944 D3000 new imprint Word template


 

Vol 13, No 1 (2025) 
ISSN 2167-8677 (online) 

DOI 10.5195/d3000/2025.944  

 

	

	

http://dentistry3000.pitt.edu	

Classifying Completely Edentulous Patients Using the Prosthodontic 
Diagnostic Index 
Al Namel Hasanen Ali, Zainab H. Al-Naser, Majed Mohamed Refaat 
 
College of Den*stry, University of Basrah, Iraq

Abstract 

Objec<ve: To use the ProsthodonFc DiagnosFc Index (PDI) to assess and assign fully edentu-
lous paFents to students at a dental school in Basrah, Iraq. Material and Methods: This study 
was conducted on 300 completely edentulous paFents who were treated at the teaching 
outpaFent dental prostheFc clinic of a dental school in Basra city, republic of Iraq during the 
years 2022, 2023, and 2024. Based on the complexity of the diagnosFc results, the edentu-
lous paFents were divided into four groups (Class I–IV). Maxillomandibular relaFonship, mus-
cle aWachments in the mandibular arch, residual ridge morphology of the maxillary arch, and 
mandibular bone height were measured in panoramic radiographs. Results: 7.5% of paFents 
were categorized as Class IV when using the PDI classificaFon. Out of the various PDI criteria, 
10% of the paFents had Class IV mandibular bone heights of 10 mm or below, whereas 15% 
of the paFents had Class III mandibular bone heights of 11–15 mm. Class I was assigned to 
65% of the paFents based on the maxillary residual ridge morphology, and 25% of the pa-
Fents were categorized as Class I or II according to their Type A mandibular muscle aWach-
ment requirements. 60% of the paFents had a Class I maxillomandibular relaFonship). Con-
clusion: Class I (severely impaired) paFents made up the bulk of the study's subjects. For 
undergraduate students to handle fewer complex cases (Class I and II) and prosthodonFsts 

or specialist centers to handle more com-
plex cases (Class IV), it is necessary to 
classify edentulous paFents based on PDI 
during the iniFal screening phase. This 
will prevent the need for expensive and 
Fme-consuming complete denture re-
makes.  

Open Access 
Cita%on: Ali ANH, et al. (2025) Classifying Completely 
Edentulous Pa%ents Using the Prosthodon%c Diagnos%c 
Index. Den%stry 3000. 1:a001 
doi:10.5195/d3000.2025.944 
Received: May 17, 2025  
Accepted: June 27, 2025 
Published: August 11, 2025 
Copyright: ©2025 Ali ANH, et al. This is an open access 
ar%cle licensed under a Crea%ve Commons ATribu%on 
Work 4.0 United States License. 
Email: Hasanen.muhsen@uobasrah.edu.iq

Introduc)on	

A	chronic,	irreversible	condition,	edentulism	
is	 the	 ultimate	 result	 of	 a	 complex	 process	
that	includes	biological	variables	(periodon-
tal	 disease,	 pulpal	 pathology,	 trauma,	 and	
oral	cancer)	as	well	as	patient-related	ones	
(access	 to	 care,	 patient	 choices,	 treatment	
possibilities	 etc.)	 [1,4,10].	 It	 affects	 overall	
health,	 nutrition,	 and	 chewing	 efDiciency,	
which	 lowers	 the	 quality	 of	 life	 associated	
with	oral	health.	"The	state	of	being	edentu-
lous	or	lacking	natural	teeth	or	truly	patient	
illness	"	is	how	the	glossary	of	prosthodontic	
terminology	 describes	 edentulism	 [1].	 A	
more	 accurate	 description	 would	 be	 "the	
physical	 state	 of	 the	 jaw(s)	 following	 re-
moval	of	all	erupted	teeth	and	the	condition	
of	 the	 supporting	 structures	 available	 for	

reconstructive	or	replacement	therapies,"	as	
a	fully	edentulous	person	would	need	some	
kind	of	therapy.	Complete	loss	of	teeth	can	be	
seen	as	a	handicap	as	it	 impairs	several	es-
sential	and	typical	human	activities,	 includ-
ing	the	capacity	to	talk	and	eat,	two	of	life's	
most	important	responsibilities	[2].	Accord-
ingly,	 edentulism	 meets	 the	 World	 Health	
Organization's	(WHO)	deDinition	of	physical	
handicap	and	can	be	difDicult	for	people	who	
suffer	from	it	[3,4].	It	is	still	and	will	continue	
to	be	a	major	worldwide	health	care	liability	
[5].	 Because	 it	 is	 a	 global	 issue,	 there	 will	
thus	be	an	 increasing	need	 for	 full	denture	
prosthesis	 in	 the	 future	 [5,6].	 Information	
gathered	 from	many	 diagnostic	 tools	 must	
be	 categorized	 based	 on	 the	 complexity	 of	
the	patient's	therapy	to	create	an	appropri-
ate	treatment	plan	for	an	edentulous	patient.	

An	 appropriate	 method	 of	 treatment	 plan-
ning	among	prosthodontists	has	always	been	
hampered	by	the	absence	of	a	categorization	
system	 and	 referral	 [7,8].	 To	 address	 all	
these	 questions	 and	 aid	 in	 treatment	 plan-
ning,	 the	 American	 College	 of	 Prosthodon-
tists	 (ACP)	 developed	 a	 categorization	 sys-
tem	 [9].	 The	 PDI	 for	 totally	 edentulism	
(1999),	partially	edentulous	patients	(2002),	
and	entirely	dentate	 individuals	(2004)	are	
among	the	categories	that	McGarry	TJ	et	al.	
developed	[10-12].	Based	on	the	severity	of	
the	oral	problems	observed	during	the	initial	
diagnostic	visit,	these	were	used	to	identify	
individuals	 in	 need	 of	 prosthetic	 therapy	
[13].	 As	 very	 few	 studies	 have	 been	 con-
ducted	on	implementing	the	PDI	on	an	eden-
tulous	 population	 in	 a	 dental	 school,	 this	
study	 was	 carried	 out	 at	 teaching	 clinic	 of	



  Classifying Completely Edentulous PaFents Using the ProsthodonFc DiagnosFc Index 

Vol 13, No 1 (2025)    DOI 10.5195/d3000/2025.944 

	http://dentistry3000.pitt.edu	
2	

Basrah	Dental	College,	Department	Prostho-
dontic	dentistry	and	formed	a	classiDication	
system	to	answer	all	these	queries	and	help	
in	treatment	planning.	

Material and Methods 
From	September	2022	to	September	2024,	a	
survey	was	carried	out	at	the	teaching	clinics	
of	the	College	of	Dentistry	in	Basrah	City,	Re-
public	of	 Iraq.	After	receiving	consent	 from	
the	patient	and	the	Institutional	Ethical	Com-
mittee	(the	University	of	Basrah's	examining	
and	 diagnostic	 department),	 the	 study	was	
carried	 out.	 According	 to	 earlier	 research	
[7,14],	300	fully	edentulous	Iraqi	patients	of	
both	sexes	between	45	and	70	years	of	age	
were	chosen	using	convenient	sampling	se-
lection	[7,14].	The	patient	was	given	written	
informed	permission	after	being	fully	told	of	
the	aim	of	the	comprehensive	clinical	and	ra-
diological	assessment.		
	
Case	exclusions	
This	study	excluded	all	patients	of	who	were	
completely	edentulous	but	had	maxillofacial	
defects,	 craniofacial	 abnormalities,	 bone	
grafts,	 or	 oral	 signs	 of	 systemic	 diseases	
(such	 as	 Crohn's	 disease,	 pemphigus	 vul-
garis,	or	lupus	erythematosus),	wanted	den-
tal	 implants,	 had	 retained	 roots,	 or	 were	
weak	and	unable	to	handle	the	treatment.		
	
Evaluating	criteria	
	The	 patient's	 medical	 and	 dental	 history,	
age,	sex,	address,	and	any	pertinent	clinical	
information	 (intraoral	 and	 extraoral)	 [7]	
were	 all	 documented	 in	 PDI	 worksheet	 by	
the	 dentist	 including	 the	 intraoral	 and	 ex-
traoral-examination,	 every	 participant	 in	
this	study	received	additional	training	about	
the	four	primary	PDI	diagnostic	criteria.	The	
four	requirements	are	listed	below.	
	
Bone	height-mandible	
The	most	straightforward	objective	criteria	
for	 the	mandibular	 edentulous	 ridge	 is	 the	
identiDication	 and	measurement	of	 residual	
bone	 height.	 Alveolar	 bone	 loss	 is	 still	 de-
scribed	by	Atwood	in	1971	as	a	"chronic	pro-
gressive,	irreversible,	and	disabling	process	
probably	of	multifactorial	origin."	The	signif-
icance	of	different	 cofactors	 is	 still	unclear.	
To	minimize	variability	in	radiographic	tech-
niques,	the	measurement	should	be	made	on	
the	radiograph	at	that	portion	of	the	mandi-
ble	of	the	least	vertical	crystal	bone	level	and	
the	base	of	the	mandibular	bone.	The	values	
assigned	to	each	of	the	four	types	listed	be-
low	are	averages	that	have	results	of	a	radi-
ographic	 survey	 of	 residual	 bone	 height	
measurement	are	the	same	variation	 in	the	
radiographic	 techniques	 and	 magniDication	

of	panoramic	machines	had	been	used	[15].	
A	measurement	was	made	 and	 the	 patient	
was	classiDied	as	follows	[7]	(Figure	1):	
Type	 I:	 (most	 favorable):	 residual	 bone	
height	measured	at	the	mandible's	minimum	
vertical	height	of	21	mm	or	more.	
Type	 II:	 residual	 bone	 height,	measured	 at	
the	mandible's	lowest	vertical	height,	is	16	to	
20	mm.	
Type	III:	residual	alveolar	bone	height,	meas-
ured	at	the	mandible's	lowest	vertical	height,	
is	between	11	and	15	mm.		
Type	IV:	residual	vertical	bone	height	at	the	
mandibular	minimum	 vertical	 height	 of	 10	
mm	or	less.	
	
Residual	ridge	morphology-maxilla	only	
Since	 radiography	 cannot	 accurately	 evalu-
ate	the	maxillary	residual	bone	height,	resid-
ual	ridge	morphology	is	the	objective	criteria	
for	the	maxilla.	Following	a	logical	sequence,	
the	 categorizations	 system	 describes	 how	
musculature	and	remaining	ridge	morphol-
ogy	affect	a	maxillary	denture	[7]	(Figure	2),	
it	could	be	classiDied	to:	
Type	A	(the	most	advantageous	kind)	
-	A	vestibular	depth	in	the	anterior	labial	and	
posterior	 buccal	 regions	 that	 prevents	 the	
denture	base	from	moving	vertically	or	hori-
zontally.	
-	The	denture	base	cannot	shift	vertically	or	
horizontally	due	to	the	palatal	anatomy.		
-	 Adequate	 deDinition	 of	 tuberosity	 to	 pre-
vent	denture	base	movement	in	both	vertical	
and	horizontal	directions.		
-	 The	denture	base's	posterior	 extension	 is	
established	by	a	well-deDined	hamular	notch.	
-	No	exostoses	or	tori	are	present	[8].	
	
Type	B	
-	The	posterior	buccal	vestibule	is	lost.		
-	The	denture	base	cannot	move	vertically	or	
horizontally	due	 to	 the	anatomy	of	 the	pal-
ate.	
-	The	posterior	extension	of	the	denture	base	
cannot	be	clearly	recognized	because	to	the	
poorly	 deDined	 tuberosity	 and	 hamular	
notch.		
-	The	denture	base's	elongation.	Lateral	ex-
ostoses	 and/or	 maxillary	 palatal	 tori	 are	
rounded	and	do	not	 interfere	with	denture	
stability	[9].	
	
Type	C	
-	The	anterior	labial	vestibule	is	lost.		
-	The	shape	of	the	palate	vault	provides	little	
resistance	to	the	denture	base's	vertical	and	
horizontal	mobility.	
-	 Lateral	 exostoses	 with	 bony	 undercuts	
and/or	maxillary	palatal	tori	that	do	not	im-
pact	the	denture	base's	posterior	extension.	
-	A	hyperplastic,	movable	anterior	ridge	pro-
vides	the	denture	foundation	with	the	least	
amount	of	rigidity	and	support.	

-	During	mandibular	 opening,	 the	 coronoid	
process	reduces	the	post-malar	space	[10].	
	
Type	D	
-	Loss	of	the	vestibules	in	the	anterior	labial	
and	posterior	buccal	regions.	
-	The	denture	base	can	shift	both	vertically	
and	horizontally	according	to	the	anatomy	of	
the	palate.		
-	 Lateral	 exostoses	 (rounded	 or	 undercut)	
and/or	 maxillary	 palatal	 tori	 that	 obstruct	
the	denture's	posterior	border.		
-	A	redundant,	hyperplastic	anterior	ridge.		
-	A	noticeable	frontal	nasal	spine	[11].	
	
Muscle	attachments	(only	mandible)		
The	most	crucial	factors	affecting	a	mandib-
ular	denture's	 functionality	 are	 its	 position	
and	 the	 impact	 of	muscle	 attachment.	 It	 is	
challenging	to	measure	these	traits.	The	cat-
egorizations	 system	 describes	 how	 muscle	
input	 affects	 a	mandibular	denture	 in	 a	 ra-
tional	manner.	After	examining	 the	patient,	
the	doctor	chooses	the	category	that	best	de-
scribes	the	mandibular	muscle	attachments.	
[12],	it	could	be	classiDied	to:		
Type	A	(most	advantageous)	
-	 All	 areas	 have	 an	 attached	mucosal	 basis	
free	 from	 excessive	 muscle	 impingement	
during	normal	operation.	
	
Type	B	
-	From	canine	to	canine,	the	mucosal	base	is	
attached	in	every	area	save	the	labial.	
-	Attachment	of	the	mentalis	muscle	close	to	
the	alveolar	vestibule	ridge	crest.	
	
Type	C		
-	All	areas	save	the	anterior	buccal	and	lin-
gual	vestibules—canine	to	canine—have	an	
attached	mucosal	base.	
-	Attachments	of	the	genioglossus	and	men-
talis	muscles	close	to	the	alveolar	ridge	crest	
[12].	
	
Type	D	
-	Only	 the	posterior	 lingual	 area	has	 an	at-
tached	mucosal	base.	
-	In	every	other	area,	the	mucosal	base	is	sep-
arated.	
	
Type	E	
-	No	mucosa	is	connected	in	any	area	[13].	
	
Maxillomandibular	relationship		
The	 classiDication	of	 the	maxillomandibular	
relationship	characterizes	the	position	of	the	
artiDicial	 teeth	 in	 relation	 to	 the	 residual	
ridge	and/or	to	opposing	dentition.	Examine	
the	patient	and	assign	a	class	as	follows	[14]	
(Figure	3):	
Class	1	(most	favorable)	



  Classifying Completely Edentulous PaFents Using the ProsthodonFc DiagnosFc Index 

Vol 13, No 1 (2025)    DOI 10.5195/d3000/2025.944 

	http://dentistry3000.pitt.edu	
3	

Maxillomandibular	relation	allows	tooth	po-
sition	that	has	normal	articulation	with	the	
teeth	supported	by	the	residual	ridge.	
	
Class	II	
Maxillomandibular	 relation	 requires	 tooth	
position	outside	the	normal	ridge	relation	to	
attain	 esthetics,	 phonetics,	 and	 articulation	
(e.g.,	 anterior	or	posterior	 tooth	position	 is	
not	supported	by	the	residual	ridge;	anterior	
vertical	 and/or	 horizontal	 overlap	 exceeds	
the	principles	of	fully	balanced	articulation)	
[15].	
	
Class	III	
Maxillomandibular	 relation	 requires	 tooth	
position	outside	the	normal	ridge	relation	to	
attain	 esthetics,	 phonetics,	 and	 articulation	
(i.e.	cross	bite-anterior	or	posterior	tooth	po-
sition	is	not	supported	by	the	residual	ridge).	
[16].	

Results 
The	 study	 found	 that,	 of	 the	 122	 patients,	
(40.6%)	were	between	the	ages	of	51	and	60	
years	old,	and	57%	were	male.	The	Dirst	PDI	
criterion,	 mandibular	 bone	 height,	 is	 dis-
played	in	Table	1.	180	(60%)	of	the	patients	
showed	Class	I	symptoms,	45	(15%)	showed	
ClassII,	and	III	symptoms,	30	(10%)	showed	
Class	IV	symptoms.	
The	result	of	the	study	appeared	signiDicant	
changes	in	relation	to	the	maxillary	residual	
ridge's	morphology,	 it	was	displayed	 in	Ta-
ble2.	 195	 patients	 (65%)	were	 categorized	
as	 type	 A,	 whereas	 the	 majority	 of	 45	 pa-
tients	(15%)	were	categorized	as	type	B,	60	
patients	 (20%)	 belonged	 to	 type	 C,	 while	
zero	 belonged	 to	 type	 D.	 The	 result	 of	 the	
study	 appeared	 signiDicant	 changes	 in	 rela-
tion	to	the	maxillary	Residual	ridge	morphol-
ogy.	
The	mandibular	arch's	muscle	attachment	is	
displayed	 in	Table3.	 There	were	75	 type	A	
patients	(25%)	with	enough	connected	mu-
cosa,	 135	 patients	 (45%)	 Type	 B	 (no	 at-
tached	 buccal	 mucosa),	 45	 patients	 (15%)	
Type	C,	and	15	patients	(5%)	Type	D.	30	pa-
tients	were	Type	E	(10%).	
The	 maxillomandibular	 connection	 is	 dis-
played	in	Table	4.	180	patients	(60%)	were	
Class	I,	90	patients	(30%)	were	Class	II,	and	
30	patients	(10%)	were	Class	III.	
The	 PDI's	 general	 categorizations	 showed	
that	7.5%	of	 the	patients	belonged	 to	Class	
IV,	21.25%	of	the	patient	belonged	to	Class	
III,	26.25%	of	the	patient	belonged	to	Class	
II,	and	45%	of	the	patients	were	Class	I.	Ac-
cording	to	the	results,	28.75%	of	the	patients	
were	sent	to	specialist	centers	or	assigned	to	
expert	 prosthodontists	 and	 71.25%	 were	
treated	 by	 Difth-year	 students	 at	 the	 dental	
school.	

Discussion 
The	study's	dentistry	school	is	situated	in	a	
low-income	 person	 at	 large	 city,	 which	 is	
also	 home	 to	many	 entirely	 edentulous	 ex-
patriate	 groups	 with	 low	 socioeconomic	
backgrounds	 and	 neglected	 oral	 health	
[17,18].	As	a	result,	there	are	many	different	
nations	with	a	wide	variety	of	intricate	clini-
cal	 situations	 of	 edentulism	 depending	 on	
the	anatomy	of	each	person	and	altered	by	a	
few	 other	 variables	 such	 systemic	 illness,	
psychological	 issues,	 and	 the	 requirement	
for	full	dentures	[19].	As	a	result,	undergrad-
uate	students	have	access	to	a	sizable	patient	
base	for	full	denture	training;	these	numbers	
are	 comparable	 to	 those	 documented	 in	
other	nations	[20,21].	The	American	College	
of	 Prosthodontists	 (ACP)	 developed	 PDI,	
which	 is	 beneDicial	 to	 prosthodontists	 who	
are	required	to	diagnose	and	arrange	treat-
ments	 for	 every	 patient.	When	 it	 comes	 to	
treating	 edentulous	 individuals,	 there	 are	
several	beneDits	to	using	a	structured	catego-
rizations	system	like	PDI	[7,22].	The	primary	
beneDit	 of	 employing	 PDI	 is	 the	 screening	
that	 can	 be	 done	 in	 a	 dental	 school,	which	
yields	an	accurate	patient	classiDication	that	
can	be	used	to	assign	patients	to	students	for	
treatment	or	to	refer	patients	to	a	specialist	
based	 on	 the	 case's	 complexity	 [7,23].	 Ac-
cording	to	the	study's	authors,	most	patients	
had	 mandibular	 bone	 heights	 in	 Class	 I	
(60%)	 as	 determined	 by	 OPG;	 however,	
Shaik	 S	 et	 al.	 reported	 that	 most	 patients	
were	in	Class	I	(39.4%)	[24],	while	Ntala	PC	
et	al.	demonstrated	that	most	patients	were	
in	 Class	 IV	 (42.7%)	 [7.25].	 The	 remaining	
three	parameters	such	as	maxillary	residual	
ridge	 morphology,	 mandibular	 muscle	 at-
tachments,	and	maxillomandibular	relation-
ships	 have	 not	 been	 compared	 in	 any	 re-
search.	 Most	 of	 the	 patients	 in	 our	 study	
(28.75)	 of	 the	 patients	 were	 classiDied	 as	
complex	(Class	III	and	IV).	This	is	compara-
ble	to	research	by	Ntala	PC	et	al.	 in	Greece,	
where	they	found	that	(56.4%)	of	the	patient	
were	 referred	 to	 specialist	 dentist	 [7,26],	
Mazurat	RD	and	Mazurat	NM	in	Canada,	who	
found	that	(64.5%)	of	the	patient	considered	
as	difDicult	cases	 [27],	and	Elfadil	S	et	al.	 in	
Ireland,	who	found	that	(69%)	of	the	patient	
must	be	referred	[28].	The	majority	in	Paki-
stan's	Class	 I	 and	 II	 categories	 (57%)	were	
only	reported	by	Chaudary	MAU	et	al.	 [27].	
The	authors	discovered	that	 the	most	com-
mon	 factor	 determining	 the	 complexity	 of	
the	 cases	 was	 mandibular	 ridge	 height,	
which	is	comparable	to	the	study	by	Ntala	PC	
et	 al.,	 [7].	Mazurat	RD	and	Mazurat	NM	re-
ported	 that	 the	 most	 common	 factors	 for	
classifying	the	cases	as	the	complex	were	the	
ridge	height	and	muscle	attachments	in	the	
mandibular	arch	[28].	Students	in	college	of	
dentistry	 university	 of	 basrah	 at	 their	 Difth	

year	were	 assigned	 to	 PDI	 Class	 I	 patients.	
Since	 PDI	 Class	 I	 and	 classII	 patients	were	
the	most	numerous,	prosthodontists	treated	
these	Classes	patients	while	 teaching	assis-
tants	under	the	supervision	of	prosthodontic	
staff.	Since	postgraduate	students	were	not	
present,	some	patients	were	referred	to	spe-
cialist	centers.	Chaudary	MAU	et	al.,	who	as-
signed	undergraduate	students	to	Class	I,	are	
comparable	to	our	study.	Class	IV	was	han-
dled	by	professionals,	whereas	Class	 II	 and	
Class	III	were	given	to	postgraduate	students	
[27].	However,	most	of	the	complicated	Class	
III	and	IV	cases	might	be	handled	by	under-
graduate	 students	under	 the	 close	 supervi-
sion	of	professionals,	according	to	Ntala	PC	
et	al.,	Mazurat	RD,	and	Mazurat	NM	[7,28].	As	
a	 result,	 outpatient	 screening	 clinics	 must	
employ	PDI	early	on.	The	proper	distribution	
of	 patients,	 especially	 those	 with	 a	 poor	
prognosis,	will	be	made	possible	by	the	gath-
ering	of	all	data	(radiographic,	clinical,	phys-
ical,	and	medical)	and	categorizations	based	
on	PDI	[27].	Class	III	cases	can	be	addressed	
by	 postgraduate	 students	 under	 the	 guid-
ance	 of	 staff	 members	 or	 specialized	 clin-
ics/units;	 however,	 prosthodontists	 often	
handle	complicated	cases	like	Class	IV	[28].	

Conclusions 

Most	of	the	edentulous	patients	screened	in	
the	dental	school	using	the	PDI	were	catego-
rized	as	Class	I,	which	is	a	most	common	cat-
egory,	the	treatment	had	to	be	provided	by	
the	 assistance	 of	 specialists.	 Thus,	 the	 PDI	
classification	system	can	help	to	identify	pa-
tients	who	are	most	 likely	 to	require	 treat-
ment	by	referred	to	a	specialist.	PDI	provides	
a	basis	from	which	an	accurate	diagnosis	can	
be	 obtained	 along	 with	 proper	 treatment	
planning.	For	easy	and	suitable	networks	be-
tween	dental	professionals,	PDI	has	certain	
terminologies	 that	 help	 in	 establishing	 a	
proper	 channel	 of	 communication.	 These	
standardized	indices	can	be	useful	for	dental	
professionals	 during	 their	 private	 practice,	
as	they	allow	better	communication	between	
specialists	 and	 dentists.	 The	 authors	 have	
successfully	implemented	the	PDI	system	at	
Basrah	 dental	 School	 and	 are	 still	 able	 to	
screen,	assign,	treat,	and	refer	totally	eden-
tulous	patients	depending	on	their	complex-
ity.	

Acknowledgements 
The	 authors	 express	 their	 gratitude	 to	 the	
teaching	assistants	and	interns	at	college	of	
dentistry,	 university	 of	 Basrah,	 republic	 of	
Iraq,	for	their	assistance	with	patient	screen-
ing.	



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Vol 13, No 1 (2025)    DOI 10.5195/d3000/2025.944 

	http://dentistry3000.pitt.edu	
4	

References 
1. The	 Glossary	 of	 Prosthodontic	 Terms:	

Ninth	 Edition.	 J	 Prosthetic	 Dent.	
2017;117(5S):	e01-105.	

2. McGarry	 TJ,	 Nimmo	 A,	 Skiba	 JF,	 Ahl-
strom	RH,	Smith	CR,	Koumjian	JH.	Clas-
siTication	 system	 for	 complete	 eden-
tulism.	 The	 American	 College	 of	 Pros-
thodontics.	 J	 Prosthodontic.	
1999;8(1):27-29.	

3. Alnamel	Hasanein,	M.	AlBadr	R,	Abdul	
Razzaq	F.	Evaluation	and	Characteriza-
tion	 of	 some	Properties	 of	 Glass	 Iono-
mer	Cement	Reinforced	by	Novel	Boron	
Nitride	 Nanoplatelets.	 Frontiers	 Bio-
med	Technol.	2024;11(3):477-485.	

4. Kovacic	 I,	 Persic	 S,	 Kranjcic	 J,	 Lesic	 N,	
Celebic	 A.	 Rehabilitation	 of	 an	 ex-
tremely	resorbed	edentulous	mandible	
by	 short	 and	 narrow	 dental	 implants.	
Case	Rep	Dent.	2018;	2018:7597851.	

5. Felton	 DA.	 Edentulism	 and	 comorbid	
factors.	 J	 Prosthodontic.	
2009;18(2):88-96.		

6. Crocombe	LA,	Slade	GD.	Decline	of	 the	
edentulism	epidemic	in	Australia.	Aust	
Dent	J.	2007;52(2):154-56.		

7. Ntala	 PC,	 Niarchou	 AP,	 Polyzois	 GL,	
Frangou	 MJ.	 Screening	 of	 edentulous	
patients	 in	 a	 dental	 school	 population	
using	 the	 prosthodontic	 diagnostic	 in-
dex.	 Gerodontology.	 2010;27(2):114-
20.	

8. Al-Rafee	MA.	The	epidemiology	of	eden-
tulism	and	the	associated	factors:	A	lit-
erature	review.	J	Family	Med	Prim	Care.	
2020;9(4):1841-43.		

9. Petersen	 PE,	 Bourgeois	 D,	 Ogawa	 H,	
Estupinan-Day	 S,	Ndiaye	 C.	 The	 global	
burden	of	oral	diseases	and	risks	to	oral	
health.	 Bull	 World	 Health	 Organ.	
2005;83(9):661-69.	

10. Polzer	I,	Schimmel	M,	Müller	F,	Biffar	R.	
Edentulism	as	part	of	the	general	health	
problems	 of	 elderly	 adults.	 Int	 Dent	 J.	
2010;60(3):143-55.	

11. Mather	H,	Thomason	M,	Ellis	J.	Are	UK	
graduates	 equipped	 with	 the	 skill	 set	
required	 to	 meet	 the	 demands	 of	 the	
UK’s	edentulous	population?	Br	Dent	J.	
2018;225(1):15-18.	

12. Parameters	of	Care	for	the	Specialty	of	
Prosthodontics.	 J	 Prosthodont.	
2020;29(S1):03-147.	

13. Tyrovolas	S,	Koyanagi	A,	Panagiotakos	
D,	Haro	JM,	Kassebaum	NJ,	Chrepa	V,	et	
al.	Population	prevalence	of	edentulism	
and	its	association	with	depression	and	
self-rated	 health.	 Sci	 Rep.	 2016;	
6:37083.	

14. AlnamelHA,AbdulBaqiHJ.Assessmen-
toftheEffectsofBoronNitrideNanoplate-
letsReinforcementonthePhysical	 and	
Mechanical	 Properties	 of	 the	 Geopoly-
mer	 Prepared	 by	 Natural	 Kaolin-
ite:AnInVitroStudy.DentHypothe-
ses2024	

15. 	
16. Felton	 DA.	 Complete	 edentulism	 and	

co-morbid	diseases-	An	update.	J	Pros-
thodont.	2016;25(1):05-20.	

17. Nordenram	 G,	 Davidson	 T,	 Gynther	 G,	
Helgesson	 G,	 Hultin	 M,	 Jemt	 T,	 et	 al.	
Qualitative	studies	of	patients’	percep-
tions	 of	 loss	 of	 teeth,	 the	 edentulous	
state	 and	 prosthetic	 rehabilitation:	 A	
systematic	review	with	meta-synthesis.	
Acta	Odontol	Scand.	2013;71(3-4):937-
51.	

18. Peltzer	K,	Hewlett	S,	Yawson	AE,	Moyni-
han	P,	Preet	R,	Wu	F,	et	al.	Prevalence	of	
loss	of	all	teeth	(edentulism)	and	asso-
ciated	 factors	 in	older	 adults	 in	China,	
Ghana,	India,	Mexico,	Russia	and	South	
Africa.	 Int	 J	Environ	Res	Public	Health.	
2014;11(11):11308-24.	

19. Almusallam	SM,	AlRafee	MA.	The	prev-
alence	 of	 partial	 edentulism	 and	 com-
plete	 edentulism	 among	 adults	 and	
above	 population	 of	 Riyadh	 city	 in	
Saudi	Arabia.	 J	 Family	Med	Prim	Care.	
2020;9(4):1868-72.	

20. Emami	 E,	 de	 Souza	 RF,	 Kabawat	 M,	
Feine	 JS.	 The	 impact	 of	 edentulism	 on	
oral	 and	 general	 health.	 Int	 J	 Dent.	
2013;	2013:498305.	

21. Almutairy	A,	Minu	M.	Prevalence	of	par-
tial	 edentulism	 among	 young	 Saudi	
women	of	Qassim	and	their	perception	
of	 early	 tooth	 loss.	 Int	 J	 Dent	 Res.	
2017;5(2):172-76.	

22. Douglass	CW,	Shih	A,	Ostry	L.	Will	there	
be	a	need	for	complete	dentures	in	the	

United	States	in	2020?	J	Prosthet	Dent.	
2002;87(1):05-08.	

23. Douglass	CW,	Watson	AJ.	Future	needs	
for	 Tixed	 and	 removable	 partial	 den-
tures	 in	 the	 United	 States.	 J	 Prosthet	
Dent.	2002;87(1):09-14.	

24. Felton	DA.	Exactly	what	is	the	hold	up?	
J	Prosthodont.	2005;14(3):155-57.		

25. McGarry	 TJ,	 Nimmo	 A,	 Skiba	 JF,	 Ahl-
strom	RH,	Smith	CR,	Koumjian	JH,	et	al.	
ClassiTication	 system	 for	 partial	 eden-
tulism.	J	Prosthodont.	2002;11(3):181-
93.	

26. McGarry	 TJ,	 Nimmo	 A,	 Skiba	 JF,	 Ahl-
strom	RH,	Smith	CR,	Koumjian	JH,	et	al.	
American	 College	 of	 Prosthodontists.	
ClassiTication	system	for	the	completely	
dentate	 patient.	 J	 Prosthodont.	
2004;13(2):73-82.	

27. Chaudary	 MAU,	 Khamar	 K,	 Naeem	 S.	
Screening	and	treatment	of	completely	
edentulous	 patients	 on	 the	 basis	 of	
prosthodontic	diagnostic	index	and	the	
level	 of	 patient	 satisfaction.	 Pakistan	
Oral	 and	 Dental	 Journal.	
2016;36(3):503-06.		

28. Mazurat	 RD,	 Mazurat	 NM.	 Communi-
cating	 complexity:	 Using	 a	 diagnostic	
classiTication	system	for	edentulous	pa-
tients.	 J	 Can	 Dent	 Assoc.	
2003;69(8):511-14.		

29. AlSheikh	 HA,	 AlZain	 S,	 Warsy	 A,	 Al-
Mukaynizi	 F,	AlThomali	A.	Mandibular	
residual	ridge	height	in	relation	to	age,	
gender	and	duration	of	edentulism	in	a	
Saudi	population:	A	clinical	and	radio-
graphic	 study.	 Saudi	 Dent	 J.	
2019;31(2):258-64.	

	
	
	
	
	
	
	
	
	
	
	

	

	



  Classifying Completely Edentulous PaFents Using the ProsthodonFc DiagnosFc Index 

Vol 13, No 1 (2025)    DOI 10.5195/d3000/2025.944 

	http://dentistry3000.pitt.edu	
5	

	 	
	

	 	
	

Figure	1.	Mandibular	residual	ridge	bone	height.	

	

	 	
	

	 	
	

Figure	2.	Maxillary	residual	ridge	morphology.	

	

Type	A		
+21	mm	

Type	B		
16-20	mm	

Type	C	
11-15mm	

Type	D	
-10	mm	

Type	
A	

Type	
B	

Type	
C	

type	D	



  Classifying Completely Edentulous PaFents Using the ProsthodonFc DiagnosFc Index 

Vol 13, No 1 (2025)    DOI 10.5195/d3000/2025.944 

	http://dentistry3000.pitt.edu	
6	

Table	1.	Mandibular	residual	ridge	bone	height.	

Total	patient	number	300	

Mandibular	RRH	 Bone	height-mandible	 Number	patients	

Type	I	 60%	 180	

Type	II	 15%	 45	

Type	III	 15%	 45	

Type	IV	 10%	 30	

	
Table	2.	Residual	ridge	morphology-maxilla	only.	

Total	patient	number	300	

RR	morphology	 Residual	ridge	morphology-maxilla	only	 Number	patients	

Type	A	 65%	 195	

Type	B	 15%	 45	

Type	C	 20%	 60	

Type	D	 0%	 	

	
Table	3.	Mandibular	arch's	muscle	attachment.	

Total	patient	number	300	

M	attachment	 Muscle	Attachments:(only	mandible)	 Number	patients	

Type	A	 25%	 75	

Type	B	 45%	 135	

Type	C	 15%	 45	

Type	D	 5%	 15	

Type	E	 10%	 30	

	
Table	4.	Maxillary	mandibular	relationship.	

Total	patient	number	300	

Skeletal	class.	 Maxillomandibular	Relationship	 Number	patients	

Class	I	 60%	 180	

Class	II	 30%	 90	

Class	III	 10%	 30