CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHESBy: Dr. Muhammad Ali Faridi

BDS, Mclindent (Restorative Dentistry)

Department of Prosthodontics

WHERE I COME FROM …

•Introduction

•Need for classification

•Requirements of a classification

•Various classification systems

•Conclusion

INTRODUCTION

Prime purpose : to enable dentist to clearly communicate to a listener.

A workable Classification helps to create order from the many number of possible combinations of missing teeth and edentulous spaces.

An aid in learning of the fundamentals of design.

NEED FOR CLASSIFICATION

To formulate a good treatment plan.

To anticipate the difficulties common to occur for that particular design.

To communicate with a professional about a case.

To design the denture according to the occlusal load usually expected for a particular group.

CRITERIA FOR CLASSIFICATION OF PARTIALLY EDENTULOUS ARCHES

Allow visualization of type of partially edentulous arches that is being considered.

Allow differentiation between tooth supported and tooth-tissue supported partial dentures.

Serve as a guide to the type of design to be used.

Be universally accepted.

Cummer (1920)

Kennedy’s (1923)

Applegate-Kennedy (1960)

Bailyn

Neurohr (1939)

Mauk

Friedman (1953)

Godfrey (1951)

Skinner (1957)

VARIOUS CLASSIFICATION SYSTEMS

Austin and Lidge (1957)

Craddock (1954)

Wild

Watt et al (1958)

Costa (1974)

Osborne and Lammie (1974)

Beckett (1953)

Swenson

ICK classification

There are many classifications available for classifying edentulous arches. The most common ones are:

KENNEDY’S CLASSIFICATION:

Most widely used method of classification

Proposed in 1923 by Dr. Edward Kennedy.

It is based on the relationship of the edentulous spaces to the abutment teeth.

Class I- Bilateral edentulous areas located posterior to the remaining natural teeth.

Class II- Unilateral edentulous area located posterior to the remaining natural teeth.

Class III- Unilateral edentulous area with natural teeth both anterior and posterior to it.

Class IV- Single, bilateral edentulous area located anterior to the remaining natural teeth.

MODIFICATIONS

This refers to multiple edentulous areas present in a case. Modifications can only apply to Kennedy Classes I, II and III.

This is because a Kennedy Class IV case with modifications would fall in to one of the other classifications, as these take priorities.

ADVANTAGES: Permits immediate visualization of the partially

edentulous arch.

Allows easy distinction between tooth supported and tooth tissue supported prosthesis.

Permits logical approach to problems of design.

DISADVANTAGES: Enough consideration is not given to condition of

teeth and remaining supporting structures.

No distinction between modification spaces in the anterior region then those of posterior segment.

APPLEGATE KENNEDY’S SYSTEM:

It is a modification of the Kennedy’s system.

It is based less on the number and location of the remaining teeth and edentulous spaces.

It takes into consideration the capabilities of the teeth, which bound the spaces to serve as abutments for the prosthesis

DR. O.C APPLEGATE (1960) later attempted to expand the kennedy system by adding class V and VI.

Class V: Edentulous area bounded anteriorly and posteriorly by the natural teeth but in which the anterior abutment is not suitable for the support.

Class VI: an edentulous situation in which the teeth adjacent to the space are capable of total support of the required prosthesis

Applegate’s Rules:Applegate also provided the following 8 rules to govern the application of the Kennedy system:

Rule 1: Classification should follow rather than precede extractions that might alter the original classification.

Rule 2:If the third molar is missing and not to be replaced it is not considered in the classification.

Rule 3:If the third molar is present and is to be used as an abutment, it is considered in the classification.

Rule 4:If the second molar is missing not to be replaced that is the opposing second molar is also missing and is not considered in the classification.

Rule 5 – The most posterior edentulous area or areas always determines the classification.

Rule 6 –Edentulous areas other than those determining the classification are referred to as the modification spaces and are designated by their number.

Rule 7 –The extent of the modification is not considered, only the number of additional edentulous areas.

Rule 8 –There can be no modification areas in class IV arches. Because any edentulous area lying posterior to the single bilateral area determines the classification.

IMPLANT CORRECTED KENNEDY'S CLASSIFICATION (ICK)

First given Given by Misch and Judy in 1987.

No previous classification include a provision for placement of implants.

Emphasis on the available bone in the edentulous area for implant placement.

Restricted to cases with severe atrophy of the edentulous area.

Improved classification based on Kennedy’s Classfication presented in 2008 by Al-Johany and Andreas.

Helps easy communication with the lab and assists professional communication.

REFRENCES

McCracken's Removable Partial Prosthodontics 11th ed. - Carr,McGivney,Brown {Elsevier Mosby}.

Al-Johany, S. S. and Andres, C. (2008), ICK Classification System for Partially Edentulous Arches. Journal of Prosthodontics