ACP Complete Edentulism Classification PDF

PROSTHODONTICS REMOVABLE DEPARTMENT CLINICS ACP Classification Complete Edentulism LILIANA ORTIZ CAMACHO,DDS Goals and Objectives To identify, diagnose and classify the Completely Edentulous Patient according to the ACP Guidelines. Background • The American College of Prosthodontists (ACP) ha...

PROSTHODONTICS REMOVABLE DEPARTMENT CLINICS ACP Classification Complete Edentulism LILIANA ORTIZ CAMACHO,DDS Goals and Objectives To identify, diagnose and classify the Completely Edentulous Patient according to the ACP Guidelines. Background • The American College of Prosthodontists (ACP) has 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 edentulous patient in this lecture. ACP Classification Benefits 1. Improved inter-operator consistence 2. Improved professional communication 3. An objective method for patient screening in dental education 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 decision-making process relating to referral EDENTULOUS RIDGES Complete Edentulism The physical state of the jaw following removal of all erupted teeth and the condition of the supporting structures available for reconstructive and replacement therapies Diagnostic Criteria • Bone height – mandibular • Maxillo-mandibular relationship • Residual ridge morphology- maxilla • Muscle attachments McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Classification System for the Completely Edentulous Patient • Class I - Ideal or minimally Compromised • Class II - Moderately Compromised • Class III - Substantially Compromised • Class IV – Severely Compromised McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular Prosthodontic Diagnostic Index Complete Edentulism Checklist 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes Class I Class II Class III Class IV Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Prosthodontic Diagnostic Index(PDI) Classification System Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Prosthodontic Diagnostic Type Index B-no buc vest, poor hamular notch no tori Complete Edentulism Checklist Type C-no ant vest, min support, mobile ant ridge 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Bone Height-Mandibular Type A-adequate 21 mm or greater attached mucosa Type B-no 16-20 mm b attach mucosa (22-27), +mentalis m Type C-no 11-15 mm ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only 10 mm or less Type E-no att mucosa, cheek/lip moves tongue Ridge Morphology-Maxilla Maxillomandibular Relationships Type A-resists vertical & horizontal, hamular notch, no tori ClassB-no I Type buc vest, poor hamular notch no tori ClassC-no II Type ant vest, min support, mobile ant ridge ClassD-no III ant/post vest, tori,redundant tissue Type Conditions Requiring Preprosthetic Surgery Muscle Attachments-Mandibular MinorA-adequate soft tissue procedures Type attached mucosa MinorB-no hard btissue Type attachprocedures mucosa (22-27), +mentalis m Implants - simple Type C-no ant b&l vest (22-27), +genio & mentalis m Implants with bone graft - complex Type D-att mucosa in post only Correction of dentofacial deformities Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular RelationshipsHard tissue augmentation Major Isoft tissue revisions Class Limited Interarch Space Class II 18-20 III mm Class Surgical correction needed Conditions Requiring Preprosthetic Surgery Tongue Anatomy Minor soft tissue procedures Large hard (occludes space) Minor tissueinterdental procedures Hyperactivewith retracted position Implants - simple Modifiers Implants with bone graft - complex Oral manifestation of systemic disease Class I Class II Bone Height – Mandibular Type I 21mm or greater . Google Images Bone Height – Mandibular Type II 16- 20mm . Google Images Bone Height – Mandibular Type III 11- 15mm Google Images Bone Height – Mandibular Type IV 10mm or less Google Images Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Prosthodontic Diagnostic Index(PDI) Classification System Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Prosthodontic Diagnostic Index Complete EdentulismProsthodontic Checklist Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Bone Height-Mandibular Index 21 mm or greater Complete Edentulism Checklist Bone Height-Mandibular Ridge Morphology-Maxilla 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 16-20 mm 11-15 mm 10 21 mm mm or or less greater 16-20 mm Type vertical & horizontal, hamular notch, no tori 11-15A-resists mm Type B-no buc vest, poor hamular notch no tori 10 mm or less Type C-no ant vest, min support, mobile ant ridge Ridge Morphology-Maxilla Type ant/post vest, tori,redundant tissuenotch, no tori Type D-no A-resists vertical & horizontal, hamular Muscle Attachments-MandibularType B-no buc vest, poor hamular notch no tori Type attached mucosa Type A-adequate C-no ant vest, min support, mobile ant ridge Type attach mucosa (22-27), +mentalis Type B-no D-no bant/post vest, tori,redundant tissue m Muscle Attachments-MandibularType C-no ant b&l vest (22-27), +genio & mentalis m Type mucosaattached in post only Type D-att A-adequate mucosa Type mucosa, cheek/lip moves tonguem Type E-no B-no att b attach mucosa (22-27), +mentalis Maxillomandibular RelationshipsType C-no ant b&l vest (22-27), +genio & mentalis m Class I Type D-att mucosa in post only Class II Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular RelationshipsClass III Conditions Requiring Preprosthetic ClassSurgery I Minor Class soft II tissue procedures Minor Class hard III tissue procedures Implants - simple Conditions Requiring Preprosthetic Surgery Implants bone graft - complex Minor softwith tissue procedures Correction dentofacial deformities Minor hard of tissue procedures Hard tissue augmentation Implants - simple Major softwith tissue revisions Implants bone graft - complex Limited Interarch Space Correction of dentofacial deformities 18-20 mm augmentation Hard tissue Surgical correction needed Major soft tissue revisions Tongue Anatomy Space Limited Interarch Large interdental space) 18-20 (occludes mm Hyperactivewith retracted Surgical correction needed position Modifiers Tongue Anatomy Class I Class II Class III Class IV Class I Class II Class III Class IV Residual Ridge Morphology- Maxilla Type A • Labial and buccal vestibular depth that resists vertical and horizontal movement of the denture base • Palatal morphology that resists vertical and horizontal movement of the denture base • Sufficient tuberosity definition that resists vertical and horizontal movement of the denture base • Hamular notch is well defined to establish the posterior extension of the denture base • Absence of tori/exostoses McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Residual Ridge Morphology- Maxilla TYPE B • Loss of posterior buccal vestibule • Tuberosity and hamular notch are poorly defined compromising delineation of the posterior extension of the denture base • Maxillary palatal and/or lateral tori are rounded and do not affect the posterior extension of the denture base • Palatal vault morphology that resists vertical and horizontal movement of the denture base McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Residual Ridge Morphology- Maxilla TYPE C • Loss of anterior labial vestibule. Prominent midline suture • Maxillary palatal and/or lateral tori with bony undercuts that do not affect the posterior extension of the denture base • Hyperplastic, mobile anterior ridge that offers minimum support and stability of the denture base • Palatal morphology that offers minimal resistance to vertical and horizontal movement of denture base of denture base • Reduction of the post malar space by the coronoid process during mandibular opening and/or excursive movements McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Residual Ridge Morphology- Maxilla TYPE D • Loss of anterior labial and posterior buccal vestibules • Maxillary palatal and/or lateral tori-rounded or undercut- that interferes with the posterior border of the denture • Hyperplastic, redundant anterior ridge • Palatal vault morphology that does not resist vertical or horizontal movement of the denture base • Prominent anterior nasal spine McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Prosthodontic Diagnostic Index(PDI) Classification System Class I Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Class III Class IV Class III Class IV 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Prosthodontic Diagnostic Index(PDI) Classification System Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes Class II Bone Height-Mandibular Prosthodontic Diagnostic Ridge Morphology-Maxilla Index Type A-resists vertical & horizontal, hamular notch, no tori Complete Edentulism Checklist Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue 21 mm or greater Muscle Attachments-Mandibular16-20 mm Type attached mucosa 11-15A-adequate mm Type B-no b attach mucosa (22-27), +mentalis m 10 mm or less Type C-no ant b&l vest (22-27), +genio & mentalis m Ridge Morphology-Maxilla Type mucosa in post only Type D-att A-resists vertical & horizontal, hamular notch, no tori Type cheek/lip moves Type E-no B-no att bucmucosa, vest, poor hamular notchtongue no tori Maxillomandibular RelationshipsType C-no ant vest, min support, mobile ant ridge Class I Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-MandibularClass II Class III Type A-adequate attached mucosa Conditions Requiring Preprosthetic TypeSurgery B-no b attach mucosa (22-27), +mentalis m Minor soft tissue procedures Type C-no ant b&l vest (22-27), +genio & mentalis m Minor hard mucosa tissue procedures Type D-att in post only Implants - simple Type E-no att mucosa, cheek/lip moves tongue Implants with bone graft - complex Maxillomandibular Relationships Correction of dentofacial deformities Class I Hard augmentation Classtissue II Major Class soft III tissue revisions Limited Interarch Space Conditions Requiring Preprosthetic Surgery 18-20 mm tissue procedures Minor soft Surgical correction needed Minor hard tissue procedures Tongue Anatomy Implants - simple Large (occludes interdental space) Implants with bone graft - complex Hyperactiveretracted position Correction of with dentofacial deformities Modifiers Hard tissue augmentation Oral of systemic disease Majormanifestation soft tissue revisions Mild Limited Interarch Space Moderate 18-20 mm Severecorrection needed Surgical Psychosocial Tongue Anatomy Bone Height-Mandibular 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 Class I Class II Diagnostic Criteria Muscle Attachments The location and influence of the muscle attachments affecting a complete denture are most commonly associated with the mandibular denture McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Muscle Attachments TYPE A • Adequate attached mucosal base without undue muscular impingement during normal function in all regions. McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Muscle Attachments TYPE B • Adequate attached mucosal base in all regions except anterior buccal vestibule—cuspid to cuspid • High mentalis muscle attachment McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Muscle Attachments TYPE C • Adequate attached mucosal base in all regions except anterior buccal and lingual vestibules—cuspid to cuspid • High genioglossus and mentalis muscle attachments McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Muscle Attachments TYPE D • Adequate attached mucosal base only in the posterior lingual region • All other regions are detached McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Muscle Attachments TYPE E • No attached mucosa in any region • Cheek and lip movement = tongue movement McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Prosthodontic Diagnostic Index(PDI) Classification System Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular A-adequate attached mucosa Prosthodontic Diagnostic Type Index Type B-no b attach mucosa (22-27), +mentalis m Complete Edentulism Checklist Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Bone Height-Mandibular Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships21 mm or greater 16-20 Imm Class 11-15 IImm Class 10 mmIIIor less Class Ridge Morphology-Maxilla Conditions Requiring Preprosthetic Surgery Type A-resists vertical & horizontal, hamular notch, no tori Minor soft tissue procedures Type B-no vest, poor hamular notch no tori Minor hard buc tissue procedures Type C-no ant vest, min support, mobile ant ridge Implants - simple Type D-no ant/post vest,-tori,redundant tissue Implants with bone graft complex Muscle Attachments-MandibularCorrection of dentofacial deformities Type tissue A-adequate attached mucosa Hard augmentation Type B-no b attach mucosa (22-27), +mentalis m Major soft tissue revisions Type C-no ant b&l vest (22-27), +genio & mentalis m Limited Interarch Space Type D-att 18-20 mm mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Surgical correction needed Maxillomandibular Tongue Anatomy Relationships Class I(occludes interdental space) Large Class II Hyperactive- with retracted position Class III Modifiers Conditions Requiring Preprosthetic Surgery Oral manifestation of systemic disease Minor soft tissue procedures Mild Minor hard tissue procedures Moderate Implants - simple Severe Implants with bone graft - complex Psychosocial Correction of dentofacial deformities Moderate Hard tissue augmentation Severe Major soft tissue revisions TMD Symptoms Limited Interarch Space Hx of paresthesia or dysesthesia 18-20 mm Maxillofacial defects Surgical correction needed Ataxia Tongue Anatomy 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 Class I Class II Diagnostic Criteria Muscle Attachments Maxillomandibular relationship classification relates to the position of the artificial teeth to the residual ridge and to the opposing dentition McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Maxillomandibular Relationship ass I Maxillomandibular relationship allows tooth position that has normal articulation with the teeth supported by the residual ridge McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Fuichet, Journal of Prosthodontics 2004 Maxillomandibular Relationship Class II ass I Maxillomandibular relationship requires tooth position outside the normal ridge relation in order to attain phonetics and articulation; i.e., anterior or posterior tooth position not supported by the residual ridge/anterior vertical overlap that exceeds the principles of articulation. Maxillomandibular Relationship Class III Maxillomandibular relationship requires tooth position outside the normal ridge relation in order to attain phonetics and articulation; i.e., crossbite – anterior or posterior, tooth position not supported by the residual ridge. Position and Angulation of the Occlusal Plane Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Prosthodontic Diagnostic Index(PDI) Classification System Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only E-no att mucosa, cheek/lip moves tongue Prosthodontic Diagnostic Type Index Maxillomandibular Relationships Complete Edentulism Checklist Class I Class II Bone Height-Mandibular Class III 21 mm or greater Conditions Requiring Preprosthetic Surgery 16-20 soft mm tissue procedures Minor 11-15 hard mm tissue procedures Minor 10 mm Implantsor- less simple Ridge Morphology-Maxilla Implants with bone graft - complex Type A-resists vertical & horizontal, Correction of dentofacial deformitieshamular notch, no tori Type tissue B-no buc vest, poor hamular notch no tori Hard augmentation Type C-no ant vest, min support, mobile ant ridge Major soft tissue revisions Type D-no ant/post vest, tori,redundant tissue Limited Interarch Space Muscle Attachments-Mandibular18-20 mm Type A-adequate Surgical correctionattached needed mucosa Type B-no b attach mucosa (22-27), +mentalis m Tongue Anatomy Type C-no ant b&l vest (22-27), +genio & mentalis m Large (occludes interdental space) Type D-att mucosa in post only Hyperactivewith retracted position Type E-no att mucosa, cheek/lip moves tongue Modifiers Maxillomandibular Relationships Oral manifestation of systemic disease Class I Mild Class II Moderate Class III Severe Conditions Requiring Preprosthetic Surgery Psychosocial Minor soft tissue procedures Moderate Minor hard tissue procedures Severe Implants - simple TMD Symptoms Implants with bone graft - complex Hx of paresthesia or dysesthesia Correction of dentofacial deformities Maxillofacial defects Hard tissue augmentation Ataxia Major soft tissue revisions Refractory Patient Limited Interarch Space 18-20 mm Surgical correction needed ICD-9-CM Diagnostic Codes Tongue Anatomy 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 Class I 525.41 Class II 525.42 525.43 525.44 Conditions Requiring Pre-Prosthetic Surgery • Minor or Major soft tissue procedures • Minor or Major hard tissue procedures • Implant placement – Simple or Complex • Correction of dentofacial anomalies Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Prosthodontic Diagnostic Index(PDI) Classification System Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Prosthodontic Diagnostic Implants Index - simple Implants with bone graft - complex Complete Edentulism Checklist Correction of dentofacial deformities Hard tissue augmentation Bone Height-Mandibular Major tissue revisions 21 mmsoft or greater Limited Interarch Space 16-20 mm 18-20 11-15 mm mm Surgical needed 10 mm orcorrection less Tongue Anatomy Ridge Morphology-Maxilla Large (occludesvertical interdental space) hamular notch, no tori Type A-resists & horizontal, Hyperactivewith retracted positionnotch no tori Type B-no buc vest, poor hamular Modifiers Type C-no ant vest, min support, mobile ant ridge Oral systemic disease tissue Typemanifestation D-no ant/postofvest, tori,redundant Muscle Attachments-Mandibular Mild Moderate Type A-adequate attached mucosa Severe Type B-no b attach mucosa (22-27), +mentalis m Psychosocial Type C-no ant b&l vest (22-27), +genio & mentalis m Moderate Type D-att mucosa in post only Severe Type E-no att mucosa, cheek/lip moves tongue TMD Symptoms Maxillomandibular Relationships Hx of paresthesia or dysesthesia Class I Maxillofacial defects Class II Ataxia Class III Refractory Patient Conditions Requiring Preprosthetic Surgery 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 Class I Class II Minor soft tissue procedures Minor hard tissue procedures 525.41 525.42 Implants - simple Implants with bone graft - complex Guidelines for use of the worksheet Correction of dentofacial deformities Hard tissue augmentation 1. Any single criterion of a more places the patient into the more complex class. Majorcomplex soft tissueclass revisions Limited Space treatment and/or adjunctive therapy can change the initial classification level. 2. InitialInterarch preprosthetic mmpresents with an edentulous maxilla opposing a partially 3. In the situation where the 18-20 patient Surgical correction needed edentulous mandible, each arch is diagnosed with the appropriate classification system. Tongue Anatomy ICD-9-CM Diagnostic Codes 525.43 525.44 Conditions Requiring Pre-Prosthetic Surgery • • • Insufficient interarch space 18 – 20mm Surgical correction required Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Prosthodontic Diagnostic Index(PDI) Classification System Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities tissue augmentation Prosthodontic Diagnostic Hard Index Major soft tissue revisions Complete Edentulism Checklist Limited Interarch Space Class I Class II 18-20 mm Bone Height-Mandibular Surgical correction needed 21 mm or greater Tongue Anatomy 16-20 mm Large (occludes interdental space) 11-15 mm Hyperactive- with retracted position 10 mm or less Modifiers Ridge Morphology-Maxilla Oral manifestation of systemic disease Type A-resists vertical & horizontal, hamular notch, no tori Mild Type B-no buc vest, poor hamular notch no tori Moderate Type C-no ant vest, min support, mobile ant ridge Severe Type D-no ant/post vest, tori,redundant tissue Psychosocial Muscle Attachments-Mandibular Moderate Type A-adequate attached mucosa Severe Type B-no b attach mucosa (22-27), +mentalis m TMD Symptoms Type C-no ant b&l vest (22-27), +genio & mentalis m Hx of paresthesia or dysesthesia Type D-att mucosa in post only Maxillofacial defects Type E-no att mucosa, cheek/lip moves tongue Ataxia Maxillomandibular Relationships Refractory Patient Class I Class II Class III ICD-9-CM Diagnostic Codes 525.41 525.42 Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Guidelines for use of the worksheet Minor hard tissue procedures Implants - simple 1. Any single criterion of a more complex class the patient into the more complex class. Implants with bone graftplaces - complex Correction of dentofacial 2. Initial preprosthetic treatment and/or adjunctivedeformities therapy can change the initial classification level. tissue augmentation 3. In the situation where the Hard patient presents with an edentulous maxilla opposing a partially Major soft tissue revisions edentulous mandible, each arch is diagnosed with the appropriate classification system. Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 525.43 525.44 Conditions Requiring Pre-Prosthetic Surgery • Large tongue that occludes the interdental space • Hyperactivity of tongue • Retracted tongue position 11-15 mm 10 mm or less Ridge Morphology-Maxilla Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space Prosthodontic Diagnostic 18-20 Indexmm Complete Edentulism Checklist Surgical correction needed Tongue Anatomy Class I Class II Large (occludes interdental space) Bone Height-Mandibular Hyperactivewith retracted position 21 mm or greater Modifiers 16-20 mm Oral of systemic disease 11-15manifestation mm 10 Mild mm or less Moderate Ridge Morphology-Maxilla Severe Type A-resists vertical & horizontal, hamular notch, no tori Psychosocial Type B-no buc vest, poor hamular notch no tori Moderate Type C-no ant vest, min support, mobile ant ridge Severe Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-MandibularTMD Symptoms Hx of A-adequate paresthesia attached or dysesthesia Type mucosa Maxillofacial Type B-no b defects attach mucosa (22-27), +mentalis m Ataxia Type C-no ant b&l vest (22-27), +genio & mentalis m Refractory Type D-att Patient mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships ICD-9-CM Diagnostic Codes 525.41 525.42 Class I Class II Guidelines for use of the worksheet Class III Conditions Requiring Preprosthetic Surgery Minorcomplex soft tissueclass procedures 1. Any single criterion of a more places the patient into the more complex class. Minor hard tissue procedures 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. Implants - simple 3. In the situation where the Implants patient with presents with- complex an edentulous maxilla opposing a partially bone graft edentulous mandible, each arch isofdiagnosed with the appropriate classification system. Correction dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease 525.43 525.44 Class III 525.43 Class IV 525.44 Conditions Requiring Pre-Prosthetic Surgery • Oral manifestation of systemic disease • Maxillomandibular ataxia (incoordination) • History of paresthesia or dysesthesia • Hyperactive gag reflex • TMD symptoms • Ataxia • Psychosocial conditions warranting professional intervention Prosthodontic Diagnostic Index(PDI) Classification System Prosthodontic Diagnostic Index Complete Edentulism Checklist Class I Class II Class III Class IV Bone Height-Mandibular 21 mm or greater 16-20 mm 11-15 mm 10 mm or less Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Severe TMD Symptoms Hx of paresthesia or dysesthesia Maxillofacial defects Ataxia Refractory Patient ICD-9-CM Diagnostic Codes Type D-no ant/post vest, tori,redundant tissue Muscle Attachments-Mandibular Type A-adequate attached mucosa Type B-no b attach mucosa (22-27), +mentalis m Type C-no ant b&l vest (22-27), +genio & mentalis m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space 18-20 mm Surgical correction needed Tongue Anatomy Large (occludes interdental space) Hyperactive- with retracted position Modifiers Oral manifestation of systemic disease Mild Moderate Severe Psychosocial Moderate Prosthodontic Diagnostic Index Severe Complete Edentulism Checklist TMD Symptoms Class I Class II Hx of paresthesia or dysesthesia Bone Height-Mandibular Maxillofacial defects 21 mm or greater Ataxia 16-20 mm Patient Refractory 11-15 mm 10 mm or less ICD-9-CM Diagnostic Codes 525.41 525.42 Ridge Morphology-Maxilla Type A-resists vertical & horizontal, hamular notch, no tori Guidelines for use of the worksheet Type B-no buc vest, poor hamular notch no tori Type C-no ant vest, min support, mobile ant ridge Type complex D-no ant/post vest, tori,redundant tissueinto the more complex class. 1. Any single criterion of a more class places the patient Muscle Attachments-Mandibular 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. Type A-adequate attached mucosa 3. In the situation where the Type patient with an(22-27), edentulous maxilla opposing a partially B-nopresents b attach mucosa +mentalis m edentulous mandible, each arch isant diagnosed with the appropriate system. Type C-no b&l vest (22-27), +genio & mentalis classification m Type D-att mucosa in post only Type E-no att mucosa, cheek/lip moves tongue Maxillomandibular Relationships Class I Class II Class III Conditions Requiring Preprosthetic Surgery Minor soft tissue procedures Minor hard tissue procedures Implants - simple Implants with bone graft - complex Correction of dentofacial deformities Hard tissue augmentation Major soft tissue revisions Limited Interarch Space Prosthodontic Diagnostic Index(PDI) Classification System 525.41 525.42 Guidelines for use of the worksheet 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level. 3. In the situation where the patient presents with an edentulous maxilla opposing a partially edentulous mandible, each arch is diagnosed with the appropriate classification system. 525.43 525.44 Class III 525.43 Class IV 525.44 Refractory Patient • 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. Guidelines for use of the Complete Edentulism Classification System ■ 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. Utilization of this system is indicated for pre-treatment evaluation and classification of patients. Retrospective analysis on a post-treatment basis may alter a patient’s final classification 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 Additional Guidelines • The presence of TMD symptoms raises the classification by 1 or more levels in Class I and II patients • Edentulous arch opposing a partially edentulous arch is classified for each individual jaw McGarry, Nimmo, Skiba, Ahlstrom, Smith, Koumjian, Arbree, Journal of Prosthodontics 2002 References • McGarry TJ, Nimmo A, Skiba JF, et al: Classification System for the Completely Dentate Patient. J Prosthodontics 2004;13:73-82 • McGarry TJ, Nimmo A, Skiba JF, et al: Classification System for Partial Edentulism. J Prosthodontics 2002;11:181-193 • McGarry TJ, Nimmo A, Skiba JF, et al: Classification System for Complete Edentulism. J Prosthodontics 1999;8:27-39 PROSTHODONTICS REMOVABLE DEPARTMENT CLINICS ACP Classification Complete Edentulism LILIANA ORTIZ CAMACHO,DDS