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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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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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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.

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