Word Classification Of Partially.docx

CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES SEMINAR ON CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

CONTENTS •

INTRODUCTION

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REQUIREMENTS

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CLASSIFICATION SYSTEMS

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SUMMARY

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BIBLIOGRAPHY

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

REQUIREMENTS OF A CLASSIFICATION •

Allow visualization of the type of partially edentulous arch being considered.

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Permit differentiation between tooth supported and tooth tissue supported partial dentures.

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Serve as a guide to the type of the design to be used.

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Be universally accepted.

Cummer’s classification system 1920 Kennedy classification system 1923 Applegate-Kennedy’s system 1960 ICK Classification system 2008 Swenson classification system 1963 Bailyn’s system 1928 Neurohr’s system 1939 Mauk’s system 1942 Beckett’s system 1953 Friedman’s system 1953 The Austin-Lidge classification system 1957 Skinner’s system 1959 American College Of Prosthodontics(ACP) classification 2002 •

CUMMER CLASSIFICATION

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES Based upon the choice of natural teeth for direct retainers •

CLASS I – DIAGONAL : 2 DIAGONALLY OPPOSITE TEETH

CLASS II –DIAMETRIC: 2 DIAMETRICALLY OPPOSITE TEETH

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

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CLASS III –UNILATERAL: ONE OR MORE TEETH ON THE SAME SIDE

CLASS IV –MULTILATERAL: THE TEETH ARE DISPOSED IN A TRIANGULAR OR QUADRILATERAL

DRAWBACKS •

Classified partial dentures and not the partially edentulous arches

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

did not consider condition of oral cavity

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Did not incorporate implants

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Does not cover wide range of combinations of partially edentulous arches

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Does not consider modification spaces

KENNEDYS CLASSIFICATION SYSTEM It is based on the relationship of the edentulous spaces to the abutment teeth. Class I – Bilateral edentulous area located posterior to the remaining natural teeth. Class II – Unilateral edentulous area located posterior to the remaining natural teeth. Class III – Unilateral edentulous area with natural teeth both anterior and posterior to it. Class IV – Single , bilateral edentulous area located anterior to the remaining natural teeth.

Class I maxillary arch

Class II mandibular arch

class III mandibular arch

Class IV maxillary arch

FEATURES DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

Simple and logical.

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Classified according to incidence of clinical situations.

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Easy to learn and apply.

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Did not consider condition of oral cavity.

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Did not incorporate implants.

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Does not consider extent of modification spaces.

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Does not cover all combinations.

KENNEDY APPLEGATE •

CLASSIFICATION

Class V - an edentulous area bounded anteriorly and posteriorly by natural teeth but in which the anterior abutment is not suitable for support

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Class VI - an adentulous situation in which the teeth adjacent to the space are capable of total support of the required prosthesis

APPLEGATE'S RULES FOR THE KENNEDY CLASSIFICATION •

Rule 1: Classification should follow rather than precede extractions that might alter the original

classification •

Rule 2: If the third molar is missing & not to be replaced, it is not considered in the

classification •

Rule 3: If the third molar is present and is to be used as an abutment, it is considered in the classification

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

Rule 4: If a second molar is missing and is not to be replaced, it is not considered in the classification

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Rule 5: The most posterior edentulous area or areas always determine the classification

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Rule 6: Edentulous areas other than those determining classification are called as modification spaces and are designated by their number

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Rule 7: The extent of the modification is not considered, only the number of additional edentulous areas Rule 8: There can be no modification areas in Class IV arches. Any edentulous area lying posterior to the single bilateral area determines the classification

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FEATURES

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Simple

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Logical

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Easy to apply.

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Covers modification spaces.

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Classified in order of incidence of situations.

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Does not consider implants.

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Wide coverage of situation but not all combinations.

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Does not consider condition of oral cavity.

SWENSON CLASSIFICATION SYSTEMDEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES CLASS I

CLASS II-

CLASS III-

CLASS IV-

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

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FEATURES

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Easy to apply

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Covers modification spaces

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Does not consider implants

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Wide coverage of situation but not all combinations

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Does not consider condition of oral cavity ICK CLASSIFICATION SYSTEM FOR PARTIALLY EDENTULOUS ARCHES

None of these classification systems include implants, simply because most of them were proposed before implants became widely accepted. At this time, there is no classification system for partially edentulous arches incorporating implants placed or to be placed in the edentulous spaces for a removable partial denture (RPD).

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Guidelines for the new classification system

(1) No edentulous space will be included in the classification if it will be restored with an implant-supported fixed prosthesis. (2) To avoid confusion, the maxillary arch is drawn as half circle facing up and the mandibular arch as half circle facing down. The drawing will appear as if looking directly at the patient; the right and left quadrants are reversed. (3) The classification will always begin with the phrase "Implant-Corrected Kennedy (class)," followed by the description of the classification. It can be abbreviated as follows: (i) ICK I, for Kennedy class I situations, DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES (ii) ICK II, for Kennedy class II situations, (iii) ICK III, for Kennedy class III situations, and (iv) ICK IV, for Kennedy class IV situations. (4) The abbreviation “max” for maxillary and “man” for mandibular can precede the classification. The word modification can be abbreviated as “mod.” (5) Roman numerals will be used for the classification, and Arabic numerals will be used for the number of modification spaces and implants. (6) The tooth number using the American Dental Association (ADA) system is used to give the number and exact position of the implant in the arch. (7) The classification of any situation will be according to the following order: main classification first, then the number of modification spaces, followed by the number of implants in parentheses according to their position in the arch preceded by the number sign (#). (8) The classification can be used either after implant placemeto describe any situation of RPD with implants, or before implant placement to indicate the number and position of future implants with an RPD. (9) A different name, ICK Classification System, is given to this classification system to be differentiated from other partially edentulous arch classification systems.

Maxillary implant-corrected Kennedy class I (#2, 15) or ICK I (#2, 15). DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

ICK 2

ICK 3-

ICK IV (#19, 22).

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

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FEATURES

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Covers features of kennedy classification that is most logical and incorporate implants as well.

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Does nor give idea of condition of oral cavity

BAILYN introduced a classification system based on whether the prosthesis is toothborne, tissue, or a combination of the

two.

A-ANTERIOR RESTORATIONS P- POSTERIOR RESTORATIONS CLASS 1 BOUNDED SADDLE not more than 3 teeth missing CLASS II FREE END SADDLE there is no distal abutment tooth CLASS III BOUNDED SADDLE MORE THAN THREEE TEETH MISSING •

FEATURES

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One of the complex classifications

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Considers extent of edentulous span

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did not consider condition of oral cavity

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Did not incorporate implants

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Does not consider modification spaces

NEUROHR’S CLASSIFICATION DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

CLASS I TOOTH BEARING-

CLASS II TOOH-TISSUE BEARINGDIVISION I

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

DIVISION II-

CLASS III : TISSUE BEARING. FEATURES •

One of the complex classifications.

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Difficult to learn.

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Difficult to apply.

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Did not consider condition of oral cavity.

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Did not incorporate implants.

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Did not consider modification spaces.

Mauk offered the profession a system of classification based on the 1)Number, length and position of the spaces and 2)The number and position of the

remaining teeth

Class I – has bilateral spaces and teeth remaining in anterior segment.

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES Class II – has bilateral posterior spaces and one or more teeth at the posterior end of the one space. Class III – bilateral posterior spaces and one or more teeth at the posterior end of both space. Class IV – unilateral posterior space with or without teeth at the posterior end of the space. Class V – Has anterior space only Class VI – Has irregular spaces around the arch.

FEATURES •

Easy to learn

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Easy to apply

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did not consider condition of oral cavity

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

Did not incorporate implants

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Cover wide number of situations but not the all GODFREY described a system based on the location and extent of the edentulous spaces where teeth are to be replaced. A feature of Godfrey's system is that there are no subdivisions or modifications to the main classes.

Class A – has tooth borne denture bases in the anterior part of the mouth Class B – has mucosa borne denture bases in the anterior of the mouth Class C – has tooth borne denture bases in the posterior part of the mouth Class D – has mucosa borne denture bases in the posterior part of mouth

CLASS A

CLASS C

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

CLASS B

CLASS D

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

FEATURES

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Easy to learn

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did not consider condition of oral cavity

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Did not incorporate implants

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Cover wide number of situations but not the all

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Does not consider modification spaces BECKETT proposed a system which, like the one suggested by Bailyn, is based on whether the denture base is tooth-borne, tissue-borne, or a combination of the two. The three basic classifications were:

Class 1- saddles (denture bases) which are tooth-borne;

Class 2, saddles (denture bases) which are mucosa-borne;

Class 3, inadequate abutments to support the saddle (denture base)

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

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FEATURES

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Easy to learn

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Narrow coverage of situations

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did not consider condition of oral cavity

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Did not incorporate implants FRIEDMAN Introduced a system in 1953 based on three essential segment types occurring either as discrete or as continuous segments. The letter A designates an anterior spaces (i.e., one or more of the six anterior teeth). The letter B designates a bounded posterior spaces. The letter C refers to a cantilever situation or a posterior free-end spaces. FREIDMANS TYPE A-

FREIDMANS TYPE B-

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

FREIDMANS TYPE C-

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FEATURES

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Easy to learn

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Narrow coverage of situations

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did not consider condition of oral cavity

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Did not incorporate implants The AUSTIN-LIDGE CLASSIFICATION system in which the letter A is used to designate an anterior spaces of spaces, P designates posterior spaces, and Bi designates a bilateral conditions.

Class A 1 – a missing anterior tooth on one side only. Class A 2 – anterior teeth missing on both right and left sides. Class P 1 – Posterior teeth are missing on one side only Class P 2- Posterior teeth are missing on both right and left sides

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES Class A 1 P1 – anterior and posterior teeth are missing on one side only. •

FEATURES

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did not consider condition of oral cavity

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Did not incorporate implants

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Does not consider modification spaces

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Does not cover all combinations SKINNERS offered the profession a new and different classification in 1957. He noted that many removable partial denture classification in the past have been based on the number of teeth remaining, as exemplified by the work of Cummer.

CLASS I PARTIALLY EDENTULOUS CONDITION

CLASS II PARTIALLY EDENTULOUS ARCHES-

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES CLASS III PARTIALLY EDENTULOUS ARCHES-

CLASS IV PARTIALLY EDENTULOUS ARCHES-

CLASS V PARTIALLY EDENTULOUS ARCHES

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FEATURES

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Simple and logical

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

Consider remainig teeth but not the condition of edentulous spaces

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Does not consider implants

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Does not cover all combinations

The American College of Prosthodontists (ACP) classification •

1. Improved intraoperator consistency

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2. Improved professional communication

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4. An objective method for patient screening in dental education

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5. Standardized criteria for outcomes assessment and research

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6. Improved diagnostic consistency

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7. A simplified, organized aid in the decision-making

process relating to referral. •

4 BROAD DIAGNOSTIC CATEGORIES

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1. Location and extent of the edentulous area(s)

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2. Condition of abutments

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3. Occlusion

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4. Residual ridge characteristics. Criteria 1: Location and Extent of the edentulous area

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

Ideally or minimally compromised

Substantially compromised

moderately compromised

Severely compromised edentulous area

Criteria 2: Abutment Conditions

Ideally or minimally compromised

moderately compromised

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

Substantially compromised

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severely compromised

Criteria 3: Occlusion

Ideally or minimally compromised

Substantially compromised

moderately compromised

severely compromised

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

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Criteria 4: Residual Ridge Characteristics

Class I-residual bone height-21mm

Class III-11 to 15mm

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FEATURES

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Logical

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Give idea of outcome of the treatment

DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE

class II- 16mm

class IV-10mm

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

Covers wide range of situations

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Complex

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Did not incorporate implants

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SUMMARY

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The treatment plan of any edentulous region depends on its classification which eventually decides the success of the prosthesis.

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Though many systems of classifications are available, the most universally used one is the Applegate – Kennedy System for its simplicity.

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BIBLIOGRAPHY

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Carr.McCracken’s Removable partial prosthodontics.11th ed.Pg.19-23

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J. McGarry, A. Nimmo and J. Skiba.(2002)Classification System for Partial Edentulism J Prosthodont.11:181-193

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S. Suleiman and A. Johanny.(2008) ICK Classification System for Partially Edentulous Arches Journal of Prosthodontics 17:502–507

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Stewart K, Rudd K, Kuebker W. Clinical removable partial prosthodontics.

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Miller E, Grasso J. Removable partial prosthodontics: Williams & Wilkins; 1981.

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Mauk E. Classification of mutilated dental arches requiring treatment by removable partial dentures. J Am Dent Assoc1942;29(19):2121-31.

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CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES •

Godfrey R.(1951) A classification of removable partial dentures.The Journal of the American College of Dentists.18(1):4.

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Friedman J. (1953)The ABC classification of partial denture segments. The Journal of Prosthetic Dentistry. 3(4):517-24.

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Skinner C. (1959)A classification of removable partial dentures based upon the principles of anatomy and physiology. The Journal of Prosthetic Dentistry. 9(2):240-6.

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Applegate.Essentials of removable partial denture prosthesis.W.B. Saunders Co. Philadelphia 1954.Pg 3-7

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G. Galagali and S. Mahoorkar.(2002) Critical Evaluation of Classification Systems of Partially Edentulous Arches. International journal of dental clinics. 2(3):45-52.

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