Classification systems for partially edentulous arches

Classification systems for partially edentulous arches
Cummer (1920)
Kennedy (1923)
Bailyn (1928)
Mauk (1942)
Neurohr (1939)
Wild (1949)
Godfrey (1951)
Beckett (1953)
Friedmann (1953)
Craddock (1954)
Austin & Lidge (1957)
Skinner (1957)
Watt (1958)
Applegate – Kennedy (1960)
Avant (1960)
Costa (1974)
Fiset (1973)
Fábián & Fejérdy (1979)
Osborne Lammine ( 1979)
Misch & Judy
ACP-PDI (2002)
Naeem & Basheer (2004)
Arbabi et al (2007)
ICK- Al Johany (2008)

1. GOOD MORNING

2. CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES DR. EAKETHA LOKESH PG 2 nd YEAR DEPT: OF PROSTHODONTICS

3. CONTENTS Introduction Need for classification Requirements of classification Different systems of classification Conclusion References 3 Dr. Eaketha Lokesh

4. McGarry TJ, Nimmo A, Skiba JF, et al: Classification system for partial edentulism . J Prosthodont 2002;11:181-193 4 Dr. Eaketha Lokesh

5. Various types of edentulous situation or partial edentulism is seen . Edentulism means state of being without teeth or lacking teeth. There may be loss of one or more teeth but not all the teeth in partially edentulous or semi edentulous situation. INTRODUCTION 5 Dr. Eaketha Lokesh

6. Unless and until actual case or a cast is seen, one will not know exactly how many teeth and also which teeth are missing. These various partially edentulous situations are difficult for remembering and memorization. Therefore a system of classification is required which will help to group or specify the situation and design them in such a way, so as to give the exact idea of the missing tooth. 6 Dr. Eaketha Lokesh

7. The primary purpose of creating a classification system for partially edentulous arches is to enable the dentist to clearly communicate to a listener or reader , the condition of oral cavity in which missing teeth are to be replaced with a prosthesis. 7 Dr. Eaketha Lokesh

8. Several classifications have been proposed and in use but a method which best classifies all possible configuration is still not achieved. 8 Dr. Eaketha Lokesh

9. Need For Classification To formulate a good treatment plan. To anticipate the difficulties commonly to occur for particular design. To communicate with professionals. To design the denture according to occlusal load usually expected for a particular group . 9 Dr. Eaketha Lokesh

10. REQUIREMENTS OF CLASSIFICATION 10 Dr. Eaketha Lokesh

11. EVOLUTION OF DIFFERENT SYSTEMS OF CLASSIFICATION Cummer (1920) Kennedy (1923) Bailyn (1928) Mauk (1942) Neurohr (1939) Wild (1949) Godfrey (1951) Beckett (1953) Friedmann (1953) Craddock (1954) Austin & Lidge ( 1957) Skinner (1957 ) Watt (1958) Applegate – Kennedy (1960 ) Avant (1960) Costa (1974) Fiset (1973 ) Fábián & Fejérdy (1979) Osborne Lammine ( 1979) Misch & Judy ACP-PDI (2002 ) Naeem & Basheer (2004) Arbabi et al (2007) ICK- Al Johany (2008) 11 A number of classifications have put forward some have been over simplified and others are immensely complex. Dr. Eaketha Lokesh

12. One simple system classifies the prosthesis according to the type of support they receive from dental arch. Soft tissue supported Tooth supported Tooth- stissue supported 12 Dr. Eaketha Lokesh

13. DEMERITS There are many possible variations of tooth tissue supported partial denture that is simplified This does not adequately describe the design that must be considered. Therefore this system is not suited for general use in discussing ,identifying or planning the prosthesis. 13 Dr. Eaketha Lokesh

14. CUMMERS CLASSIFICATION SYSTEM ( 1920) First recognized classification by the professional Based on the relationship of the edentulous spaces to the abutment teeth Based on the number and position of the DIRECT RETAINER Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 14 Dr. Eaketha Lokesh

15. His mathematical computations indicated that there are some 65,534 possible combinations of teeth present and missing in the dental arch. Cummer believed that “the possible combinations and their classifications had a particular relevance to partial denture design and that a good classification system would immensely simplify the development of sound and universally applicable design principles”. 15 Miller E.L. System for classifying partially edentulous arches. J Prosthet Dent 1970; 24(1):25-40 SS Dr. Eaketha Lokesh

16. Class I – A partially dentulous arch in which two diagonally opposite teeth are chosen as an abutment for the attachment of direct retainers with an indirect retainer. Class II – A partially dentulous arch in which two diametrically opposite teeth are chosen as abutment for the attachment of the direct retainers with an indirect retainer. 16 Dr. Eaketha Lokesh

17. Class III – A partially dentulous arch in which one or more teeth on the same side are chosen as abutment for the attachment of the direct retainers with or without an indirect retainer. Class IV – A partially dentulous arch in which three or more teeth are chosen as abutment for the attachment of the direct retainers (Triangular or Quadrilateral) 17 Dr. Eaketha Lokesh

18. MERITS Helps in design Allows analysis of support available DEMERITS Edentulous area has no representation No . or class of teeth not elaborated 18 Dr. Eaketha Lokesh

19. KENNEDY'S SYSTEM In 1923, Dr. Kennedy's  system based on the relationships of the edentulous spaces to abutment teeth. 19 Dr. Eaketha Lokesh

20. Class I – Bilateral edentulous regions located posterior to the remaining teeth. Class II – Unilateral edentulous region posterior to the remaining teeth. 20 Dr. Eaketha Lokesh

21. Class III – Unilateral edentulous region bounded anteriorly and posteriorly by natural teeth. Class IV – Single bilateral edentulous region anterior to the remaining teeth, crossing the midline 21 Dr. Eaketha Lokesh

22. Advantages of Kennedy’s System Permits immediate visualization of the partially edentulous arch Permits a logical approach to the problems of design It makes possible the application of sound principles of partial denture design Differentiates between bounded & free end saddles 22 Dr. Eaketha Lokesh

23. DEMERITS Edentulous areas have no individual representation No . of teeth missing in modification spaces & condition of abutment teeth not elaborated upon 23 Dr. Eaketha Lokesh

24. Class I arches being the most common and class IV being the least common Class I partial denture is designed as tooth-tissue supported prosthesis . Class III as wholly tooth supported partial denture . Class II as combination of I and III partly tooth tissue supported and partly tooth supported. 24 Dr. Eaketha Lokesh

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26. APPLEGATE- KENNEDY CLASSIFICATION (1960) Class V – An edentulous area bounded anteriorly and posteriorly by natural teeth , but in which the anterior abutment is not suitable for support . 26 Dr. Eaketha Lokesh

27. APPLEGATE- KENNEDY CLASSIFICATION Class VI – An edentulous situation in which the teeth adjacent to the space are capable of total support of the required prosthesis. 27 Dr. Eaketha Lokesh

28. APPLEGATE RULES Classified partially edentulous arches based on Kennedy's classification. Any teeth require extraction it should be done prior to classification. Applegate has given 8 rules as follows 28 Dr. Eaketha Lokesh

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30. 30 Dr. Eaketha Lokesh

31. BAILYN CLASSIFICATION (1928) Dr. Charles M Bailyn Based on whether the prosthesis is tooth borne ,tissue borne and combination of the two that is based on support . Bailyn divided all removable partial dentures into anterior restoration and posterior restoration using the letters a and p . Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 31 Dr. Eaketha Lokesh

32. A - Anterior restorations where there are saddle areas (denture bases) anterior to the first bicuspid (premolar). P -Posterior restoration saddle areas (denture bases) posterior to canine. 32 Dr. Eaketha Lokesh

33. Further they are subdivided into :- Class I - BOUNDED SADDLE (Abutment teeth present at each extremity of a saddle area representing a span of not more than three teeth. Class I – Abutment teeth present at each extremity of a saddle area representing a span of not more than three teeth. Class II – Tooth support at one extremity only of the saddle area. Class III – Tooth support at both extremities of the saddle area representing a span of more than three teeth. 33 Dr. Eaketha Lokesh

34. Class II - FREE END SADDLE (there is no distal abutment). Class III – BOUNDED SADDLE (more than 3 teeth missing). 34 Class II Class III Dr. Eaketha Lokesh

35. 35 Class P.I Class P.II Class P.III Posterior edentulous region between two available abutments, not more than three teeth distant from each other Edentulous (bilateral) regions posterior to the cuspids with one available abutment for each denture-base area An edentulous region, with at least three teeth posterior to the cuspid with a distal abutment Dr. Eaketha Lokesh

36. Class A.III. – an edentulous space anterior to the first bicuspid with b/w two teeth, which might be available as abutments, more than three teeth distant from each other. 36 Miller E.L. System for classifying partially edentulous arches. J Prosthet Dent 1970; 24(1):25-40 Dr. Eaketha Lokesh

37. Class A.I.P. II – One of the two edentulous areas is anterior to the first bicuspid and between two available abutments <3 teeth distant from each other, the other edentulous space being posterior to the cuspid with only one tooth available as abutment. 37 Dr. Eaketha Lokesh

38. Class P.I.P. II – Both edentulous spaces are posterior to the cuspids ; one with only one tooth available for anchorage, the other with two available teeth separated by a distance of <3 teeth. 38 Dr. Eaketha Lokesh

39. Class A.I.P. III – It has three edentulous spaces. anterior to the first bicuspid with two available anchor teeth separated by a distance of <3 teeth another posterior to the cuspid with only one tooth available for anchorage third one posterior to the cuspid with two teeth available for abutments separated by <3 teeth 39 Dr. Eaketha Lokesh

40. MERITS First to emphasize the importance of support to partial denture by the remaining tissue DEMERITS Does not give immediate visualization of partially edentulous arch No representation of individual teeth involved 40 Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 Dr. Eaketha Lokesh

41. Neurohr's classification (1939) 41 Neurohr , in his textbook, devoted an entire chapter to the subject of classification of partially dentulous jaws (Figs. 5, 6, and 7). He described the difficulties in communication which he frequently experienced as lecturer and clinician when a specific partial denture situation was discussed. Although Neurohr sought to simplify the classification process, the system which he proposed is, by any standard, one of the most complex of all those reviewed. The literature contains little reference to it, and from all available evidence, it is little used at present. Dr. Ferdinand Neurohr * not commonly used due to its complexity . Dr. Eaketha Lokesh

42. Class I – Tooth bearing. A partial denture situation falls under this classification when there are teeth posterior to all spans, and when there are no more than four teeth missing in any space. Class I-A - when there are teeth posterior to all spans, and when there are no more than four teeth missing in any space. Class I-B- Posterior teeth are missing, and anterior teeth are in place. Class I-C- Posterior teeth are missing, and some anterior teeth are missing. Class I-D- Anterior teeth are missing, and posterior teeth are in place. 42 Dr. Eaketha Lokesh

43. 43 Dr. Eaketha Lokesh

44. Class II – Tooth and tissue bearing . A partial denture situation falls under this classification when there are no teeth missing posterior to one or more spans, or when there are more than four teeth in one or more spans . Class II-A - Posterior teeth are missing, and anterior teeth are in place. Class II-B - Posterior teeth are missing, and some anterior teeth are missing. Class II-C - Anterior teeth are missing, and some posterior teeth are missing. 44 Dr. Eaketha Lokesh

45. 45 Dr. Eaketha Lokesh

46. Class II Div. II Teeth posterior to all spans, but there are more than four teeth (including a cuspid ) in one or more spans . ( A) Posterior teeth and some anterior teeth are missing. ( B) Anterior teeth are missing, but the posterior teeth are in place. ( C) Anterior and posterior teeth are missing. 46 Dr. Eaketha Lokesh

47. 47 Dr. Eaketha Lokesh

48. MERITS DEMERITS Complexity Does not provide the location of edentulous span- side, quadrant, etc. No representation of individual teeth 48 Classifies on the basis of length of span, hence provides an idea about support required. Defines the dominant edentulous area of concern Dr. Eaketha Lokesh

49. Mauk's classification (1941) Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 49 Dr. Edwin. H. Mauk Based on studies conducted on over 100  Dr. Eaketha Lokesh

50. Class I – Bilateral posterior spaces and teeth remaining in a segment in the anterior region. Class II – Bilateral posterior spaces and one or more teeth at the posterior end of one space. Class I Class II 50 Dr. Eaketha Lokesh

51. Class III – Bilateral posterior spaces and one or more teeth at the posterior end of both spaces. Class IV – Unilateral posterior space with or without teeth at the posterior end of the space. The arch is unbroken on the opposite side. 51 Class III Class IV Dr. Eaketha Lokesh

52. Class V – Anterior space only. The posterior part of the arch is unbroken on either side. Class VI – Irregular spaces around the arch. The remaining teeth are single or in small groups 52 Class V Class VI Dr. Eaketha Lokesh

53. MERITS DEMERITS No clear representation with respect to multiple edentulous spans(CLASS-VI ??) No . of teeth missing per span not described No representation of individual teeth involved 53 Differentiates between unilateral v/s bilateral, tooth supported v/s tooth-tissue supported edentulous spans. Dr. Eaketha Lokesh

54. Wild's classification (1949 ) Proposed a simple, yet self- explanatory classification 54 Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 Dr. Eaketha Lokesh

55. 55 Class I – Interruption of the dental arch (bounded) Class II – Shortening of the dental arch Class III – Combination of 1 and 2 Dr. Eaketha Lokesh

56. Godfrey's classification (1951) Proposed in 1951 by Dr.R.J . Godfrey as was being implemented by him at the time at the University of Toronto Based on the location and extent of the edentulous spaces. i.e ; tooth- borne, mucosa-borne, anterior or posterior Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 56 Dr. Eaketha Lokesh

57. 57 Dr. Eaketha Lokesh

58. Class A – tooth-borne denture bases in the anterior part of the mouth . It may be an unbroken five-tooth space broken five-tooth space unbroken four-tooth space. 58 Dr. Eaketha Lokesh

59. Class B – Mucosa-borne denture bases in the anterior of the arch . It may be an unbroken six-tooth space unbroken five-tooth space broken five tooth space. 59 Dr. Eaketha Lokesh

60. Class C – Tooth-borne denture bases in the posterior part of the arch . It may be an unbroken three-tooth space broken three-tooth space unbroken two-tooth space broken two-tooth space. 60 Dr. Eaketha Lokesh

61. Class D – Mucosa-borne denture bases in the posterior part of the mouth. It may be an unbroken four-tooth space or a three-tooth, two-tooth, or single-tooth space 61 Dr. Eaketha Lokesh

62. MERITS DEMERITS No description provided with regard to unilateral /bilateral edentulous situation Quadrant wise location not provided No representation of no. or type of teeth missing in the edentulous span 62 Differentiates between anterior and supported edentulous spans Dr. Eaketha Lokesh

63. Beckett's classification (1953)   Dr.Leonard S.Beckett Based on the load distribution of the individual component saddles of the partial denture . Inspired by Bailyn’s classification,i.e , kind of support available for the saddle. 63 Dr. Eaketha Lokesh

64. Class I – saddles (denture bases) which are tooth-borne. 64 Dr. Eaketha Lokesh

65. Class II – saddles (denture bases) which are mucosa-borne. Two types: all free end saddle , bounded saddle where the length of the saddle or condition of the abutment teeth contraindicates a tooth-borne saddle . 65 Dr. Eaketha Lokesh

66. Class III – inadequate abutments to support the saddle (denture base) and probably inadequate mucosa support. 66 Dr. Eaketha Lokesh

67. Dr. Beckett states, “. . . these three basic classes of saddles frequently appear in combination. Thus , there are dentures which would contain both Class 1 and Class 2 denture bases - designated Class 1.2 dentures . 67 Dr. Eaketha Lokesh

68. In a similar way, there are Class 1.3 dentures, Class 2.3 dentures, and Class 1.2.3 dentures. Therefore , partial dentures can be classified into seven groups from a functional point of view .” 68 Dr. Eaketha Lokesh

69. MERITS DEMERITS Anteroposterior location of saddle not specified. specified. Quadrant wise location not provided. No representation of exact no. or type of teeth missing in the teeth missing in the edentulous spans 69 Kind of support, quality of support specified for every individual edentulous span. Dr. Eaketha Lokesh

70. Friedman's classification (1953) Dr.Joel Freidman Based on three essential segment types occurring either as discrete or continuous segments . 70 Dr. Eaketha Lokesh

71. A – An anterior space (i.e., one or more of the six anterior teeth). B – a bounded posterior space. C – Refers to a cantilever situation or a posterior free end space. D - C-A-B spaces 71 Dr. Eaketha Lokesh

72. Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 72 Dr. Eaketha Lokesh

73. MERITS DEMERITS Location of saddle not specified from quadrant/unilateral-bilateral quadrant/unilateral-bilateral point of view. view. No representation of exact no. or type of teeth missing in the of teeth missing in the edentulous spans 73 Simplicity Dr. Eaketha Lokesh

74. Craddock's classification (1954 ) Dr. William H Craddock Based on the support. Class I, II, III Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 74 Dr. Eaketha Lokesh

75. 75 Class I – saddle supported at both ends by substantial abutment teeth Class II – vertical biting forces applied to denture insisted entirely by soft tissue Class III – tooth supported at only one end of the saddle Dr. Eaketha Lokesh

76. MERITS DEMERITS No light is shed upon the anteroposterior location, quadrant or jaw 76 Classifies the kind of support available on either side of a saddle Dr. Eaketha Lokesh

77. Austin And Lidge Classification Dr.Karl P. Austin Dr . Eduard F. Lidge Based on the position of edentulous space . Pointed out 65,000 possible combinations “A” designates anterior spaces “P” designates posterior spaces “Bi” designates bilateral Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 77 Dr. Eaketha Lokesh

78. Class A – Missing anteriors A1 : Missing anteriors on one side only A2 : Missing anteriors on both right and left sides. 78 Dr. Eaketha Lokesh

79. Class  P  – Missing posteriors P1 : Missing posteriors on one side. Unilateral construction. P2 : Posterior teeth are missing on both right and left sides. 79 Dr. Eaketha Lokesh

80. P1Bi: Missing posterior on one side, with bilateral construction. 80 Dr. Eaketha Lokesh

81. Class AP – Missing anterior and posteriors. A1P1: Anterior and posterior teeth are missing on one side only 81 Dr. Eaketha Lokesh

82. Austin & Lidge suggest that, if desired, an X might be used to designate a free-end denture base . Thus , a partial denture situation wherein a lower lateral incisor and all posterior teeth missing on both sides ( posterior to the second bicuspids ) could be designated as A1 P2 X2 . 82 Dr. Eaketha Lokesh

83. MERITS DEMERITS Quadrant not defined No representation of exact no. or type of teeth missing in the teeth missing in the edentulous spans 83 First to classify in a unilateral v/s bilateral perspective with respect to antero -posterior edentulous spans. Provision for visualization of the general edentulous span location. Dr. Eaketha Lokesh

84. Watt's classification (1958) Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 84 Entirely tooth-borne Entirely tissue borne partially tooth and tissue -borne By Watt et al Dr. Eaketha Lokesh

85. Skinner's classification (1957) Dr. C.N. Skinner  Based on the relationship of the abutment to the residual alveolar ridge . He stated that “ the value of RPD – directly related to the quality & degree of support which it receives from the abutment teeth & the residual ridge ” 85 Miller E.L. System for classifying partially edentulous arches. J Prosthet Dent 1970; 24(1):25-40 Dr. Eaketha Lokesh

86. Class I – abutment teeth located both anterior and posterior to the denture base, and the spaces may be unilateral or bilateral. Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 86 Dr. Eaketha Lokesh

87. Class II – All teeth are posterior to the denture base which functions as a partial denture unit (may be unilateral or bilateral ) Class III – All abutment teeth are anterior to the denture base which functions as a partial denture base and may occur unilaterally or bilaterally. 87 Dr. Eaketha Lokesh

88. Class IV – Denture bases are located both anterior and posterior to the remaining teeth, and these may be unilateral or bilateral. Class V – Abutment teeth are unilateral in relation to the denture base 88 Dr. Eaketha Lokesh

89. MERITS DEMERITS Quadrant not defined No representation of exact no. or type of teeth missing in the teeth missing in the edentulous spans 89 Defines the relation of the abutment teeth to the edentulous space in an anteroposterior and saggital plane, providing an idea about the support available. Dr. Eaketha Lokesh

90. Swenson's classification Dr. Swenson et al (1963) Described in the textbook authored by Terkla and Laney in 1955 Based on logical reasoning . 90 Dr. Eaketha Lokesh

91. The 4 primary classes represent only slight modifications of the Kennedy system , whereas the modification of these 4 primary classes are changed more dramatically. 91 Dr. Eaketha Lokesh

92. Class I – An arch with one free-end denture base. Class II – An arch with two free-end denture bases. 92 Dr. Eaketha Lokesh

93. Class III – An arch with an edentulous space posteriorly on one or both sides of the mouth but with teeth presents anteriorly and posteriorly to each space. Class IV – An arch with an anterior edentulous space and with five or more anterior teeth missing. 93 Dr. Eaketha Lokesh

94. Class I A – An arch with one free end base and one or more missing anterior teeth. Class II A – Basic Class II with an anterior space. Class IV P – Basic Class IV with a posterior space 94 Dr. Eaketha Lokesh

95. MERITS DEMERITS Criteria for dominant and subdivided edentulous space not edentulous space not described No representation of exact no. or type of teeth missing in the of teeth missing in the edentulous spans . 95 Classifies on the basis of support available and allows for anteroposterior design to be visualised Dr. Eaketha Lokesh

96. Avant's classification (1960) Based on the position of the edentulous space on the anterior and posterior segments of the arch. Class I – replaces one or more posterior teeth on one side of the arch mesial to the most distal abutment. Avant WE. A universal classification for removable partial denture situations. J Prosthet Dent 1966;16:533-9. 96 Dr. W.E.Avant Dr. Eaketha Lokesh

97. Class I  F  – Replaces one or more posterior teeth on both sides of the arch terminating a free end. Three minor notations are possible with class I F . “a”-anterior segment, “ p”–posterior segment, “ ap ”-both segments. F– means free end 97 Dr. Eaketha Lokesh

98. Class II – Replaces one or more posterior teeth on both sides of the arch mesial to the most distal abutment tooth on both sides. Class II  F  – Replaces one or more posterior teeth on both sides of the arch terminating in free ends on both sides . 98 Dr. Eaketha Lokesh

99. Class III – Replaces one or more anterior teeth. Class I-F-a - Class I-F situation with anterior teeth being replaced also 99 Dr. Eaketha Lokesh

100. MERITS DEMERITS Memory dependant;complexity . No representation of exact no. or type of teeth missing in the of teeth missing in the edentulous spans 100 Provides a significant idea of the primary edentulous area of concern. Combines the abutment location aspect with support available .. Dr. Eaketha Lokesh

101. Costa's classification Dr . Charles. E. Costa  in 1974 described the existing edentulous condition as anterior, lateral and terminal . Anterior – Edentulous space located in the ant: part Lateral - Edentulous space bounded mesially and distally by remaining teeth. Terminal - Edentulous space with no remaining teeth distal to it. 101 Dr. Eaketha Lokesh

102. Fiset's classification In 1973, Dr.Jacques Fiset  used Applegate–Kennedy system . Added 4 additional classes &made AKS to 10 classes . Class VII – An edentulous situation in which all the remaining teeth are located on one side of the arch . The fulcrum line is rather compatible with the action of physiologic forces. 102 Dr. Eaketha Lokesh

103. Class VIII – An edentulous situation in which only one or two remaining teeth are located at either anterior corner of the arch. The fulcrum line is rather incompatible with the action of physiologic forces. 103 Dr. Eaketha Lokesh

104. Class IX – An edentulous situation in which functional and cosmetic requirements and the magnitude of inter- occlusal distance require the use of a telescoped prosthesis. Remaining teeth are capable of total or partial support. 104 Dr. Eaketha Lokesh

105. Class X – An edentulous situation in which the remaining teeth are incapable of any support . If the teeth are kept to maintain alveolus integrity, the arch must be restored with an OVERDENTURE which is a complete denture supported primarily by the denture foundation area. 105 Dr. Eaketha Lokesh

106. MERITS DEMERITS Edentulous areas have no individual representation. representation. Concept of modification spaces not involved. Individualised representation of teeth missing/present not available . 106 Adds to Kennedy’s & Applegate’s system with regard to large partially edentulous situations such as those resulting from maxillofacial trauma, congenital defects, generalised periodontal compromise etc. Dr. Eaketha Lokesh

107. Osborne's classification (1979) Osborne Lammine in 1979 classification includes Class I – Mucosa borne Class II – Tooth borne Class III – combination of mucosa and tooth-borne. 107 Dr. Eaketha Lokesh

108. Fábián & Fejérdy Classification (1979) Based on: Position of remaining teeth in the arch No . of occlusal contacts Torquing * movement on constructed denture -Enhances treatment planning and denture design procedures ( Torque- / tɔːk /-rotatory force resulting from the vertical component of the occlusal load acting on a prosthesis; GPT-9) 108 Dr. Eaketha Lokesh

109. CLASS I Completely tooth supported edentulous spans Torquing movement on occlusal / incisal surface of denture teeth CLASS 1A One or more fulcrum lines based on the no. of tooth bound edentulous spaces No additional secondary abutments needed CLASS 1B Moderate torquing effects require utilisation of secondary abutments Fulcrum line created outside of pontic space due to arch configuration/span 109 Dr. Eaketha Lokesh

110. CLASS II A CLASS II B Tooth & tissue supported longer spans Longer bounded saddles or short free end saddles Structural modifications to prevent fulcral rotation indespensable Primarily tissue and secondarily tooth supported edentulous spans 110 Dr. Eaketha Lokesh

111. Class III Denture exhibits movement in more than one directions about more than one axis Large amount of tissue support derived Extended edentulous areas with lesser teeth remaining than missing and located diagonally Mostly telescopic in design Indirect retention impossible plan hence complete coverage desired 111 Dr. Eaketha Lokesh

112. MERITS DEMERITS Edentulous areas have no individual representation wrt location/tooth representation wrt location/tooth type/no. of teeth/etc. 112 First and only classification to categorize based on the kind of forces acting on the denture as a consequence of the no. and location of missing teeth. Contributes functionally to treatment planning and denture design procedures Dr. Eaketha Lokesh

113. Arbabi , A hmadian and Sharifi Classification Rasoul Arbabi , Leila Ahmadian & E smaeel Sharifi (2007) They attempted to provide a simpler classification of partially edentulous arches while considering most of Kennedy’s and all of Applegate’s rules in this system. 113 Arbabi et al. A simplified classification system for partial edentulism : A theoretical explanation JIPS 2007;7(2) : 85-87 Dr. Eaketha Lokesh

114. Based on NUMERICAL CODES Enable quick visualization of the partial edentulous arch. 114 Arbabi et al. A simplified classification system for partial edentulism : A theoretical explanation JIPS 2007;7(2) : 85-87 Dr. Eaketha Lokesh

115. 6 Rules of this Numerical system An edentulous area is coded from the right to the left The code “0” shows the midline A distal extended area is denoted by the code “ 1” A tooth-supported edentulism is illustrated by the code “ 3” The code “4” indicated a tooth supported edentulism that crossing the midline The code “5” is used to illustrate distal extended edentulism that crosses the midline. 115 Dr. Eaketha Lokesh

116. 116 Arbabi et al. A simplified classification system for partial edentulism : A theoretical explanation JIPS 2007;7(2) : 85-87 Dr. Eaketha Lokesh

117. 117 Arbabi et al. A simplified classification system for partial edentulism : A theoretical explanation JIPS 2007;7(2) : 85-87 Thus, if Kennedy’s class II rule is being used to represent a unilateral distal extension located on the left side of the arch, the code “01” is used to describe the existing state of edentulism according to our classification system Kennedy’s Class II – Unilateral distal extension – left side code “01” Dr. Eaketha Lokesh

118. 118 Code: 101 Code: 05 Code: 103 Code: 4 Dr. Eaketha Lokesh

119. Potential benefits of the system Determination of the position of the edentulous area in the arch with respect to the midline Simplified imagination of the partial edentulous arch Improved professional communication Facilitated data transformation from the edentulous arch to the computer 119 Arbabi et al. A simplified classification system for partial edentulism : A theoretical explanation JIPS 2007;7(2) : 85-87 In this system, all of Applegate’s classifi cation rules have been considered. There was no conflict between Kennedy’s classifi cation and our system. Dr. Eaketha Lokesh

120. ACP CLASSIFICATION SYSTEM (2002) American College of Prosthodontist (ACP) developed a classification systemin 1999 & published in 2002 for partially edentulous patients based on clinical criteria 120 Loto Adolphus Odogun ., et al. “A Newly Proposed Quantitative Codification of the Principles of Classification Partial Edentulism ”. EC Dental Science 18.6 (2019): 1091-1103. Dr. Eaketha Lokesh

121. 121 6 1 2 3 4 5 Dr. Eaketha Lokesh

122. 122 The most high-graded criteria establishes the class of the case  Extra aesthetic requirements increase the complexity of the class (for class 1 & 2 for every criteria)  If temporo -mandibular disorder is present this also increases the complexity of the class (for class 1 & 2 for every criteria).  If the maxillary arch is completely edentulous and the mandibular one partially edentulous than each one is considered in its own classification system. Dr. Eaketha Lokesh

123. Additional guidelines to assist the consistent application of the classification Consideration of future treatment procedures must not influence the decision as to which diagnostic level to place the patient in. Initial pre-prosthetic treatment and/or adjunctive therapy can change the initial classification level . The classification may need to be re-assessed after the removal of existing prostheses . 123 Dr. Eaketha Lokesh

124. 3. Esthetic concerns or challenges raise the classification in complexity by one level in Class I and II patients . 4. In the presence of TMD symptoms , the classification is increased in complexity by one or more levels in Class I and II patients 5. Periodontal health is intimately related to the diagnosis and prognosis for partially edentulous patients. For the purpose of this system , it is assumed that patients will receive periodontal therapy to achieve and maintain periodontal health so that prosthodontic care can be accomplished. 124 Dr. Eaketha Lokesh

125. 6. 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. In this situation, the maxilla would be classified according to the complete edentulism classification system and the mandible according to the partial edentulism classification system . A single exception to this rule is when the patient presents with an edentulous mandible opposed by a partially edentulous or dentate maxilla. This clinical situation presents significant complexity and long-term morbidity and as such, should be diagnosed as a Class IV in either system . 125 Dr. Eaketha Lokesh

126. MERITS DEMERITS Edentulous areas have no individual representation wrt location/too th 126 Provides a clear clinical description of the quality of support(tooth/tissue), condition of the edentulous foundation, state of occlusion, etc. Demarcates between shorter and longer edentulous spans hence classifying the kind of support required. Dr. Eaketha Lokesh

127. Misch and Judy Classification Recently , Misch and Judy described a classification system depending on the Applegate–Kennedy system, with emphasis on the available bone in the edentulous area for implant placement . Their classification involves four divisions : Al- Johany and Andres. Classification system for RPD’s with Implants. J Prosthodont 2008; 17: 502-507. 127 Dr. Eaketha Lokesh

128. Divisions A and B when bone is available for implant placement, Division C when bone is not available for implant placement, Division D , restricted to cases with severe atrophy of the edentulous area involving basal bone. 128 Dr. Eaketha Lokesh

129. Implant-corrected Kennedy (ICK) classification Implants with or without attachments can be used to improve the support, stability, and retention of an RPD. The esthetic result of the RPD can be greatly improved by the use of implant attachments , thus eliminating unesthetic clasps . With the use of implants , the options for RPD use have increased, and the high demands of many patients for esthetic prostheses have been satisfied Al- Johany and Andres. Classification system for RPD’s with Implants. J Prosthodont 2008; 17: 502-507. 129 Dr. Eaketha Lokesh

130. Implant-corrected Kennedy classification In 2008, Al- Johany and Andres described the situations without implants, and then the implant-corrected classification can be used to describe the situation with implants. Al- Johany and Andres. Classification system for RPD’s with Implants. J Prosthodont 2008; 17: 502-507. 130 Dr. Eaketha Lokesh

131. Guidelines for the New Classification System No edentulous space will be included in the classification if it will be restored with an implant-supported fixed prosthesis. To avoid confusion, the maxillary arch is drawn as half circle facing up and the mandibular arch as half circle facing down . The drawing will appear as if looking directly at the patient; the right and left quadrants are reversed . 131 Dr. Eaketha Lokesh

132. 3. The classification begins with the phrase “Implant-corrected Kennedy (Class)” followed by the description of the classification It can be abbreviated as follows : ( i ) ICK I, for Kennedy class I situations, (ii) ICK II, for Kennedy class II situations, (iii) ICK III, for Kennedy class III situations, and (iv) ICK IV, for Kennedy class IV situations. 132 Dr. Eaketha Lokesh

133. 4. The abbreviation “max” for maxillary and “man” for mandibular can precede the classification. The word modification can be abbreviated as “mod.” 5. Roman numerals will be used for the classification , and Arabic numerals will be used for the number of modification spaces and implants . 6. The tooth number using the American Dental Association ( ADA ) system is used to give the number and exact position of the implant in the arch. ( Note : other tooth numbering systems such as F´ed´eration Dentaire Internationale [ FDI ] can be used, as can the tooth name . The ADA system was used by the authors because of familiarity ). 133 Dr. Eaketha Lokesh

134. 7. The classification of any situation will be according to the following order: main classification first , then the number of modification spaces , followed by the number of implants in parentheses according to their position in the arch preceded by the number sign (#). 8. The classification can be used either after implant placement to describe any situation of RPD with implants , or before implant placement to indicate the number and position of future implants with an RPD . 9. A different name , ICK Classification System , is given to this classification system to be differentiated from other partially edentulous arch classification systems. Al- Johany and Andres. Classification system for RPD’s with Implants. J Prosthodont 2008; 17: 502-507. 134 Dr. Eaketha Lokesh

135. Eg ; for Kennedy’s Class I (ICK-I) ICK I (#2, 15) ICK I (# 2) ICK I (#18,22,31) 135 Dr. Eaketha Lokesh

136. ICK -I with Modifications 136 Dr. Eaketha Lokesh

137. ICK II (#2) Eg ; for Kennedy’s Class II (ICK-II) & MODIFICATIONS ICK II (# 2,7) ICK II Mod 2 (#24,29) ICK II Mod 1 (# 21,26,30) 137 Dr. Eaketha Lokesh

138. Eg ; ICK - III with Modifications ICK III (#6) ICK III Mod 1 (#6,11) ICK III mod 3 (#23,26 ) 138 Dr. Eaketha Lokesh

139. Eg ; ICK - IV ICK IV (# 6,11) ICK IV (#19,22) Al- Johany and Andres. Classification system for RPD’s with Implants. J Prosthodont 2008; 17: 502-507. 139 Dr. Eaketha Lokesh

140. It means that the classification can be used either retrospectively to describe an existing situation, or prospectively for future planning. 140 Dr. Eaketha Lokesh

141. Emphasis should be made about using the new classification system only when implants are incorporated with an RPD , not to be confused with the original classification without implants . Al- Johany and Andres. Classification system for RPD’s with Implants. J Prosthodont 2008; 17: 502-507. 141 Dr. Eaketha Lokesh

142. ADVANTAGES OF ICK CLASSIFICATION The presented classification is simple and easy to visualize , but needs practice for familiarization. A software program (Dental Flash, Attachments International , San Mateo, CA) can be used to assist in drawing and designing any classification, and printing the design cleanly . 142 Dr. Eaketha Lokesh

143. DRA W BACKS OF ICK CLASSIFICATION The classification will be difficult for individuals who are unfamiliar with the Kennedy classification . Information is provided about the location and the number of the implants, but not the quality of the bone. 143 Dr. Eaketha Lokesh

144. Naeem & Basheer Classification (2014) Proposed in 2014 by Naeem A & Basheer T Based on location of missing teeth Notations used– Maxillary( Mx ), Mandibular( Md ), Left(L), Right(R), Numbering 1,2,3… – for Incisors, canine etc. Class denoted by roman numerals , type by arabic . Tooth missing other than the classification denoted thereafter. 144 Dr. Eaketha Lokesh

145. CLASS I Type 1-Both 2nd molar’s missing ( M2) Type 2-All molar’s missing (M2, M1) Type 3-All molar’s, 2nd pre-molar missing (M2, M1, PM2) Type 4-All posterior teeth missing (M2, M1, PM2, PM1) Type 5-All posterior teeth + any anterior tooth missing (M2, M1, PM2, PM1, Ant.) 145 Dr. Eaketha Lokesh

146. CLASS II Type 1-Unilateral 2nd molar missing ( M2) Type 2-Unilateral both molar’s missing (M2, M1) Type 3-Unilateral both molar’s, 2nd pre-molar missing (M2, M1, PM2) Type 4-Unilateral all posterior teeth missing (M2, M1, PM2, PM1) Type 5-Unilateral all posterior teeth missing +any anterior tooth (M2, M1, PM2, PM1, Ant.) 146 Dr. Eaketha Lokesh

147. CLASS III Type 1-Unilateral 2nd molar missing ( M2) Type 2-Unilateral 2nd molar, 1st molar missing ( M2,M1) Type 3-Unilateral 2nd molar, 1st molar, 2nd premolar missing (M2, M1, PM2) Type 4-Unilateral 2nd molar, 1st molar, both premolars missing (M2, M1, PM2, PM1) Type 5- Unilateral 2nd molar, 1st molar, both premolars missing + any anterior tooth (M2, M1, PM2, PM1, Ant.) 147 Dr. Eaketha Lokesh

148. CLASS IV Type 1-Bilateral central incisor missing ( CI) Type 2-Bilateral incisor missing (I) Type 3-Bilateral anterior missing (I,C) Type 4-Bilateral anterior, 1st premolar missing (I, C,P) Type 5-Bilateral anterior, both premolars missing(I, C, P) Type 6-Bilateral anterior, both premolar, 1st molar missing (I, C, P, M1) 148 Dr. Eaketha Lokesh

149. 149 Mx , Class-I,Type-1,L 5 Mx , Class-II,Type-1R,L 5 Mx , Class-III,Type-2R,L 5 Mx , Class-I,,L 1,1 Dr. Eaketha Lokesh

150. MERITS DEMERITS Complexity requires memory based analysis. No information retrieved regarding periodontal status of periodontal status of abutments/general soft tissue structure 150 Only classification to specify the tooth type, quadrant, no. of teeth involved in the partially edentulous state. Gives invidualised reference to every variety of support vs space situation Dr. Eaketha Lokesh

151. 151 Dr. Eaketha Lokesh

152. 152 Dr. Eaketha Lokesh

153. 153 Dr. Eaketha Lokesh

154. 154 Loto Adolphus Odogun ., et al. “A Newly Proposed Quantitative Codification of the Principles of Classification Partial Edentulism ”. EC Dental Science 18.6 (2019): 1091-1103. Dr. Eaketha Lokesh

155. 155 Dr. Eaketha Lokesh

156. 156 Dr. Eaketha Lokesh

157. CONCLUSION The originators of systems tried to solve huge number of possible combinations into classes and subclasses, but so far none of the classifications proposed by researchers fulfill all the requirements of classification. If anyone of the classification systems was to be accepted, it would be in favor of either Kennedy or American College of Prosthodontics. 157 Dr. Eaketha Lokesh

158. JOURNAL REFERENCES Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57 Avant WE. A universal classification for removable partial denture situations. J Prosthet Dent 1966;16:533-9 . Al- Johany and Andres. Classification system for RPD’s with Implants. J Prosthodont 2008; 17: 502-507 . 158 Dr. Eaketha Lokesh

159. 4. Miller E.L. System for classifying partially edentulous arches. J Prosthet Dent 1970; 24(1): 25-40 5. Arbabi et al. A simplified classification system for partial edentulism : A theoretical explanation JIPS 2007;7(2) : 85-87 6. Loto Adolphus Odogun ., et al. “A Newly Proposed Quantitative Codification of the Principles of Classification Partial Edentulism ”. EC Dental Science 18.6 (2019): 1091-1103. 159 Dr. Eaketha Lokesh

160. TEXTBOOK REFERENCES Rodney D Phoenix, David R Cagna , Charles F DeFreest . Stewarts clinical removable partial prosthodontics, 3 rd Edition, Quintessence books. Alan B Carr, David T Brown. Mc Crackens removable partial prosthodontics, 12 th Edition, 2012, Elsevier Mosby. Alan B Carr, David T Brown. Mc Crackens removable partial prosthodontics, 1 st South Asia Edition, 2012, Elsevier Mosby. 160 Dr. Eaketha Lokesh

161. 161 Dr. Eaketha Lokesh