CLASSIFICATION SYSTEM FOR

COMPLETE EDENTULISM

Thomas J. McGarry, DDS, Arthur Nimmo, DDS, James F. Skiba, DDS,Robert H.

Ahlstrom, DDS,Jack H. Koumjian, DDS, MSD,Christopher R. Smith, DDS.

Journal of Prosthodontics, Vol 8, March 1999;Pg: 27-39

By
Sahana.R
PG – II YR
 CONTENTS
• Introduction

• Reasons for a Classification System

• Diagnostic Criteria for classifying Patients

• Classification system for complete edentulism

• Guidelines for use of the complete edentulism classification system

• Conclusion

• References
 INTRODUCTION
• Completely edentulous patients exhibit a broad range of
physical variations and health concerns.

• Classifying all edentulous patients as a single diagnostic group

is insensitive to the multiple levels of physical variation and
the differing treatment procedures required to restore
function and comfort.

• A formal system of classifying patients with varying levels of

loss of denture-supporting structures was developed.
REASONS FOR A CLASSIFICATION SYSTEM
• Establish a basis for diagnostic and treatment procedures

• Justify treatment procedures to the patients

• Provide data for review of treatment outcome

• Simplify communication in discussions of treatment with

patients and colleagues
 DIAGNOSTIC CRITERIA

• To apply the classification system, the clinician uses a checklist

or worksheet to focus attention on specific diagnostic
variables.

• The items in the checklist are ordered according to the

objectivity of their assessment (i.e., the ease with which they
can be measured and assessed), not their order of
significance.
 Ideal or minimally Bone Height-Mandibular
Class I compromised

Residual ridge morphology

Moderately of maxilla
Class II compromised
Tongue anatomy

Modifiers
Class III Substantially
compromised
Limited Inter-arch Space

Conditions Requiring Pre-

prosthetic Surgery
Severely
Class IV compromised Maxillomandibular
relationship

Muscle attachments in
mandible
 BONE HEIGHT - MANDIBLE
• Atwood (1971) description of alveolar bone loss – “Chronic
progressive, irreversible and disabling process probably of
multifactoral origin.”

QUANTITY OF UNDERLYING
BONE AFFECTS

1. Denture-bearing area

2. Tissues remaining for reconstruction

3. Facial muscle support/attachment

4. Total facial height

5. Ridge morphology.
 RADIOGRAPHIC MEASUREMENT
• The measurement should be made on the radiograph at that
portion of the mandible of the least vertical height.

Type IV : Residual vertical bone height of 10 mm or less

 RESIDUAL RIDGE MORPHOLOGY- MAXILLA
• Residual ridge morphology – Objective criterion for maxilla
• Radiographic method – Not reliable

Type A (most favorable)

• Anterior labial and posterior buccal vestibular depth that resists
vertical and horizontal movement of the denture base.

• Palatal morphology resists vertical and horizontal movement of

the denture base.

• Sufficient tuberosity definition to resist 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 or exostoses

 Type B
• Loss of posterior buccal vestibule.

• Palatal vault morphology resists

vertical and horizontal movement
ofthe denture base.

• Tuberosity and hamular notch are

poorly defined, compromising
delineation of the posterior
extension the denture base.

• Maxillary palatal tori and/or lateral

exostoses are rounded and do not
affect the posterior extension of the
denture base.
 Type C
• Loss of anterior labial vestibule.

• Palatal vault morphology offers minimal

resistance to vertical and horizontal
movement of the denture base.

• Maxillary palatal tori and/or lateral exostoses

with bony undercuts that do not affect the
posterior extension of the denture base.

• Hyperplastic, mobile anterior ridge offers

minimum support and stabilit) of the denture
base.

• Reduction of the post malar space by the

coronoid process during mandibular opening
and/or excursive movements.
 Type D
• Loss of anterior labial and posterior
buccal vestibules.

• Palatal vault morphology does not

resist vertical or horizontal movement
of the denture base.

• Maxillary palatal tori and/or lateral

exostoses (rounded or undercut) that
interfere with the posterior border of
the denture.

• Hyperplastic, redundant anterior ridge.

• Prominent anterior nasal spine

 MUSCLE ATTACHMENTS - MANDIBLE
• The effects of muscle attachment and location are most
important to the function of a mandibular denture.

Type A (most favorable)

• Attached mucosal base without undue

muscular impingement during normal
function in all regions.

Type B

• Attached mucosal base in all regions

except labial vestibule.

• Mentalis muscle attachment near crest

of alveolar ridge
 Type C

• Attached mucosal base in all regions

except anterior buccal and lingual
vestibules-canine to canine.

• Genioglossus and mentalis muscle

attachments near crest of alveolar
ridge.

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

 MAXILLOMANDIBULAR RELATIONSHIP
• Characterizes the position of the artificial teeth in relation to the residual
ridge and/or to opposing dentition.

• Class I (most favorable): Maxillomandibular relation allows tooth position

that has normal articulation with the teeth supported by the residual
ridge.

• Class II: Maxillomandibular relation requires tooth position outside the

normal ridge relation to attain esthetics, phonetics, and articulation (eg,
anterior or posterior tooth position is not supported by the residual ridge;
anterior vertical and/or horizontal overlap exceeds the principles of fully
balanced articulation).

• Class III: Maxillomandibular relation requires tooth position outside the

normal ridge relation to attain esthetics, phonetics, and articulation (ie
crossbitc-anterior or posterior tooth position is not supported by the
residual ridge).
 CLASSIFICATION SYSTEM
FOR COMPLETE EDENTULISM

CLASS I

• Characterizes the stage of edentulism that is most apt to be

successfully treated with complete dentures using conventional
prosthodontic 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.

• Class I
maxillomandibular
relationship.
• Residual ridge
morphology resists
horizontal and
vertical movement of
the denture base;
Type A maxilla.
Occlusal view of maxillary arch. Tongue in resting position.

• Location of muscle
attachments that arc
conducive to denture
base stability and
retention; Type A or B
mandible.
Tongue in elevated position. Lateral view of mandible:
patient left.
 CLASS II

• Residual bone height of 16

to 20 mrn measured at the
least vertical height of the
mandible on a panoramic
radiograph.

• Class I maxillomandibular
relationship.
• Residual ridge morphology
that resists horizontal and
vertical movement of the
denture base; Type A or B
maxilla.

Occlusal view of maxillary arch. Tongue in resting position.

• Location of muscle
attachments with limited
influence on denture base
stability and retention; Type
A or B mandible.

• Minor modifiers,
psychosocial considerations,
mild systemic disease with
oral manifestation
Tongue in elevated position. Lateral view of mandible:
patient left.
 Class III

• Characterized by the need for

surgical revision of supporting
structures to allow for adequate
prosthodontic function.

• Residual alveolar bone height of 11

to 15 mm measured at the least
vertical height of the mandible on a
panoramic radiograph.

• Class I, II, or III maxillomandibular

relationship.

• Limited interarch space (18-20 mm).

• Characterized by Type C maxilla
and Type C mandible.

• Moderate psychosocial
consideration and/or moderate
oral manifestations of systemic Occlusal view of maxillary arch. Tongue in resting position.
diseasese or conditions such as
xerostomia.

• TMD symptoms present.

• Large tongue (occludes

interdental space) with or
without hyperactivity.

• Hyperactive gag

Tongue in elevated position. Lateral view of mandible:

patient right.
CONDITIONS REQUIRING PREPROSTHETIC
SURGERY
●
Minor soft tissue procedures

●
Minor hard tissue procedures including alveoloplasty

●
Multiple extractions leading to complete edentulism for
immediate denture placement.

●
Simple implant placement, no augmentation required
 CLASS IV

• Characterised by 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, prosthodontic

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.

• Class I, II, or III

maxillomandibular
relationships.

• Insufficient interarch space

with surgical correcection
required.
• Type D maxilla and Type
D or E mandible.

• Psychosocial conditions
warranting professional
intervention. Occlusal view of maxillary arch. Tongue in resting position.

• Hyperactivity of tongue
that can be associated
with a retracted tongue
position and/or its
associated morphology.

• Hyperactive gag reflex

managed with
medication.
Tongue in elevated position. Lateral view of mandible:
patient left.
• History of paresthesia or dysesthesia

• Acquired or congenital maxillofacial defects.

• Severe oral manifestation of systemic disease or conditions

such as sequelae from oncological treatment.

• Maxillo-mandibular ataxia (incoordination).

• Refractory patient - A patient who presents with chronic

complaints following appropriate therapy. These patients may
continue to have difficulty achieving their treatment
expectations despite the thoroughness or frequency of the
treatments provided.
MAJOR CONDITIONS REQUIRING
PREPROSTHETIC SURGERY
●
Complex implant placement, Augmentation required

●
Surgical correction of dentofacial deformities

●
Hard tissue augmentation required.

●
Major soft tissue revision required, ie, vestibularextensions with or without soft tissue grafting
 GUIDELINES FOR USE OF THE COMPLETE
EDENTULISM CLASSIFICATION SYSTEM
• When a patient’s diagnostic criteria are mixed between two or
more classes, any single criterion of a more complex class
places the patient into the more complex class.

• Use of this system is indicated for pretreatment evaluation

and classification of patients.

• Reevaluation of classification status should be considered

following preprosthetic surgery.

• Retrospective analysis on a post treatment basis may alter a

patient’s classification.
 CONCLUSION
• 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

• This classification system will help to identify those patients

most likely to require treatment by a specialist and experience
in advanced techniques.
 REFERENCES
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Periodontal Disease, in Robert J. Cenco, Henry M. Goldman, D.
Walter Cohen (eds): Contemporary Periodontics (ed 6). St.
Louis, MO, CV Mosby, 1990;65.

• Parameters of Care for The American College Prosthodontists.

J Prosthod 1996;5:3-71.

• Kolb HR. Variable denture-limiting structures of the

edeutulous mouth. Mandibular border areas. J Prosthet
Dent.1966;16:202-212.
• Pendleton EC: The anatomy of the maxilla from the point of
view of full denture prosthesis.J Am Dent Assoc 1932;19:543-
572.

• Tilton GE: The denture periphery. J Prosthet Dent 1952;2:290-

306.

• DeVan MM. Basic principles in impression making. J Prosthet

Dent 1952;2:26-35.

• Randall D,Mazurat, Nita M,Mazurat. Communicating

Complexity:Using a Diagnostic Classification System for
Edentulous Patients. J Can Dent Assoc 2003; 69(8):511–514