ACP Classifications PDF

9/5/2017 ACP Classifications Michael B. Ferguson D.M.D., C.A.G.S. Department of Prosthodontics Co-Director Fixed Prosthodontics Clinics New York University College of Dentistry Goals and Objectives  To identify, diagnose and classify the Completely Dentate and Partially Dentate Patient, accordin...

9/5/2017 ACP Classifications Michael B. Ferguson D.M.D., C.A.G.S. Department of Prosthodontics Co-Director Fixed Prosthodontics Clinics New York University College of Dentistry Goals and Objectives  To identify, diagnose and classify the Completely Dentate and Partially Dentate Patient, according to the ACP Guidelines. 1 9/5/2017 Background  The American College of Prosthodontists (ACP) have developed a classification system designed for the dental professionals in the diagnosis and treatment of the completely dentate, partially edentulous and the completely edentulous patient. McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004  Categories and diagnostic criteria will be discussed for the completely dentate, partially edentulous patients in this lecture.  A separate lecture will follow discussing the completely edentulous patient. ACP Classification Benefits 1. Improved interoperator consistency 2. Improved professional communication 3. Insurance reimbursement commensurate with complexity of care 4. An objective method for patient screening in dental education McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 2 9/5/2017 ACP Classification Benefits 5. Standardized criteria suitable for use in outcomes assessment and research 6. Improved diagnostic consistency 7. A simplified, organized aid in the decisionmaking process relating to referral McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 Completely Dentate  An individual with an intact continuous permanent dentition with no missing teeth or roots excluding the third molars.  This includes patients who may have missing teeth or roots but who nevertheless have a continuous symmetric dental arch of at least 12 teeth, such as occurs in many post-orthodontic treatment patients who are missing a premolar in each quadrant. McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 3 9/5/2017 Diagnostic Criteria 1. Tooth Condition 2. Occlusal Scheme McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Class I 1. Ideal or minimally compromised tooth condition • No localized adjunctive therapy required • Pathology affecting the coronal morphology of 3 or fewer teeth in a sextant McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 4 9/5/2017 Class I 2. Ideal or minimally compromised occlusal scheme • No preprosthetic therapy required • Contiguous, intact dental arches McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom,2004 Smith, McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics Koumjian, Fuichet, Journal of Prosthodontics 2004 5 9/5/2017 Class II 1. Moderately compromised tooth condition • Tooth condition – insufficient tooth structure available to retain or support intracoronal or extracoronal restorations – in 1 sextant • Pathology affecting the coronal morphology of 4 or more teeth in a sextant • Pathology may be present in 2 sextants and may occur in opposing arches McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Class II 2. Moderately compromised occlusal scheme • Intact anterior guidance • Occlusal scheme requires localized adjunctive therapy McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 6 9/5/2017 McGarry, Nimmo, Skiba, Ahlstrom,2004 Smith, McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics Koumjian, Fuichet, Journal of Prosthodontics 2004 Class III 1. Substantially compromised tooth condition • Tooth condition – insufficient tooth structure to retain or support intracoronal or extracoronal restorations – in 2 sextants • Pathology affecting the coronal morphology of 4 or more teeth in 3 or more sextants • Pathology may occur in 3 sextants in the same arch and/or in opposing arches • Teeth require localized adjunctive therapy in 2 sextants McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 7 9/5/2017 Class III 2. Substantially compromised occlusal scheme • Major therapy required to maintain occlusal scheme without any change in the occlusal vertical dimension McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom,2004 Smith, McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics Koumjian, Fuichet, Journal of Prosthodontics 2004 8 9/5/2017 Class IV 1. Severely compromised tooth condition • Tooth condition – insufficient tooth structure to retain or support intracoronal or extracoronal restorations – in 3 or more sextants • Pathology affecting the coronal morphology of 4 or more teeth in all sextants • Teeth require localized adjunctive therapy procedure in 3 or more sextants McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Class IV 2. Severely compromised occlusal scheme • Major therapy required to reestablish the entire occlusal scheme including any necessary changes in the occlusal vertical dimension McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 9 9/5/2017 Class IV  Severe manifestations of local or systemic disease  Sequelae from oncologic treatment  Maxillomandibular dyskensia and/or atxia McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom,2004 Smith, McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics Koumjian, Fuichet, Journal of Prosthodontics 2004 10 9/5/2017 Summary McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Additional Guidelines  Patient is always classified as the highest checked box  Classification may need to be reassessed after existing prostheses are removed  Esthetic concerns or challenges raise the classification by 1 level in Class I and II patients McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 11 9/5/2017 Additional Guidelines  The presence of TMD symptoms raises the classification by 1 or more levels in Class I and II patients McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Partial Edentulism  The absence of some but not all of the natural teeth in a dental arch. McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 12 9/5/2017 Diagnostic Criteria 1. Location and extent of the edentulous area(s) 2. Condition of abutments 3. Occlusion 4. Residual ridge characteristics McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 Class I 1. The location and extent of the edentulous area are ideal or minimally compromised: • The edentulous area is confined to a single arch • The edentulous area does not compromise the physiologic support of the abutments • The edentulous area may include any anterior maxillary span that does not exceed 2 incisors, any anterior mandibular span that does not exceed 4 missing incisors, or any posterior span that does not exceed 2 premolars or 1 premolar and 1 molar McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 13 9/5/2017 Class I 2. The abutment condition is ideal or minimally compromised, with no need for preprosthetic therapy 3. The occlusion is ideal or minimally compromised, with no need for preprosthetic therapy; maxillomandibular relationship: Class I molar and jaw relationships McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 Class I 4. Residual ridge morphology conforms to the Class I complete edentulism description McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 14 9/5/2017 McGarry, Nimmo, Skiba, Ahlstrom,2004 Smith, McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics Koumjian, Arbree, Journal of Prosthodontics 2002 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 15 9/5/2017 Class II 1. The location and extent of the edentulous area are moderately compromised: • Edentulous areas may exist in 1 or both arches • The edentulous areas do not compromise the physiologic support of the abutments • Edentulous areas may include an anterior maxillary span that does not exceed 2 incisors, any anterior mandibular span that does not exceed 4 incisors, any posterior span that does not exceed 2 premolars, or 1 premolar and 1 molar or any missing canine McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 Class II 2. Condition of the abutments is moderately compromised: • Abutments in 1 or 2 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations • Abutments in 1 or 2 sextants require localized adjunctive therapy McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 16 9/5/2017 Class II 3. 4. Occlusion is moderately compromised: • Occlusal correction requires localized adjunctive therapy • Maxillomandibular relationship: Class I molar and jaw relationships Residual ridge morphology conforms to the Class II complete edentulism McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 McGarry, Nimmo, Skiba, Ahlstrom,2004 Smith, McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics Koumjian, Arbree, Journal of Prosthodontics 2002 17 9/5/2017 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 18 9/5/2017 Class III 1. The location and extent of the edentulous areas are substantially compromised: • Edentulous areas may be present in 1 or both arches • Edentulous areas compromise the physiologic support of the abutments • Edentulous areas may include any posterior maxillary or mandibular edentulous area greater than 3 teeth or 2 molars, or anterior and posterior edentulous areas of 3 or more teeth McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 Class III 2. The condition of the abutments is moderately compromised: • Abutments in 3 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations • Abutments in 3 sextants require more substantial localized adjunctive therapy • Abutments have a fair prognosis McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 19 9/5/2017 Class III 3. 4. Occlusion is substantially compromised: • Requires reestablishment of the entire occlusal scheme without an accompanying change in the occlusal vertical dimension • Maxillomandibular relationship: Class II molar and jaw relationships Residual ridge morphology conforms to the Class III complete edentulism description McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 20 9/5/2017 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 21 9/5/2017 Class IV 1. The location and extent of the edentulous areas results in severe occlusal compromise: • Edentulous areas may be extensive and may occur in both arches • Edentulous areas compromise the physiologic support of the abutment teeth to create a guarded prognosis • Edentulous areas include acquired or congenital maxillofacial defects • At least 1 edentulous area has a guarded prognosis McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 Class IV 2. Abutments are severely compromised: • Abutments in 4 or more sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations • Abutments in 4 or more sextants require extensive localized adjunctive therapy • Abutments have a guarded prognosis McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 22 9/5/2017 Class IV 3. Occlusion is severely compromised: • Reestablishment of the entire occlusal scheme, including changes in the occlusal vertical dimension, is necessary • Maxillomandibular relationship: Class II division 2 or Class III molar and jaw relationships 4. Residual ridge morphology conforms to the Class IV complete edentulism description McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 23 9/5/2017 McGarry, Nimmo, Skiba, Ahlstrom,2004 Smith, McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics Koumjian, Arbree, Journal of Prosthodontics 2002 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 24 9/5/2017 Summary McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 Additional Guidelines  Patient is always classified as the highest checked box  Classification may need to be reassessed after existing prostheses are removed  Esthetic concerns or challenges raise the classification by 1 level in Class I and II patients McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 25 9/5/2017 Additional Guidelines  The presence of TMD symptoms raises the classification by 1 or more levels in Class I and II patients  Edentulous maxilla opposing a partially edentulous mandible is classified for each individual jaw McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 References 1. McGarry TJ, Nimmo A, Skiba JF, et al: Classification System for the Completely Dentate Patient. J Prosthodontics 2004;13:73-82 2. McGarry TJ, Nimmo A, Skiba JF, et al: Classification System for Partial Edentulism. J Prosthodontics 2002;11:181-193 3. McGarry TJ, Nimmo A, Skiba JF, et al: Classification System for Complete Edentulism. J Prosthodontics 1999;8:27-39 26