International Journal of Medical Research
&
Health Sciences
www.ijmrhs.com Volume 3 Issue 2 (April - Jun) Coden: IJMRHS Copyright @2014 ISSN: 2319-5886
Received: 1stJan 2014 Revised: 5thFeb 2014 Accepted: 10thFeb 2014
Review article
A SIMPLIFIED CLASSIFICATION SYSTEM FOR PARTIALLY EDENTULOUS SPACES
*
Bhandari Aruna J1, Bhandari Akshay J2 1
Department of Prosthodontics, Dean, Dental Faculty, Rural Dental College, Pravara Institute of Medical Sciences (DU), Loni, Ahmednagar, Maharashtra, India
2
MBBS, Pravara Institute of Medical Sciences, Loni, Ahmednagar Maharashtra, India *Corresponding author email: drarunajb@gmail.com
ABSTRACT
Background:There is no single universally employed classification system that will specify the exact edentulous situation. Several classification systems exist to group the situation and avoid confusion. Classifications based on edentulous areas, finished restored prostheses, type of direct retainers or fulcrum lines are there. Some are based depending on the placement of the implants. Widely accepted Kennedy Applegate classification does not give any idea about length, span or number of teeth missing. Rule 6 governing the application of Kennedy method states that additional edentulous areas are referred as modification number 1,2 etc. Rule 7 states that extent of the modification is not considered; only the number of edentulous areas is considered. Hence there is a need to modify the Kennedy–Applegate System.Aims:This new classification system is an attempt to modify Kennedy –Applegate System so as to give the exact idea about missing teeth, space, span, side and areas of partially edentulous arches. Methods and Material: This system will provide the information regarding Maxillary or Mandibular partially edentulous arches, Left or Right side, length of the edentulous space, number of teeth missing and whether there will be tooth borne or tooth–tissue borne prosthesis.Conclusions:This classification is easy for application, communication and will also help to design the removable cast partial denture in a better logical and systematic way. Also, this system will give the idea of the edentulous status and the number of missing teeth in fixed, hybrid or implant prosthesis.
Key words:Partially edentulous spaces, Classification System, Edentulism, Removable Partial Denture INTRODUCTION
Various types of edentulous situation or partial edentulism is seen. Edentulism means state of being without teeth or lacking teeth.1 There may be loss of one or more teeth but not all the teeth in partially edentulous or semi edentulous situation. 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 required2
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. For any type of situation, the requirements of an acceptable method of classification include the following criteria.3,4
• Classification should permit immediate visualization of the type of partially edentulous arch being considered.
• Classification should permit immediate differentiation between the tooth-borne and the tooth-tissue supported removable partial denture.
437 Aruna et al.,
• It should be universally acceptabl • It should serve as a guide to the
be used.
Several classification systems hav till date5but perhaps the best known used is the classification of the par dental arch proposed by Edward K York in 1923 which is based on the the edentulous areas with the re teeth6. Widely accepted Kenne classification does not give the i number of teeth and the extent of t Situations like Kennedy Class I, II, I mention about the number and type on one or both sides. Also Ke modification 2 will not give any ide and number of the missing teeth edentulous areas are located. Rule application of the Kennedy method additional edentulous areas othe determining the classification are modifications and designated by the etc.Also Rule 7 states that extent of is not considered only the number areas are considered.7
This new classification system will pr information regarding Maxillary partially edentulous arches, Left or R of the edentulous space, number of t whether there will be tooth borne or borne prosthesis.
Abbreviations used:
Maxillary (Mx), Mandibular (Md), Right Side ®, CI (Central Incisor Incisor), C (Canine), P (Premolar) and Rules governing the classification: 1. The posterior most edentulous a
the classification.
2. 3rd molars will not be in classification because most of the replaced.
3. Classification system follows the 4. Missing teeth will be considered a 5. Classification System will have C IV with Type 1, 2, 3, 4, 5, 6, or 7. 6. Maxillary and Mandibular
considered as Mx. and Md. respe
Md. Class I ,Type 4 Md . Class I, Type 5 Md . Class I, Type 6
Fig 1:
437 Int J Med Res Health S
able.
he type of design to
have been designed nown and commonly partially edentulous d Kennedy of New n the relationship of remaining natural nnedy Applegate idea of missing of the modification. I, III or IV will not pe of teeth missing Kennedy Class II idea about the side th and where the ule 6 governing the ethod states, that other than those are referred as their number as 1,2 of the modification bers of edentulous
ll provide the exact y or Mandibular or Right side, length of teeth missing and ne or tooth – tissue
d), Left Side (L), ncisor), LI (Lateral
and M (Molar) on:
ous area will govern
included in the the times it is not
the extraction. ed as Type.
e Class I, II, III and , or 7.
r arch will be pectively.
7. Additional missing te be denoted by FDI Federation Notation] 8. Side determination in
and R for Right side. 9. Classification system
permanent dentition. New Classification Edentulous Arches:-Class-I
Type 1. Bilateral 2ndmol Type 2. All bilateral mola Type 3. All bilateral missing. (M2, M1, P2) Type 4. All bilateral po M1, P2, P1)
Type 5. All bilateral missing. (M2, M1, P2, P1, C Type 6. All bilateral po lateral incisor missing. (M L & R: - If missing teeth (R) side.
Md. Class I ,Type 4 Md . Class I, Type 5 Md . Class I, Type 6
Fig 1:CLASS–I
Class -II
Type 1. Unilateral 2ndmol Type 2. Unilateral both m Type 3. Unilateral both missing. ( M2, M1, P2) Type 4. Unilateral all M2, M1, P2, P1)
Type 5. Unilateral all missing. ( M2, M1, P2, P1 Type 6. Unilateral all p lateral incisor missing. ( M
437 alth Sci. 2014;3(2):436-440
teeth other than the Type will DI System 8. [World Dental on]
included will be L for Left de.
m will be applicable only for on.
System for Partially
olars missing. (M2) olars missing. (M2, M1) al molars and 2nd pre-molar
posterior teeth missing. (M2,
al posterior teeth & canines , C,)
l posterior teeth, canines and . (M2, M1, P2, P1, C, LI )
th are on either left (L) or right
Md. Class I ,Type 4 Md . Class I, Type 5 Md . Class I, Type 6
Fig 1:
molar missing. ( M2)
h molars missing. ( M2, M1) both molars and 2nd pre-molar
ll posterior teeth missing (
l posterior teeth and canine , P1,C.)
Type 7. Unilateral all posterior lateral incisor and central incisor mi P2, P1, C, LI, CI. )
L & R :–If missing teeth is on eithe (R) side.
Fig 2: CLASS II
Class-III
Type 1. Unilateral 1st molar missing Type 2. Unilateral 1st molar and missing. ( M1, P2)
Type 3. Unilateral 1st molar and missing. ( M1, P2, P1)
Type 4. Unilateral 1st molar, both canine missing. ( M1, P2, P1, C ) Type 5. Unilateral 1stmolar, both pr and lateral incisor missing. (M1, P2, P Type 6 Unilateral 1st molar, bo canine, lateral incisor and unilatera missing. ( M1, P2, P1, C, LI, CI ) L & R :- If missing teeth is on either (R) side
Fig 3: CLASS–III
Class-IV
Type 1. Bilateral central incisor miss Type 2. Bilateral central and lateral (CI, LI )
or teeth , canine, missing. ( M2, M1,
her left (L) or right
Fig 2: CLASS II
sing. ( M1)
and 2nd pre-molar
nd both pre-molars
both pre-molars and
h pre-molars, canine , P1,C, LI .)
, both pre-molars, eral central incisor
her left (L) or right
issing. (CI)
al incisors missing.
Type 3. Bilateral anterior t Type 4. Bilateral anterio molars missing. (CI, LI, C Type 5. Bilateral anterior missing. (CI, LI, C, P1, P Type 6. Bilateral anterior both 1stmolars missing. (C
L & R :– If missing right (R) side.
Fig 4: Class-IV
Modification examples teeth or edentulous space System [Federation Denta In case if there are situati uniform e.g.
• If in maxillary arch on on right side two mol right premolar teeth written as Mx. Class I • If in maxillary arch if one molar of right addition there are tw lateral incisor and le then it will be written 12, 24.
• If in maxillary arch pos side are missing and missing then it will be Type 2R, 24.
• If in mandibular arc missing and in addi premolars and one m denoted as Md. Class I • If mandibular bilater
then it can be denoted or Md. Class I, Type 1L Fig 2: CLASS II
or teeth missing. (CI, LI, C) rior teeth and both 1st pre-I, C, P1)
ior teeth and both pre-molars , P2)
ior teeth, both pre-molars and . (CI, LI, C, P1, P2, M1)
ng teeth is on either left (L) or
les: Additional missing tooth, paces will be demarked by FDI
ntaire Internationale (1971). uations where teeth lost are not
h on left side two molars and olar teeth and in addition two th are missing then it will be ss I, Type 2, 14,15.
h if two teeth one premolar and ht side are missing and in two additional teeth like right nd left first premolar is missing ten as Mx. Class III, Type 2R,
h posterior two teeth on right and one left first premolar is ll be denoted as Mx. Class II,
rch canine to canine teeth are addition right side, both molar are missing, it will be
ss IV, Type 3, 44,45,46. teral first molars are missing, noted as Md. Class I, Type 1R,36
439 Aruna et al.,
Fig 5:Modification examples: DISCUSSION
Different types of partially edentul in our day to day practice. Seve systems exist to group the situa confusion. Classifications based on e finished restored prostheses, type of or fulcrum lines are there. Ther universally accepted classification s the exact idea about length, span, s teeth missing. Dental literature proposed classification systems Cummer’s System that is earliest on Although many classification syste but none has been without critics and acceptance.
Perhaps the best known and widely Kennedy - Applegate classification relationship of the edentulous a remaining natural teeth9. The mai Kennedy’s classification is that it do information regarding missing teeth a edentulous area. In 1928 Baily classification system based on whethe is tooth borne, tissue borne or bo 1953 introduced an ABC system essential segment types like A for a for bounded posterior and C for posterior free end space. ICK or Im Kennedy classification is based on position of implants to be pl classification systems are based on Fulcrum lines11or on the diagnostic c Each classification gives some inform edentulous situation of the patient or prosthesis. But for proper unde
439 Int J Med Res Health S
ntulous arches seen veral classification tuation and avoid on edentulous areas, of direct retainers here is no single on system that gives n, side or number of ure abounds with beginning with on record till date. stems have merits, and has unanimous
dely accepted is the tion based on the areas with the ain drawback of does not give any th and the length of ilyn introduced a hether the prosthesis both. Friedman in m based on three or anterior space, B or canty lever or Implant corrected n the number and placed. 10 Some on the types of the
c criterias12
ormation about the t or the type of the understanding and
treatment planning it is situation of the edentulous This new classification actual clinical condition a give an exact idea of following respect:-1 Maxillary or Mandibu 2 Left or Right side of t 3 Length of the ede
determined.
4 Number of teeth miss 5 Immediate visualizati
teeth.
6 Tooth borne or Too determined.
The primary purpose of designing is to simplify combination of teeth to ri to colleague, students a improved 13. This will si the edentulous arches and teaching. Exact partially to design the prosthesi exerted on the remain removable partial denture determining the prognosi This will help to design denture in a better logical relation
to:-a. Selection of abutment Location of guide plan connector, e. Placement Selection of retentive, elements g: Placement elements, h. Selection of r LIMITATIONS
1. Mobility status of t
considered.
2. Abutment status is not
3. Oral health status is not
4. System does not de
changed with drifti
abutment teeth.
CONCLUSION
Various types of partiall seen which create co designing and memori
439 alth Sci. 2014;3(2):436-440
is better to know the exact ous arch.
tion system will specify the on and just by reading will of missing teeth in the
ibular partial edentulous arch. of the arch can be understood.
edentulous space can be
issing can be determined. zation of the type of missing
Tooth -Tissue borne can be
of a classification for RPD fy the description of potential o ridges so that communication and laboratory technique is simplify the identification of and will help to enhance in lly edentulous status will help esis by knowing the forces aining abutment teeth of a re, as it plays a critical role in nosis of the remaining teeth.14 gn the removable cast partial cal and systematic process15in
ent, b. Location of rest, c. lanes, d. Selection of major ent of minor connector, f: ve, bracing and reciprocal nt of denture base retentive n of replacement teeth.
of the remaining teeth is not
is not considered.
us is not considered.
denote the span which gets
ifting or bodily shifting of
universally employed classification system that will specify the exact partially edentulous situation. This new classification system will provide the exact information regarding Maxillary or Mandibular partially edentulous arches, Left or Right side, length of the edentulous space, number of teeth missing and whether there will be tooth borne or tooth – tissue borne prosthesis. This classification is easy for application, communication and will also help to design the removable cast partial denture in a better logical and systematic way. Also, this system will give the idea of the edentulous status and the number of missing teeth in fixed, hybrid or implant prosthesis.
ACKNOWLEDGEMENT
Authors would like to thank all the staff members and PG students of Department of Prosthodontics, Rural Dental College, Loni, for their timely interaction and help.
REFERENCES
