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ICK Classification System for Partially Edentulous Arches

Sulieman S. Al-Johany, BDS, MSD1 & Carl Andres, DDS, MSD2
1
Assistant Professor, Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
2
Professor and Director, Graduate Prosthodontics, Department of Restorative Dentistry, Indiana University, School of Dentistry, Indianapolis, IN

Keywords Abstract
Classification system; dental implants;
removable partial denture. Several methods of classification of partially edentulous arches have been proposed and
are in use. The most familiar classifications are those originally proposed by Kennedy,
Correspondence Cummer, and Bailyn. None of these classification systems include implants, simply
Sulieman S. Al-Johany, College of Dentistry, because most of them were proposed before implants became widely accepted. At this
King Saud University, P.O. Box 60169, time, there is no classification system for partially edentulous arches incorporating
Riyadh 11545, Saudi Arabia. E-mail: implants placed or to be placed in the edentulous spaces for a removable partial denture
saljohany@hotmail.com (RPD). This article proposes a simple classification system for partially edentulous
Previously presented at the Table Clinic arches with implants based on the Kennedy classification system, with modification, to
Session at the American College of be used for RPDs. It incorporates the number and positions of implants placed or to be
Prosthodontists 2006 Annual Session, placed in the edentulous areas. A different name, Implant-Corrected Kennedy (ICK)
Miami, FL. Classification System, is given to the new classification system to be differentiated
from other partially edentulous arch classification systems.
Accepted May 24, 2007

doi: 10.1111/j.1532-849X.2008.00328.x

Partial edentulism is defined as the absence of some but not all phasis on the available bone in the edentulous area for implant
the natural teeth in a dental arch.1 Several methods of classifi- placement. Their classification involves four divisions: Divi-
cation of partially edentulous arches have been proposed and sions A and B when bone is available for implant placement,
are in use. It has been estimated that there are over 65,000 pos- division C when bone is not available for implant placement,
sible combinations of teeth and edentulous spaces in opposing and division D, restricted to cases with severe atrophy of the
arches.2 edentulous area involving basal bone.
The most familiar classifications are those originally pro- Implants with or without attachments can be used to improve
posed by Kennedy,3 Cummer,4 and Bailyn.5 Costa6 in 1974 the support, stability, and retention of an RPD. The esthetic
summarized most of the classification systems for partially result of the RPD can be greatly improved by the use of implant
edentulous arches and the rationale of the classification. These attachments, thus eliminating unesthetic clasps. With the use of
included: (i) the number and position of direct retainers,4 (ii) the implants, the options for RPD use have increased, and the high
relation of edentulous spaces to abutment teeth,3 (iii) the type demands of many patients for esthetic prostheses have been
of denture support, that is, tooth-supported, tissue-supported, satisfied.19-21
or a combination,5,7 (iv) the quality and degree of support a At this time, there is no classification system for partially
removable partial denture (RPD) receives from the abutment edentulous arches incorporating implants placed or to be placed
teeth and residual ridge,8 (v) the number, length, and position in the edentulous spaces for an RPD.
of edentulous spaces and the number and position of remain- The purpose of this article is to present a simple classification
ing teeth,9 (vi) the location and extent of edentulous spaces,10 system for partially edentulous arches with implants based on
(vii) the boundaries of the spaces,11 and (viii) combinations of the Kennedy classification system, with modification, to be used
these principles.3,12,13 Classifications have also been proposed for RPDs.
by Neurohr,14 Austin and Lidge,15 Avant,16 and others.6,17
Kennedy’s method of classification is probably the most widely
accepted classification of partially edentulous arches today.2,17 Kennedy classification system
None of these classification systems include implants, simply
because most were proposed before implants became widely The Kennedy method of classification was originally proposed
accepted. Recently, Misch and Judy18 described a classification by Dr. Edward Kennedy in 1925.3 He divided all partially eden-
system depending on the Applegate–Kennedy system, with em- tulous arches into four basic classes. Edentulous areas other

502 Journal of Prosthodontics 17 (2008) 502–507 
c 2008 by The American College of Prosthodontists

used by the authors because of familiarity)." followed by the de- scription of the classification. the edentulous areas other than those determining the classifi. The drawing will appear as if looking directly tulous spaces has implants. The word mod- ification can be abbreviated as “mod. The main classification. will be placed first. The new classification system will follow the Kennedy method The arrangement of the implants will be from right to left with the following guidelines: in the maxillary arch and from left to right in the mandibular arch. ICK Classification System. This will mean their number. is given to In 1954.” (5) Roman numerals will be used for the classification. and ment to describe any situation of RPD with implants.18 The first principle is that for partially edentulous arches the classification should include only natural teeth involved in Examples for Kennedy class I situations the definitive prostheses and follow rather than precede any extractions of teeth that might alter the original classification. and Arabic numerals will be used for the number of modifica- tion spaces and implants. and Figure 5 if two modification spaces exist. for Kennedy class IV situations. (4) The abbreviation “max” for maxillary and “man” for mandibular can precede the classification. Applegate12 provided eight rules governing the ap. The proposed ICK classification system rized in three general principles. Figures 1. as can the tooth name. followed by the number of modi- fication spaces. The ADA system was modification spaces. Figure 4 shows the situation if only one modification (2) To avoid confusion. (ii) ICK II. before implant placement to indicate the number and posi- tulous area located anterior to the remaining natural tion of future implants with an RPD. for Kennedy class III situations. the right and left quadrants are reversed. Journal of Prosthodontics 17 (2008) 502–507  c 2008 by The American College of Prosthodontists 503 . (9) A different name. eden. of modification spaces. 5. 15) or ICK I systems such as Fédération Dentaire Internationale [FDI] (#2. (iii) ICK III. it will be indicated between parentheses. It can be abbreviated as follows: (i) ICK I. then the number remaining natural teeth. (6) The tooth number using the American Dental Association (ADA) system is used to give the number and exact position of the implant in the arch. These rules can be summa. (8) The classification can be used either after implant place- maining both anterior and posterior to it. spaces. (Note: other tooth numbering Figure 1 Maxillary implant-corrected Kennedy class I (#2. it will be as (3) The classification will always begin with the phrase shown in Figure 6. this classification system to be differentiated from other plication of the Kennedy system and proposed a new classi. fication named the Applegate–Kennedy classification system for partially edentulous situations. only that no implants were placed or to be placed in the other eden- the number of additional edentulous areas. but bilateral (crossing the midline). 15). (7) The classification of any situation will be according to the Class I: Bilateral edentulous areas located posterior to the following order: main classification first. For Kennedy class I situations. "Implant-Corrected Kennedy (class). the maxillary arch is drawn as half space exists. at the patient. tion if it will be restored with an implant-supported fixed Figures 4. The extent of modification is not considered.Al-Johany and Andres Classification System for RPDs with Implants than those determining the basic classes were designated as can be used. If only one implant is placed in one of the two edentulous cation are referred to as modifications and are designated by areas. 2. The full text can always determines the classification. and (iv) ICK IV. followed by the position Guidelines for the new classification (number) of the implants in the edentulous areas in parenthesis system arranged according to the tooth numbering system used. When more than two modification spaces exist. teeth. or preferably the abbreviation (Fig 1). (Fig 3). The third principle is that be used. preceded by the number sign (#). for Kennedy class I situations. partially edentulous arch classification systems. or Class IV: A single. for Kennedy class II situations. and 6 show the classification with modification prosthesis. circle facing up and the mandibular arch as half circle If only one of the modification spaces or one of the main eden- facing down. following the arrangement of the tooth numbering system (1) No edentulous space will be included in the classifica. Class III: A unilateral edentulous area with natural teeth re. it will be the same as in Figure 5. and 3 show the The second principle is that the most posterior edentulous area classification if no modification spaces exist. followed by the number of im- Class II: A unilateral edentulous area located posterior to the plants in parentheses according to their position in the arch remaining natural teeth. tulous area (Fig 2).

but with modification spaces. 22. but with modification spaces. Discussion One requirement of a classification of partially edentulous Figure 3 ICK I (#18. arches is that it provides immediate visualization of the Figure 4 ICK I mod 1 (#19. 22. Figures 9 and 10 show the same. Figure 2 ICK I (#2). 25. Examples for Kennedy class II situations Figures 7 and 8 show the implant-corrected classification (ICK) for Kennedy class II situations without any modification spaces. Figures 12 and 13 show the same. 22. Examples for Kennedy class IV situations Figures 14 and 15 show the implant-corrected classification for Kennedy class IV situations. Figure 6 ICK I mod 3 (#18. 31). 504 Journal of Prosthodontics 17 (2008) 502–507  c 2008 by The American College of Prosthodontists . 31). 28.Classification System for RPDs with Implants Al-Johany and Andres Figure 5 ICK I mod 2 (#18. Examples for Kennedy class III situations Figure 11 shows the implant-corrected classification for Kennedy class III without modification spaces. 30). 26. 31).

length. if desired. and division D when the edentulous area implant-corrected classification can be used to describe the sit. this new clas- teeth #2 and 15. 26. prospectively for future planning. For example. sification system can be included to make the original classi- ing situation as shown in Figure 1. Figure 10 ICK II mod 2 (#24. If the same fication broader to incorporate implants with RPDs. follows: divisions A and B for edentulous areas with bone avail- plant placement. retrospectively. edentulous situation and the proposed treatment planning and Misch and Judy18 classification can be used for the edentu- design. marized or compacted for teaching purposes. 30). lous area regarding the available bone for implant placement. the new implant-corrected classification can be in- treatment planning. vided with drawings showing the use of this new classification Figure 8 ICK II (#2. It means that the classification can be use this in the classification to avoid complexity. be placed in the area of teeth #1 and 15. It can be men- used either retrospectively to describe an existing situation. This can situation has no implants placed. sification system only when implants are incorporated with an supported fixed prosthesis will not be included in the classi. RPD. The guidelines of the new classification system can be sum- tioned following the classification. The authors did not uation with implants.Al-Johany and Andres Classification System for RPDs with Implants Figure 7 ICK II (#2). Emphasis should be made about using the new clas- Any edentulous space to be restored with an implant. division C when bone is insufficient used to describe the situation without implants. The original Kennedy classification can be able for implant placement. Figure 9 ICK II mod 1 (#21. not to be confused with the original classification without fication as mentioned earlier in the guidelines. and then the for implant placement. or tioned after the classification. The implant size. 29) Journal of Prosthodontics 17 (2008) 502–507  c 2008 by The American College of Prosthodontists 505 . as The proposed classification can be used before or after im. this system can be then after the students become familiar with the original clas- used prospectively to describe the future situation and help in sification. troduced. is severely atrophied involving basal bone. but implants were planned to be done by explaining the original Kennedy classification first. the types of the removable and/or fixed prosthesis can be men. A description of implants. in a Kennedy For dental schools using Kennedy’s classification system for class I situation with two implants already placed in the area of the classification of partially edentulous arches. this system can be used to describe the exist. The examples pro- and system can also be included. 7).

Refinement and revision may be considered as simple and placed as class III (implants-simple) required. if the residual ridge is classified as class III according to the vides ease in communication with the laboratory and assists complete edentulism classification. the condition will be not the quality of the bone. for familiarization. A software program (Dental Flash. PDI. it can be done by observing For partial edentulism. 11).g. The system pro- ple. Information is pro- implant-corrected classification (ICK) of the condition involves vided about the location and the number of the implants. 26). San Mateo. of partially edentulous arches with implants for RPDs. 11).1 and completely dentate pa.22 partial edentulism. Implants are involved in the classification for drawing and designing any classification. plant procedure. The authors suggest that this new classification be used with The classification will be difficult for individuals who are the PDI for partial edentulism according to the following: if the unfamiliar with the Kennedy classification. For exam. This is very helpful for students and residents. as complex and placed as class IV (implants-complex) in the The recently developed Prosthodontic Classification Sys. in proposed treatment planning and design. but the placement of two or fewer implants. If the condition A widely used classification (Kennedy) is followed with requires complex implant procedures with bone graft.. but needs practice edentulism. sign cleanly. and printing the de- complete edentulism. it will be modification for implant location and number. Figure 13 ICK III mod 3 (#23. 506 Journal of Prosthodontics 17 (2008) 502–507  c 2008 by The American College of Prosthodontists .23 has gained more interest among educational centers ments International. it will be considered purposes. The classifica- class IV. or Prosthodontic Diagnostic Index (PDI) for complete The presented classification is simple. If the condition involves placement of more than in explaining the use of this new classification for educational two implants. tem. it will be classified as class III. and so on. tion is simple and easy to visualize. Figure 12 ICK III mod 1 (#6. with or without bone graft. if no other factors make it class IV. and assists according to the complete edentulism classification. the condition will be class professional communication regarding the different situations III.Classification System for RPDs with Implants Al-Johany and Andres Figure 11 ICK III (#6). Panorex). in different Kennedy classification classes should be helpful in the PDI. the residual ridge will be classified the diagnostic casts or radiograph (e. CA) can be used to assist in and clinicians. Figure 14 ICK IV (#6. If the condition requires a simple im. Attach- tients.

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