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5th class Lec.2 Prosthodontic Dr. Thekra Ismael Classification System for Complete Edentulism (continue) Integration of Diagnostic Findings The previous four sub classifications are important determinants in the overall diagnostic classification of complete edentulism. In...

5th class Lec.2 Prosthodontic Dr. Thekra Ismael Classification System for Complete Edentulism (continue) Integration of Diagnostic Findings The previous four sub classifications are important determinants in the overall diagnostic classification of complete edentulism. In addition, variables that can be expected to contribute to increased treatment difficulty are distributed across all classifications according to their significance. Diagnostic Classification of Complete Edentulism Class I This classification level characterizes the stage of edentulism that is most appear to be successfully treated with complete dentures using conventional prosthodontics techniques. All four of the diagnostic criteria are favorable. Residual bone height of 21 mm or greater measured at the least vertical height of the mandible on a panoramic radiograph. Residual ridge morphology resists horizontal and vertical movement of the denture base; Type A maxilla. Location of muscle attachments that are conducive to denture base stability and retention; Type A or B mandible. Class I maxillomandibular relationship Class II (Fig 15 A-H) This classification level distinguishes itself by the continued physical degradation of the denture supporting anatomy, and, in addition, is characterized by the early onset of systemic disease interactions, patient management, and/or lifestyle considerations. Residual bone height of 16 to 20 mm measured at the least vertical height of the mandible on a panoramic radiograph. Residual ridge morphology that resists horizontal and vertical movement of the denture base; Type A or B maxilla. Location of muscle attachments with limited influence on denture base stability and retention; Type A or B mandible.  Class I maxillomandibular relationship. Minor modifiers, psychosocial considerations, mild systemic disease with oral manifestation. Class III This classification level is characterized by the need for surgical revision of supporting structures to allow for adequate prosthodontic function. Additional factors now play a significant role in treatment outcomes. Residual alveolar bone height of 11 to 15 mm measured at the least vertical height of the mandible on a panoramic radiograph. Residual ridge morphology has minimum influence to resist horizontal or vertical movement of the denture base; Type C maxilla. Location of muscle attachments with moderate influence on denture base stability and retention;Type C mandible. Class I, II, or III maxillomandibular relationship. Conditions requiring preprosthetic surgery: 1) minor soft tissue procedures; 2) minor hard tissue procedures including alveolotomy. 3) simple implant placement, no augmentation 4) multiple extractions leading to complete edentulism for immediate denture placement. Limited interarch space (18-20 mm). Moderate psychosocial consideration and or moderate oral manifestations of systemic diseases or conditions such as xerostomia TMD symptoms present. Large tongue (occludes interdental space) with or without hyperactivity. Hyperactive gag reflex. Class IV This classification level depicts the most debilitated edentulous condition. Surgical reconstruction is almost always indicated but cannot always be accomplished because of the patient's health, preferences, dental history, and financial considerations. When surgical revision is not an option, prosthodontics techniques of a specialized nature must be used to achieve an adequate treatment outcome. Residual vertical bone height of 10 mm or less measured at the least vertical height of the mandible on a panoramic radiograph. Residual ridge offers no resistance to horizontal or vertical movement; Type D maxilla. Muscle attachment location that can be expected to have significant influence on denture base stability and retention; Type D or E mandible. Class I, II, or III maxillomandibular relationships. Major conditions requiring preprosthetic surgery: I) complex implant placement, augmentation 2) surgical correction of dentofacial deformities; 3) hard tissue augmentation required; 4) major soft tissue revision required, ie, vestibular extensions with or without soft tissue grafting. History of paresthesia or dysesthesia. Insufficient interarch space with surgical correction required. Acquired or congenital maxillofacial defects. Severe oral manifestation of systemic disease or conditions such as sequelae from oncological treatment. Maxillo-mandibular ataxia (incoordination). Hyperactivity of tongue that can be associated with a retracted tongue position and/or its associated morphology. Hyperactive gag reflex managed with medication. Refractory patient (a patient who presents with chronic complaints following appropriate therapy). These patients may continue to have difficult achieving their treatment expectations despite the thoroughness or frequency of the treatments provided. Psychosocial conditions warranting professional intervention Reasons for a Classification System Classifying edentulous patients according to present criteria can be an aid in numerous aspects of treatment: establishing a basis for diagnostic and treatment procedures justifying treatment procedures and fees to patients screening patients treated in dental faculties for assignment to undergraduate or graduate students providing data for review of treatment outcome simplifying communication in discussions of treatment with patients and colleagues. The classes are differentiated from each other according to the following features: The skill level required to treat that class of patient: Does the patient require novice or expert treatment? The necessity for modification of basic clinical or laboratory procedures: Will more complicated procedures or more time be required for treatment? Overall management and complexity of treatment: Will expert intervention and referral be required? Guidelines for Use of the Complete Edentulism Classification System In those instances when a patient’s diagnostic crileria are mixed between two or more classes, any single criterion of a more complex class places the patient into the more complex class. The analysis of diagnostic factors is facilitated with the use of a worksheet. Use of this system is indicated for pre-treatment evaluation and classification of patients. Re-evaluation of classification status should be considered following preprosthetic surgery. Retrospective analysis on a post treatment basis may alter a patient’s classification. The classification system for complete edentulism is based on the most objective criteria available to facilitate uniform utilization of the system. With such standardization, communication will be improved among dental professionals. This classification system will help to identify those patients most likely to require treatment by a specialist or by a practitioner with additional training and experience in advanced techniques. This system should also be valuable to research protocols a different treatment procedures are evaluated. Examples about questions on the subject ; whats more important in the maxilla, the shape of the palate or the thickness of the bone? the shap. whats more important in the mandible, the shape of the ridge or the thickness of the bone? the thickness what class jaw realationship does class I edentulous pt have? class I maxillary residual ridge morphology resists horizontal and vertical movment of denture base: name the type? type A location of muscle attachments that are conducive to denture base stability and retention type A, B- mandible what is going on the class II patient physiologically and with their oral health? early onset of systemic disease interactions, localized soft tissue factors and patient management/lifestyle considerations what is the residual bone height of a class II pt? 16-20 mm what class jaw relationship does the class II pt have? class I what types have residual ridge morphology that resists movement of denture A, B- maxilla what types have location of muscle attachments with limited influence on denture base stability and retention Type A,B—Mandible name the kind of disease condition exists in the class II patient (psychologically, systemically, orally)  Minor modifiers, psychosocial considerations, mild systemic disease with oral manifestations and localized soft tissue conditions what is class III characterized by clinically characterized by the need for surgical revision of denture supporting structures to allow for adequate prosthodontic function. residual bone height of class III pt 11-15 mm what jaw relationship does the class III pt have I, II, or III in what type of pt does Residual ridge morphology have minimum influence to resist horizontal or vertical movement of the denture base— type C max in what sort of pt do Location of muscle attachments yield moderate influence on denture base stability and retention— type C mandible what are some things that would require preprosthetic surgery Minor soft tissue procedures Minor hard tissue procedures Implant placement (simple)—no augmentation required Multiple extractions leading to complete edentulism for immediate denture placement Limited interarch space—18-20 mm Moderate psychosocial considerations and/or moderate oral manifestations of systemic diseases or localized soft tissue conditions TMD symptoms present Large tongue with or without hyperactivity Hyperactive gag reflex Do class IV pts need surgery almost always in what patient type does the residual ridge offer no resistance to horizontal or vertical movement. type D, maxilla, class IV In what class IV pt does Location of muscle attachments have significant influence on denture base stability and retention— type D and E mandible what are some major conditions that require preprosthetic surgery Implant placement (complex)—augmentation required. Surgical correction of dentofacial deformities Hard tissue augmentation Major soft tissue revision, i.e., vestibular extensions with or without soft tissue grafting History of paresthesia or dysensthesia Insufficient interarch space with surgical correction required Acquired or congenital maxillofacial defects what is a refractory pt? a patient who has chronic complaints following appropriate therapy. These patients continue to have difficulty in achieving their treatment expectations despite the thoroughness or frequency of the treatment provided. would we err on the side of more or less complex when classifying edentulous pt In those instances when a patient's diagnostic criteria are mixed between two classes, any single criteria of a more complex class will move the patient into that respective class.