PROSTHODONTICS - American College of Prosthodontists

June 2004, Volume 13, Number 2 81Table 2. Worksheet Used to Determine ClassificationClass I Class II Class III Class IVTeeth ConditionIdeal or minimally compromised—3 or less teeth in 1 sextantModerately compromised—4 or more teeth in 1 to 2 sextantsSubstantially compromised—4 or more teeth in 3 to 5 sextantsSeverely compromised—4 or more teeth, all sextantsOcclusal SchemeIdeal or minimally compromisedModerately compromised—anterior guidance intactSubstantially compromised—extensive rest/same OVDSeverely compromised—extensive rest/new OVDConditions Creating a Guarded PrognosisSevere oral manifestations of systemic diseaseMaxillomandibular dyskinesia and/or ataxiaRefractory patientxxxxxxxxxxxNote. Individual diagnostic criteria are evaluated and the appropriate box is checked. The most advanced finding determines thefinal classification.Guidelines for use of the worksheet1. Consideration of future treatment procedures must not influence the diagnostic level.2. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level.3. If there is an esthetic concern/challenge, the classification is increased in complexity by one or more levels.4. In the presence of TMD symptoms, the classification is increased in complexity by one or more levels.5. It is assumed that the patient will receive therapy designed to achieve and maintain optimal periodontal health.6. Patients who fail to conform to the definition of completely dentate should be classified using the classification system forpartial edentulism.Guidelines for the Use of theClassification System for theCompletely Dentate PatientThe analysis of diagnostic factors will be facilitatedwith the use of a worksheet (Table 2). Aseach criterion is evaluated, a checkmark is placedin the appropriate box. In those instances in whicha patient’s diagnostic criteria overlap 2 or moreclasses, the patient is assigned to the more complexclass.The following additional guidelines should befollowed to ensure consistent application of theclassification system:4. The presence of temporomandibular disorders(TMD) symptoms raises the classification by 1or more levels in Class I and II patients.5. Periodontal health is intimately related to thediagnosis and prognosis for completely dentatepatients. For the purposes of this system, itis assumed that patients will receive therapydesigned to achieve and maintain periodontalhealth so that appropriate prosthodontic carecan be accomplished.6. Patients who fail to conform to the definitionof completely dentate should be classifiedusing the classification system for partialedentulism. 61. Consideration of future treatment proceduresmust not influence the choice of diagnosticlevel.2. Initial adjunctive therapy may change the originalclassification level. Classification may needto be reassessed after existing restorations areremoved.3. Esthetic concerns or challenges raise the classificationby 1 or more levels in Class I and IIpatients (see Fig 2).Closing StatementThe classification system for the completely dentatepatient is based on the most objective criteriaavailable to facilitate uniform use of the system.It is anticipated that such standardization shouldlead to improved communications among dentalprofessionals and third parties. This classificationsystem will serve to identify those patients mostlikely to require treatment by a specialist or a2010 CDEL Re-recognition of the Specialty Report 182 of 279