CLASSIFICATION SYSTEMS

FOR REMOVABLE PARTIAL

DENTURES

Presented by:
Dr. Varun Sehgal
GOOD MORNING
INTRODUCTION

Purpose
Enables dentist to clearly
communicate to a listener or fellow
dentist the condition of oral cavity in
which missing teeth are to be replaced
with a prosthesis

To streamline treatment planning

Requirements of an
acceptable method of
classification
1. Permit immediate visualization of the
type of partially edentulous arch that is
being considered
2. Permit immediate differentiation between
the tooth supported and the tooth and
tissue supported removable partial
denture
3. Be universally acceptable
4. Be simple, objective and easy to
understand
5. Aid in formulating a treatment plan
Classification systems of partial
edentulism
Cummer (1920) No. and position of direct retainers

Kennedy (1925) Relationship of edentulous spaces

to the remaining teeth

Bailyn (1928) Importance of support in RPD

Neurohr (1939) Importance of support in RPD

Godfrey (1951) Location and extent of edentulous

space
Classification systems of partial
edentulism
Friedman(1953) Importance of support in
RPD
Relation of abutment teeth to
Skinner (1959)
residual ridge

Kennedy-Applegate Emphasized on the condition

of the abutment teeth
(1960)
Slight modification of
Swenson (1963)
Kennedys classification

Osborne and Importance of support in

RPD
Lammie (1974)
Graber (1986) Tooth and tissue support
 REVIEW OF LITERATURE
In a poll conducted in dental schools of US
in 1967 ,it was found that various
classification systems were taught ,however
the most widely taught and used was
Kennedys classification (20 Schools).
Several others included
Applegate-Kennedys system( 11 Schools)

Swenson system(2 Schools)

Cummer (1 School)
Friedman (1 School)
Miller E L. Systems for classifying partially edentulous arches.
J Prosthet Dent 1970;24: 25-40
CUMMER SYSTEM (1920)
Proposed by Dr. William Ernest Cummer
(Toronto, Canada).

First classification system in the literature.

First system to receive recognition and

served as inspiration for many of the
numerous classifications proposed later.
CUMMER SYSTEM
Believed that the possible combinations
of teeth and their classifications had a
relevance to partial denture design.

System classified partial dentures

based on the number and position of
the direct retainer.
 CUMMER
CLASS I
Partially dentulous
arch in which 2
diagonally opposite
teeth are chosen as
an abutment for the
attachment of direct
retainer
an indirect retainer is
used as an auxiliary
attachment
 CUMMER
CLASS II

Two diametrically
opposite teeth are
chosen as abutment
teeth for direct retainer
an indirect retainer is
used as an auxiliary
attachment
 CUMMER
CLASS III

One or more teeth

on the same side are
chosen as abutment
teeth for direct
retainer with or
without an indirect
retainer
 CUMMER
CLASS IV

Three or more teeth are

chosen as abutment for
attachments of direct
retainers.

Teeth are disposed in a

triangular or quadrilateral
relationship without the
use of an indirect retainer
 KENNEDY
CLASSIFICATION
Proposed by Dr. Edward Kennedy in 1925.
Unlike Cummer, Kennedy did not classify
partial dentures, but classified partially
edentulous arches
It is based on the relationship of the
edentulous spaces to the remaining teeth.
Best known of all the systems that have been
proposed and the most widely accepted and
used classification till date.
 KENNEDY
Class I

Bilateral edentulous area

located posterior to the
remaining natural teeth
 KENNEDY
Class II
A unilateral edentulous
area located posterior to
the remaining natural
teeth
 KENNEDY
Class III
A unilateral edentulous
area with natural teeth
remaining both anterior
and posterior to it.
 KENNEDY
Class IV
A single, but bilateral (
crossing the midline),
edentulous area located
anterior to the remaining
natural teeth.
Advantage of Kennedys
Classification
Immediate visualization of tooth lost.
Immediate visualization of tooth lost.
Immediate differentiation between tooth-
borne and tissue supported RPDs.
Communication among dentists and
laboratory
Permit a logical approach to problems of
design.
Universally understood
 Limitations
KENNEDY
Classification does not
consider:

Extent of the edentulous span

(No. of teeth missing)

Condition of the

abutment teeth.
KENNEDY Limitations
Condition of the mucosa and
bone of the edentulous span.
Primary nature of support not
exactly determined.

Example--A class III case

with teeth between lateral
incisor and 3rd molar
missing. Although the
edentulous span is
supported by teeth at
each end, primary support
is mainly mucosa-borne.
 KENNEDY
Limitations
The state of the opposing dental arch
Complexity of treatment and future prognosis
 Bailyn
Classification(1928)
Proposed by Bailyn C.M in 1928.

Classification is based on whether the

prosthesis is tooth-borne, tissue-borne or
a combination.

Was the first to

emphasize the
importance of support of partial dentures
by the remaining tissues.
 BAILYN
He used the descriptive
letters A & P

A- anterior restorations
with saddle areas anterior
to the first bicuspid.

P- posterior restorations
with saddle areas posterior
to canines
 BAILYN
In addition to this , he described three
classes:

Class I-Bounded
saddle(not > than 3 teeth
missing)

Class II-Free-end saddle

(no distal abutment)
 BAILYN

Class III-Bounded saddle( >

than 3 teeth missing )

This classification did not

make any significant impact
and is little known today
because it does not give
immediate visualization of
partial edentulous arch .
 BAILYN
Limitations:
Does not determine the no. of
edentulous areas.
Modification spaces not considered

Advantages:
Determines the type of support

Edentulous span isknown to an extent

as the number of teeth missing is
determined.
 NEUROHR
Neurohr
classification(1939)
Ferdinand G.Neurohr (New York) also
classified partially edentulous arches
according to the type of support of
available, but the system is one of the
most complex of all the systems
discussed.

Many of his denture designs did not

match his principles of classification.
 Neurohr NEUROHR

classification(1939)
Class I- Tooth-bearing
(unilateral/bilateral)
Teeth posterior to all
spans

Nomore than 4 teeth

missing in any space
 NEUROHR
Neurohr
classification(1939)
Class II
Tooth-and-tissue bearing Div.I
(unilateral/bilateral)
DivisionI: No teeth
posterior to one or more
spans Div. I
DivisionII: Teeth present
posterior in all spans but
more than 4 teeth in one
or more spans. Div-II
 GODFREY

Godfreys
Godfrey R.J gave classification
classification(1951)
Based on location and extent of
edentulous space where teeth are to be
replaced

A feature of this system is that there

are no modifications or subdivisions to
the main classes
 GODFREY
Godfreys classification
Class A
Tooth borne denture
bases in the anterior
part of the mouth. It
may be an unbroken 5
tooth space, a broken 5
tooth space, or an
unbroken 4 tooth space
 GODFREY
Godfreys classification

Class B
Mucosa borne denture
base in the anterior part
of the mouth. It may be
6 tooth unbroken, an
unbroken 5 tooth space
or a broken 5 tooth
space
 GODFREY
Godfreys classification
Class C
Tooth borne denture
base in the posterior
part of the mouth. It may
be an unbroken 3 tooth
space, broken 3 tooth
space, an unbroken 2
tooth space or a broken
2 tooth space
 GODFREY
Godfreys classification
Class D
Mucosa borne denture
base in the posterior part
of the mouth. It may be an
unbroken 4 tooth space or
a 3 tooth,2 tooth or single
tooth space

Limitation: in cases where

there is unbroken five
tooth space in posterior
part- how to classify?
 FRIEDMAN
Friedmans
Classification(1953)
Joel Friedman based his classification on
three essential segment types occurring
either as discrete or as continuous segments.
A- designates an anterior

space

B- designates a bounded

posterior space
 FRIEDMAN
Friedmans
Classification(1953)
C- designates a
cantilever(posterior
free-end) space.

D- combination
 FRIEDMAN
Friedmans
Classification(1953)
Limitation:
The designation C in this classification does not
make it clear whether it is a unilateral or a bilateral
posterior free end space.
Therefore, verbal communication doesnt enable
to identify the exact number of edentulous spaces.
Advantage:
Simplicity pertaining to its system of classification.
 SKINNER
Skinners
classification(1959)
Skinner C. N (California) based his
classification on the relationship of abutment
teeth to the supporting residual alveolar ridge
He believed the value of an RPD is directly
related to the quality and degree of support
which it receives from the abutment teeth and
the residual ridge.
Formed a classification with four classes
characterised mostly by the anatomical or
positional relationship of the remaining teeth .
 SKINNER

Class I- An edentulous area

with natural teeth remaining
both anterior and posterior to it
and they may occur unilateral or
bilateral.

Class II- All of the teeth present

as posterior to the denture base
area and may occur unilateral
or bilateral.
 SKINNER
Class III- All the
abutment teeth are
related anterior to the
denture base.

Class IV- Denture base is

both anterior and
posterior to the
remaining teeth. The
abutment teeth are in
centre or between the
functional denture bases.
 Kennedy-Applegate
Classification (1960)
Oliver C. Applegate believed that a system
should take into consideration the capabilities
of the teeth which bound the spaces to serve as
abutments rather than the number and location
of remaining teeth and edentulous spaces.

Class V and Class VI were added to

the four basic classes of Kennedy
classification.

O.C Applegate was the Professor of Dentistry and Director of

Partial Denture Prosthesis in School of Dentistry & W.K.Kellogg
Foundation Institute of Graduate and Postgraduate Dentistry-
University of Michigan-Michigan.
Kennedy-Applegate Classific
Class V: An edentulous
area bounded by teeth
anteriorly and posteriorly
where the anterior
boundary tooth is not
suitable to be used as an
abutment.
Class VI: An edentulous
situation where the
boundary teeth are
capable of total support of
the prosthesis.
Kennedy-Applegate
Classification
Confusion inthis classification is
highlighted by three of the six classes
having the same anatomical landmarks

There is little advantage over Kennedys

classification , except that the class is
determined after deciding which abutment
teeth can be used.
 Applegates rules for
applying Kennedy
1.classification
Classification follows
any extractions.

2. Missing third molars

not being considered if
not
to be replaced.

Missing 3rd molar-not

considered
3.Third molars that will
be used as an
abutment are
considered.

4. Missing second and

third molars not
being considered if
not
to be replaced.
 Modification
spaces
5. The most posterior
edentulous area(s)
ALWAYS determines
the classification.

6. Edentulous areas
other than those
determining the
classification are
modification spaces
& are designated by
their number
7. The extent of the modification space is
not considered ,only the number of
additional edentulous areas.

8. There can be no modification areas in a

Cl IV.
 Swenson
Classification(1963)
Another altered Kennedys Classification.
Terkla G.Louis and Laney W.R
recommended use of this system
because it is:
Simple

Based on logical reasoning

Slight modification of Kennedy

classification
 Class I of this classification is Kennedys
Class II and Class II is Kennedys Class I

Modifications in all four Kennedys primary

classes were completely changed

Result was another descriptive classification

without much contribution to the problem
 Swenson's Classification

Class I- one free-end Class II- two free-end

denture base denture bases

Class IV- Anterior edentulous

Class III-Bounded posterior space with 5 or more teeth
space on one or both sides missing
Swensons Classification
The four main classes are subdivided
without denoting the exact tooth
missing( Limitation) into
An anterior region A
A posterior region P
Combination AP

Class III-A
 Osborne & Lammie
Classification(1974)
Based on the support of the
denture
Class I- Mucosa-borne

Class II- Tooth-borne

ClassIII- Combination of
mucosa-borne and tooth-borne
 Grabers Classification
George Graber (1986) classified partially edentulous
arches into seven classes

Unilaterally shortened Bilaterally shortened

arch arch

Unilaterally interrupted
arch
Grabers Classification

Bilaterally interrupted arch Anteriorly interrupted arch

Antero-laterally interrupted Multiple interruptions

arch
 American College of
Prosthodontists
Classification System
(2002)

McGarry TJ, Nimmo A, Skiba JF, et.al: Classification system for

partial edentulism. J Prosthodont 2002;11:181-193
 The purpose of this classification is to provide
a framework for the organization of clinical
observations.

Clinical variables that establish different levels

of partial edentulism are organized in a
simplified sequential progression designed to
facilitate consistent and predictable treatment
planning decisions.
 Designed to indicate increasing levels of
diagnostic and treatment complexity presented
by patients with varying degrees of partial
edentulism which will facilitate treatment
decisions.
The classification system is
intended to offer the following
benefits:
1. Improved intra-
Improved intra-
operator consistency

2. Improved professional
communication

3. Insurance
reimbursement
commensurate with
complexity of care
4. An objective method for patient
screening in dental education

5. Standardized criteria for

outcomes assessment and
research

6. Improved diagnostic
consistency

7. A simplified organized aid in the

decision making process
relating to specialist referral
Complexity Is
Determined From Four
Broad Diagnostic
Criteria
1. Location and extent of the
edentulous area(s)

2. Condition of the abutment teeth

3. Occlusion

4. Residual ridge
 Ideal or minimally Classification System for the
Class I compromised Partially Edentulous Patient

Moderately Diagnostic Criteria

Class II compromised 1. Location and extent of the
edentulous area(s)
2. Condition of the abutment teeth
3. Occlusion
Substantially 4. Residual ridge
Class III compromised

Severely
Class IV compromised
 Criteria 1: Location and extent
of the edentulous ridge
A. Ideal or minimally compromised
edentulous area

B. Moderately compromised edentulous

area

C. Substantially compromised edentulous

area

D. Severely compromised edentulous area

 A. Ideal or minimally compromised
edentulous area
The edentulous span is
confined to a single arch and 1
of the following:
any anterior maxillary

edentulous area not

exceeding 2 incisors
any anterior mandibular

edentulous area not

exceeding 4 incisors
any posterior maxillary or

mandibular edentulous area

exceeding 2 premolars or 1
premolar and molar
 B. Moderately compromised edentulous area

Edentulous areas occur in both arches and

in addition to the three criteria's of the ideal
edentulous area ,additional criteria is

A missing maxillary or mandibular canine

 C. Substantially compromised
edentulous area
Anyposterior maxillary or
mandibular edentulous area
greater than 3 teeth or 2
molars.

Any edentulous areas

including anterior and
posterior areas of 3 or more
teeth.
D. Severely compromised edentulous area

Any edentulous area or a

combination of edentulous
areas requiring a high level
of patient compliance.
Criteria 2: Abutment conditions
A. Ideal or minimally compromised
abutment conditions
B. Moderately compromised abutment
condition
C. Substantially compromised abutment
condition
D. Severely compromised abutment
condition
A. Ideal or minimally compromised
abutment conditions

No pre-prosthetic therapy is indicated

 B. Moderately compromised
abutment condition
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( periodontal,
endodontic or orthodontic
procedures.

Sextant- maxillary and mandibular dental arches are subdivided into 6

areas or sextants (3rd molar-2nd premolar on both sides and canine to central
each side.)
 C. 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 localized adjunctive
therapy ( periodontal,
endodontic or orthodontic
procedures).
D. Severely compromised abutment
condition

Abutments in 4 or more sextants have

insufficient tooth structure to retain or
support intracoronal or extracoronal
restorations.
Criteria 3: Occlusion
A. Ideal or minimally compromised
occlusal characteristics
B. Moderately compromised occlusal
characteristics
C. Substantially compromised
occlusal characteristics
D. Severely compromised occlusal
characteristics
A. Ideal or minimally compromised
occlusal characteristics

No preprosthetic therapy is required

Class I molar and jaw relationship are seen

B. Moderately compromised occlusal
characteristics

Occlusion requires localized adjunctive

therapy (enameloplasty on premature
occlusal contacts).

Class I molar and jaw relationships are

seen
C. Substantially compromised occlusal
characteristics

Entire occlusion must be reestablished

but without any change in the occlusal
vertical dimension.

Class II molar and jaw relationship

D. Severely compromised occlusal
characteristics :

Entire occlusion must be reestablished

including changes in the occlusal vertical
dimension.

Class IIand class III molar and jaw

relationship are seen.
Criteria 4: Residual ridge
characteristics

The criteria used inthe ACP

classification system for complete
edentulism are used to categorize any
edentulous span present in the partially
edentulous.
 Classification
Ideal or minimally
System for the
Class I compromised
Completely
Edentulous Patient
Class II Moderately
compromised
Diagnostic Criteria
1. Bone height--mandibular
2. Maxillomandibular
relationship
3. Residual ridge morphology-
Substantially maxilla
Class III compromised 4. Muscle attachments

Severely
Class IV compromised
Class I
This classification level describes the stage
of edentulism that is most appropriate to be
successfully treated by conventional
prosthodontic techniques with complete
denture prosthesis.
All four of the diagnostic criteria are
favorable.
CLASS II
This classification level distinguishes itself with the
noted continuation of the physical degradation of the
denture supporting structures and in addition is
characterised
with the early onset of systemic disease interactions

localized soft tissue factors and

specific patient management/lifestyle considerations.

 CLASS III

This classification level is characterized by

the need for surgical revision of denture
supporting structures to allow for adequate
prosthodontic function.

Additional factors now play a significant role

in treatment outcomes.
 CLASS IV
This classification level depicts the most
debilitated edentulous condition
Surgical reconstruction is almost always
indicated but can not always be accomplished
due to the patients health, desires, past dental
history and financial considerations.
When surgical revision is not selected,
prosthodontic techniques of a specialized nature
must be used in order to achieve an adequate
treatment outcome.
 Classification of partial
edentulism (ACP)
Class I: This class is characterized by
Ideal or minimal compromise in the location
and extent of edentulous area confined to a
single arch.
Abutment conditions.
Occlusal characteristics.
Residual ridge conditions.
All 4 diagnostic criteria are favorable
Class I
(ACP)
 Class II ACP
This class is characterized by moderately
compromised
Location and extent of edentulous areas in both
arches.
Abutment (1 or 2 sextants) require localized
adjunctive therapy , and cannot support
intracoronal or extracoronal restorations.
Occlusal characteristics requiring localized
adjunctive therapy.
Residual ridge conditions conforms to the class
II complete edentulism description.
Class II
(ACP)
 Class III ACP
This class is characterised by :
Location and extent of the edentulous areas are
substantially compromised.

Condition of the abutments is moderately to

substantially compromised.

Occlusion is substantially compromised requiring

reestablishment of entire occlusal scheme without
change in OVD. Class II molar and jaw
relationships.

Residual ridge morphology confirms to Class III

complete edentulism description.
Class III
(ACP)
 ACP
Class IV
This class is characterized by
severely compromised
Location and extent of
edentulous areas are extensive
and include congenital or
acquired defects with guarded
prognosis.

Abutments require extensive

therapy .
 ACP
Class IV
Occlusion characteristics
requiring reestablishment of
the occlusion with a change
in the occlusal vertical
dimension . Class II div 2 or
Class III molar relationship.
Protruded and overclosed
Residual ridge morphology mandibular position
conforms to the class IV
complete edentulism.

Significantly irregular maxillary

occlusal plane
Class IV
(ACP)
 Guidelines for
use
1. If patients diagnostic criteria overlap
in 2 or more levels then the patient is
placed in the more complex class.
2. Consideration for future treatment
procedures must not influence the
choice of diagnostic level.
3. Initial preprosthetic treatment and/or
adjunctive therapy can change the
initial classification level.
Classification may need to be
reassessed.
4. Esthetic concerns or challenges raise
the classification by 1 level in class I
and II patients.
 Guidelines for use
5. The presence of TMD symptoms raises the
classification by 1 or more levels in class I
and II patients.
6. In patient with an edentulous maxilla and
opposing a partially edentulous mandible,
appropriate classification system is chosen
for each arch.
7. Periodontal health is intimately related to
the diagnosis and prognosis for partially
edentulous patients. In this system it is
assumed that patient will receive ,achieve
and maintain periodontal health.
Advantages
1. It is an objective classification.
2. It is exhaustive and takes into account
more factors than the other
classifications.
3. The classification gives a more complete
intraoral picture thereby facilitating
treatment planning.
4. Enables efficient intraoperator
communication.
 Limitations

Time consuming

The ACP classification has its own

advantages and limitations. It is not a
complete classification and requires
further modifications.
 SUMMARY
Many classification of partially edentulous
arches have been proposed by different
clinicians since 1920.
Kennedys classification till date forms a
common partial denture language among
colleagues. However, it does not take into
account available support on which success
or failure ultimately depends.
The new ACP classification is more
exhaustive and uses several diagnostic
criteria for predictable treatment planning
decisions. But, it is quite complex and does
not permit immediate visualization.
 REFRENCES
Removable partial denture prosthetics- STEWART, 2 rd edition.
McCrackens Removable Partial Prosthodontics, 8 th edition.
Miller E L. Systems for classifying partially edentulous
arches. J Prosthet Dent 1970;24: 25-40.
McGarry TJ, Nimmo A, Skiba JF, et.al: Classification system
for partial edentulism. J Prosthodont 2002;11:181-193.
Galagali G, Mahoorkar S: Critical evaluation of classification
systems of partially edentulous arches. Int J Dental Clinics
2010;2:45-52.
Thank You