Pdi

prosthodontic diagnostic index

1. PROSTHODONTIC DIAGNOSTIC INDEX PRESENTED BY : PRAMOD CHAHAR

2. PROSTHODONTIC DIAGNOSTIC INDEX

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

8. 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

9. 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

10. 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.

11. 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.

12. 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.

13. 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 .

14. 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.

15. 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)

16. 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

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

18. TONGUE ANATOMY Class III Large and occludes interdental space Class IV Hyperactive with retracted position

19. 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.

20. 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

21. 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

22. 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

23. 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.

24. DIAGNOSTIC CRITERIA

25. CRITERIA 1: LOCATION AND EXTENT OF THE EDENTULOUS AREA(S)

26. CRITERIA 2: ABUTMENT CONDITIONS

27. CRITERIA 3: OCCLUSION

28. CRITERIA 4: RESIDUAL RIDGE CHARACTERISTICS

29. 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.

30. 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. .

31. CLASS III CLASS 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

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

33. 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.

34. GUIDELINES FOR THE USE OF CLASSIFICATION FOR PARTIAL EDENTULISM Any single criterion of a more complex class places the patient into the more complex class. 2. Consideration of future treatment procedures must not influence the diagnostic level. 3. Initial pre-prosthetic treatment and/or adjunctive therapy can change the initial classification level. 4. If there is an aesthetic concern/challenge, the classification is increased in complexity by one level in Class I and II patients. 5. In the presence of TMD symptoms, the classification is increased in complexity by one or more levels in Class I and II patients. 6. In the situation where the patient presents with an edentulous mandible opposing a partially endentulous or dentate maxilla: classification IV

35. 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

36. DIAGNOSTIC CRITERIA

37. CRITERIA 1. TOOTH CONDITION

38. CRITERIA 2. OCCLUSAL SCHEME

39. CLASSIFICATION OF COMPLETELY DENTATE PATIENT CLASS I Characterized by an ideal or minimally compromised tooth condition and occlusal scheme.  Ideal or minimally compromised tooth conditio n 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

40. 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.

41. 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

42. 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

43. 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.  

44. 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

45. 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.

46. CONCLUSION

47. REFERENCES 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. 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. 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. GPT 9