessed after the removal of existing
prostheses

 Periodontal health is intimately related to the diagnosis and
prognosis for partially edentulous patients
 For the purpose of this system, it is assumed that patients
will receive periodontal therapy to achieve and maintain
periodontal health so that prosthodontic care can be
accomplished

 In the situation where the patient
presents with an edentulous maxilla opposing a
partially edentulous mandible, each arch is diagnosed
with the appropriate classification system
In this situation, the maxilla would be
classified according to the complete edentulism
classification system and the mandible according to the
partial edentulism classification system

A single exception to this rule is when the patient presents
with an edentulous mandible opposed by a partially
edentulous or dentate maxilla
This clinical situation presents significant complexity and
long-term morbidity and as such, should be diagnosed as a
Class IV in either system

ICK CLASSIFICATION SYSTEM
 ICK classification system will follow the Kennedy
method with the following guidelines:
1. No edentulous space will be included in the
classification if it will be restored with an
implant supported fixed prosthesis
Al-Johany et al, ICK Classification System for Partially Edentulous Arches, J Prosthodont
2008;17: 502–507

To avoid confusion, maxillary arch is drawn as half circle
facing up and mandibular arch as as half circle facing
down. The drawing will appear as if looking directly at
the patient; right and left quadrants are reversed

The implant classification will always begin with the
phrase “Implant Corrected Kennedy (class)” followed by
the description of the classification. It can be abbreviated
as follows:
ICK I, for Kennedy class I situations
ICK II, for Kennedy class II situations
ICK III, for Kennedy class III situations and
ICK IV, for Kennedy class IV situations

•The abbreviation “max” for maxillary and “man” for
mandibular can precede the classification. The word
modification can be abbreviated as “mod”.
• man ICK I mod 2(#18, 22, 26, 31)
•Roman numerals will be used for the classification, and
Arabic numerals will be used for the number of
modification spaces and implants
• The tooth number using the American dental Association
(ADA) system is used to give the number and exact
position of the implant in the arch

 The classification of any situation will be according to the
following order: main classification first, then followed by the
number of modification spaces, followed by the number of
implants in parentheses according to their position in the arch
preceded by the number sign(#).eg;
 man ICK I mod 2(#18, 22, 26, 31)
 The classification can be used either after implant placement
to describe any situation of RPD with implants, or before
implant placement to indicate the number and position of
future implants with an RPD

 The arrangement of implants will be from right to left in
the maxillary arch and from left to right in the mandibular
arch following the tooth numbering system
ICK I (#2,15 ) ICK I (# 18, 22, 31)

Class I (Div A-D)
Class II (Div A-D)
Class III (Div A-D)
Class IV (Div A-D)
CLASSIFICATION OF PARTIALLY EDENTULOUS
ARCHES IN IMPLANT DENTISTRY
Misch CE, Judy WMK, classification of partially edentulous arches for implant dentistry, Int J
Oral Implantal 1987;4:7-12

 Stewart, Rudd, Kuebker, Clinical removable partial
prosthodontics, 2nd edition, India, IEA Publishers, 1997,
pp 1-18
 McCracken, Removable partial denture
prosthodontics,11th edition, India, Elsevier Publisher’s,
2005, pp 19-24
 Avant E W, A Universal classification for removable
partial denture situation, J Prosthet Dent,1996;533-39
References

 Nallaswamy D, Textbook of Prosthodontics, 1st edition,
India, Jaypee Publications, 2003, pp 270-287
 McGarry T H, Classsification system for partial
edentulism, J prosthodont, 2002;11:181-193
 Friedman J, The ABC classification of partial denture
segments, J Prosthet Dent 1953;3:517-23
 Costa E, A simplified system for identifying partially
edentulous dental arches, J Prosthet Dent
1974;32(6):639-45

 Miller L E, System for classifying partially dentulous
arches, J Prosthet Dent 1970;24(1):25-40
 Beckett S L, The influence of saddle classification on the
design of partial removable restorartions, J Prosthet Dent,
1953;3(4):506-16
 Skinner C N, A Classification of removable partial
dentures based upon the principles of anatomy and
physiology, J Prosthet Dent,1959;9(2):240-46
 Al-Johany et al, ICK Classification System for Partially
Edentulous Arches, J Prosthodont, 2008;17:502–507

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