Professional Documents
Culture Documents
Mcgarry1999 PDF
Mcgarry1999 PDF
The American College of Prosthodontists has developed a classification system for complete
edentulism based on diagnostic findings. These guidelines may help practitioners determine
appropriate treatments for their patients. Four categories are defined, ranging from Class It o Class
IV, with Class I representing an uncomplicated clinical situation and a Class IV patient representing
the most complex and higher-risk situation. Each class is differentiated by specific diagnostic
criteria. This system is designed for use by dental professionals who are involved in the diagnosis of
patients requiring treatment for complete edentulism. Potential benefits of the system include: 1)
better patient care, 2) improved professional communication, 3) more appropriate insurance
reimbursement, 4) a better screening tool t o assist dental school admission clinics, and 5)
standardized criteria for outcomes assessment.
J Prosthod 1999;8:27-39.Copyright 0 7999 by TheAmerican College of Prosthodontists.
Figure 1. Radiograph with residual bonc height of 2 1 mm Figure 3. Radiograph with residual bone height of 11 to
or greater measured at the least vertical height of the 15 mm mcasured at the least vertical height of the
mandible (Type I). mandible (Type HI).
Figure 2. Radiograph with residual bone height of 16 to Figure 4. Radiograph with residual bone height of 10 mm
20 mm measured at the least vertical height of the or less measured at the least vertical height of the man-
mandible (Type n). dible (Type IV).
March 1999, Volume 8, Number 1 31
Type C (Fig7)
0 Loss of anterior labial vestibule.
Palatal vault morpholog~7offers minimal rcsis-
tance to vertical and horizontal movement of the
denture base.
0 Maxillary palatal tori and/or lateral exostoses with
bony undercuts that do not affect the posterior
extension of the denture base.
Hyperplastic, mobile anterior ridgc offcrs mini-
mum support and stabilit).-ofthedenture base.13,14 Figure 10. T\pe B mandibular muscle attarhmrnts. Loss
of anterior labial vestibule.
0 Reduction of the post malar space by the coronoid
process during mandibular opening and/or excur-
progression to describe the effects of muscular influ-
sive movemcnts.
ence on a mandibular denture. The clinician exam-
ines the patient and selects the category that is most
Type D (Fig 8 )
descriptive of the mandibular muscle attachments.
0 Loss of anterior labial and posterior buccal vesti-
bules. Type A (most favorable) (Fig9)
0 Palatal vault morpholoa does not resist vertical or Attached mucosal base without undue muscular
horizontal movement of the denture base. impingement during normal function in all re-
Maxillary palatal tori and/or lateral exostoses" gions.
(rounded or undercut) that intcrferc with the
posterior border of the denture. Type B (Fig10)
Hyperplastic, redundant anterior ridge. Attached niucosal base in all regions exccpt labial
Prominent anterior nasal spine. vestibule .
Mentalis muscle attachment near crest of alveolar
ridgc.
Muscle Attachments: Mandible only
The effects of muscle attachment and location are Type C (Fig11)
most important to the function of a mandibular Attached mucosal base in all regions except antc-
d e n t ~ r e . ~ ~These
' " ' ~ characteristics are difficult to rior buccal and lingual vestibules-canine to ca-
quantify. The classification system follows a logical nine.
Figure 9. Type A mandibular muscle attachments. All Figure 11. Type C mandibular muscle attachments. Loss
vestibules are adequate. of anterior labial and lingual vestibulcs.
March 1.999, Volume 8, iVumber I 33
Guidelines for Use of the Complete 5. Zarb GA Biomechanics of the edentulous state, in Zarb GA,
Bolender CL, Carlsson GE (eds): Prosthodontic Treatment
Edentulism Classification System for Edentulous Patients (ed 11). St. Louis, MO, Mosby-Year
Book, 1997,p 15
In those instances when a patient’s diagnostic crile- 6. Atwood DA Some clinical factors related to rate of resorption
ria are mixed between two or more classes, any single ofresidual ridges.J Prosthet Dent 1962;12:441
criterion of a more compt?ex c l m places the patient into 7. Ortman HR: Factors of bone resorption of the residual ridge.
the mnre complex class. The analysis of diagnostic JProsthet Dent 1962;12:42940
factors is facilitated with the use of a worksheet 8. Tallgren A The continuing reduction of the residual alveolar
ridges in complete denture wearers: h mixed-longitudinal
(Table 1).
study covering 25 years. J Prosthet Dent 1972;27:120-132
Use of this system is indicated for pretreatment 9. Davis D M Developing an analoguehbstitute for the mandibu-
evaluation and classification of patients. Reevalua- lar denture-bearing area. in Zarb, Bolender, Carlsson (eds).
tion of classification status should be considered Prosthodontic Treatment for Edentulous Patients (ed 11).
following prcprosthetic surgery. Retrospective analy- St. Louis, MO. h4osby-Year Book, Inc, 1997, pp 162-173
10. Zarb GA: Biomechanics of the edentulous state, in Zarb,
sis on a posttreatment basis may alter a patient’s
Bolender, Carlsson (eds): ProsthodonticTreatment for Eden-
classification. tulous Patients (ed 11). St. Louis, MO, Mosby-Year Book,
1997, pp 23-24
11. Davis DhC Developing an analoguehbstitute for the maxil-
Closing Statement lary denture-bearing area, in Zarb, Bolender, Carlsson (eds).
Prosthodontic Treatment for Edentulous Patients, 11th edi-
The classification system for complete edentulism is
tion, St. Louis,MO, Mosby-Year Book, 1997,pp 141-149
based on the most objective criteria available to 12. Kolb H k Variable denture-limiting structures of the edentu-
facilitate uniform utilization of the system. With lous mouth. Part I. hIaxillary border arras. J Prosthet Dent
such standardization, communication will be im- 1966;16:194-201
proved among dental professionals and third parties. 13. Hillerup S: Preprosthetic surgery in the elderly. J Prosthet
This classification system will help to identify those Dent 1994;72:.551-558
14. Carlsson GE: Clinical morbidity and sequelae of treatment
patients most likely to require treatment by a spccial- with complete dentures.J Prosthet Dent 1998;79:20
ist or by a practitioner with additional training and 15. KazanjianVH:Surgery as an aid to more efficient service with
experience in advanced techniques. This system prosthetic dentures.JAm Dent Assoc 1935;22:566-581
should also be valuable to research protocols as 16. DeVan h&k Basic principles in impressionmaking.J Prosthet
different treatment proccdures are evaluated. Dent 1952;2:26-35
17. Tilton GE: The denture periphery.JProsthet Dent 1952;2:290-
306
Acknowledgment 18. Kolb H R Variable denture-limiting structures of the edeutu-
bus mouth. Part 11. Mandibular border areas.J Prosthet Dent
The authors thank Dr. Nancy Arbree and Ms. Brtty 1966;ifi:2n2-212
Freeman for their assistance in the preparation of this 19. van Waas MA: The influence ofpsychologic factors on patient
manuscript. The authors also wish t o recognize Dr. Kent satisfactionwith complete dentures. J Prosthet Dent 1990;63:
Cohenour, Oral and Maxillofacial Surgeon, for his contribu- 545-548
tion to the original concept of a classification for complete 20. Vervoorn Jhl, Duinkerke ASH, Luteijn F, et al: Relative
edentulism. importance of psychologic factors in denture satisfaction.
Commun Dent Oral Epidemiol 1991;1945-47
21. Pendleton EC: The anatomy of the maxilla from the point of
References view of full denture prosthesis.J Am Dent Assoc 1932;19:543-
572
Genco RJ: Classification and Clinical Radiographic Features 22. Kinaldi P, Sharry J: Tongue force and fatigue in adults.
of Periodontal Disease, in Robert J. Cenco, Henry M. Gold- J Prosthet Dent 1963;13:857
man, D. Walter Cohen (eds): Contemporary Periodontics 23. Borkin UW Impression technique for patients that gag.
(ed 6). St. Louis, MO, CliMosby, 1990,p 65 JProsthet Dent 1958;9386-387
American Association of Endodontists.Evaluating endcdontic 24. Krol AJ: A new approach to the gagging problem. J Prosthet
treatment risk factors. Spring/Summer 1997. AAE, Chicago, Dent 1963;13:611-616
IL 25. Carlson B, CarlssonGE: Prosthodonticcomplications inosseo-
Parameters of Care for The American College of Prosthodon- integrated dental implant treatment. Int J Oral Maxillofac
tists.J Prosthod 1996;5:3-71 Implants 1994;9:90-94
Nimmo A, Wwlsey GD, Arbree NS, et al: Defining predoc- 26. .Jamb R Mixillofacid prosthodontics for the edentulous
toral prosthodontic curriculum:A workshop sponsnrcd by The patient. in Zarb, Bolender, Carlsson (eds). Prosthodontic
Ammican College of Prosthodontists and the Prosthodontic Treatment for Edentulous Patients (ed 11). St. Louis, MO,
Forum. J Prosthod 1998;7:30-34 Mohy-Year Book, 1997,pp 469-490