This document presents classification systems for complete edentulism, partial edentulism, and completely dentate patients. For complete edentulism, it describes 4 classes based on factors like residual bone height, ridge morphology, muscle attachments, and occlusal relationships. Partial edentulism classes are determined by location/extent of edentulous areas, abutment conditions, occlusion, and residual ridges. Completely dentate classes consider tooth condition and occlusal scheme, with higher classes requiring more extensive pre-prosthetic therapy.

1. PROSTHODONTIC DIAGNOSTIC
INDEX
PRESENTED BY :
PRAMOD CHAHAR

2. PROSTHODONTIC DIAGNOSTIC INDEX
Complete edentulism
Partial edentulism
Complete dentate

3. CLASSIFICATION SYSTEM FOR
COMPLETE EDENTULISM
• Developed by American college of prosthodontics
• Published in 1999 in Journal of Prosthetic
dentistry
• By McGarry et al
• Review of prosthodontic literature was done
• 89 variables identified

4. • The data collected via this questionnaire were
formatted into a new survey instrument that
differentiated variables into four subclasses:
 Physical findings
 Prosthetic history
 Pharmaceutical history
 Systemic disease evaluation

5. The variables in these four subclasses were further
evaluated to determine their importance in relation to:
 Educational requirement
 Clinical responsibility
 Clinical technique modification
 Clinical and laboratory time requirement
 Overall clinical significance

6. • The subcommittee established a ranking of individual
variables. Subsequently, a classification system was
developed based on the most objective variables
• Four categories were defined ranging from Class I to Class IV
– Class I patient: an uncomplicated clinical situation
– Class IV patient: the most complex and higher-risk situation

7. PROSTHODONTIC DIAGNOSTIC INDEX
COMPLETE EDENTULISM CHECKLIST
Bone Height-Mandibular
Residual ridge morphology of maxilla
Muscle attachments in mandible
Maxillomandibular relationship
Conditions Requiring Pre-prosthetic Surgery
Limited Inter-arch Space
Tongue anatomy
Modifiers

9. BONE HEIGHT
• Chronic progressive, irreversible and disabling process probably of
multifactorial origin.
 Type I :(most favourable): residual bone height of 21 mm or greater
 Type II: bone height of 16 to 20 mm
 Type III: bone height of 11 to 15 mm
 Type IV: bone height of 10 mm or less

10. RESIDUAL RIDGE MORPHOLOGY:
MAXILLA
Type A (most favourable)
 Vestibular depth and palatal morphology that resists vertical
and horizontal movement
 Sufficient tuberosity definition
 Hamular notch is well defined
to establish the posterior extension
 Absence of tori or exostoses

11. Type B
 Loss of buccal vestibule
 Palatal vault morphology resists vertical and
horizontal movement of the denture base.
 Tuberosity and hamular notch are poorly
defined.
 Maxillary palatal tori and/or lateral
exostoses do not affect the posterior
extension of the denture base.

12. Type C
 Loss of labial vestibule
 Palatal vault morphology offers minimal
resistance.
 Maxillary palatal tori and/or lateral
exostoses do not affect the posterior
extension
 Hyperplastic, mobile anterior ridge offers
minimum support and stability
 Reduction of the post malar space by the
coronoid process during mandibular
opening and/or excursive movements.

13. • Type D
 Loss of labial and buccal vestibules.
 Palatal vault morphology : No
resistance.
 Maxillary palatal tori and/or lateral
exostoses: interferes
 Hyperplastic, redundant anterior
ridge.
 Prominent anterior nasal spine.

14. Muscle Attachments: Mandible
• Type A (most favourable)
 Attached mucosal base without undue muscular
impingement during normal function in all regions.
• Type B
 Attached mucosal base in all regions except labial
Mentalis muscle attachment near crest of alveolar
vestibule ridge.
• Type C
 Attached mucosa in all regions except anterior
labial and lingual vestibules-canine to canine.

15. • Type D
 Attached mucosal base only in the posterior
lingual region.
 Mucosal base in all other regions is detached.
• Type E
 No attached mucosa in any region.

16. MAXILLO-MANDIBULAR RELATIONSHIP
• Class I (most favorable):
 Tooth position that has normal articulation
 Teeth supported by the residual ridge.
• Class II: Maxillomandibular relation requires
 Tooth position outside the normal ridge relation (excessive
overlap)
• Class III: Maxillomandibular relation requires
 Tooth position outside the normal ridge relation to attain
aesthetics, phonetics, and articulation (cross bite)

17. CONDITIONS REQUIRING
PREPROSTHETIC SURGERY
• Any situation requiring pre-prosthetic surgery are considered
in class 3 and class 4 of classification system
• Class III
 Minor soft/hard tissue surgical procedure
 Implant placement without graft
• Class IV
 Implant with bone-graft complex
 Hard tissue augmentation
 Correction of dentofacial deformity
 Major soft tissue revision

18. LIMITED INTERARCH SPACE
• Class III
 18-20 mm
• Class IV
 Surgical correction required

19. TONGUE ANATOMY
• Class III
 Large and occludes interdental space
• Class IV
 Hyperactive with retracted position

20. CLASS I
 Residual bone height of 21 mm or greater.
 Residual ridge morphology resists horizontal
and vertical movement
 Location of muscle attachments that are
conducive to denture base stability and
retention.
 Class I maxillomandibular relationship.

21. CLASS II
 Residual bone height of 16 to 20 mm
 Residual ridge morphology that resists
horizontal and vertical movement
 Location of muscle attachments with limited
influence on denture base stability and
retention
 Class I maxillomandibular relationship.
 Minor modifiers, psychosocial considerations,
mild systemic disease with oral manifestation

22. CLASS III
 Residual alveolar bone height of 11 to 15 mm
 Residual ridge morphology has minimum
influence to resist horizontal or vertical
movement
 Location of muscle attachments with moderate
influence on denture base stability and retention.
 Class I, II, or III maxillomandibular relationship
 Minor pre-prosthetic surgery is required
 Limited inter-arch space (18-20 mm)
 TMD symptoms present
 Hyperactive gag reflex

23. CLASS IV
 Residual vertical bone height of 10 mm or less
 Residual ridge offers no resistance to horizontal
or vertical movement
 Muscle attachment location have significant
influence on denture base stability and retention
 Class I, II, or III maxillomandibular relationships.
 Major conditions requiring pre-prosthetic surgery
 Insufficient interarch space with surgical
correction
 Maxillo-mandibular ataxia (incoordination).
 Hyperactive gag reflex managed with medication
 Hyperactivity of tongue associated with a
retracted tongue position

24. CLASSIFICATION SYSTEM FOR
PARTIAL EDENTULISM
 Partial edentulism is defined as the absence of
some but not all of the natural teeth in a dental
arch
 The quality of the supporting structures
contributes to the overall condition and is
considered in the diagnostic levels of the
classification system.
 PARTIALLY EDENTULOUS patients exhibit a wide
range of physical variations and health conditions.

25. DIAGNOSTIC CRITERIA
Location
and extent
of the
edentulous
area
Condition
of
abutments
Occlusion
Residual
ridge
characteris
tics

27. CRITERIA 1: LOCATION AND EXTENT
OF THE EDENTULOUS AREA(S)
Any anterior maxillary : max 2 incisors are
missing
Any anterior mandibular max 4 incisors are
missing
Any posterior maxillary or mandibular
edentulous area that does not exceed 2
premolars or 1 premolar and 1 molar.
A. Ideal or
minimally
compromised
edentulous
area

28. Any anterior maxillary edentulous area
that does not exceed 2 incisors
Any anterior mandibular edentulous area
that does not exceed 4 incisors
Any posterior maxillary or mandibular
edentulous area that does not exceed 2
premolars, or 1 premolar and 1 molar
A missing maxillary or mandibular canine.
B.
Moderately
compromised
edentulous
area

29. Any posterior maxillary or mandibular
edentulous area greater than 3 teeth or 2
molars
Any edentulous areas including anterior
and posterior areas of 3 or more teeth.
C.
Substantially
compromised
edentulous
area

30. Any edentulous area or
combination of edentulous areas
requiring a high level of patient
compliance.
D. Severely
compromised
edentulous
area

31. CRITERIA 2: ABUTMENT CONDITIONS
A. Ideal or minimally
compromised
abutment conditions
No pre-prosthetic
therapy is
indicated.
B. Moderately
compromised
abutment condition
Abutments in 1 or
2 sextants have
insufficient tooth
structure
Abutments in 1 or
2 sextants require
localized
adjunctive therapy

32. C. Substantially
compromised
abutment condition
Abutments in 3
sextants have
insufficient tooth
structure.
Abutments in 3
sextants require more
substantial localized
adjunctive therapy
D. Severely
compromised
abutment condition
Abutments in 4 or
more sextants have
insufficient tooth
structure.
Abutments in 4 or
more sextants require
extensive adjunctive
therapy.
Abutments have
guarded prognoses

33. CRITERIA 3: OCCLUSION
• No pre-prosthetic therapy required
• Class I molar and jaw relationships
A. Ideal or
minimally
compromised
occlusal
characteristics
• Occlusion requires localized
adjunctive therapy
• Class I molar and jaw relationships
B. Moderately
compromised
occlusal
characteristics

34. • Occlusion is re-established without
change in the vertical dimension.
• Class II molar and jaw relationships
C.
Substantially
compromised
occlusal
characteristics
• Occlusion is re-established, with
changes in the vertical dimension.
• Class II division 2 and Class III molar
and jaw relationships
D. Severely
compromised
occlusal
characteristics

35. CRITERIA 4: RESIDUAL RIDGE
CHARACTERISTICS
The criteria published for the Classification
System for Complete Edentulism are used to
categorize any edentulous span present in the
partially edentulous patient

36. CLASS I
 The location and extent of the edentulous
area are ideal or minimally compromised
 Adequate physiologic support of the
abutments.
 The abutment condition: no need for pre-
prosthetic therapy.
 The occlusion : no need for pre-prosthetic
therapy
 Maxillomandibular relationship: Class I
molar and jaw relationships.
 Residual ridge morphology conforms to the
Class I complete edentulism description.

37. CLASS II
 The location and extent of the
edentulous area are moderately
compromised
 Condition of the abutments is
moderately compromised
 Occlusion is moderately compromised
 Maxillomandibular relationship: Class I
molar and jaw relationships.
 Residual ridge morphology conforms to
the Class II complete edentulism
description.
.

38. CLASS IIICLASS III
 The location and extent of the edentulous
areas are substantially compromised:
 The abutments is moderately compromised:
less no: of teeth and requires adjunctive
therapy
 Occlusion is substantially compromised
Requires reestablishment of occlusal scheme
without change in the vertical dimension

39.  Maxillomandibular relationship:
Class II molar and jaw
relationships.
 Residual ridge morphology
conforms to the Class III complete
edentulism description

40. CLASS IV
• The location and extent of the edentulous
areas results in severe occlusal compromise
• Abutments are severely compromised:
Abutments in 4 or more sextants require
extensive localized adjunctive therapy.
 Occlusion is severely compromised with
reestablishment of the occlusion with a
change in the occlusal vertical dimension
 Maxillomandibular relationship: class II
division 2 or Class III molar and jaw
relationships.
 Residual ridge morphology conforms to the
class IV complete edentulism description.

41. CLASSIFICATION SYSTEM FOR THE
COMPLETELY DENTATE PATIENT
• A completely dentate
patient is defined as
an individual with an
intact continuous
permanent dentition
with no missing teeth
or roots excluding

42. DIAGNOSTIC CRITERIA
Tooth
Condition
Occlusal
Scheme

43. CRITERIA 1. TOOTH CONDITION
A. Ideal or minimally compromised tooth condition
No
localized
adjunctive
therapy
required.
B. Moderately compromised tooth
condition
Insufficient tooth
structure to
retain or support
in 1 sextant.
Pathology that
affects the
coronal
morphology of 4
or more teeth in
a sextant.
Pathology may
occur in 2
sextants and may
be present in
opposing arches.
Teeth require
localized
adjunctive
therapy for a
single tooth or in
a single sextant.

44. Insufficient tooth structure to retain or
support in 2 sextants.
Pathology affecting the coronal
morphology of 4 or more teeth in 3–5
sextants.
Pathology may occur in 3 sextants in the
same arch and/or in opposing arches.
Teeth require localized adjunctive therapy
in 2 sextants.
C.
Substantially
compromised
tooth
condition

45. Tooth condition—insufficient
tooth structure in 3 or more
sextants
Pathology affecting the coronal
morphology of 4 or more teeth in
all sextants.
Teeth requiring localized
adjunctive therapy in 3 or more
sextants
D. Severely
compromised
tooth
condition

46. CRITERIA 2. OCCLUSAL SCHEME
No pre-prosthetic therapy required.
Ideal or minimally
compromised
occlusal scheme.
Intact anterior guidance.
Occlusal scheme requires localized adjunctive
therapy.
Moderately
compromised
occlusal scheme
Major therapy required to maintain entire
occlusal scheme without any change in the
occlusal vertical dimension.
Substantially
compromised
occlusal scheme
Major therapy required to re-establish entire
occlusal scheme including any necessary
changes in the occlusal vertical dimension.
Severely
compromised
occlusal scheme

47. CLASSIFICATION OF COMPLETELY
DENTATE PATIENT
CLASS I
• Characterized by an ideal or minimally
compromised tooth condition and
occlusal scheme.
Ideal or minimally compromised tooth
condition
• No localized adjunctive therapy
required.
• Pathology affecting the coronal
morphology of 3 or fewer teeth in a
sextant.
Ideal or minimally compromised occlusal
scheme
• No pre-prosthetic therapy required.
Contiguous, intact dental arches

48. CLASS II
• Moderately compromised tooth
condition
 Tooth condition insufficient tooth
structure available to retain or support
in 1 sextant.
• Moderately compromised occlusal
scheme
 Intact anterior guidance
 Occlusal scheme requires localized
adjunctive therapy.

49. CLASS III
 Substantially
compromised tooth
condition requiring
localized adjunctive
therapy in multiple
sextants
 Substantially
compromised occlusal
scheme requires major
therapy to maintain
occlusal scheme without
change in vertical
dimension

50. CLASS IV
• Severely compromised tooth condition
 Tooth condition—insufficient tooth
structure
 Teeth require localized adjunctive
therapy in 3 or more sextants
• Severely compromised occlusal scheme
 Major therapy required to re-establish
occlusion with changes vertical
dimension
 Other characteristics of the Class IV
patient may include :Severe
manifestations of local or systemic
disease

51. GUIDELINES FOR THE USE OF THE
CLASSIFICATION SYSTEM
 Those instances in which a patient’s diagnostic criteria overlap
2 or more classes, the patient is assigned to the more complex
class.
 Consideration of future treatment procedures must not
influence the choice of diagnostic level.
 Initial adjunctive therapy may change the original
classification level. Classification may need to be reassessed
after existing restorations are removed.

52.  Aesthetic concerns or challenges raise the classification by 1
or more levels in Class I and II patients.
 The presence of temporomandibular disorders (TMD)
symptoms raises the classification by 1 or more levels in Class
I and II patients.
 Patients who fail to conform to the definition of completely
dentate should be classified using the classification system for
partial edentulism

53. POTENTIAL BENEFITS OF
CLASSIFICATION SYSTEM
 Improved intra-operator consistency
 Improved professional communication
 Insurance reimbursement commensurate with complexity of
care
 An objective method for patient screening in dental education
 Standardized criteria for outcomes assessment and research
 Improved diagnostic consistency
 A simplified, organized aid in the decision-making process
relating to referral.

54. CONCLUSION

55. REFERENCES
1. McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH.
Classification system for complete edentulism. Journal of Prosthodontics.
1999 Mar 1;8(1):27-39.
2. McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH,
Arbree NS. Classification system for partial edentulism. Journal of
Prosthodontics. 2002 Sep 1;11(3):181-93.
3. McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH,
Guichet GN. Classification system for the completely dentate patient.
Journal of Prosthodontics. 2004 Jun 1;13(2):73-82.
4. GPT 9