Dental ICD-9-CM April 2004 (2)

8/6/2019 Dental ICD-9-CM April 2004 (2)

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Complete and PartialComplete and PartialEdentulismEdentulism

April 2, 2004April 2, 2004

ICDICD--9 C & M Meeting9 C & M Meeting

Baltimore, MDBaltimore, MD


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525525 Other diseases and conditionsOther diseases and conditionsof the teeth and supportingof the teeth and supporting

structuresstructures

525.1525.1 Classification of edentulism basedClassification of edentulism basedon the etiology of tooth losson the etiology of tooth loss

-- TraumaTrauma

-- ExtractionExtraction-- Periodontal DiseasePeriodontal Disease


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CompleteCompleteEdentulismEdentulism


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Complete EdentulismComplete Edentulism


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Edentulism, defined as total tooth loss, is more prevalentEdentulism, defined as total tooth loss, is more prevalentamong persons with less than a high school education,among persons with less than a high school education,those without dental insurance, nonthose without dental insurance, non--Hispanic blacks, andHispanic blacks, and

current everyday smokers (CDC, 1999)current everyday smokers (CDC, 1999) Between the 1950s and the early 1990s the prevalenceBetween the 1950s and the early 1990s the prevalence

of edentulism in the United States decreased from 50%of edentulism in the United States decreased from 50%to 42% among people aged 65 and older, from 28% toto 42% among people aged 65 and older, from 28% to11% for 4511% for 45-- to 64to 64--yearyear--olds, and from 5% to 2% forolds, and from 5% to 2% forpersons 18 to 44 years old (Oliver & Brown, 1993)persons 18 to 44 years old (Oliver & Brown, 1993)

1998 National Health Interview Survey, National Center for Health Statistics,

and the 1999 Behavioral Risk Factor Surveillance System, CDC


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Classification System forClassification System forComplete EdentulismComplete Edentulism

McGarry TJ, Nimmo A, Skiba JF, AhlstromMcGarry TJ, Nimmo A, Skiba JF, AhlstromRH, Smith CR, Koumjian JHRH, Smith CR, Koumjian JH

J Prosthodont. 1999 Mar;8(1):27J Prosthodont. 1999 Mar;8(1):27--3939


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Classification System for the

Completely Edentulous PatientClass I

Class II

Class III

Class IV

Diagnostic Criteria1. Bone height--mandibular2. Maxillomandibular

relationship

3. Residual ridge morphology-

maxilla

4. Muscle attachments

Ideal or minimally

compromised

Moderately

compromised

Substantially

compromised

Severely

compromised


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Diagnostic CriteriaDiagnostic Criteria

1. Bone height--mandibular

2. Maxillomandibularrelationship

3. Residual ridge morphology-maxilla

4. Muscle attachments


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1. Bone Height1. Bone Height

MandibularMandibular


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Type IType I

Residual bone height ofResidual bone height of21mm or greater21mm or greatermeasured at the leastmeasured at the leastvertical height of thevertical height of the

mandible.

mandible.


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Type IVType IV

Residual vertical boneResidual vertical bone

height of10 mm orheight of10 mm orless measured at theless measured at theleast vertical height ofleast vertical height ofthe mandiblethe mandible


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2. Residual Ridge2. Residual Ridge

MorphologyMorphology

MaxillaMaxilla


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Type AType A Anterior labial and posterior buccal vestibular depth thatAnterior labial and posterior buccal vestibular depth that

resists vertical and horizontal movement of the dentureresists vertical and horizontal movement of the denturebasebase

Palatal morphology that resists vertical and horizontalPalatal morphology that resists vertical and horizontal

movement of the denture basemovement of the denture base

Sufficient tuberosity definition that resists vertical andSufficient tuberosity definition that resists vertical andhorizontal movementhorizontal movementof the denture baseof the denture base

Hamular notch is wellHamular notch is welldefined to establish thedefined to establish theposterior extension of theposterior extension of thedenture basedenture base

Absence of tori or exostosesAbsence of tori or exostoses


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Type DType D

Loss of anterior labial and posterior buccal vestibulesLoss of anterior labial and posterior buccal vestibules

Maxillary palatal and/or lateral toriMaxillary palatal and/or lateral tori--rounded or undercutrounded or undercut-- thatthatinterferes with the posterior border of the dentureinterferes with the posterior border of the denture

Hyperplastic, redundant anterior ridgeHyperplastic, redundant anterior ridge

Palatal vault morphologyPalatal vault morphologythat does not resistthat does not resistvertical or horizontalvertical or horizontalmovement ofmovement of

the denture basethe denture base

Prominent anterior nasalProminent anterior nasalspinespine


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3. Maxillomandibular3. Maxillomandibular

RelationshipRelationship


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Class IClass IMaxillomandibularMaxillomandibularrelationship allowsrelationship allows

tooth position thattooth position thathas normalhas normalarticulation with thearticulation with theteeth supported byteeth supported by

the residual ridge.the residual ridge.


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Class IIIClass III MaxillomandibularMaxillomandibularrelationship requiresrelationship requirestooth position outsidetooth position outsidethe normal ridgethe normal ridge

relation in order torelation in order toattain phonetics andattain phonetics andarticulation;articulation;i.e., crossbitei.e., crossbite

anterior or posterior,anterior or posterior,tooth position nottooth position notsupported by thesupported by theresidual ridge.residual ridge.


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4. Muscle Attachments4. Muscle Attachments


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Type AType A

Adequate attached mucosal base withoutAdequate attached mucosal base withoutundue muscular impingement during normalundue muscular impingement during normal

function infunction inall regions.all regions.


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Type DType D

Adequate attached mucosal base only inAdequate attached mucosal base only inthe posterior lingualthe posterior lingual

regionregion

All other regions areAll other regions aredetacheddetached


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Diagnostic ClassificationDiagnostic Classificationofof



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Class IClass I

This classification level describes theThis classification level describes the

stage of edentulism that is most apt to bestage of edentulism that is most apt to besuccessfully treated by conventionalsuccessfully treated by conventionalprosthodontic techniques with completeprosthodontic techniques with complete

denture prosthesis.

denture prosthesis.

All four of the diagnostic criteria areAll four of the diagnostic criteria arefavorable.favorable.


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Class IClass I

Residual bone heightResidual bone height

of 21

mm or greaterof 21

mm or greatermeasured at the leastmeasured at the leastvertical height of thevertical height of themandiblemandible

Class IClass Imaxillomandibularmaxillomandibularrelationshiprelationship


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Class IIClass II

This classification level distinguishes itselfThis classification level distinguishes itself

with the noted continuation of thewith the noted continuation of thephysical degradation of the denturephysical degradation of the denturesupporting structures and in addition issupporting structures and in addition is

characterized with the early onset ofcharacterized with the early onset ofsystemic disease interactions, localizedsystemic disease interactions, localizedsoft tissue factors and patientsoft tissue factors and patientmanagement/lifestyle considerations.management/lifestyle considerations.


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Class IIClass II

Residual bone height ofResidual bone height of1616--20 mm measured at20 mm measured at

the least vertical heightthe least vertical heightof the mandibleof the mandible

Class IClass I

maxillomandibularmaxillomandibularrelationshiprelationship

Residual ridgeResidual ridgemorphology that resistsmorphology that resists

horizontal and verticalhorizontal and verticalmovement of themovement of thedenture basedenture baseType A,Type A,BB----MaxillaMaxilla


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Class IIIClass IIIThis classification level isThis classification level is

characterized by the need forcharacterized by the need forsurgical revision of denturesurgical revision of denturesupporting structures to allow forsupporting structures to allow foradequate prosthodontic function.adequate prosthodontic function.

Additional factors now play aAdditional factors now play asignificant role in treatmentsignificant role in treatment

outcomes.outcomes.


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Class IIIClass III

Residual bone height ofResidual bone height of1111--15 mm measured at15 mm measured atthe least vertical heightthe least vertical heightof the mandibleof the mandible

Class I, II and IIIClass I, II and IIImaxillomandibular relationshipmaxillomandibular relationship

Residual ridge morphologyResidual ridge morphologyhas minimum influence tohas minimum influence to

resist horizontal or verticalresist horizontal or verticalmovement of the denture basemovement of the denture baseType CType CMaxillaMaxilla

Location of muscle attachments with moderate influence onLocation of muscle attachments with moderate influence ondenture base stability and retentiondenture base stability and retentionType CType C----MandibleMandible


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Class IVClass IV

This classification level depicts the mostThis classification level depicts the mostdebilitated edentulous conditiondebilitated edentulous condition

Surgical reconstruction is almost always indicatedSurgical reconstruction is almost always indicatedbut can not always be accomplished due to thebut can not always be accomplished due to thepatients health, desires, past dental history andpatients health, desires, past dental history andfinancial considerationsfinancial considerations

When surgical revision is not selected,When surgical revision is not selected,prosthodontic techniques of a specialized natureprosthodontic techniques of a specialized naturemust be used in order to achieve an adequatemust be used in order to achieve an adequate

treatment outcometreatment outcome


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Class IVClass IV Residual bone height ofResidual bone height of

least vertical heightleast vertical heightof the mandibleof the mandible

Class I, II and IIIClass I, II and IIImaxillomandibular relationshipsmaxillomandibular relationships

Residual ridge offers noResidual ridge offers noresistance to horizontal orresistance to horizontal orvertical movementvertical movement

TypeType DDMaxillaMaxilla Location of muscle attachments with significant influence onLocation of muscle attachments with significant influence on

denture base stability and retentiondenture base stability and retentionType D and EType D and E----MandibleMandible


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Completely DentateCompletely Dentate


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PartialPartialEdentulismEdentulism


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Partial EdentulismPartial Edentulism


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Classification System for PartialClassification System for PartialEdentulismEdentulism

McGarry TJ, Nimmo A, Skiba JF, AhlstromMcGarry TJ, Nimmo A, Skiba JF, AhlstromRH, Smith CR, Koumjian JH, Arbree NSRH, Smith CR, Koumjian JH, Arbree NS

J Prosthodont. 2002 Sep;11(3):181J Prosthodont. 2002 Sep;11(3):181--9393


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DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA

1.1. Location and extent of the edentulousLocation and extent of the edentulous

area(s)area(s)

2.2. Condition of the abutment teethCondition of the abutment teeth

3.3. Occlusal schemeOcclusal scheme

4.4. Residual ridgeResidual ridge

Class I Class II Class III Class IV


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Class I Class II Class III Class IV

Location & Extent of Edentulous Areas

Ideal or minimally compromised-single arch

Moderately compromised-both arches

Substantially compromised- >3 teeth

Severely compromised-guarded prognosisCongenital or acquired maxillofacial defect

Abutment Tooth Condition

Ideal or minimally compromised

Moderately compromised-local adjunctive tx

Substantially compromised-mod adjunctive tx

Severely compromised-extensive adjunctive tx

Occlusal Scheme

Ideal or minimally compromised

Moderately compromised-local adjunctive tx

Substantially compromised-occlusal scheme

Severely compromised-change in VDO

Residual Ridge

Class I EdentulousClass II Edentulous

Class III Edentulous

Class IV Edentulous

Conditions Creating a Guarded Prognosis

Severe oral manifestations of systemic disease

Maxillomandibular dyskinesia and/or ataxiaRefractory patient


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Committed to developing a dental educationalCommitted to developing a dental educationalcurriculum that is diagnosis drivencurriculum that is diagnosis driven

The only dental school in the third largest city inThe only dental school in the third largest city in

the US providing service to more than 100,000the US providing service to more than 100,000patient visits per yearpatient visits per year Need for clinical studies that have a common,Need for clinical studies that have a common,

transparent and systematic diagnosis. Achievedtransparent and systematic diagnosis. Achievedby employing the evidenceby employing the evidence--based process tobased process to

assemble, organize and synthesize clinicalassemble, organize and synthesize clinicalresearch in a rigorous and transparent fashion.research in a rigorous and transparent fashion.This body of evidence, coupled with clinicalThis body of evidence, coupled with clinicalexpertise, will lead to the creation of guidelinesexpertise, will lead to the creation of guidelinesdesigned to enhance clinical judgment anddesigned to enhance clinical judgment and

decisiondecision--makingmaking


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Concluding RemarksConcluding Remarks

The codes being proposed are part of normalThe codes being proposed are part of normaldiagnostic data collection that occurs for alldiagnostic data collection that occurs for all

patients, meeting with the existing standard ofpatients, meeting with the existing standard ofcare in dentistrycare in dentistry

The proposed new codes are within the scopeThe proposed new codes are within the scopeand conventions of the existing classificationand conventions of the existing classification

By adopting these codes into the public domain,By adopting these codes into the public domain,dental educators, researchers and clinicians willdental educators, researchers and clinicians willbe able to contribute significantly to the body ofbe able to contribute significantly to the body ofevidenceevidence


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AcknowledgementsAcknowledgements

Dr. Stephen CampbellDr. Stephen Campbell UIC CODUIC COD Dr. Kent KnoernschildDr. Kent Knoernschild UIC CODUIC COD

Dr.John ZarbDr

.John Zarb UIC CODUIC COD

Dr. Thomas McGarryDr. Thomas McGarry ACPACP Dr. Barry ShipmanDr. Barry Shipman ACPACP Dr. Rosemary WalkerDr. Rosemary Walker UIC SBHIUIC SBHI

Ms. Teri JorwicMs. Teri Jorwic UIC SBHIUIC SBHI Dr. Bruce GrahamDr. Bruce Graham UIC CODUIC COD Ms. Lea AlexanderMs. Lea Alexander UIC CODUIC COD


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Documents

Dental ICD-9-CM April 2004 (2)