www.prosthodontics.orgpdfpdi complete dentate
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Classification Systemfor the
Completely Dentate
Patient
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Thomas J. McGarry, DDS
Arthur Nimmo, DDS James F. Skiba, DDS
Christopher R. Smith, DDS
Jack H. Koumjian, DDS, MSD
Robert H. Ahlstrom, DDS, MS
Greg Guichet, DDS John Zarb, DDS, MSc
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This completely dentate classification
system offers the following potentialbenefits:
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 outcome assessment andresearch
Improved diagnostic consistency
Simplified, organized aid in the decision to refer a patient
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Classification System for theCompletely Dentate PatientClass I
Class II
Class III
Class IV
Diagnostic Criteria
1. Tooth condition2. Occlusal scheme
Ideal or minimallycompromised
Moderatelycompromised
Substantiallycompromised
Severelycompromised
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REVIEW OF THE
DIAGNOSTIC CRITERIA
1. Tooth condition
2. Occlusal scheme
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Criteria 1
Tooth Condition
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Ideal or minimally compromisedtooth condition
No localized adjunctive therapy required
Pathology that affects the coronalmorphology of three or less teeth in a sextant
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Moderately compromised toothcondition
Insufficient tooth structure to retain or supportintracoronal or extracoronal restorations-- in onesextant
Pathology that affects the coronal morphology of 4or more teeth in a sextant
Pathology can be in two sextants and can be in
opposing arches
Teeth require localized adjunctive therapy, i.e.,periodontal, endodontic or orthodontic procedure
for a single tooth or in a single sextant
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Substantially CompromisedTooth Condition
Insufficient tooth structure to retain or support
intracoronal or extracoronal restorationin twosextants
Pathology that affects the coronal morphology of 4or more teeth in three or more sextants
Pathology can be in three sextants in the same
arch and /or can be in opposing arches
Teeth require localized adjunctive therapy, i.e.,periodontal, endodontic or orthodontic procedure
for teeth in two sextants
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Severely Compromised ToothCondition
Insufficient tooth structure to retain or supportintracoronal or extracoronal restorationsinthree or more sextants
Pathology that affects the coronal morphologyof 4 or more teeth in all sextants
Teeth require localized adjunctive therapy,i.e., periodontal, endodontic or orthodontic
procedure for teeth in three or more sextants
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Criteria 2
Occlusal Scheme
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Ideal or minimally compromised
occlusal scheme No preprosthetic therapy required
Contiguous, intact dental arches
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Moderately compromisedocclusal scheme
Anterior guidance is intact
Occlusal scheme requires localizedadjunctive therapy
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Substantially compromised
occlusal scheme Occlusal scheme requires major
therapy to maintain the entire occlusalscheme without any change in theocclusal vertical dimension
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Severely compromised
occlusal scheme Occlusal scheme requires major therapy
to reestablish the entire occlusal schemeincluding any changes in the occlusalvertical dimension
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Class I
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Ideal or minimally compromised
tooth condition
No localized adjunctive therapy
required
Pathology that affects the coronal
morphology of three or less teethin a sextant
Criteria 1
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Ideal or minimally compromised
occlusal scheme
No preprosthetic therapy required
Contiguous, intact dental arches
Criteria 2
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Class II
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Moderately compromised toothcondition
Insufficient tooth structure to retain orsupport intracoronal or extracoronalrestorationsin one sextant
Pathology that affects the coronal morphologyof four or more teeth in a sextant
Pathology can be in two sextants and can bein opposing arches
Criteria 1
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Moderately compromised
occlusal scheme
Anterior guidance is intact
Occlusal scheme requires localizedadjunctive therapy
Criteria 2
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Class III
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Substantially compromised tooth condition
Insufficient tooth structure to retain or support
intracoronal or extracoronal restorationsintwo sextants
Pathology that affects the coronal
morphology of four or more teeth in threeor more sextants
Pathology can be in three sextants in the
same and/or can be in opposing arches
Teeth require localized adjunctive therapy,i.e., periodontal, endodontic, or orthodonticprocedure in two sextants
Criteria 1
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Substantially compromised
occlusal scheme
Occlusal scheme requires major therapy to
maintain the entire occlusal scheme withoutany change in the occlusal vertical dimension
Criteria 2
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Class IV
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Severely compromised toothcondition
Insufficient tooth structure to retain or supportintracoronal or extracoronal restorationsinthree or more sextants
Pathology that affects the coronal morphologyof four or more teeth in all sextants
Teeth require localized adjunctive therapy, i.e.,periodontal, endodontic or orthodontic
procedure for teeth in three or more sextants
Criteria 1
C i i 2
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Severely compromised occlusal
scheme
Occlusal scheme requires major therapy
to reestablish the entire occlusal schemeincluding any changes in the occlusalvertical dimension
Criteria 2
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Other Class IV characteristics Severe manifestations of local or systemic
disease, including the sequelae fromoncologic treatment
Maxillomandibular dyskensia and/or ataxia
A refractory patienta patient who
presents with chronic complaints followingappropriate treatment
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Guidelines for the Use ofthe Classification System
for theCompletely Dentate Patient
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In those instances when a patients
diagnostic criteria are mixedbetween two or more classes, anysingle criterion
of a morecomplex
classplaces the patient into themore complex class
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The following additional guidelines will assist in the
consistent application of the classification:
Consideration of future treatment
procedures must not influence thechoice of diagnostic level
Initial adjunctive therapy canchange the original classification
level. Classification may need tobe reassessed after existingrestorations are removed.
Esthetic concerns or challengesraise the classification incomplexity by one or more levels inClass I and II patients
In the presence of TMD symptoms,
the classification is increased incomplexity by one or more levels inClass I and II patients
Periodontal health is intimately
related to the diagnosis andprognosis for completelydentate patients.
For the purpose of this system, it isassumed that patients will receivetherapy to achieve and maintainperiodontal health so thatappropriate prosthodontic care canbe accomplished.