Topics Ofinterest

8/10/2019 Topics Ofinterest

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TOPICS OFINTEREST

Classifcation System or Partial Edentulism

Thomas J. Mcarry! ""S!

#

$rthur Nimmo! ""S!

%

James F. S&i'a! ""S!

(

Ro'ert ). $hlstrom! ""S! MS!

*

Christo+her R. Smith! ""S!

,

Jac& ). -oumian! ""S! MS"!

/

and Nancy S. $r'ree! ""S! MS

0

The $merican Colle1e o Prosthodontists 2$CP3 has de4elo+ed a classifcation

system or +artial

edentulism 'ased on dia1nostic fndin1s. This classifcation system is similar to the

classifcation

system or com+lete edentulism +re4iously de4elo+ed 'y the $CP. These 1uidelines

are intended to

hel+ +ractitioners determine a++ro+riate treatments or their +atients. Four

cate1ories o +artial

edentulism are defned! Class I to Class I5! 6ith Class I re+resentin1 an

uncom+licated clinical

situation and class I5 re+resentin1 a com+le7 clinical situation. Each class is

di8erentiated 'y


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s+ecifc dia1nostic criteria. This system is desi1ned or use 'y dental +roessionals

in4ol4ed in the

dia1nosis and treatment o +artially edentulous +atients. Potential 'enefts o the

system include 2#3

im+ro4ed intrao+erator consistency! 2%3 im+ro4ed +roessional communication! 2(3

insurance reim9'ursement commensurate 6ith com+le7ity o care! 2*3 im+ro4ed

screenin1 tool or dental school

admission clinics! 2,3 standardi:ed criteria or outcomes assessment and research!

2/3 enhanced

dia1nostic consistency! and 203 sim+lifed aid in the decision to reer a +atient.

J Prosthodont %;;%#9#?(. Co+yri1ht@%;;% 'y The $merican Colle1e o

Prosthodontists.

IN"EA BOR"S= dia1nosis! treatment +lannin1! +rosthodontics! dental education!

outcomes

assessment! uality assurance! treatment outcomes! +atient ris& +rofles

P

$RTI$DD E"ENTDOS+atients e7hi'it a 6ide

ran1e o +hysical 4ariations and health con9ditions. The a'sence o or1ani:ed

dia1nostic

criteria or +artial edentulism has 'een a lon19standin1 im+ediment to e8ecti4e

reco1nition

o ris& actors that may a8ect treatment out9comes. $lthou1h descri'ed thorou1hly

in the

dental literature!#9;

the di4erse nature o +ar9tial edentulism has not 'een or1ani:ed in such

a 6ay to 1uide dental +roessionals in the treat9ment +lannin1 +rocess. To address

this +ro'9lem! the $merican Colle1e o Prosthodontists

2$CP3 Su'committee on Prosthodontic Classi9fcation 6as ormed and char1ed 6ith

de4elo+9in1 a classifcation system or +artial edentu9lism consistent 6ith the

e7istin1 classifcation

system or com+lete edentulism.


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%

$ summary

o the $CP edentulous classifcation system is

1i4en in Ta'le #.

The +ur+ose o this classifcation system is to

+ro4ide a rame6or& or the or1ani:ation o clinical

o'ser4ations. Clinical 4aria'les that esta'lish di9erent le4els o +artial edentulism

are or1ani:ed in

a sim+lifed! seuential +ro1ression desi1ned to a9cilitate consistent and

+redicta'le treatment +lan9nin1 decisions. This rame6or& is desi1ned to indi9cate

increasin1 le4els o dia1nostic and treatment

com+le7ity +resented 'y +atients 6ith 4aryin1 de91rees o +artial edentulism. This

may su11est

+oints at 6hich reerral to other s+ecialists is a+9+ro+riate. The rame6or& is

structured to su++ort

#

Pri4ate Practice! O&lahoma City! O-.

%

Proessor and Chairman! "e+artment o Prosthodontics! ni4ersity o

Florida Colle1e o "entistry! ains4ille! FD.

(

Pri4ate Practice! Montclair! NJ.

*

Pri4ate Practice! Reno! N5! and $ssociate Clinical Proessor! "e+art9ment o

Restorati4e "entistry! ni4ersity o the Pacifc! Stoc&ton! C$.

,

$ssociate Proessor! "e+artment o Clinical Sur1ery! ni4ersity o

Chica1o! Chica1o! ID.

/


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Clinical $ssociate Proessor! "e+artment o Restorati4e "entistry!

ni4ersity o Caliornia9San Francisco School o "entistry! San

Francsico! C$! and Pri4ate Practice! Palo $lto! C$.

0

Proessor and $ssociate "ean o $cademic $8airs! Tuts ni4ersity

School o "ental Medicine and Pri4ate Practice! Goston! M$.

$cce+ted $+ril >! %;;%.

This +roect 6as unded 'y the $merican Colle1e o Prosthodontists.

Presented at the $nnual Sessions o the $merican "ental Education

$ssociation! Bashin1ton! "C! $+ril %! %;;;! and the $merican Colle1e o

Prosthodontists! )a6aii! No4em'er #,! %;;;.

Corres+ondence to= Thomas J. Mcarry! ""S! *(%; Mc$uley Gl4d.!

O&lahoma City! O- 0(#%;.

Co+yri1ht @ %;;% 'y The $merican Colle1e o Prosthodontists

#;,?9?*#AH;%H##;(9;;;/(,.;;H;

doi=#;.#;,(H+ro.%;;%.#%/;?*

#># Journal o Prosthodontics! 5ol ##! No ( 2Se+tem'er3! %;;%= ++ #>#9#?(

T$GDE #.$CP Classifcation System o Com+lete Edentulism

Class I

This class characteri:es the sta1e o edentulism that is most a+t to 'e successully

treated 6ith com+lete dentures

usin1 con4entional +rosthodontic techniues. $ll * o the dia1nostic criteria are

a4ora'le.

Residual 'one hei1ht o %# mm measured at the least 4ertical hei1ht o the

mandi'le on a +anoramic radio1ra+h.

Residual rid1e mor+holo1y resistant to hori:ontal and 4ertical mo4ement o the

denture 'ase< ty+e $ ma7illa.


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Docation o muscle attachments conduci4e to denture 'ase sta'ility and retention to %; mm3

Moderate +sychosocial considerations andHor moderate oral maniestations osystemic diseases or conditions

such as 7erostomia

TM" sym+toms

Dar1e ton1ue 2occludes interdental s+ace3 6ith or 6ithout hy+eracti4ity

)y+eracti4e 1a1 reKe7

Class I5

This class re+resents the most de'ilitated edentulous condition. Sur1ical

reconstruction is almost al6ays indicated

'ut cannot al6ays 'e accom+lished 'ecause o the +atientLs health! +reerences!

+ast dental history! and fnancial

considerations. Bhen sur1ical re4ision is not an o+tion! +rosthodontic techniues o

a s+eciali:ed nature must 'e

used to achie4e an adeuate outcome.

Residual 4ertical 'one hei1ht o#; mm measured at the least 4ertical hei1ht o themandi'le on a +anoramic

radio1ra+h

Class I! II! or III ma7illomandi'ular relationshi+s


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Residual rid1e o8erin1 no resistance to hori:ontal or 4ertical mo4ement< ty+e "

ma7illa

Muscle attachment location that can 'e e7+ected to ha4e si1nifcant inKuence on

denture 'ase sta'ility and

retention< ty+e " or E mandi'le

Maor conditions reuirin1 +re+rosthetic sur1ery

Com+le7 im+lant +lacement! au1mentation reuired

Sur1ical correction o dentoacial deormities reuired

)ard tissue au1mentation reuired

Maor sot tissue re4ision reuired! that is! 4esti'ular e7tensions 6ith or 6ithout

sot tissue 1ratin1

)istory o +aresthesia or dysesthesia

Insucient interarch s+ace necessitatin1 sur1ical correction

$cuired or con1enital ma7illoacial deects

Se4ere oral maniestation o systemic disease or conditions such as seuelae rom

oncolo1ic treatment

Ma7illomandi'ular ata7ia 2incoordination3

)y+eracti4ity o ton1ue +ossi'ly associated 6ith a retracted ton1ue +ositionandHor its associated mor+holo1y

)y+eracti4e 1a1 reKe7 mana1ed 6ith medication

Reractory +atient 2a +atient 6ho +resents 6ith chronic com+laints ollo6in1

a++ro+riate thera+y3! 6ho may

continue to ha4e diculty achie4in1 their treatment e7+ectations des+ite the

thorou1hness or reuency o the

treatments +ro4ided.

Psychosocial conditions 6arrantin1 +roessional inter4ention

#>% Classifcation System or Partial Edentulism Mcarry et al

dia1nostically dri4en treatment +lan o+tions and

6ill also 'e useul in an educational en4ironment


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or tria1in1 the +atient u+on entry into an institu9tional settin1.

Partial edentulism is defned as the a'sence

o some 'ut not all o the natural teeth in a

dental arch. In a +artially edentulous +atient!

the loss and continuin1 de1radation o the al94eolar 'one! adacent teeth! and

su++ortin1

structures inKuence the le4el o diculty in

achie4in1 adeuate +rosthetic restoration.

The uality o the su++ortin1 structures con9tri'utes to the o4erall condition and is

consid9ered in the dia1nostic le4els o the classifcation

system.

Only the most si1nifcant dia1nostic criteria

ha4e 'een identifed. Selection o a++ro+riate treat9ment 6ill 'e de4elo+ed

su'seuently in a Parame9ters o Care document.

(

It is antici+ated that 'oth

the edentulous and +artially edentulous classifca9tion systems 6ill 'e incor+orated

into e7istin1 elec9tronic dia1nostic and +rocedural data'ases 2SNO9"ENT! IC"! CPT!and C"T3.

The classifcation system is intended to o8er the

ollo6in1 'enefts=

#.Im+ro4ed intrao+erator consistency

%.Im+ro4ed +roessional communication

(.Insurance reim'ursement commensurate 6ith

com+le7ity o care

*.$n o'ecti4e method or +atient screenin1 in

dental education

,.Standardi:ed criteria or outcomes assessment


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and research

/.Im+ro4ed dia1nostic consistency

0.$ sim+lifed! or1ani:ed aid in the decision9ma&9in1 +rocess relatin1 to reerral.

$++lications

"ia1nosis must 'e determined 'eore treat9ment recommendations can 'e made.

Bhile

this classifcation system is not a +redictor o

success o the +rosthodontic treatment! clinical

outcomes 6ill 'e e4aluated in terms o e4i9dence9'ased criteria.

Bhen com'ined 6ith the Parameters o Care

document! this classifcation system 6ill +ro4ide a

'asis or dia1nosis and treatment +rocedures. The

e7+eriences 1ained 6ill ena'le u+datin1 o the Pa9rameters o Care. The

classifcation system 6ill 'e

su'ect to re4ision 'ased u+on in+ut rom clinicians!

as 6ell as 6hen ne6 dia1nostic and treatment in9ormation 'ecomes a4aila'le.

Re4ie6 o the "ia1nostic Criteria

This section descri'es our 'road dia1nostic cate1o9ries rele4ant to classifcation o

+artially edentulous

+atients=

#.Docation and e7tent o the edentulous area2s3

%.Condition o a'utments

(.Occlusion

*.Residual rid1e characteristics.

The criteria descri+tions 'e1in 6ith the least

com+licated and +ro1ress to the most com+licated.

The dia1nostic criteria are as ollo6s.


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Criteria #= Docation and E7tent o the

Edentulous $rea2s3

$.Ideal or minimally com+romised edentulous area

The edentulous s+an is confned to a sin1le arch

and # o the ollo6in1=

$ny anterior ma7illary edentulous area that does

not e7ceed % incisors

$ny anterior mandi'ular edentulous area that

does not e7ceed * incisors

$ny +osterior ma7illary or mandi'ular edentu9lous area that does not e7ceed %+remolars! or #

+remolar and # molar.

G.Moderately com+romised edentulous area

Edentulous areas in 'oth arches and in # o the

ollo6in1=





$ny +osterior ma7illary or mandi'ular edentu9lous area that does not e7ceed %

+remolars! or #

+remolar and # molar

$ missin1 ma7illary or mandi'ular canine.

C.Su'stantially com+romised edentulous area

$ny +osterior ma7illary or mandi'ular edentu9lous area 1reater than ( teeth or %

molars

$ny edentulous areas includin1 anterior and +os9terior areas o ( or more teeth.


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#>( Se+tem'er %;;%! 5olume ##! Num'er (

".Se4erely com+romised edentulous area

$ny edentulous area or com'ination o edentulous

areas reuirin1 a hi1h le4el o +atient com+liance.

Criteria %= $'utment Conditions

$.Ideal or minimally com+romised a'utment conditions

No +re+rosthetic thera+y is indicated.

G.Moderately com+romised a'utment condition

$'utments in # or % se7tants ha4e insucient

tooth structure to retain or su++ort intracoronal

or e7tracoronal restorations.

$'utments in # or % se7tants reuire locali:ed

aduncti4e thera+y 2ie! +eriodontal! endodontic!

or orthodontic +rocedures3.

Fi1ure #.Class I +atient. This +atient # is cate1ori:ed in Class I due to an ideal or

minimally com+romised edentulous

area! a'utment condition! and occlusion. There is a sin1le edentulous area in #

se7tant. The residual rid1e is considered

ty+e $.2$3Frontal 4ie6! ma7imum intercus+ation.2G3Ri1ht lateral 4ie6! ma7imum

intercus+ation.2C3Det lateral 4ie6!

ma7imum intercus+ation.2"3 Occlusal 4ie6! ma7illary arch.2E3 Occlusal 4ie6!

mandi'ular arch.2F3 Frontal 4ie6!

+rotrusi4e relationshi+.

#>* Classifcation System or Partial Edentulism Mcarry et al

C.Su'stantially com+romised a'utment condition

$'utments in ( se7tants ha4e insucient tooth

structure to retain or su++ort intracoronal or

e7tracoronal restorations.


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$'utments in ( se7tants reuire more su'stan9tial locali:ed aduncti4e thera+y 2ie!

+eriodontal!

endodontic! or orthodontic +rocedures3.

".Se4erely com+romised a'utment condition

$'utments in * or more se7tants ha4e insu9cient tooth structure to retain or

su++ort intra9coronal or e7tracoronal restorations.

$'utments in * or more se7tants reuire e7ten9si4e aduncti4e thera+y 2ie!

+eriodontal! end9odontic! or orthodontic +rocedures3.

$'utments ha4e 1uarded +ro1noses.

Criteria (= Occlusion

$.Ideal or minimally com+romised occlusal characteristics

No +re+rosthetic thera+y is reuired

Class I molar and a6 relationshi+s are seen.

G.Moderately com+romised occlusal characteristics

Occlusion reuires locali:ed aduncti4e thera+y

2e1! enamelo+lasty on +remature occlusal con9tacts3.


C.Su'stantially com+romised occlusal characteristics

Entire occlusion must 'e reesta'lished! 'ut 6ith9out any chan1e in the occlusal

4ertical dimen9sion.

Class II molar and a6 relationshi+s are seen.

Fi1ure #. 2ContLd3 23 Ri1ht lateral 4ie6! ri1ht 6or&in1 mo4ement.2)3 Det lateral

4ie6! let 6or&in1 mo4ement.2I3

Full mouth radio1ra+hic series.

$ se7tant is a su'di4ision o the dental arch. The

ma7illary and mandi'ular dental arches may 'e su'9di4ided into / areas or

se7tants. In the ma7illa! the ri1ht

+osterior se7tant e7tends rom tooth # to tooth ,! the let

+osterior se7tant e7tends rom tooth #% to tooth #/! and


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the anterior se7tant e7tends rom tooth / to tooth ##. In

the mandi'le! the ri1ht +osterior se7tant e7tends rom

tooth %> to tooth (%! the let +osterior se7tant e7tends

rom tooth #0 to tooth %#! and the anterior se7tant

e7tends rom tooth %% to tooth %0.

#>, Se+tem'er %;;%! 5olume ##! Num'er (

Fi1ure %.Class II +atient. This +atient is Class II 'ecause he has edentulous areas in

% se7tants in di8erent arches.

2$3 Frontal 4ie6! ma7imum intercus+ation.2G3 Ri1ht lateral 4ie6! ma7imum

intercus+ation.2C3 Det lateral 4ie6!

ma7imum intercus+ation.2"3 Occlusal 4ie6! ma7illary arch.2E3 Occlusal 4ie6!mandi'ular arch.2F3 Frontal 4ie6!

+rotrusi4e relationshi+.23 Ri1ht lateral 4ie6! ri1ht 6or&in1 mo4ement.2)3 Det

lateral 4ie6! let 6or&in1 mo4ement.

#>/ Classifcation System or Partial Edentulism Mcarry et al

".Se4erely com+romised occlusal characteristics

Entire occlusion must 'e reesta'lished! includin1

chan1es in the occlusal 4ertical dimension.

Class II di4ision % and Class III molar and a6

relationshi+s are seen.

Criteria *= Residual Rid1e Characteristics

The criteria +u'lished or the Classifcation System

or Com+lete Edentulism are used to cate1ori:e

any edentulous s+an +resent in the +artially eden9tulous +atient 2see Ta'le #3.

Classifcation System or Partial

Edentulism

The * criteria and their su'classifcations are or1a9ni:ed into an o4erall classifcation

system or +artial


14/173


15/173

This class is characteri:ed 'y moderately com+ro9mised location and e7tent o

edentulous areas in

'oth arches! a'utment conditions reuirin1 local9i:ed aduncti4e thera+y! occlusal

characteristics re9uirin1 locali:ed aduncti4e thera+y! and residual

rid1e conditions.

#.The location and e7tent o the edentulous area

are moderately com+romised=

Edentulous areas may e7ist in # or 'oth arches.

Fi1ure %. 2ContLd32I3 Full mouth radio1ra+hic series.

#>0 Se+tem'er %;;%! 5olume ##! Num'er (

Fi1ure (.Class III +atient. This +atient is Class III 'ecause the edentulous area2s3 arelocated in 'oth arches and

multi+le locations 6ithin each arch. The a'utment condition is su'stantially

com+romised due to the need or

e7tracoronal restorations. There are teeth that are e7truded and mal+ositioned. The

occlusion is su'stantially

com+romised 'ecause reesta'lishment o the occlusal scheme is reuired 6ithout a

chan1e in the occlusal 4ertical

dimension.2$3Frontal 4ie6! ma7imum intercus+ation.2G3Ri1ht lateral 4ie6! ma7imum

intercus+ation.2C3Det lateral

4ie6! ma7imum intercus+ation.2"3Occlusal 4ie6! ma7illary arch.2E3Occlusal 4ie6!

mandi'ular arch.2F3Frontal 4ie6!



#>> Classifcation System or Partial Edentulism Mcarry et al

The edentulous areas do not com+romise the

+hysiolo1ic su++ort o the a'utments.

Edentulous areas may include any anterior ma79illary s+an that does not e7ceed %

incisors! any

anterior mandi'ular s+an that does not e7ceed *


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incisors! any +osterior s+an 2ma7illary or man9di'ular3 that does not e7ceed %

+remolars! or #

+remolar and # molar or any missin1 canine

2ma7illary or mandi'ular3.

%.Condition o the a'utments is moderately com9+romised=





aduncti4e thera+y.

(.Occlusion is moderately com+romised=

Occlusal correction reuires locali:ed aduncti4e

thera+y.

Ma7illomandi'ular relationshi+= Class I molar

and a6 relationshi+s.

*.Residual rid1e mor+holo1y conorms to the

Class II com+lete edentulism descri+tion.

Class III 2Fi1 (3

This class is characteri:ed 'y su'stantially com+ro9mised location and e7tent o

edentulous areas in

'oth arches! a'utment condition reuirin1 su'stan9tial locali:ed aduncti4e thera+y!

occlusal character9istics reuirin1 reesta'lishment o the entire occlu9sion 6ithout a


dimension! and residual rid1e condition.

#.The location and e7tent o the edentulous areas

are su'stantially com+romised=

Edentulous areas may 'e +resent in # or 'oth

arches.


17/173

Edentulous areas com+romise the +hysiolo1ic

su++ort o the a'utments.

Edentulous areas may include any +osterior ma79illary or mandi'ular edentulous

area 1reater

than ( teeth or % molars! or anterior and +oste9rior edentulous areas o ( or more

teeth.

%.The condition o the a'utments is moderately

com+romised=





+eriodontal!

endodontic or orthodontic +rocedures3.

$'utments ha4e a air +ro1nosis.

(.Occlusion is su'stantially com+romised=

Reuires reesta'lishment o the entire occlusal

scheme 6ithout an accom+anyin1 chan1e in the

occlusal 4ertical dimension.

Ma7illomandi'ular relationshi+= Class II molar



Class III com+lete edentulism descri+tion.

Class I5 2Fi1 *3

This class is characteri:ed 'y se4erely com+romised

location and e7tent o edentulous areas 6ith

Fi1ure (. 2ContLd32I3 Full mouth radio1ra+hic series.


18/173

#>? Se+tem'er %;;%! 5olume ##! Num'er (

Fi1ure *.Class I5 +atient. Edentulous areas are ound in 'oth arches! and the

+hysiolo1ic a'utment su++ort is

com+romised. $'utment condition is se4erely com+romised due to ad4anced

attrition and ailin1 restorations!

necessitatin1 e7tracoronal restorations and aduncti4e thera+y. The occlusion is

se4erely com+romised! necessitatin1

reesta'lishment o occlusal 4ertical dimension and a +ro+er occlusal scheme.

2$3Frontal 4ie6! ma7imum intercus+ation.

2G3 Ri1ht lateral 4ie6! ma7imum intercus+ation.2C3 Det lateral 4ie6! ma7imum

intercus+ation.2"3 Occlusal 4ie6!

ma7illary arch.2E3Occlusal 4ie6! mandi'ular arch.2F3Frontal 4ie6! +rotrusi4erelationshi+.23Ri1ht lateral 4ie6! ri1ht

6or&in1 mo4ement.2)3 Det lateral 4ie6! let 6or&in1 mo4ement.

1uarded +ro1nosis! a'utments reuirin1 e7tensi4e

thera+y! occlusion characteristics reuirin1 rees9ta'lishment o the occlusion 6ith a

chan1e in the

occlusal 4ertical dimension! and residual rid1e con9ditions.


results in se4ere occlusal com+romise=

Edentulous areas may 'e e7tensi4e and may

occur in 'oth arches.


su++ort o the a'utment teeth to create a

1uarded +ro1nosis.

Edentulous areas include acuired or con1enital

ma7illoacial deects.

$t least # edentulous area has a 1uarded +ro19nosis.

%.$'utments are se4erely com+romised=


19/173



$'utments in * or more se7tants reuire e7ten9si4e locali:ed aduncti4e thera+y.

$'utments ha4e a 1uarded +ro1nosis.

(.Occlusion is se4erely com+romised=

Reesta'lishment o the entire occlusal scheme!

includin1 chan1es in the occlusal 4ertical dimen9sion! is necessary.

Ma7illomandi'ular relationshi+= class II di4ision

% or Class III molar and a6 relationshi+s.

*.Residual rid1e mor+holo1y conorms to the class

I5 com+lete edentulism descri+tion.

Other characteristics include se4ere maniesta9tions o local or systemic disease!

includin1 seuelae

rom oncolo1ic treatment! ma7illomandi'ular dys9&inesia andHor ata7ia! and

reractory +atient 2a

+atient 6ho +resents 6ith chronic com+laints ol9lo6in1 a++ro+riate thera+y3.

uidelines or the se o

Classifcation System or

Partial Edentulism

The analysis o dia1nostic actors is acilitated 6ith

the use o a 6or&sheet 2Ta'le %3. Each criterion is

e4aluated and a chec&mar& +laced in the a++ro+ri9ate 'o7. In those instances in

6hich a +atientLs

dia1nostic criteria o4erla+ % or more classes! the

+atient is +laced in the more com+le7 class.

The ollo6in1 additional 1uidelines should 'e

ollo6ed to ensure consistent a++lication o the

classifcation system=


20/173

#.Consideration o uture treatment +rocedures

must not inKuence the choice o dia1nostic le4el.

%.Initial +re+rosthetic treatment andHor adunc9ti4e thera+y can chan1e the initial

classifcation

le4el. Classifcation may need to 'e reassessed

ater e7istin1 +rostheses are remo4ed.

(.Esthetic concerns or challen1es raise the classi9fcation 'y # le4el in Class I and II

+atients.

Fi1ure *. 2ContLd3 2I3 Full mouth radio1ra+hic series.

#?# Se+tem'er %;;%! 5olume ##! Num'er (

*.The +resence o TM" sym+toms raises the clas9sifcation 'y # or more le4els inClass I and II

+atients.

,.In a +atient +resentin1 6ith an edentulous ma79illa o++osin1 a +artially

edentulous mandi'le!

each arch is dia1nosed accordin1 to the a++ro9+riate classifcation system< that is!

the ma7illa is

classifed accordin1 to the com+lete edentulism

classifcation system! and the mandi'le is classi9fed accordin1 to the +artial

edentulism classif9cation system. The sole e7ce+tion to this rule

occurs 6hen the +atient +resents 6ith an eden9tulous mandi'le o++osed 'y a

+artially edentu9lous or dentate ma7illa. This clinical situation

+resents si1nifcant com+le7ity and +otential

lon19term mor'idity and as such! should 'e di9a1nosed as a Class I5 in either

system.

/.Periodontal health is intimately related to the

dia1nosis and +ro1nosis or +artially edentulous

+atients. For the +ur+ose o this system! it is

assumed that +atients 6ill recei4e thera+y to


21/173


22/173

Moderately com+romisedQ#9% se7tants

Su'stantially com+romisedQ( se7tants

Se4erely com+romisedQ* or more se7tants

Occlusion

Ideal or minimally com+romised

Moderately com+romisedQlocal aduncti4e t7

Su'stantially com+romisedQocclusal scheme

Se4erely com+romisedQchan1e in O5"

Residual Rid1e

Class I Edentulous

Class II Edentulous

Class III Edentulous

Class I5 Edentulous

Conditions Creatin1 a uarded Pro1nosis

Se4ere oral maniestations o systemic disease

Ma7illomandi'ular dys&inesia andHor ata7ia

Reractory +atient

NOTE. Indi4idual dia1nostic criteria are e4aluated and the a++ro+riate 'o7 is

chec&ed. The most ad4anced fndin1 determines the fnal

classifcation.

uidelines or use o the 6or&sheet

#. $ny sin1le criterion o a more com+le7 class +laces the +atient into the more

com+le7 class.

%. Consideration o uture treatment +rocedures must not inKuence the dia1nostic

le4el.

(. Initial +re+rosthetic treatment andHor aduncti4e thera+y can chan1e the initial

classifcation le4el.


23/173

*. I there is an esthetic concernHchallen1e! the classifcation is increased in

com+le7ity 'y one le4el in Class I and II +atients.

,. In the +resence o TM" sym+toms! the classifcation is increased in com+le7ity 'y

one or more le4els in Class I and II +atients.

/. In the situation 6here the +atient +resents 6ith an edentulous mandi'le o++osin1

a +artially endentulous or dentate ma7illa!

classifcation I5.

#?% Classifcation System or Partial Edentulism Mcarry et al

tients or the most a++ro+riate +atient assi1nment

or 'etter care. Gased on use and o'ser4ations 'y

+ractitioners! educators! and researchers! this sys9tem 6ill 'e modifed as needed.

$c&no6led1ement

The authors than& "r. "a4id Ca1na and "r. Rodney ".

Phoeni7! "e+artment o Prosthodontics! ni4ersity o

Te7as )ealth Science Center! San $ntonio or their

assistance in +ro4idin1 the classifcation illustrations.

Reerences

#. "e5an MM= The nature o the +artial denture oundation=

Su11estions or its +reser4ation. J Prosthet "ent #?,#

%. $++le1ate OC= $n e4aluation o the su++ort or the remo49a'le +artial denture. J

Prosthet "ent #?/;


24/173


25/173

#?>?


26/173


27/173

criteria or +artial edentulism has 'een a lon19standin1 im+ediment to e8ecti4e

reco1nition

o ris& actors that may a8ect treatment out9comes. $lthou1h descri'ed thorou1hly

in the

dental literature!#9;

the di4erse nature o +ar9tial edentulism has not 'een or1ani:ed in such

a 6ay to 1uide dental +roessionals in the treat9ment +lannin1 +rocess. To address

this +ro'9lem! the $merican Colle1e o Prosthodontists

2$CP3 Su'committee on Prosthodontic Classi9fcation 6as ormed and char1ed 6ith

de4elo+9in1 a classifcation system or +artial edentu9lism consistent 6ith the

e7istin1 classifcation


%

$ summary


1i4en in Ta'le #.




are or1ani:ed in


+redicta'le treatment +lan9nin1 decisions. This rame6or& is desi1ned to indi9cate

increasin1 le4els o dia1nostic and treatment


may su11est

+oints at 6hich reerral to other s+ecialists is a+9+ro+riate. The rame6or& isstructured to su++ort

#


%


28/173



(


*



,



/




0



$cce+ted $+ril >! %;;%.








#;,?9?*#AH;%H##;(9;;;/(,.;;H;

doi=#;.#;,(H+ro.%;;%.#%/;?*


29/173



Class I

This class characteri:es the sta1e o edentulism that is most a+t to 'e successullytreated 6ith com+lete dentures


a4ora'le.





Docation o muscle attachments conduci4e to denture 'ase sta'ility and retention% Classifcation System or Partial Edentulism Mcarry et al








su++ortin1





system.




(



into e7istin1 elec9tronic dia1nostic and +rocedural data'ases 2SNO9"ENT! IC"! CPT!

and C"T3.


33/173


ollo6in1 'enefts=




com+le7ity o care


dental education


and research



$++lications


Bhile













34/173



+atients=



(.Occlusion






Edentulous $rea2s3









+remolars! or #




ollo6in1=




35/173




+remolars! or #





molars





















36/173











$'utments in ( se7tants reuire more su'stan9tial locali:ed aduncti4e thera+y 2ie!+eriodontal!


















37/173































38/173








Edentulism


system or +artial

edentulism.

Class I 2Fi1 #$I3

This class is characteri:ed 'y ideal or minimal

com+romise in the location and e7tent o edentu9lous area 26hich is confned to a

sin1le arch3! a'ut9ment conditions! occlusal characteristics! and resid9ual rid1e

conditions. $ll * o the dia1nostic criteria

are a4ora'le.


are ideal or minimally com+romised=

The edentulous area is confned to a sin1le arch.

The edentulous area does not com+romise the


The edentulous area may include any anterior

ma7illary s+an that does not e7ceed % incisors!

any anterior mandi'ular s+an that does not e79ceed * missin1 incisors! or any

+osterior s+an

that does not e7ceed % +remolars or # +remolar

and # molar.


39/173

%.The a'utment condition is ideal or minimally

com+romised! 6ith no need or +re+rosthetic

thera+y.

(.The occlusion is ideal or minimally com+ro9mised! 6ith no need or +re+rostheticthera+y# Journal o Prosthodontics! 5ol ##! No ( 2Se+tem'er3! %;;%= ++ #>#9#?(


Class I



usin1 con4entional +rosthodontic techniues. $ll * o the dia1nostic criteria area4ora'le.






54/173



such as 7erostomia

TM" sym+toms



Class I5









radio1ra+h



56/173


ma7illa









sot tissue 1ratin1





oncolo1ic treatment














57/173






su++ortin1





system.




(



into e7istin1 elec9tronic dia1nostic and +rocedural data'ases 2SNO9"ENT! IC"! CPT!and C"T3.


ollo6in1 'enefts=




com+le7ity o care


dental education



58/173

and research



$++lications


Bhile














+atients=



(.Occlusion






59/173


Edentulous $rea2s3








$ny +osterior ma7illary or mandi'ular edentu9lous area that does not e7ceed %+remolars! or #




ollo6in1=






+remolars! or #





molars



60/173






























61/173


+eriodontal!





























62/173











ma7imum intercus+ation.2"3 Occlusal 4ie6! ma7illary arch.2E3 Occlusal 4ie6!mandi'ular arch.2F3 Frontal 4ie6!














Edentulism


system or +artial


63/173

edentulism.

Class I 2Fi1 #$I3


com+romise in the location and e7tent o edentu9lous area 26hich is confned to asin1le arch3! a'ut9ment conditions! occlusal characteristics! and resid9ual rid1e


are a4ora'le.









+osterior s+an


and # molar.



thera+y.

(.The occlusion is ideal or minimally com+ro9mised! 6ith no need or +re+rosthetic

thera+y# Journal o Prosthodontics! 5ol ##! No ( 2Se+tem'er3! %;;%= ++ #>#9#?(


Class I




a4ora'le.

Residual 'one hei1ht o %# mm measured at the least 4ertical hei1ht o themandi'le on a +anoramic radio1ra+h.




Moderate +sychosocial considerations andHor moderate oral maniestations o

systemic diseases or conditions

such as 7erostomia

TM" sym+toms



Class I5

This class re+resents the most de'ilitated edentulous condition. Sur1icalreconstruction is almost al6ays indicated






Residual 4ertical 'one hei1ht o#; mm measured at the least 4ertical hei1ht o the

mandi'le on a +anoramic

radio1ra+h



ma7illa








81/173



sot tissue 1ratin1





oncolo1ic treatment


)y+eracti4ity o ton1ue +ossi'ly associated 6ith a retracted ton1ue +osition

andHor its associated mor+holo1y
















su++ortin1




82/173


83/173












+atients=



(.Occlusion






Edentulous $rea2s3








84/173



+remolars! or #




ollo6in1=






+remolars! or #




$ny +osterior ma7illary or mandi'ular edentu9lous area 1reater than ( teeth or %molars











85/173


86/173










Entire occlusion must 'e reesta'lished! 'ut 6ith9out any chan1e in the occlusal4ertical dimen9sion.






ma7illary and mandi'ular dental arches may 'e su'9di4ided into / areas orse7tants. In the ma7illa! the ri1ht












87/173


88/173







+osterior s+an


and # molar.



thera+y.

(.The occlusion is ideal or minimally com+ro9mised! 6ith no need or +re+rosthetic

thera+y# Journal o Prosthodontics! 5ol ##! No ( 2Se+tem'er3! %;;%= ++ #>#9#?(


Class I

This class characteri:es the sta1e o edentulism that is most a+t to 'e successullytreated 6ith com+lete dentures


a4ora'le.






Moderate +sychosocial considerations andHor moderate oral maniestations o

systemic diseases or conditions

such as 7erostomia

TM" sym+toms



Class I5


105/173








Residual 4ertical 'one hei1ht o#; mm measured at the least 4ertical hei1ht o the

mandi'le on a +anoramic

radio1ra+h



ma7illa









sot tissue 1ratin1





oncolo1ic treatment


)y+eracti4ity o ton1ue +ossi'ly associated 6ith a retracted ton1ue +osition

andHor its associated mor+holo1y


106/173
















su++ortin1





system.




(



into e7istin1 elec9tronic dia1nostic and +rocedural data'ases 2SNO9"ENT! IC"! CPT!

and C"T3.


107/173


108/173


109/173




+remolars! or #





molars





















110/173











$'utments in ( se7tants reuire more su'stan9tial locali:ed aduncti4e thera+y 2ie!+eriodontal!


















111/173































112/173








Edentulism


system or +artial

edentulism.

Class I 2Fi1 #$I3


com+romise in the location and e7tent o edentu9lous area 26hich is confned to a

sin1le arch3! a'ut9ment conditions! occlusal characteristics! and resid9ual rid1e


are a4ora'le.









+osterior s+an


and # molar.


113/173


114/173


115/173

Class II com+lete edentulism descri+tion.

Class III 2Fi1 (3

This class is characteri:ed 'y su'stantially com+ro9mised location and e7tent o

edentulous areas in

'oth arches! a'utment condition reuirin1 su'stan9tial locali:ed aduncti4e thera+y!

occlusal character9istics reuirin1 reesta'lishment o the entire occlu9sion 6ithout a


dimension! and residual rid1e condition.


are su'stantially com+romised=

Edentulous areas may 'e +resent in # or 'oth

arches.


su++ort o the a'utments.

Edentulous areas may include any +osterior ma79illary or mandi'ular edentulous

area 1reater

than ( teeth or % molars! or anterior and +oste9rior edentulous areas o ( or more

teeth.

%.The condition o the a'utments is moderately

com+romised=





+eriodontal!

endodontic or orthodontic +rocedures3.

$'utments ha4e a air +ro1nosis.

(.Occlusion is su'stantially com+romised=

Reuires reesta'lishment o the entire occlusal


116/173

scheme 6ithout an accom+anyin1 chan1e in the

occlusal 4ertical dimension.

Ma7illomandi'ular relationshi+= Class II molar



Class III com+lete edentulism descri+tion.

Class I5 2Fi1 *3

This class is characteri:ed 'y se4erely com+romised

location and e7tent o edentulous areas 6ith

Fi1ure (. 2ContLd32I3 Full mouth radio1ra+hic series.

#>? Se+tem'er %;;%! 5olume ##! Num'er (

Fi1ure *.Class I5 +atient. Edentulous areas are ound in 'oth arches! and the

+hysiolo1ic a'utment su++ort is

com+romised. $'utment condition is se4erely com+romised due to ad4anced

attrition and ailin1 restorations!

necessitatin1 e7tracoronal restorations and aduncti4e thera+y. The occlusion is

se4erely com+romised! necessitatin1

reesta'lishment o occlusal 4ertical dimension and a +ro+er occlusal scheme.

2$3Frontal 4ie6! ma7imum intercus+ation.

2G3 Ri1ht lateral 4ie6! ma7imum intercus+ation.2C3 Det lateral 4ie6! ma7imum

intercus+ation.2"3 Occlusal 4ie6!

ma7illary arch.2E3Occlusal 4ie6! mandi'ular arch.2F3Frontal 4ie6! +rotrusi4e

relationshi+.23Ri1ht lateral 4ie6! ri1ht

6or&in1 mo4ement.2)3 Det lateral 4ie6! let 6or&in1 mo4ement.

1uarded +ro1nosis! a'utments reuirin1 e7tensi4e

thera+y! occlusion characteristics reuirin1 rees9ta'lishment o the occlusion 6ith a

chan1e in the

occlusal 4ertical dimension! and residual rid1e con9ditions.



117/173


118/173

Classifcation System or

Partial Edentulism

The analysis o dia1nostic actors is acilitated 6ith

the use o a 6or&sheet 2Ta'le %3. Each criterion is

e4aluated and a chec&mar& +laced in the a++ro+ri9ate 'o7. In those instances in

6hich a +atientLs

dia1nostic criteria o4erla+ % or more classes! the

+atient is +laced in the more com+le7 class.

The ollo6in1 additional 1uidelines should 'e

ollo6ed to ensure consistent a++lication o the

classifcation system=

#.Consideration o uture treatment +rocedures

must not inKuence the choice o dia1nostic le4el.

%.Initial +re+rosthetic treatment andHor adunc9ti4e thera+y can chan1e the initial

classifcation

le4el. Classifcation may need to 'e reassessed

ater e7istin1 +rostheses are remo4ed.

(.Esthetic concerns or challen1es raise the classi9fcation 'y # le4el in Class I and II

+atients.

Fi1ure *. 2ContLd3 2I3 Full mouth radio1ra+hic series.

#?# Se+tem'er %;;%! 5olume ##! Num'er (

*.The +resence o TM" sym+toms raises the clas9sifcation 'y # or more le4els in

Class I and II

+atients.

,.In a +atient +resentin1 6ith an edentulous ma79illa o++osin1 a +artially

edentulous mandi'le!

each arch is dia1nosed accordin1 to the a++ro9+riate classifcation system< that is!

the ma7illa is

classifed accordin1 to the com+lete edentulism


119/173

classifcation system! and the mandi'le is classi9fed accordin1 to the +artial

edentulism classif9cation system. The sole e7ce+tion to this rule

occurs 6hen the +atient +resents 6ith an eden9tulous mandi'le o++osed 'y a

+artially edentu9lous or dentate ma7illa. This clinical situation

+resents si1nifcant com+le7ity and +otential

lon19term mor'idity and as such! should 'e di9a1nosed as a Class I5 in either

system.

/.Periodontal health is intimately related to the

dia1nosis and +ro1nosis or +artially edentulous

+atients. For the +ur+ose o this system! it is

assumed that +atients 6ill recei4e thera+y to

achie4e and maintain +eriodontal health so that

a++ro+riate +rosthodontic care can 'e accom9+lished.

Closin1 Statement

The classifcation system or +artial edentulism is

'ased on the most o'ecti4e criteria a4aila'le to

acilitate uniorm use o the system. Such standard9i:ation may lead to im+ro4ed

communications

amon1 dental +roessionals and third +arties. This

classifcation system 6ill ser4e to identiy those

+atients most li&ely to reuire treatment 'y a s+e9cialist or 'y a +ractitioner 6ith

additional trainin1

and e7+erience in ad4anced techniues. This sys9tem should also 'e 4alua'le to

research +rotocols as

di8erent treatment +rocedures are e4aluated. Bith

the increasin1 com+le7ity o +atient treatment! this

+artial edentulism classifcation system! cou+led

6ith the com+lete edentulism classifcation system!


120/173


121/173


122/173

Su11estions or its +reser4ation. J Prosthet "ent #?,#

%. $++le1ate OC= $n e4aluation o the su++ort or the remo49a'le +artial denture. J

Prosthet "ent #?/;


123/173

J #?>;

#(. Pe&&arinen 5! li9r+o $= "ysunction o the masticatory

system and the mutilated dental arch= $namnestic inde7!

dysunction inde7 and occlusal inde7 'eore restorati4e and

+rosthetic treatment. Proc Finn "ent Soc #?>*;=0(90?

#*. Misch CE! Judy -B= Classifcation o +artially edentulous

arches or im+lant dentistry. Int J Oral Im+lantol #?>0?


124/173

%%. Parameters o Care or the $merican Colle1e o Prosth9odontists. J Prosthodont

#??/


125/173


126/173


%

$ summary


1i4en in Ta'le #.




are or1ani:ed in


+redicta'le treatment +lan9nin1 decisions. This rame6or& is desi1ned to indi9cateincreasin1 le4els o dia1nostic and treatment


may su11est

+oints at 6hich reerral to other s+ecialists is a+9+ro+riate. The rame6or& is

structured to su++ort

#


%



(


*



,




127/173

/




0



$cce+ted $+ril >! %;;%.








#;,?9?*#AH;%H##;(9;;;/(,.;;H;

doi=#;.#;,(H+ro.%;;%.#%/;?*



Class I



usin1 con4entional +rosthodontic techniues. $ll * o the dia1nostic criteria area4ora'le.






128/173



such as 7erostomia

TM" sym+toms



Class I5









radio1ra+h



130/173


ma7illa









sot tissue 1ratin1





oncolo1ic treatment














131/173






su++ortin1





system.



su'seuently in a Parame9t

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