Romanian Journal of Oral Rehabilitation

Vol.12, No. 1, January - March 2020

EPIDEMIOLOGICAL ASPECTS OF PARTIAL EDENTATION

Roxana-Maria Pascu1, Mihaela Ionescu2, Monica-Mihaela Iacov-Crăiţoiu1,

Luminiţa Dăguci1, Veronica Mercuţ1, Ileana-Cristiana Petcu1,
Alma-Maria Florescu1, Simina Găman1

1
U.M.Ph. - Craiova, Romania, Faculty of Dental Medicine, Department of Prosthetic Dentistry
2
U.M.Ph. - Craiova, Romania, Faculty of Dental Medicine, Department of Medical Informatics
and Biostatistics
Corresponding author: Mihaela Ionescu; e-mail: mihaelaionescu.info@gmail.com

ABSTRACT
Aim of the study This study aims to define the prevalence of partial edentation in a group of patients, based on
the Kennedy classification and the size of dental breaches, establishing also correlations with social-economical
and local factors. Material and methods Our study group consisted of 337 patients with rural residence, with
ages comprised between 17 and 79 years old. Results Partial edentation was identified for 325 patients, at early
ages too, and its prevalence increased progressively up to 50-60 years old, when the number of patients with full
dental arches becomes almost insignificant. Kennedy Class III has the highest prevalence for both maxillaries;
and the size of edentation breaches increases proportionally with age. Most patients presented also caries
(92.62%). Conclusions Our study emphasized a high prevalence of partial edentation, for both maxillaries,
the most frequent edentation form being Kennedy Class III identified for both young and ad ult patients.

Key words: partial edentation, dental breaches, Kennedy classification

INTRODUCTION considerably decreased in different countries

Partial edentation represents an indicator
of the population oral health state, directly
dependant on the patient’s attitude towards
oral care and the social-economical
conditions in the respective country [1]. It is a
complex condition of the dental-maxillary
system caused by the absence of one to 15
dental units in a dental arch. By the onset of
partial edentation, there is modified the force
balance in the dental arches [2], a fact that
generates dental migrations, dislevelments of
the occlusion plane and even the onset of an
occlusal dysfunction, sometimes with the
involvement of the temporomandibular joint.
Besides these disorders, there are affected the
appearance, voice, mastication, general state,
life quality and even the economic flow of the
patients with partial edentation [3,4]. Even if
the prevalence of partial edentation has
in the past decades [5-7], it still has a high
value. In 2017, a report about disabilities [8]
showed that partial edentation and its
progression to total edentation represents one
of the first causes leading to the increase of
years with disability for the elder patients in
developed countries.
The etiology of partial edentation is
multifactorial, involving both local and
general factors. Of the local factors, we
specify tooth decay, periodontal disease,
dental and maxillary trauma, suppuration and
dental-starting tumours, including the absence
of dental buds [9-11]. Besides these local
etiological factors, a series of indications of
dental extraction for prosthetic, orthodontic
reasons, or due to supernumerary teeth,
contribute to tooth loss from the dental
arches.

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The general factors involved in the
etiology of partial edentation are related to
the social-economical status and the general
health state of patients. Therefore, from the
social-economical point of view, aging,
female sex, low educational level, low
economical level, rural residence [12-16],
lack of sanitary education [17] are factors
associated to partial edentation. Some bad
habits and general conditions are also
associated with tooth loss. By losing one or
more teeth from a dental arch there appears a
dental breach. According to the number of
missing teeth, to their localization and to the
association between them and the remaining
teeth, there may result a multitude of clinical
situations. For the systematization of these
clinical forms and for an easy collaboration
among specialists, there were proposed
multiple classifications of partial edentation.
Of these, there was distinguished the
Kennedy classification, through its simplicity
and practical character. Kennedy
classification divided the forms of partial
edentation in four classes, according to the
localization of dental breaches. Thus,
Kennedy calls biterminal edentation as Class
I edentation, uniterminal edentation as Class
II edentation, intercalated edentation as Class
III edentation and frontal edentation in both
sides of the medial line as Class IV
edentation. This classification is found in
most literature papers, and it is the most
commonly used.
This study has the objective of defining
the prevalence of partial edentation in a group
of patients, based on the Kennedy
classification, the size of dental breaches,
establishing also correlations between the
prevalence of partial edentation with the
social-economical factors (general state,
medication, alcohol and tobacco
consumption), as well as local factors (tooth
decay and periodontitis).
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MATERIAL AND METHODS
This study took place between 1st of
October 2017 and 31st of June 2018, on a lot
of 337 patients with rural residence, who
were admitted within the Prosthetics Clinic
from The Faculty of Dental Medicine,
University of Medicine and Pharmacy of
Craiova, in order to receive specialized
treatment. The study group included both
males and females, with ages comprised
between 17 and 79 years old.
The inclusion criteria were, for both males
and females, the rural residency and their
presence for specialized treatment during the
above-mentioned period, no matter their
social-economical condition. The exclusion
criteria were the following: total edentation,
lack of wisdom teeth only, communication
issues or the refusal to participate in this
study.
This study was approved by the Ethic
Committee from the University of Medicine
and Pharmacy of Craiova; all patients gave
their informed consent regarding the
treatment and personal data management.
The examination was performed by two
dental specialists, using consultation
instruments, in artificial light, with the
patients sitting in the dental chair. The
examination was performed on quadrants,
starting from the first quadrant and up to the
fourth quadrant, according to FDI
classification. The following data were
recorded: personal information, general
health, dental formula (present teeth, teeth
with caries or gangrene, fixed prosthetics
treatments) and oral hygiene. This evaluation
followed the OMS protocol [18].
All data were recorded in observation
sheets. Also, for each patient, we’ve added
orthopantomographs and study models, for a
correct interpretation and differential
diagnostic. All data were regrouped in a
Microsoft Excel file. We have used the same
software to apply Chi-square (if necessary,
 Romanian Journal of Oral Rehabilitation
Vol.12, No. 1, January - March 2020
with Yates correction), T-student tests and
multiple regression analysis for the evaluation
RESULTS AND DISCUSSIONS
Our study group comprised 337 patients,
divided by sex as following: 224 females
(66.47%) and 113 males (33.53%).
Patients had ages between 19 and 79 years
old and were grouped by age decades. Most
of them, 85 patients (representing 25.22%)
belonged to age decade 50-59 years old. The
following age decades, ordered by number of
Table 1. Distribution of patients according to sex and age decades
AGE DECADES (years)
10-19 20-29 30-39
Males 3 16 20
Females 3 24 46
Total 6 40 66
Regarding the prevalence of partial
edentation within our study group, we have
observed that 325 patients presented a form
of edentation, representing 96.44%, (only 12
patients (3.56%) had complete dental arches).
Patients with edentation were divided as
following: 307 patients (91.09%) presented a
form of partial maxilla edentation, 299
patients (88.72%) presented a form of partial
mandibular edentation and 277 patients
(82.19%) presented partial edentation in both
arches.
Figure 1. Prevalence of partial edentation,
divided by maxillary level and age decades
The prevalence of various forms of
of our study group (we have set the
significance level p to 5%).
patients, are: decade 40-49, comprising 72
patients (21.36%), decade 30-39 with 66
patients (19.58%), decade 60-69 with 56
patients (16.62%), decade 20-29 with 40
patients (11.78%), decade 70-79 with 12
patients (3.56%) and the last decade, with the
fewest patients (6, representing 1.78%) is 10-
19 years old (Table 1).
40-49 50-59 60-69 70-79 Total
21 28 17 8 113
51 57 39 4 224
72 85 56 12 337
edentation, at maxillary and mandibular level,
increases progressively with age, from
33.33% up to 100% for decades 50-59 and
60-69 years. Fig. 1 indicates that partial
edentation is present at early ages too, 17
years old, and its prevalence increases
constantly up to 50-60 years old, when the
number of patients with full dental arches
becomes almost insignificant. A summary of
edentation status according to Kennedy’s
classification system is indicated in Table 2.
Another aspect of partial edentation within
our study group emerges from the
combination of maxilla and mandible
edentation classes, indicating that edentation
Class III has the highest prevalence for both
maxillaries (Fig. 2). We have observed 196
Kennedy’s class III maxillary edentation
breaches, and 173 Kennedy’s class III
mandibular edentation breaches, so this class
is more frequent at maxillary level. Its
prevalence increases up to 49 years old, and
then it decreases, while the number of
Kennedy’s classes I and II is increasing, both
for maxilla and mandible.
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Table 2. Distribution of patients according to Kennedy edentation classes and sex

MAXILLA
Age decades 10-19 20-29 30-39 40-49 50-59 60-69 70-79 Total
TOTAL 4 12 12 2 0 0 0 30
No partial
Males 2 6 4 1 0 0 0 13
Kennedy edentation class

Edentation
Females 2 6 8 1 0 0 0 17
TOTAL 0 2 0 8 11 16 5 42
Class I Males 0 0 0 3 4 7 4 18
Females 0 2 0 5 7 9 1 24
TOTAL 0 3 3 10 28 21 4 69
Class II Males 0 1 0 5 13 7 1 27
Females 0 2 3 5 15 14 3 42
TOTAL 2 23 51 52 46 19 3 196
Class III Males 1 9 16 12 11 3 3 55
Females 1 14 35 40 35 16 0 141
MANDIBLE
Age decades 10-19 20-29 30-39 40-49 50-59 60-69 70-79 Total
TOTAL 4 12 10 8 5 1 2 42
No partial
Males 3 6 6 5 2 0 2 24
Edentation
Kennedy edentation class

Females 1 6 4 3 3 1 0 18
TOTAL 0 0 1 6 17 22 6 52
Class I Males 0 0 0 2 2 4 3 11
Females 0 0 1 4 15 18 3 41
TOTAL 0 5 5 16 25 16 3 70
Class II Males 0 2 0 4 8 5 2 21
Females 0 3 5 12 17 11 1 49
TOTAL 2 23 50 42 38 17 1 173
Class III Males 0 8 14 10 16 8 1 57
Females 2 15 36 32 22 9 0 116

patients at mandibular level and 69 patients at

maxillary level. Kennedy’s Class I was
observed for 52 patients at mandibular level
and 42 patients at maxillary level. Therefore,
classes I and II were the most frequent partial
edentation forms for mandible.
Analysing the number of missing teeth
relative to the number of edentation breaches,
on age decades, we have observed that, up to
Figure 2. Distribution of patients according
to maxillary and mandibular Kennedy 79 years old, the size of edentation breaches
edentation classes increases proportionally with age.
There is a statistical correlation between
Kennedy’s Class II was recorded for 70 both Kennedy edentation classes and age

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groups (p < 0.05). The ratio between the breaches, divided on age decades, is indicated
number of absent teeth and edentation in Table 3.

Table 3. Ratio of missing teeth and edentation breaches, according to age decades
AGE DECADES (years old)
10-19 20-29 30-39 40-49 50-59 60-69 70-79 10-79
Number of missing teeth 9 139 368 651 988 803 205 3163
Number of edentation
7 62 141 207 292 241 58 1008
breaches
RATIO 1.28 2.24 2.60 3.14 3.38 3.33 3.53 3.13

Based on a correlation between edentation indicates that females without prosthetic

breaches’ size and indications of prosthetic treatment represent the majority of the study
treatment either conjunct (fixed) or adjunct group.
(mobile), we can state that, after 40 years old,
a series of patients from our study group need
adjunct (mobile) prosthetic treatment.
The status of fixed prosthetic treatments
for patients included in our study group is
presented in Fig. 3.

Only a small part of the patients has

previously received prosthetic treatment, and
it did not restore the complete dental arches.

Figure 3. Distribution of patients according Figure 4. Distribution of patients with

to their prosthetic status observed during additional affections, smoking habit,
the initial examination, sex and age decades alcohol consumption and medication,
according to sex and age decades
Analysing this aspect on age decades, we
In what concerns general factors related
have observed that this is valid for almost all
to partial edentation, we have studied
age groups, a better status being emphasized
additional affections, medication, alcohol,
for decade 60-69 (more than a quarter of
and tobacco consumption. The study group
patients have prosthetic treatment). A
was divided as following: 148 patients
summary based on age decades and sex,

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(representing 43.91%) presented additional
affections, 140 patients (41.54%) had
treatments for various affections, 63 patients
(18.69%) consumed alcohol and 144
patients (42.72%) were active smokers (Fig.
4).
A statistical summary indicates that there
is no significant relationship between
general factors related to partial edentation
and gender (p > 0.05). There is only an
obvious correlation between general
affections and medication (p < 0.05).
We have also analysed two local factors
related to the etiology of partial edentation:
caries and periodontitis.
We can mention the high percentage of
patients with partial edentation and caries
(92.62%). Periodontitis generated teeth loss
only in a small proportion, for 8 patients
(2.46% from the entire study group). For a
small number of patients (16, representing
4.92%), the etiology of partial edentation
included both caries and periodontitis (Fig.
5).
Figure 5. Distribution of local factors
related to partial edentation etiology
This study was performed on a group of
patients with rural residency. Implicitly, these
patients had a lower socioeconomic status,
lower incomes, reduced access to medical
services, a low level of medical education,
but, in the same time, they had a healthier
diet, with food that was less processed.
158
According to patients’ sex and age decade,
we have observed that, for the first decade
defined in our study group, the interest for
oral health is the same for both sexes but, as
patients grow old, the interest of females for
oral health is increasing (approximately 2/3 of
all patients), excepting the last decade, 70-79
years old, where most patients that came in
for dental specialized treatment were males
(approximately 2/3). The reason is given by
the fact that women are more preoccupied by
their oral health. Jeylapan, Muneeb and
Shaqiri have obtained similar results
[1,11,19].
Our study indicated a high prevalence of
partial edentation for all age decades, higher
than the values from literature, for patients
with both rural [20] and urban [21] residency.
Bruce indicated that edentation breaches exist
for all ages [22]. Analysing the status of both
dental arches, the highest prevalence was met
for maxilla (91.09%), beyond other values
reported in literature: 32.6% [23] or 67.2%
[24]. For mandible, the status is similar, with
a prevalence of 88.72% compared to other
studies: 36.8% [23] and 67.4% [25].
With respect to edentation forms, our
study reported the highest prevalence for
Kennedy Class III, both in maxilla and
mandible. Still, at maxillary level, for patients
over 60 years old, Classes I and II are
predominant; same for mandibular level, even
after 50 years old; Class IV edentation was
not recorded. This status is related to the fact
that patients had rural residency and were not
exposed to frontal teeth traumatisms.
Other studies have also associated
edentation Class III with the highest
prevalence values: Naveed in Pakistan [23],
Charyeva in Kazakhstan Republic [26], Fayad
in Saudi Arabia [24]. The latest study [24]
showed that Kennedy Class IV represents the
rarest edentation form, and that there is an
increase in the prevalence of Kennedy
Classes I and II with age, as well as a
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Vol.12, No. 1, January - March 2020

decrease of Classes III and IV. In 2012,
Hoshang Khalid Abdel-Rahman [27]
performed a study showing that 3rd Class
edentation was the most common found in
comparison to 4th Class edentation, the rarest
form found.
Fayad MI reported that Kennedy Class III
is the most frequent edentation form, with a
higher prevalence in maxilla, compared to
mandible, followed by Class II with the same
prevalence for both maxillaries [24].
Regarding the affected age groups, Kennedy
Class III mainly affects the age decade 31-40
years, and Class IV is mostly characteristic
for age decade 41-50 years. A similar
correlation related to age was reported by
Zaigham [28].
With respect to the size of edentation
breaches, we have not found any data in
literature, but it is logic that the number of
absent teeth to be higher when age is
increased. The number of absent teeth for an
edentation breach is determined by the choice
between a conjunct or adjunct treatment, at
least from a theoretical point of view. In
reality, patients demand more often fixed
restorations and hardly accept mobile
restorations. Their attitude justifies the fact
that only a small number of our patients
present restorations, and these do not restore
completely the dental arches. A similar status
is found in other countries too. Zitzmann
reported that the frequency of fixed
restorations was the highest in Sweeden with
45% and Switzerland with 34% [29].
Enabulele indicated in a similar study that
42.6% of patients present fixed restorations
and their number decreases with age [30].
Regarding the etiology of partial
edentation, from the general factors taken into
study, only age was directly correlated with
the prevalence of partial edentation. Still,
other studies have found other correlations.
Thus, smoking is considered an important
etiological factor for edentation in a series of
studies [12,14,31-33]. The most frequent
additional affections studied in literature are
diabetes mellitus [33-35], arterial
hypertension [33], arthritis [34-35],
depression, functional disabilities,
cerebrovascular accident [17]. Another cause
of partial edentation is polymedication or,
more precisely, certain drugs that generate
alterations in oral tissues and determine
partial edentation through various
mechanisms [33]. For our study group, the
main local factor involved in partial
edentation etiology was tooth decay
(92.62%). Similar results were reported by
Bruce [22] who stated that caries are mostly
responsible for tooth loss (83%), followed by
periodontitis (17%) [3].

CONCLUSIONS level. This edentation form has the highest

Our study reports a high prevalence of prevalence in young and adult patients; for
partial edentation, for both maxillaries. The older patients, the prevalence of Classes I and
most frequent edentation form was Kennedy II is increasing. The number of absent teeth
Class III, both at maxillary and mandibular was correlated to patients’ age.

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