PROSTHODONTIC

DIAGNOSTIC
INDEX

PRESENTED BY-AISHA SAMREEN

JR1
 CONTENTS

1. Uses of classification system

2. Classification system for completely dentate patients
3. Classification system for partial edentulism
4. Classification system for complete edentulism
5. Conclusion
USES OF CLASSIFICATION SYSTEM

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
5. Standardized criteria for outcomes assessment
Classification System for the
Completely Dentate Patient
Class I
1.Ideal or minimally compromised
tooth condition
• No localized adjunctive therapy
required.
• Pathology affecting the coronal
morphology of teeth in only one
sextant.
2.Ideal or minimally compromised occlusal scheme
• No preprosthetic therapy required.
• Contiguous, intact dental arches
 Class II
1. Moderately compromised tooth
condition
• Insufficient tooth structure to retain or
support intracoronal or extracoronal
restorations—in one sextant
• Pathology that affects the coronal
morphology of four or more teeth in a
sextant
• Pathology can be in two sextants and
can be in opposing arches
• Teeth require localized adjunctive
therapy, i.e., periodontal, endodontic,
or orthodontic procedure in 1 sextants
• 2. Moderately compromised occlusal scheme
• Intact anterior guidance.
• Occlusal scheme requires localized adjunctive therapy
Class III
1.Substantially compromised tooth
condition
• Insufficient tooth structure to retain or
support intracoronal or extracoronal
restorations—in two sextants
• Pathology that affects the coronal
morphology of four or more teeth in
three or more sextants
• Pathology can be in three sextants in
the same and/or can be in opposing
arches
• Teeth require localized adjunctive
therapy, i.e., periodontal, endodontic,
or orthodontic procedure in two
sextant
2. Substantially compromised occlusal scheme
• Major therapy required to maintain occlusal scheme without any change in the
occlusal vertical dimension
Class IV
1.Severely compromised tooth
condition
• Insufficient tooth structure to retain
or support intracoronal or
extracoronal restorations—in three or
more sextants
• Pathology that affects the coronal
morphology of four or more teeth in
all sextants
• Teeth require localized adjunctive
therapy, i.e., periodontal, endodontic
or orthodontic procedure for teeth in
three or more sextants
2. Severely compromised occlusal scheme
• Major therapy required to reestablish the entire occlusal scheme including any
necessary changes in the occlusal vertical dimension.
Classification System for
Partial Edentulism
 Class I
1.The location and extent of the edentulous
area are ideal or minimally compromised
● The edentulous area is confined to a
single arch.
● The edentulous area may include:
• any anterior maxillary span that does not
exceed 2 incisors,
• any anterior mandibular span that does
not exceed 4 missing incisors,
• or any posterior span that does not
exceed 2 premolars or 1 premolar and 1
molar.
2. The abutment condition is ideal or minimally compromised, with no
need for preprosthetic therapy
3. The occlusion is ideal or minimally compromised, with no need for
preprosthetic therapy; maxillomandibular relationship: Class I molar
and jaw relationships.
4. Residual ridge morphology conforms to the Class I complete
edentulism description
Class II
1. The location and extent of the
edentulous area are moderately
compromised:
● Edentulous areas exist in both
arches and in one of the following
• any anterior maxillary span that does
not exceed 2 incisors,
• any anterior mandibular span that does
not exceed 4 incisors,
• any posterior span (maxillary or
mandibular) that does not exceed 2
premolars,
• or 1 premolar and 1 molar or any
missing canine (maxillary or
mandibular)
2. Condition of the abutments is moderately compromised:
● 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.
3. Occlusion is moderately compromised:
● Occlusal correction requires localized adjunctive therapy(enamaloplasty or
premature occlusal contacts)
● Maxillomandibular relationship: Class I molar and jaw relationships.
4. Residual ridge morphology conforms to the Class II complete edentulism
description.
Class III
1.The location and extent of the
edentulous areas are substantially
compromised:
● Edentulous areas present in one or
both arches.
● Edentulous areas compromise the
physiologic support of the abutments.
● Edentulous areas may include any
posterior maxillary or mandibular
edentulous area greater than 3 teeth or
2 molars
or anterior and posterior edentulous
areas of 3 or more teeth.
2. The condition of the abutments is moderately compromised:
● Abutments in 3 sextants have insufficient tooth structure to retain or
support intracoronal or extracoronal restorations.
● Abutments in 3 sextants require more substantial localized adjunctive
therapy (ie, periodontal, endodontic or orthodontic procedures).
● Abutments have a fair prognosis.
3. Occlusion:
● Requires reestablishment of the entire occlusal scheme without an
accompanying change in the occlusal vertical dimension.
● Maxillomandibular relationship: Class II molar and jaw relationships.
4. Residual ridge morphology conforms to the Class III complete
edentulism description
Class IV
1.The location and extent of the
edentulous areas results in severe
occlusal compromise:
• Edentulous areas may be extensive
and may occur in both arches.
• Edentulous areas compromise the
physiologic support of the abutment
teeth to create a guarded prognosis.
• Edentulous areas include acquired
or congenital maxillofacial defects.
• At least 1 edentulous area has a
guarded prognosis.
2. Abutments are severely compromised:
• Abutments in 4 or more sextants have insufficient tooth structure to retain or
support intracoronal or extracoronal restorations.
• Abutments in 4 or more sextants require extensive localized adjunctive
therapy.
3. Occlusion is severely compromised:
• Reestablishment of the entire occlusal scheme, including changes in the
occlusal vertical dimension, is necessary.
• Maxillomandibular relationship: class II division 2 or Class III molar and jaw
relationships.
4. Residual ridge morphology conforms to the class IV complete edentulism
description.
Other characteristics include severe manifestations of local or systemic disease,
including sequelae from oncologic treatment
maxillomandibular dyskinesia and/or ataxia
and refractory patient (a patient who presents with chronic complaints following
appropriate therapy).
 CLASSIFICATION SYSTEM
FOR COMPLETE
EDENTULISM
Bone Height: Mandible only
• The continued decrease in bone volume affects:
1) denture-bearing area
2) tissues remaining for reconstruction
3) facial muscle support/attachment
4) total facial height
5) ridge morphology.
• 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
• Type III: residual alveolar bone height
of 11 to 15 mm
• Type IV: residual vertical bone height
of 10 mm or less.
Residual Ridge Morphology: Maxilla Only
Type A (most favorable)
For resistance to vertical and horizontal
movement of the denture base -
• Anterior labial and posterior buccal
vestibular depth
• Palatal morphology
• Sufficient tuberosity -
• Hamular notch is well defined to
establish the posterior extension of the
denture base. Absence of tori or
exostoses.
Type B
• Loss of posterior buccal vestibule.
• Palatal vault morphology resists vertical
and horizontal movement ofthe 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.
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
• Reduction of the post malar space by the
coronoid process during mandibular opening
and/or excursive movements.
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 (rounded or undercut)
that interfere with the posterior
border of the denture.
• Hyperplastic, redundant anterior
ridge.
Muscle Attachments: Mandible only

• The effects of muscle attachment and

location are most important to the
function of a mandibular denture
• 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.

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.
Maxillomandibular Relationship
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 I (most favorable)
Tooth position that has normal
articulation with the teeth supported by
the residual ridge
Class II
• Tooth position outside the normal ridge
relation to attain esthetics, phonetics,
and articulation (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 articulation).

Class III
• Tooth position lies 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)
Classification System for
Complete Edentulism
Class I
• It is most apt to be successfully
treated as all four of the diagnostic
criteria are favorable.
• Residual bone height of 21 mm or
greater.
• Residual ridge morphology resists
horizontal and vertical movement
of the denture base; Type A maxilla.
• Location of muscle attachments
that are conducive to denture base
stability and retention; Type A or B
mandible.
• Class I maxillomandibular
relationship.
Class II
• It is characterized by continued
physical degradation of the denture
supporting anatomy.
• Residual bone height of 16 to 20 mm
• 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 manifestation.
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
• 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
 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
• Residual vertical bone height of 10 mm or less
• 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, or III maxillomandibular relationships
CONCLUSION
• The standarization of classification system may lead to improved
communications among dental professionals and third parties and
identify those patients most likely to require treatment by a specialist
or by a practitioner with additional training and experience in
advanced techniques.
• It is also valuable to research protocols as different treatment
procedures are evaluated.
• Based on use and observations by practitioners, educators, and
researchers, this system will be modified as need
REFERENCES
• McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH.
Classification system for complete edentulism. Journal of Prosthodontics.
1999;8(1):27–39.
• McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH, et al.
Classification system for partial edentulism. Journal of Prosthodontics.
2002;11(3):181–93.
• McGarry T, Nimmo A, Skiba J, Ahlstrom R, Smith C, Koumjian J, et al. Classification
system for the completely dentate patient. Journal of Prosthodontics.
2002;11(3):181–93.
• Parameters of Care | American College of Prosthodontists (prosthodontics.org)
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