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 Table of Contents  
REVIEW ARTICLE
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 49-57

Critical analysis of classification system of partially edentulous spaces: A literature review


Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India

Date of Web Publication11-Oct-2019

Correspondence Address:
Dr. S C Ahila
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai - 600 089, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_43_18

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  Abstract 


There are more than 65,000 possible combinations of standing teeth and edentulous spaces which are encountered in the human dental arch. The system of classifying the partially edentulous arch would be an enormous aid in providing a precise word picture of a particular dental arch that is to be discussed. However, there are numerous classification systems which create confusion. Hence, a broad search of published literature was performed electronically using the keyword classification, partially edentulous, and denture from January 1928 to December 2018. This article enlisted the various classification systems and its critical analysis.

Keywords: Classification; denture; partially edentulous


How to cite this article:
Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent 2019;9:49-57

How to cite this URL:
Ahila S C, Suganya S, Muthukumar B. Critical analysis of classification system of partially edentulous spaces: A literature review. Indian J Multidiscip Dent [serial online] 2019 [cited 2019 Dec 10];9:49-57. Available from: http://www.ijmdent.com/text.asp?2019/9/1/49/268994




  Introduction Top


Two principal benefits might arise from universal adoption of the classification system of partially edentulous arches in prosthodontics which enable a dentist to communicate with much greater facility in describing an oral cavity with missing teeth. This article critically analyzes the partial edentulous classification[1] [Table 1].
Table 1: Analysis of classification system

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Cummer's system

The first system was proposed by Dr. Cummer[2] in 1920.

Class I – A partially dentulous arch in which two diagonally opposite teeth are chosen as an abutment for the attachment of direct retainers with an indirect retainer. Class II – A partially dentulous arch in which two diametrically opposite teeth are chosen as abutment for the attachment of the direct retainers with an indirect retainer. Class III – A partially dentulous arch in which one or more teeth on the same side are chosen as abutment for the attachment of the direct retainers with or without an indirect retainer. Class IV – A partially dentulous arch in which three or more teeth are chosen as abutment for the attachment of the direct retainers [Figure 1].
Figure 1: Cummer's classification

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Kennedy's system

In 1923, Dr. Kennedy's[3] system based on the relationships of the edentulous spaces to abutment teeth.

Class I – Bilateral edentulous regions located posterior to the remaining teeth. Class II – Unilateral edentulous region posterior to the remaining teeth. Class III – Unilateral edentulous region bounded anteriorly and posteriorly by natural teeth. Class IV – Single bilateral edentulous region anterior to the remaining teeth, crossing the midline [Figure 2].
Figure 2: Kennedy's classification

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Applegate's rules

In 1954, Applegate[4],[5] provided eight rules governing the Kennedy system and proposed Applegate–Kennedy classification (1960) and expanded to Classes V and VI.

Class V – An edentulous area bounded anteriorly and posteriorly by natural teeth but in which the anterior abutment is not suitable for support. Class VI – an edentulous situation in which the teeth adjacent to the space are capable of total support of the required prosthesis.

Bailyn's classification

In 1928, Dr. Bailyn's[6] system based on whether the prosthesis is tooth-borne, tissue borne, or combination A-Saddle areas anterior to the first bicuspids. P-Saddle areas posterior to the cuspids.

Class I – Abutment teeth present at each extremity of a saddle area representing a span of not more than three teeth. Class II – Tooth support at one extremity only of the saddle area. Class III – Tooth support at both extremities of the saddle area representing a span of more than three teeth.

Class P.I. – Posterior edentulous region between two available abutments, not more than three teeth distant from each other. Class P.II. – Edentulous (bilateral) regions posterior to the cuspids with one available abutment for each denture-base area. Class P.III. – An edentulous region at least three teeth posterior to the cuspid with a distal abutment. Class A.III. – an edentulous space anterior to the first bicuspid with two abutment, more than three teeth distant from each other. Class A.I.P. II – One of the two edentulous areas is anterior to the first bicuspid and between two available abutments <3 teeth distant from each other, the other edentulous space being posterior to the cuspid with only one tooth available as abutment. Class P.I.P. II – Both edentulous spaces are posterior to the cuspids; one with only one tooth available for anchorage, the other with two available teeth separated by a distance of <3 teeth. Class A.I.P. III – It has tthree edentulous spaces. One of these is anterior to the first bicuspid with two available anchor teeth separated by a distance of <3 teeth, another posterior to the cuspid with only one tooth available for anchorage, and a third one posterior to the cuspid with two teeth available for abutments separated by <3 teeth [Figure 3].
Figure 3: Bailyn's classification

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Neurohr's classification

Dr. Neurohr,[7] in 1939, classification includes:

Class I – Tooth bearing. A partial denture situation falls under this classification when there are teeth posterior to all spans, and when there are no more than four teeth missing in any space. Posterior teeth are missing, and anterior teeth are in place. Posterior teeth are missing, and some anterior teeth are missing. Anterior teeth are missing, and posterior teeth are in place. Anterior and Posterior teeth are missing. Class II – Tooth and tissue bearing. A partial denture situation falls under this classification when there are no teeth missing posterior to one or more spans, or when there are more than four teeth in one or more spans. Posterior teeth are missing, and anterior teeth are in place. Posterior teeth are missing, and some anterior teeth are missing. Anterior teeth are missing, and some posterior teeth are missing. Class II Div. II – Teeth posterior to all spans, but there are more than four teeth (including a cuspid) in one or more spans. (A) Posterior teeth and some anterior teeth are missing. (B) Anterior teeth are missing, but the posterior teeth are in place. (C) Anterior and posterior teeth are missing. This may be unilateral or bilateral [Figure 4].
Figure 4: Neurohr's classification

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Mauk's classification

In 1941, Dr. Mauk[8] proposed a classification based on:

  1. Number, length, and position of the spaces
  2. Number and position of the remaining teeth.


Class I – Bilateral posterior spaces and teeth remaining in a segment in the anterior region. Class II – Bilateral posterior spaces and one or more teeth at the posterior end of one space. Class III – Bilateral posterior spaces and one or more teeth at the posterior end of both spaces. Class IV – Unilateral posterior space with or without teeth at the posterior end of the space. The arch is unbroken on the opposite side. Class V – Anterior space only. The posterior part of the arch is unbroken on either side. Class VI – Irregular spaces around the arch. The remaining teeth are single or in small groups [Figure 5].
Figure 5: Mauk's classification

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Wild's classification (1949)[9]

Class I – Interruption of the dental arch (bounded), Class II – Shortening of the dental arch, Class III – Combination of 1 and 2.

Godfrey's classification

In 1951, Dr. Godfrey[10] described a system based on the location and extent of the edentulous spaces.

Class A – Tooth-borne denture bases in the anterior part of the mouth. It may be an unbroken five-tooth space, broken five-tooth space, or unbroken four-tooth space. Class B – Mucosa-borne denture bases in the anterior of the arch. It may be an unbroken six-tooth space, an unbroken five-tooth space, or a broken five tooth space. Class C – Tooth-borne denture bases in the posterior part of the arch. It may be an unbroken three-tooth space, a broken three-tooth space, an unbroken two-tooth space, or a broken two-tooth space. Class D – Mucosa-borne denture bases in the posterior part of the mouth. It may be an unbroken four-tooth space or a three-tooth, two-tooth, or single-tooth space [Figure 6].
Figure 6: Godfrey's classification

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Beckett's classification

This classification proposed by Dr. Beckett[11] in 1953 was based on the load distribution of the individual component saddles of the partial denture.

Class I – saddles (denture bases) which are tooth-borne. Class II – saddles (denture bases) which are mucosa-borne. Two types: all free end saddle, bounded saddle where the length of the saddle or condition of the abutment teethcontra indicates a tooth-borne saddle. Class III – inadequate abutments to support the saddle (denture base) and probably inadequate mucosa support.

The combination on Class I and Class 2 is represented as Class 1.2. In a similar way, there are designated Class 1.2.3, Class 1.3, and Class 2.3 dentures [Figure 7].
Figure 7: Beckett's classification

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Friedman's classification

Dr. Friedman (1953)[12] classification was based on three essential segment types occurring either as discrete or continuous segments. A – An anterior space (i.e., one or more of the six anterior teeth). B – A bounded posterior space. C – Refers to a cantilever situation or a posterior free end space. C-A-B spaces [Figure 8].
Figure 8: Friedman's classification

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Craddock's classification

Craddock's (1954)[9] classification is based on the support. Class I – Saddle supported at both ends by substantial abutment teeth. Class II – Vertical biting forces applied to denture insisted entirely by soft tissue. Class III – Tooth supported at only one end of the saddle.

Austin and Lidge classification

Austin and Lidge[13] system is based on the position of edentulous space. A designates anterior spaces; “P:” designates posterior spaces. “Bi” designates bilateral. Class A – Missing anteriors. A1: Missing anteriors on one side only. A2: Missing anteriors on both right and left sides. Class P – Missing posteriors.P1: Missing posteriors on one side. Unilateral construction. P2: Posterior teeth are missing on both right and left sides. P1Bi: Missing posterior on one side, with bilateral construction. Class AP – Missing anterior and posteriors. A1P1: Anterior and posterior teeth are missing on one side only [Figure 9].
Figure 9: Austin and Lidge classification

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Watt's classification

Watt in 1958 classification includes entirely tooth-borne, entirely tissue borne, partially tooth-borne and tissue borne.

Skinner's classification

In 1957, Dr. Skinner's[14] classification was based on the relationship of the abutment to the residual alveolar ridge.

Class I – Abutment teeth located both anterior and posterior to the denture base, and the spaces may be unilateral or bilateral. Class II – All teeth are posterior to the denture base which functions as a partial denture unit. It may be unilateral or bilateral. Class III – All abutment teeth are anterior to the denture base which functions as a partial denture base and may occur unilaterally or bilaterally. Class IV – Denture bases are located both anterior and posterior to the remaining teeth, and these may be unilateral or bilateral. Class V – Abutment teeth are unilateral in relation to the denture base [Figure 10].
Figure 10: Skinner's classification

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Swenson's classification

In 1955, Terkla and Laney[15] classification was based on logical reasoning.

Class I – An arch with one free-end denture base. Class II – An arch with two free-end denture bases. Class III – An arch with an edentulous space posteriorly on one or both sides of the mouth but with teeth presents anteriorly and posteriorly to each space. Class IV – An arch with an anterior edentulous space and with five or more anterior teeth missing. Class IA – An arch with one free end base and one or more missing anterior teeth. Class IIA – Basic Class II with an anterior space. Class IVP– Basic Class IV with a posterior space [Figure 11].
Figure 11: Swenson's classification

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Avant's classification

In 1960, Dr. Avant[16] classification was based on the position of the edentulous space on the anterior and posterior segments of the arch.

Class I – Replaces one or more posterior teeth on one side of the arch mesial to the most distal abutment. Class I F – Replaces one or more posterior teeth on both sides of the arch terminating a free end. Three minor notations are possible with class I F. “a”-anterior segment, “p”–posterior segment, “ap”-both segments. Class II – Replaces one or more posterior teeth on both sides of the arch mesial to the most distal abutment tooth on both sides. Class II F – Replaces one or more posterior teeth on both sides of the arch terminating in free ends on both sides. Class III – Replaces one or more anterior teeth.

Costa's classification

Dr. Costa[17] in 1974 described the existing edentulous condition as anterior, lateral and terminal.

Fiset's classification

In 1973, Fiset[18] used Applegate–Kennedy system.

Class VII – An edentulous situation in which all the remaining teeth are located on one side of the arch. The fulcrum line is rather compatible with the action of physiologic forces. Class VIII – An edentulous situation in which only one or two remaining teeth are located at either anterior corner of the arch. The fulcrum line is rather incompatible with the action of physiologic forces. Class IX – An edentulous situation in which functional and cosmetic requirements and the magnitude of interocclusal distance require the use of a telescoped prosthesis. Remaining teeth are capable of total or partial support. Class X – An edentulous situation in which the remaining teeth are incapable of any support. If the teeth are kept, the prosthesis is totally tissue borne.

Osborne's classification

Osborne Lammine[19] in 1979 classification includes Class I – Mucosa borne, Class II – Tooth borne, Class III – combination of mucosa and tooth-borne.

Implant-corrected Kennedy classification

In 2008, Al-Johany and Andres[20] described the situations without implants, and then the implant-corrected classification can be used to describe the situation with implants. The classification begins with the phrase implant-corrected Kennedy (class) followed by the description of the classification [Figure 12]. (a) Implant-corrected Kennedy (ICK) 1 for Kennedy Class I situations, (b) ICK I1 for Kennedy Class II situations, (c) ICK II1 for Kennedy Class III situations, (d) ICK II1 for Kennedy Class IV situation.
Figure 12: Implant-corrected Kennedy classification

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American College of Prosthodontics edentulous classification system[21]

Criteria 1

Location and extent of the edentulous area(s)

  1. Ideal or minimally compromised edentulous area confined to a single arch:


    • Any anterior maxillary edentulous area that does not exceed 2 incisors
    • Any anterior mandibular edentulous area that does not exceed 4 incisors
    • Any posterior maxillary or mandibular edentulous area that does not exceed 2 premolars, or 1 premolar and 1 molar.


  2. Moderately compromised edentulous area in both the arches:


    • Any anterior maxillary edentulous area that does not exceed 2 incisors
    • Any anterior mandibular edentulous area that does not exceed 4 incisors
    • Any posterior maxillary or mandibular edentulous area that does not exceed 2 premolars, or 1 premolar and 1 molar
    • A missing maxillary or mandibular canine.


  3. Substantially compromised edentulous area:


    • Any posterior maxillary or mandibular edentulous area >3 teeth or 2 molars
    • Any edentulous areas including anterior and posterior areas of 3 or more teeth.


  4. Severely compromised edentulous area:


Criteria 2

Abutment conditions

  1. Ideal or minimally compromised abutment conditions
  2. Moderately compromised abutment condition:


    • Abutments in 1 or 2 sextantism have insufficient tooth structure to retain or support intracoronal or extracoronal restorations
    • Abutments in 1 or 2 sextants require localized adjunctive therapy.


  3. Substantially compromised abutment condition:


    • Abutments in 3 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations
    • Abutments in 3 sextants require more substantial localized adjunctive therapy.


  4. Severely compromised abutment condition:


    • Abutments in 4 or more sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations
    • Abutments in 4 or more sextants require extensive adjunctive therapy
    • Abutments have guarded prognoses.


Criteria 3

Occlusion

  1. Ideal or minimally compromised occlusal characteristics:


    • No preprosthetic therapy is required
    • Class I molar and jaw relationships.


  2. Moderately compromised occlusal characteristics:


    • Occlusion requires localized adjunctive therapy
    • Class I molar and jaw relationships.


  3. Substantially compromised occlusal characteristics:


    • Entire occlusion must be reestablished, but without any change in VDO
    • Class II molar and jaw relationships.


  4. Severely compromised occlusal characteristics:


    • Entire occlusion must be reestablished, including changes in VDO
    • Class II division 2 and Class III molar and jaw relationships.


Criteria 4

Residual ridge characteristics

Class I:

1. The location and extent of the edentulous area are ideal or minimally compromised:

  • The edentulous area is confined to a single arch
  • The edentulous area does not compromise the physiologic support of the abutments
  • The edentulous area may include any anterior maxillary span that does not exceed 2 incisors, any anterior mandibular span that does not exceed 4 missing incisors, or any posterior span that does not exceed 2 premolars or 1 premolar and 1 molar. 2. The abutment condition is ideal or minimally compromised, with no need for preprosthetic therapy. 3. The occlusion is ideal or minimally compromised, with no need for preprosthetic therapy and I molar and jaw relationships. 4. Residual ridge morphology conforms to Class I.


Class II – Moderately compromised location and extent of edentulous areas in both arches, abutment conditions requiring localized adjunctive therapy:

  • Edentulous areas may exist in one or both arches. The edentulous areas do not compromise the physiologic support of the abutments
  • Edentulous areas may include any anterior maxillary span that does not exceed two incisors, any anterior mandibular span that does not exceed 4 incisors and 2 premolars, or 1 premolar and 1 molar or any missing canine.


2. Condition of the abutments is moderately compromised:

  • Abutments in 1 or 2 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations
  • Abutments in 1 or 2 sextants require localized adjunctive therapy.


3. Occlusion is moderately compromised:

  • Occlusal correction requires localized adjunctive therapy. Class I molar and jaw relationship.


4. Residual ridge morphology conforms to Class II.

Class III – Substantially compromised and extent of edentulous areas in both arches, abutment condition requiring substantial localized adjunctive therapy.

1 The location and extent of the edentulous areas are substantially compromised:

  • Edentulous areas may be present in 1 or both arches
  • Edentulous areas compromise the physiologic support of abutments
  • Edentulous areas may include any posterior maxillary or mandibular edentulous area >3 teeth or 2 molars, or anterior and posterior edentulous areas of 3 or more teeth.


2 The condition of the abutments is moderately compromised:

  • Abutments in 3 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations
  • Abutments in 3 sextants require more substantial localized adjunctive therapy
  • Abutments have a fair prognosis.


3 Occlusion is substantially compromised:

  • Requires reestablishment of the entire occlusal scheme without a change in VDO
  • Class II molar and jaw relationships.


4 Residual ridge morphology conforms to Class III.

Class IV – Severely compromised location and extent of edentulous areas with guarded prognosis, abutments requiring extensive therapy.

1. The location and extent of the edentulous areas results in severe occlusal compromise:

  • Edentulous areas may be extensive and may occur in both arches
  • Edentulous areas compromise the physiologic support of the abutment teeth to create a guarded prognosis
  • Edentulous areas include acquired or congenital maxillofacial defects
  • At least 1 edentulous area has a guarded prognosis.


2. Abutments are severely compromised:

  • Abutments in 4 or more sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations
  • Abutments in 4 or more sextants require extensive localized adjunctive therapy
  • Abutments have a guarded prognosis.


3. Occlusion is severely compromised:

    Reestablishment of the entire occlusal scheme, including changes in VDO
  • Class II division 2 or Class III molar and jaw relationships.


4. Residual ridge morphology conforms to Class IV.


  Conclusion Top


The originators of systems tried to solve huge number of possible combinations into classes and subclasses, but so far none of the classifications proposed by researchers fulfill all the requirements of classification. If anyone of the classification systems was to be accepted, it would be in favor of either Kennedy or American College of Prosthodontics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Miller EL. Systems for classifying partially dentulous arches. J Prosthet Dent 1970;24:25-40.  Back to cited text no. 1
    
2.
Cummer W. Partial Denture Service. In: Anthony LP, editor. American Textbook of Prosthetic Dentistry. Philadelphia, PA: Lea & Febiger; 1942. p. 339-452.  Back to cited text no. 2
    
3.
Kennedy E. Partial denture construction. Dent Items Interest 1928;1:3-8.  Back to cited text no. 3
    
4.
Applegate O. Essentials of Removable Prosthesis. 1st ed. Philadelphia, PA: Saunders; 1954. p. 40-50.  Back to cited text no. 4
    
5.
Misch CE, Judy KW. Classification of partially edentulous arches for implant dentistry. Int J Oral Implantol 1987;4:7-13.  Back to cited text no. 5
    
6.
Bailyn M. Tissue support in partial denture construction. Dent Cosmos 1928;70:988-97.  Back to cited text no. 6
    
7.
Neurohr F. Partial Dentures: A System of Functional Restoration. 1st ed. Philadelphia, PA: Lea & Febiger; 1939. p. 120-37.  Back to cited text no. 7
    
8.
Mauk E. Classifications of mutilated dental arches requiring treatment by removable partial dentures. J Am Dent Assoc 1942;29:2121-31.  Back to cited text no. 8
    
9.
Miller E, Grasso J. Removable Partial Prosthodontics. 2nd ed. Baltimore; Williams and Wilkins 1981. p. 346 7.  Back to cited text no. 9
    
10.
Godfrey RJ. A classification of removable partial dentures. J Am Coll Dent 1951;18:4-13.  Back to cited text no. 10
    
11.
Beckett LS. The influence of saddle construction on the design of partial removable restoration. J Prosthet Dent 1953;3:506-16.  Back to cited text no. 11
    
12.
Friedman J. The ABC classification of partial denture segments. J Prosthet Dent 1953;3:517-24.  Back to cited text no. 12
    
13.
Austin K, Lidge E. Partial Dentures: A Practical Textbook. 1st ed. St. Louis, MO: Mosby; 1957. p. 17-21.  Back to cited text no. 13
    
14.
Skinner C. A classification of removable partial dentures based upon the principles of anatomy and physiology. J Prosthet Dent 1959;9:240-6.  Back to cited text no. 14
    
15.
Terkla L, Laney W. Partial Dentures. 3rd ed. St. Louis, MO: Mosby; 1963. p. 40-50.  Back to cited text no. 15
    
16.
Avant WE. A universal classification for removable partial denture situations. J Prosthet Dent 1966;16:533-9.  Back to cited text no. 16
    
17.
Costa E. A simplified system for identifying partially edentulous dental arches. J Prosthet Dent 1974;32:639-45.  Back to cited text no. 17
    
18.
Fiset J. A Classification utilized in the treatment of exceptionally or terminal definations. J Prosthet Dent 1973;30:526-32.  Back to cited text no. 18
    
19.
Lammine GA, Laird WRE. Osborne and Lammies Partial Dentures. 5th ed. Oxford, London, Edinburg: BlackWell Scientific Publications; 1986. p. 20-40.  Back to cited text no. 19
    
20.
Al-Johany SS, Andres C. ICK classification system for partially edentulous arches. J Prosthodont 2008;17:502-7.  Back to cited text no. 20
    
21.
McGarry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH, et al. Classification system for partial edentulism. J Prosthodont 2002;11:181-93.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]
 
 
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