4. INTRODUCTION
• Evaluation of patients for complete-denture therapy
should be thorough and well documented. A logical
method to accomplish this is to use a checklist.
• The checklist format makes the form quick and
convenient to use. Once completed, this form can be
added to the patient's dental record for future reference.
• Provides a greater level of understanding of the
patient's problems, anatomy, and treatment goals.
5. DEFINITIONS
• Diagnosis consists of planned observations
to determine and evaluate the existing
conditions, which lead to decision making
based on the conditions observed- ACC TO
BOUCHER
• The determination of the nature of a
disease- GPT 9
6. Definitions….
• The examination of the physical state and evaluation of
the mental or psychological make up and understanding
the needs of each patient to ensure a predictable result-
SHELDON WINKLER
• TREATMENT PLAN- The sequence of procedures planed
for the treatment of a patient after diagnosis- GPT 9
7. I. PERSONAL DATA
Name: It is useful for establishment of patient’s identity.
Addressing by name gains patience confidence and
psychological security to patient.
For record purpose
SSN: A Social Security number or Patient number is
required for contact purpose
8. Age: Indicator of the patient's ability to wear and to use
dentures.
• Till fourth decade of life- Tissues are relatively resilient
and heal rapidly. Individuals adapt to new conditions more
readily and esthetics are of major importance.
• Beyond the fifth decade- Tissues do not heal as rapidly.
The body does not adapt readily to new situations.
• For teeth selection
• For determing the prognosis of the treatment
• Some age related diseases like - Scleroderma ,
Rheumatoid arthritis, Hypertension, Diabetes.
9. Sex
• Generally, appearance is a higher priority for women than
for men.
• Though younger men often are concerned with esthetics,
males often grow indifferent to their own appearances as
they age and shift focus to comfort and function.
• For teeth selection according to SPA FACTOR men will
have sharp and broad teeth and women will have round
and small teeth.
10. Address
• Helps in future communication, knowledge of patient’s
social status and setting up of appointments.
• To determine location related diseases like fluorosis which
is an endemic disease. So such people may want
characterization of teeth that is pattern staining for natural
appearance.
• To know the living style of the individual for teeth selection
11. Occupation
• A patient's job and social standing often determine the
value he or she places on oral health, as well as the
esthetics and other qualities desired in denture.
• Tooth position is very important for a musician who plays
a wind instrument.
• Public speakers, teachers and singers are more particular
about phonetics.
• People with high socio economic status will have more
expectations and requirements than people with low
socioeconomic status.
12. HISTORY
Chief Complaint
Reason for teeth loss
Duration of completeedentulousness
Weather a previous denturewearer
Patients comments on presentdentures
Patient’s expectations with the new dentures
13. HISTORY
• Chief Complaint: should be recorded in patients own
words
• According to DeVan, "The dentist should meet the mind of
the patient before he meets the mouth of the patient.“
• Reasons for seeking this information:-
• If this is not done, the chief complaint may be overlooked
during therapy.
• The response allows the practitioner to assess whether
the patient's expectations are "realistic" or "attainable.“
• The response provides information regarding the patient's
psychological classification
14. Reasons for teeth loss
Provide insight into their appreciationof the dentistry
and contribute to the prognosisfor prosthodontic
success.
The patient should be questioned regarding the
reasons for tooth loss (e.g., periodontal disease, gross
caries, trauma, etc.).
Patients who lost their teeth in an accident might be more
unhappy about their edentulous state than those who lost
teeth as a consequence of decay resulting from neglect.
• DURATION OF EDENTULOUSNESS: Provide information
about bone resorption patterns, progression, timing of tooth
loss.
• Large, rapid changes occurs in the alveolar ridge morphology
during the first year after extraction.
15. • Previous Dentures, Max/Man:
• Questioned regarding the number and types of previous
dentures.
• Patients should be asked to comment on the reasons for
replacement.
• Patients displaying consistent patterns of remarks should
be educated regarding the realities of denture service.
• A patient with a history of several dentures over a short
period of time is a poor prosthodontic risk.
16. • Existing or Current Dentures:
• The patient should be questioned about the length of time
he or she has worn the current dentures.
• Careful observation may provide valuable information
about denture experience, denture care, dental
knowledge, parafunctional habits
• Denture Success:
• The patient should be asked about the esthetics and
function of existing maxillary and mandibular dentures.
• Responses may indicate the patient's ability to wear or
adjust to complete dentures.
• Denture success for each arch should be noted as
"favorable" or "unfavorable."
17. MEDICAL HISTORY
• General Health: A thorough and accurate medical history
must be obtained during the diagnostic phase of complete-
denture therapy and must be updated as necessary.
• The medical history provides important insights regarding the
patient's dental prognosis.
• Hence, the practitioner must be aware of local and systemic
factors and must consider them during treatment planning.
• Knowledge of medications that patient is takingis important to
avoid any conflict in the therapy.
18. Medical history….
• Systemic factors that may affect complete-denture therapy
include: arthritis, Bell's palsy, diabetes and diseases,
conditions, or therapies leading to xerostomia
• Pathology: Thorough head and neck examination
All pathologic processes
Appropriate diagnostic tests
surgical procedures should be performed
19. PERSONAL HISTORY
• Oral hygiene habits
• Other habits
• Cosmetic index
• Mental attitude- Philosophical
- Exacting
- Hysterical
- Indifferent
20. Oral hygiene habits
Method and frequency of oral hygiene should be asked
by the patient.
These factors may affect denture-base contouring (e.g,
closed interdental contours versus open interdental
contours) and tooth arrangement (e.g., presence or
absence ofdiastema).
Hygiene should be classified as (1) good, (2) fair, (3) poor
21. Other habits
Other potentially unfavorable habits
• Tobacco smoking and alcohol consumption
• Patient should be informed about their systemic
effects, potential local impacts e.g. detrimental effect
on wound healing, soft tissue health, or the durability
of tissue conditioners
Para functional habits
• Like bruxism and clenching
• Must be considered and their while forming a
treatment protocol
22. Cosmetic index
• Classify from class 1 (high cosmetic index) to class 3 (low
cosmetic index).
• Patients with high cosmetic indices, though often
exacting, usually are appreciative and cooperative.
• Patients with low cosmetic indices often are indifferent,
uncooperative, and place little value on the efforts of the
prosthodontist.
23. Personality
• BY HOUSE
• Philosophic: Those patients are easy going, congenial,
mentally well-adjusted, cooperative, and confident in the
dentist. Prognosis is excellent.
• Exacting: These patients are precise, above average in
intelligence, immaculate in dress and appearance, often
dissatisfied with past treatment, doubt the ability of the
practitioner to satisfy him or her, and often want written
guarantees or remakes at no additional charge. Once
satisfied, an exacting patient may become the
practitioner's greatest supporter.
24. Personality
• Hysterical: These patients submit to treatment as a last
resort, have a negative attitude, are often in poor health,
are poorly adjusted, often appear "exacting" but with
unfounded complaints, have failed at past attempts to
wear dentures, and have unrealistic expectations
(hysterical patients often demand esthetics and function
equal to or greater than natural teeth). Prognosis is poor.
• Indifferent: These patients are not concerned with
appearance, often go without dentures for years (or wear
poor or worn-out dentures far beyond serviceability) do
not persevere, and do not adapt well. Such patients have
no desire to wear dentures and do not value the efforts or
skills of the dentist.
31. Facial muscle tone
BY HOUSE
a) Class 1: The patient exhibits normal tension, tone, and
placement of the muscles of mastication and facial
expression. No apparent degenerative changes. The
majority of edentulous patients have experienced some
degree of degeneration. Usually, only immediate-
denture patients have normal musculature.
b) Class 2: The patient displays approximately normal
function but slightly impaired muscle tone. Maximum
muscle function cannot be used following the loss of all
natural teeth.
32. Muscle tone
• c) Class 3: The patient exhibits greatly impaired muscle
tone and function. This impairment usually is coupled with
poor health, inefficient dentures, and loss of vertical
dimension, wrinkles, decreased biting force, and drooping
commissures.
• MUSCLE DEVELOPMENT
BY HOUSE
a) Class 1: Heavy
b) Class 2: Medium
c) Class 3: Light
33. Complexion & Eyes
• Hair, eye, and skin color provide useful guides in shade
selection.
• Skin color also can reveal underlying disease and
pathology.
• Pale, anemic-looking patients may have underlying
systemic diseases and may require longer adjustment
periods.
34. Complexion….
• Heavy wrinkles at the commissures and nasolabial fold
usually suggest decreased Vertical Dimension of
Occlusion (VDO) or poor support of facial musculature by
the denture.
35. Lips
• The contour and appearance of the vermillion border
usually are altered by tooth loss.
• Restoration of lip support and vermillion border width must
be considered during placement of anterior teeth.
• NOTE-
1)Lip contour:-Adequately supported
Unsupported
2)Amount of vermillion border visible
3)Lip mobility:- Normal (class 1)
Reduced mobility (class 2)
Paralysis (class 3)
4)Lip length:- Long, Normal or Medium, Short
36. Lips…..
• Patients with minimal lip mobility show very
little of the anterior teeth.
• Some stroke victims may have paralysis of
half the lip, leading to unilateral mouth droop
and facial asymmetry. These patients must
be counseled regarding treatment limitations.
If not, they may have unrealistic expectations
regarding functional and esthetic results.
• A long lip reveals little of the anterior teeth
• A very short lip allows the display of the
denture base
• Mold selection and denture characterization
can be critical factors in these cases
37. Temporomandibular joint
• NOTE- Any crepitus or clicking
-Any history of TMJ discomfort or locking
-smoothness of mandibular movements
-Deviation of the mandible.
Severe joint pain can indicate a severe discrepancy in the
VDO.
39. Neuromuscular evaluation
• Speech:
• Note as "normal" or "affected"
• Patients who are capable of articulate speech with
existing dentures; (or natural teeth) usually have no
problem producing articulate speech with new dentures.
• Patients with speech impediments or those who cannot
articulate optimally with their existing dentures require
special attention when the dentist places the anterior
teeth and forms the palatal portions of the denture base.
40. Neuromuscular evaluation….
• Coordination:-
• Note as- Class 1: Excellent
Class 2: Fair
Class 3: Poor
• Patients with good neuromuscular coordination can be
expected to learn to manipulate dentures quickly and
adapt readily to new dentures.
• Patients with poor coordination or a neurologic deficit
(such as from a stroke) may never adapt to a denture
completely.
42. EXAMINATION OF RESIDUAL RIDGES
• Arch Form: Classify according to House:
• Class 1: Square Class 2: Tapering Class 3: Ovoid
Many arches are combinations of the aforementioned
categories (e.g., square-tapering)
44. Residual ridge examination….
• Arch Size:-
1) Class 1: Large (best for retention and stability)
2) Class 2: Medium (good retention and stability but not
ideal)
3) Class 3: Small (difficult to achieve good retention and
stability)
45. Residual ridge examination….
• Ridge Form: Maxillary ridge and vault form should be
classified as follows:
• Class 1: Square to gently rounded
46. • Class 2: Tapering or "V" shaped
Class 3: Flat
48. Residual ridge examination….
• Mandibular Ridge Form: Mandibular ridge form is
classified as follows:
• Class 1: Inverted "U" shaped
parallel walls from medium
to tall with broad crest
Class 2: Inverted "U"
shaped
Short with
flat crest
51. Residual ridges examination….
• Ridge Parallelism: Classify ridge parallelism as follows:
• Class 1: Both ridges are parallel to the occlusal plane.
52. • Class 2: The mandibular ridge is divergent from the
occlusal plane anteriorly.
53. • Class 3: The maxillary ridge is divergent from the occlusal
pladne anteriorly or both ridges are divergent anteriorly,
54. Residual ridge examination….
• Interach distance: Classify interach space as follows:
• Class 1: Ideal interach space to accommodate the
artificial teeth.
55. • Class 2- Excessive interarch space to accommodate the
artificial teeth
57. Examination of residual ridges….
• MUCOSA- COLOUR
Ranges healthy pink to angry red.
Redness indicative of inflammation:
related to ill fitting denture, underlying
infection, systemic disease or chronic
smoking.
Pigmented spots or lesions.
White patches keratotic areas
caused by denture irritation.
58. Residual ridges examination….
Mucosa condition according to House
Class I: Healthy
Class II: Irritated
Class III: Pathologic
Mucosal Thickness according to House
Class I: Normal uniform density (1 mm)
Class II: Thin investing membrane
Class III: Thick investing membrane
59. QUALITY OF MUCOSA COVERING
RESIDUAL RIDGE
• Firm Mucosa
• Hard Mucosa and Keratinized
• Soft Mucosa
60. QUALITY OF MUCOSA COVERING
RESIDUAL RIDGE
• 1)Ideally, the residual ridges should be of moderate height
with a rounded shape. On gentle palpation, the mucosa
should be firm and not painful
• 2)The patient may present with a sharp bony residual
ridge or mylohyoid ridge, which are painful when lightly
pressed.
• 3)If the residual ridge is uneven and irregular then
movement of the lower denture during function can be
painful. Incorporation of a resilient liner in the fitting
surface of the new lower denture can do much to relieve
these symptoms
61. CLASSIFICATIONS OF RESIDUAL
RIDGE RESORPTION
• According to BRANEMARK et al in 1985, ridges were
classified on the basis of bone quantity and bone quality
by radiographic means
BONE QUANTITY:
• CLASS A: Most of the alveolar bone is present
• CLASS B: Moderate residual ridge resorption occurs
• CLASS C: Advance residual ridge resorption occurs
• CLASS D: Moderate resorption of the residual bone is
present
• CLASS E: Extreme resorption of the basal bone
62.
63. CLASSIFICATIONS OF RESIDUAL
RIDGE RESORPTION
Bone quality:
• CLASS 1- Almost entire jaw is composed of homogenous
compact bone
• CLASS 2- A thick layer of compact bone surrounds a
core of dense trabecular bone
• CLASS 3- A thin layer of cortical bone surrounds a core
of dense trabecular bone
• CLASS 4- A thin layer of cortical bone surrounds a core
of low density trabecular bone
65. Residual ridges examination….
• Defects: Note ridge defects, such as exostoses or divots,
that may pose problems for complete-denture patients or
may warrant preprosthetic surgery.
• Tori:
• Class 1: Tori are absent or minimal in size. Existing tori do
not interfere with denture construction.
• Class 2: Clinical examination reveals tori of moderate
size. Such tori offer mild difficulties in denture construction
and use. Surgery is not required.
• Class 3: Large tori are present. These tori compromise
the fabrication and function of dentures. Such tori usually
require surgical recontouring or removal.
66. FLOOR OF THE MOUTH
• LATERAL THROAT FORM:-
• Neil defined as the contour of the hard
lingual surfaces of the mandibular ridge
and the velum like tissue distal to the
mylohyoid ridge in the retromylohyoid
fossa as it functions under the influence
of tongue
Examination
• The lateral throat form depth and width in
moderate function is estimated by
placing a mouth mirror in the disto-
lingual vestibule. This has been
classified by Ewell Neil
67. Lateral throat form….
• Classification BY NEIL:
• CLASS I: The mouth mirror is not
visible when the tongue is in a
slightly protruded position; most
favorable for retention and stability
• CLASS II: One half of the mouth
mirror is visible; less favorable
• CLASS III: The entire mouth mirror
is visible; least favorable
68. TONGUE
• BY HOUSE
• Class 1: Normal in size, development, and function.
Sufficient teeth are present to maintain normal form and
function.
• Class 2: Teeth have been absent long enough to permit a
change in the form and function of the tongue.
• Class 3: Excessively large tongue. All teeth have been
absent for an extended period of time, allowing for
abnormal development of the size of the tongue.
Inefficient dentures sometimes can lead to the
development of a class 3 tongue.
69.
70. Tongue….
• Tongue Position: BY WRIGHT
• Class 1– Tongue lies in the floor of the mouth with the tip
forward and slightly below the incisal edges of mandibular
anterior teeth.
• CLASS 2- The tip is in a normal position but the tongue is
broadened and flattened
• CLASS 3- The tongue is retracted and depressed into the
floor of the mouth with the tip curled upward, downward or
assimilated into body of tongue.
71. Tongue….
GAG REFLEX-
Normal defense mechanism developed by the body to
prevent foreign bodies from enetering the trachea.
Can be caused by:
Systemic disorders,
Psychological factors,
Extraoral & intraoral physiological factors
Iatrogenic factors.
Controlled by glossopharyngeal nerve.
74. Palate….
• Palatal Throat Form: BY HOUSE
• Class 1: Large and normal in form, with a relatively
immovable band of resilient tissue 5 to 12 mm distal to a
line drawn across the distal edge of the tuberosities.
75. • Class 2: Medium size and normal in form, with a relatively
immovable resilient band of tissue 3 to 5 mm distal to a
line drawn across the distal edge of the tuberosities
76. • Class 3: Usually accompanies a small maxilla. The curtain
of soft tissue turns down abruptly 3 to 5 mm anterior to a
line drawn across the palate at the distal edge of the
tuberosities.
77. SOFT PALATE CLASSIFICATION
CLASS I:
• It is horizontal and demonstrates little muscular
movement.
• In this case more tissue coverage is possible for posterior
palatal seal
78. Soft palate….
CLASS II:
• Soft palate makes a 45ᵒ angle to the
hard palate
• Tissue coverage for posterior palatal
seal is less than that class I
CLASS III:
• Soft palate make a 70ᵒ angle to the
hard palate
• Tissue coverage for posterior palatal
seal is mininmum
79. Palate….
• Palatal Sensitivity: BY HOUSE
• Class 1: Normal
• Class 2: Subnormal (hyposensitive)
• Class 3: Supernormal (hypersensitive)
80. HARD PALATE
U-shaped palatal vault; most
favourable for retention & lateral
stability.
V-shaped vault: less favourable for
retention.
Flat palatal vault: also unfavourable.
81. Frenum Attachments:
• BY HOUSE (classified in same manner as border
attachments)
• Class 1: High in the maxilla or low in the mandible with
respect to the crest of the ridge.
• Class 2: Medium
• Class 3: Freni encroach on the crest of the ridge and may
interfere with the denture seal. Surgical correction may be
required.
• All lingual tissues of the mandible are classified as muscle
attachments.
82.
83. • Border Attachments: BY HOUSE
• Class 1: Attachments are high in maxilla or low in
mandible with relation to ridge crest (0.5 inches or more
between level of attachment and crest of ridge).
• Class 2: Attachment height in relation to the crest of the
ridge is between 0.25 and 0.50 inches.
• Class 3: Attachment height is less than 0.25 inches from
the ridge crest.
84. SALIVA
• Class 1: Normal quality and quantity of saliva. Cohesive
and adhesive properties of saliva are ideal.
• Class 2: Excessive saliva; contains much mucus.
• Class 3: Xerostomia; remaining saliva is mucinous.
• Thin watery saliva may affect retention.
• Thick ropy salivacomplicates impression making and is
annoying to the patient as it clings to the denture.
• Abundant saliva is common when the denture is first
inserted but usually improves withtime.
85. EXAMINATION OF SALIVA
• QUANTITY OF SALIVA:
• A pre- weighed cotton ball is placed in the mouth at the
orifices of the major salivary glands (mostly in the sub
lingual area) and is removed for reweighing at the end
86. Increase in salivary rate can be due to:-
• Direct cholinergic / muscarinic agonists
-Bethanechol, Pilocarpine
• Antipsychotics
-Haloperidol, Fluphenazine, Clozapine
• Medications irritating the esophagus
-Tetracycline, Iron preparations
87. Decrease in the salivary rate may be due to:-
• Anticholinergic/ antimuscarinic- Atropine, Belladona,
Benzotropine
• Anti hypertensives- Enalapril, Lisinopril
• Antihistamines- Chlorpheniramine, Diphenhydramin
• Psychoactive agents- Amitriptyline
• Opioids and analgesic agents- Codeine, Meperidine,
Methadone
• Nonsteroidal anti-inflammatory agents- Ibuprofen,
Naproxen
88. EXAMINATION OF SALIVA
• QUALITY:
• Cotton ball or blunt end of the instrument is placed in the
sublingual region
• 3 types-
• Thin serous saliva- There is no string formation by lifting
the instrument
• Mixed type- Formation of strings by lifting the instrument
• Thick mucous saliva- Thick saliva pooled and lifted by
the instruments
89. Remarks of existing dentures
1)Anterior Tooth Shade, Mold, and Material
2)Posterior Tooth Shade, Mold, and Material:- Physical,
esthetic, and anatomic characteristics should be
determined. If the mold cannot be determined, the general
shape of the teeth should be recorded (e.g., square,
square-tapering, tapering, ovoid, etc.).
3)Esthetics, phonetics, retention, stability, extensions, and
contours:- Existing esthetics, phonetics, retention, stability,
extensions, and contours should be evaluated.
• Rated as (1) good, (2) fair, and (3) poor
90. • 4)Centric Relation and Vertical Dimension of Occlusion:-
Rated as "acceptable" or "unacceptable," If unacceptable,
it should be noted whether the existing VDO is
"inadequate" or "excessive.“
• 5)Occlusal Plane Orientation:- Improper orientation as a
result of tooth setting or changes in bony architecture often
creates a "reverse smile line." This condition is
characterized by teeth that slope downward as one
progresses posteriorly. Consequently, the anterior teeth
assume a curvature that does not follow the arc of the
lower lip.
91. Existing dentures….
Palate: -
NOTE- The denture base material and thickness
-Anatomic features
-The presence or absence of rugae on the cameo
surface of the denture base
-Should listen to speech patterns
Post dam:
• NOTE- Soft tissues in the vicinity of the "vibrating line”
-The seal of the existing maxillary denture
The post dam should be rated "acceptable" or
"unacceptable."
92. Existing dentures….
• Base Adaptation:- The fit of maxillary and mandibular
bases should be assessed using an appropriate disclosing
medium, Noted as "acceptable" or "unacceptable."
• Midline:- Noted as "acceptable" or "unacceptable.'
• Discrepancies in midline placement create noticeable facial
disharmonies. The existing maxillary midline should be
evaluated using intraoral (e.g., incisive papilla) and
extraoral landmarks (e.g., nasion, filtrum, middle of the
chin). Deviations of the maxillary midline should be
recorded by direction and amount (e.g., maxillary midline 2
mm to the right of the facial midline).
93. Existing dentures….
• Buccal Vestibule:- It is an important esthetic and
functional component. The buccal vestibule should be
judged "acceptable" or "unacceptable." Corrective actions
should be proposed.
• Crossbite:- The presence of a unilateral or bilateral
crossbite should be observed and entered into the
diagnostic record using the categories "none “, “
unilateral," or "bilateral."
• Characterization:- Characterization or staining of
existing denture bases should be evaluated and recorded.
• Noted as "characterized" or ' 'uncharacterized."
94. Existing dentures….
• Wear:- Wear is an indicator of parafunctional habits or an
abrasive diet. The wear process must be assessed with
respect to time. Wear should be classified as (1) minimal,
(2) moderate, or (3) severe.
• Attachments and Hardware:- Attachments and
hardware usually are limited to overdenture situations.
When working under these constraints, it is important to
know the specific system in use and the availability of
components
95. SPECIAL INVESTIGATIONS
• RADIOGRAPHS:-
• OPG should beadvised. Check for:
• Root pieces
• Foreign bodies
• Impacted/Embedded teeth
• Rarefaction of bone
• TMJ-Findings
96. Investigations….
DIAGNOSTIC CASTS:-
Aid in determining the inter ridge space, ridge
relationships, ridge shape and form that cannot be
adequately determined by clinical examination alone.
97. PROGNOSIS
• A forecast as to the probable result of a disease or a
course of therapy- GPT 9
• A number of factors affect the prognosis are - gross
appraisal of the patient, patient’s needs and expectations,
medical, psychological and behavioral considerations,
anatomic factors, physiological factors etc.
• It can be rated as - most favourable prognosis/ integral /
least favourable prognosis
98. TREATMENT PLANNING
• Evaluation of the patient includes assessment of mental as well
as physical conditions
• Tissue conditioning: List proposed therapy as finger
massage, prescribed medications, type of tissue treatment
material to be used and frequency of soft reline changes
• Preprosthetic surgery: List any proposed preprosthetic
procedures along with the staging of these procedures.
• Articulator:
• Instrument Number and Manufacturer
• Control Settings:- Horizontal condylar guidance (right and left);
lateral condylar guidance (right and left); incisal guide anterior
angle (right and left); and incisal guide lateral angle (right and
left).
99. Treatment planning….
• Tooth Selection:- The shade, mold, and
material of the maxillary anterior, mandibular
anterior, maxillary posterior, and mandibular
Posterior should be selected
• Denture Base Material: Available materials
include microwave resin, gold, heat-cured resin,
soft base
• Denture Base Shade: Base shade depends on
the brand of acrylic.
• Anatomic Palate: Yes or no.
• Characterization: Establish the stains to be
used; draw a "map" of the proposed stain
placement.
104. INTRODUCTION
• The American College of Prosthodontists has developed a
classification system for complete edentulism based on
diagnostic findings.
• These guidelines may help practitioners determine
appropriate treatments for their patients.
• Four categories are defined, ranging from Class I to Class
IV, with Class I representing an uncomplicated clinical
situation and a Class IV patient representing the most
complex and higher-risk situation.
• Each class is differentiated by specific diagnostic criteria.
This system is designed for use by dental professionals
who are involved in the diagnosis of patients requiring
treatment for complete edentulism.
105. Introduction….
Potential benefits of the system include
• 1) better patient care
• 2) improved professional communication
• 3) more appropriate insurance reimbursement
• 4) a better screening tool to assist dental school
admission clinics, and
• 5) standardized criteria for outcomes assessment.
106.
107. 1. BONE HEIGHT- MANDIBLE ONLY
• Type I (most favorable): Residual
bone height of 21 mm or greater
measured at the least vertical
height of the mandible
• Type II: Residual bone height of 16 to
20 mm measured at the least vertical
height of the mandible
108. 1. BONE HEIGHT- MANDIBLE ONLY
• Type III: Residual alveolar bone
height of 11 to 15 mm measured at
the least vertical height of the
mandible
• Type IV: Residual vertical bone
height of 10 mm or less measured
at the least vertical height of the
mandible
109. 2. RESIDUAL RIDGE MORPHOLOGY-
MAXILLA ONLY
Type A (most favorable):
• Anterior labial and posterior buccal
vestibular depth that resists vertical and
horizontal movement of the denture base
• Palatal morphology resists vertical and
horizontal movement of the denture base.
• Sufficient tuberosity definition to resist vertical
and horizontal movement of the denture base.
• Hamular notch is well defined to establish the
posterior extension of the denture base.
• Absence of tori or exostoses.
110. 2. RESIDUAL RIDGE MORPHOLOGY-
MAXILLA ONLY
Type B
• Loss of posterior buccal vestibule.
• Palatal vault morphology resists vertical and
horizontal movement of the denture base.
• Tuberosity and hamular notch are poorly
defined, compromising delineation of the
posterior extension of the denture base.
• Maxillary palatal tori and/or lateral
exostoses are rounded and do not affect
the posterior extension of the denture base.
111. 2. RESIDUAL RIDGE MORPHOLOGY-
MAXILLA ONLY
Type C
• Loss of anterior labial vestibule.
• Palatal vault morphology offers minimal
resistance to vertical and horizontal movement
of the denture base.
• Maxillary palatal tori and/or lateral exostoses
with bony undercuts that do not affect the
posterior extension of the denture base.
• Hyperplastic, mobile anterior ridge offers
minimum support and stability of the denture
base.
• Reduction of the post malar space by the
coronoid Process during mandibular opening
and/or excursive movements.
112. 2. RESIDUAL RIDGE MORPHOLOGY-
MAXILLA ONLY
Type D
• Loss of anterior labial and posterior buccal
vestibules.
• Palatal vault morphology does not resist
vertical or horizontal movement of the
denture base.
• Maxillary palatal tori and/or lateral
exostoses interfere with the posterior
border of the denture.
• Hyperplastic, redundant anterior ridge.
• Prominent anterior nasal spine.
113. 3. MUSCLE ATTACHMENTS-
MANDIBLE ONLY
Type A (most favorable):
• Attached mucosal base without undue
muscular impingement during normal
function in all regions.
Type B:
• Attached mucosal base in all regions
except labial vestibule.
• Mentalis muscle attachment near crest
of alveolar ridge.
114. 3. MUSCLE ATTACHMENTS-
MANDIBLE ONLY
Type C
• Attached mucosal base in all regions
except anterior buccal and lingual
vestibules- canine to canine
• Genioglossus and mentalis muscle
attachments near crest of alveolar ridge.
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.
115. 4. MAXILLOMANDIBULAR
RELATIONSHIP
Class I (most favorable):
• Maxillomandibular relation allows tooth position that has
normal articulation with the teeth supported by the
residual ridge.
Class II:
• Maxillomandibular relation requires tooth position outside
the normal ridge relation to attain esthetics, phonetics,
and articulation (e.g; anterior or posterior tooth position
is not supported by the residual ridge; anterior vertical
and/or horizontal overlap exceeds the principles of fully
balanced articulation).
116. 4. MAXILLOMANDIBULAR
RELATIONSHIP
Class III:
• A Maxillomandibular relation requires tooth position
outside the normal ridge relation to attain esthetics,
phonetics, and articulation (i.e., crossbite- anterior or
posterior tooth position is not supported by the residual
ridge)
120. CLASS I
• This classification level characterizes the stage of
edentulism that is most apt to be successfully treated with
complete dentures using conventional prosthodontic
techniques.
• All four of the diagnostic criteria are favorable.
• Residual bone height of 21 mm or greater measured at
the least vertical height of the mandible on a panoramic
radiograph.
• Residual ridge morphology resists horizontal and vertical
movement of the denture base; Type A maxilla.
• Location of muscle attachments that arc conducive to
denture base stability and retention; Type A or B
mandible.
• Class I maxillomandibular relationship.
121. CLASS II
• 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.
• Residual bone height of 16 to 20 mm measured at the least
vertical height of the mandible on a panoramic radiograph
• Residual ridge morphology that resists horizontal and vertical
movement of the denture base; Type A or B maxilla
• Location of muscle attachments with limited influence on
denture base stability and retention; Type A or B mandible
• Class I maxillomandibular relationship
• Minor modifiers, psychosocial considerations, mild systemic
disease with oral manifestations
122. CLASS III
• This classification level is characterized by the need for
surgical revision of supporting structures to allow for
adequate prosthodontic function. Additional factors now
play a significant role in treatment outcomes.
• Residual alveolar bone height of 11 to 15 mm measured at
the least vertical height of the mandible on a panoramic
radiograph
• Residual ridge morphology has minimum influence to
resist horizontal or vertical movement of the denture base;
Type C maxilla
• Location of muscle attachments with moderate influence
on denture base stability and retention; Type C mandible
• Class I, II, or III maxillomandibular relationship
123. CLASS III…..
Conditions requiring preprosthetic surgery
• 1) minor soft tissue procedures
• 2) minor hard tissue procedures including alveolo-
• 3) simple implant placement, no augmentation
• 4) multiple extractions leading to complete edentulism for
immediate denture placement.
124. CLASS III….
• Limited interarch space (18-20 mm)
• Moderate psychosocial consideration and/or moderate
oral manifestations of systemic diseases or conditions
such as xerostomia
• TMD symptoms present
• Large tongue (occludes interdental space) with or without
hyperactivity
• Hyperactive gag
125. CLASS IV
• 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
• When surgical revision is not an option, prosthodontic
techniques of a specialized nature must be used to
achieve an adequate treatment outcome
126. CLASS IV….
• Residual vertical bone height of 10 mm or less measured
at the least vertical height of the mandible on a panoramic
radiograph
• Residual ridge offers no resistance to horizontal or vertical
movement; Type D maxilla
• Muscle attachment location that can be expected to have
significant influence on denture base stability and
retention; Type D or E mandible
• Class I, II, III maxillomandibular relationships.
127. CLASS IV….
Major conditions requiring preprosthetic surgery:
I) complex implant placement, augmentation required
2) surgical correction of dentofacial deformities
3) hard tissue augmentation required
4) major soft tissue revision required, ie, vestibular
extensions with or without soft tissue grafting
• History of paresthesia or dysesthesia.
• Insufficient interarch space with surgical correction
required
• Acquired or congenital maxillofacial defects
128. CLASS IV….
• Severe oral manifestation of systemic disease or conditions
such as sequelae from oncological treatment.
• Maxillo-mandibular ataxia (incoordination)
• Hyperactivity of tongue that can be associated with a
retracted tongue position and/or its associated morphology
• Hyperactive gag reflex managed with medication
• Refractory patient (a patient who presents with chronic
complaints following appropriate therapy). These patients
may continue to have difficulty achieving their treatment
expectations despite the thoroughness or frequency of the
treatments provided
• Psychosocial conditions warranting professional intervention
129. CONCLUSION
Successful complete denture therapy is obtained by
thorough assessment of patients physical and
psychological condition and determining a treatment plan
that will satisfy patient’s expectations.
• All the facts must be known before they can be correlated
in such a way that decision can be made. Only then can
treatment plans be developed to best serve the needs of
each individual patient.
• For the patient to be happier the dentist should not only
require the skills of complete denture construction but
also the skills to treat a patient’s aspirations &
expectations
130. REFERENCES
• Examination, diagnosis and treatment planning- chester
perry, university of detroit, school of dentistry, vol 10, no 6
• Examination, diagnosis and treatment planning for
complete denture therapy- a review, sandeep chiramana,
ashok.k, journal of orofacial sciences, 2(3)2010
• Bandookar, kranti ashoknath, aras meena., psychological
considerations for complete denture patients; journal of
indian prosthodontic society 2007;7[2]:71-76
