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.
3. CLASSIFICATION SYSTEM FOR
COMPLETE EDENTULISM
• 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 data collected 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 in these 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 subcommittee established 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
COMPLETE EDENTULISM 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
8.
9. BONE HEIGHT
• Chronic progressive, 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
Type A (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
Loss of 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
Loss of 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
• Class I (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
19. TONGUE ANATOMY
• Class III
Large and occludes interdental space
• Class IV
Hyperactive with retracted position
20. CLASS I
Residual bone 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
Residual bone 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
Residual alveolar 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
Residual vertical 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
PARTIAL EDENTULISM
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.
27. CRITERIA 1: LOCATION AND 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 maxillary edentulous 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 maxillary or 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 area or
combination of edentulous areas
requiring a high level of patient
compliance.
D. Severely
compromised
edentulous
area
31. CRITERIA 2: ABUTMENT CONDITIONS
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
Abutments in 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 is re-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: RESIDUAL RIDGE
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
The location 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
The location 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:
Class II molar and jaw
relationships.
Residual ridge morphology
conforms to the Class III complete
edentulism description
40. CLASS IV
• The location 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 FOR THE
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
43. CRITERIA 1. TOOTH CONDITION
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 structure to 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 structure in 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. OCCLUSAL SCHEME
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
DENTATE PATIENT
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
• Moderately compromised 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
compromised tooth
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
• Severely compromised 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 THE USE 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 concerns or 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
CLASSIFICATION SYSTEM
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.
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
Correct classification of any situation is very imp for coreect diagnosis, to formulate correct treatment plan and to asses the treatment outome
Three dif class systems have been given in pdi for completely edentulous patients , partial and completely dentate patients
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.
On the basis of data collected from this questionarre , these variables were differentiated into 4 subclasses
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?
After avaluation of these variables ranking of individual varibles was established and 4 categories were defibed
At the present time, the importance of various cofactors is unknown.”
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
Tuberosity and hamular notch are poorly defined, compromising delineation of the posterior extension of the denture base.
Palatal vault morphology offers minimal resistance to vertical and horizontal movement of the denture base
Maxillary palatal tori and/or lateral exostoses intcrfere with the posterior border of the denture.
with the posterior border of the denture.
The effects of muscle attachment and location are most important to the function of mandibular denture
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).
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.
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.
This classification level is characterized by the need for surgical revision of supporting structures to allow for adequate prosthodontic function
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
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
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).
to retain or support intracoronal or extracoronal restorations
(ie, periodontal, endodontic, or orthodontic procedures).
therapy eg, enameloplasty on premature occlusal contacts).
This class is characterized by ideal or minimal compromise in the location and extent of edentulous area
This class is characterized by ideal or minimal compromise in the location and extent of edentulous area
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.
Retain or support resorations
No preprosthetic therapy required. Contiguous, intact dental arches.
Characterized by severely compromised tooth conditions requiring extensive therapy and/or reestablishment of occlusal scheme with change in the occlusal vertical dimension