PDI

Question 1

Dentistry uses many classification systems
* Despite challenges (not always applicable, agreement not always present…)
* Examples
(3)

Answer 1

• ASA
• Kennedy’s classification of edentulous space and Applegate’s rules
• Other disciplines have classification systems

Question 2

Dentistry uses many classification systems
Main Advantage:

Answer 2

• Comprehensive evaluation and Assessment of all necessary parameters to help in
  Diagnosis, Treatment, and Prognosis

Question 3

skiipped
Prosthodontic Diagnostic Index (PDI)
Evidence Based Dentistry
(3)

Answer 3

• 3 published articles, J Prosthodont, official publication of the American College
  of Prosthodontists
• Glossary of Prosthodontic Terms ed 9
• Rosenstiel S “Contemporary Fixed Prosthodontics” textbook, Elsevier ed

Question 4

Prosthodontic Diagnostic Index (PDI)
Potential benefits of the system include:
(7)

Answer 4

(1) improved intraoperator consistency
(2) improved professional communication
(3) insurance reimbursement commensurate with complexity of care
(4) an improved screening tool for dental school admission clinics
(5) standardized criteria for outcomes assessment and research
(6) enhanced diagnostic consistency and
(7) a simplified aid in the decision-making process associated with referral

Question 5

Prosthodontic Diagnostic Index (PDI)
* 3 classifications:

Answer 5

edentulous, partially edentulous, dentate

Question 6

Four (4) categories in each classification:

Answer 6

class I - class IV
* Class I: an uncomplicated clinical situation
Class IV: represents a complex clinical situation

Question 7

Classification System for Complete Edentulism
Diagnostic Criteria
(4)

Answer 7

1. Bone Height (mandibular)
2. Residual Ridge Morphology (maxilla)
3. Muscle Attachments (mandibular)
4. Maxillomandibular Relation

Question 8

Class I
Class II
Class III
Class IV

Answer 8

Ideal or minimally
compromised
Moderately
compromised
Substantially
compromised
Severely compromised

Question 9

Modifiers for all classifications: Increase Complexity
and Classification Level
(7)

Answer 9

• Esthetic concerns / challenges
• Presence of TMD symptoms
• Oral manifestations of systemic disease
• Psychosocial factors
• Maxillofacial defects
• Ataxia
• Refractory Patient

Question 10

Class I: Partial Edentulism
1. Location and extent of edentulous area: ideal or minimally compromised
edentulous area confined to a single arch and may include:
(3)

Answer 10

• anterior maxillary span that does not exceed 2 incisors,
• anterior mandibular span that does not exceed 4 missing incisors,or
• posterior span that does not exceed 2 premolars or 1 premolar and 1 molar

Question 11

Class I: Partial Edentulism
2. Abutment Condition:

Answer 11

ideal or minimally compromised
no need for pre-prosthetic therapy

Question 12

Class I: Partial Edentulism
3. Occlusion:

Answer 12

ideal or minimally compromised
no need for pre-prosthetic therapy
Class I molar and jaw relationships.

Question 13

Class I: Partial Edentulism
4. Residual Ridge Morphology:

Answer 13

Class I Complete Edentulism description

Question 14

Biomechanical Considerations for Partial Fixed
Dental Prosthesis (FDP)
(4)

Answer 14

• Number of abutment teeth and number of missing teeth (simple vs complex)
• Splinted or pier abutment
• Non-parallel abutments
• Combined anterior and posterior FDP

Question 15

Class I Partial Edentulism
(3)

Answer 15

• Ideal or minimally compromised edentulous area, abutment condition,
  and occlusion
• There is a single edentulous area in 1 sextant.
• The residual ridge is considered type A.

Question 16

Most common FDP to replace more than two teeth with success

Answer 16

mandibular anterior FDP (replacing 4 incisors)

Question 17

mandibular anterior FDP (replacing 4 incisors)
mandible vs maxilla prognosis

Answer 17

• Mandibular – better prognosis than maxillary
• Direction of forces inward toward arch

Question 18

mandibular anterior FDP (replacing 4 incisors)
Replacement of missing canine
(2)

Answer 18

• Adjacent premolar and lateral incisor are weakest potential abutments
• Maxillary replacement – forces outside inter-abutment axis & directed outward

Question 19

Class II: Partial Edentulism
Location and extent of the edentulous area: moderately compromised
Location: both arches have edentulous spaces and 1 of the following:
(4)

Answer 19

• anterior maxillary span that does not exceed 2 incisors
• anterior mandibular span that does not exceed 4 missing incisors
• posterior span that does not exceed 2 premolars or 1 premolar and 1 molar
• Any missing canine (maxillary or mandibular)

Question 20

Class II: Partial Edentulism
Abutment Condition: moderately compromised
*Insufficient tooth structure to retain or support intracoronal or extracoronal restorations – — sextants
*Abutments in — sextants require localized adjunctive therapy (minor)

Answer 20

1 or 2
1 or 2

Question 21

Class II: Partial Edentulism
Occlusion: moderately compromised
(2)

Answer 21

*Occlusion requires localized adjunctive therapy (enameloplasty – prematurities)
*Class I molar and jaw relationships are seen.

Question 22

Class II: Partial Edentulism
Residual Ridge Morphology:

Answer 22

Class II Complete Edentulism description

Question 23

Replacement of missing canine
(3)

Answer 23

• Adjacent premolar and lateral incisor are weakest potential abutments
• Maxillary replacement – forces outside inter-abutment axis & directed outward
• Best restored with implant-supported single crown

Question 24

Restoration of the occlusal plane
(2)

Answer 24

*Occlusal interferences produced when FDP made to over-erupted
opposing dentition.
*Opposing tooth restored to correct occlusal plane

Question 25

*Opposing tooth restored to correct occlusal plane (2)

Answer 25

* May require RCT; periodontal surgery; orthodontics; extraction * Prevents occlusal interferences in restored dentition

Question 26

Tilted molar abutments (3)

Answer 26

* Generally poor abutments * Mesial wall must be over-reduced / overtapered (↓ resistance) * Distal adjacent tooth may intrude on the path of insertion

Question 27

* Distal adjacent tooth may intrude on the path of insertion (2)

Answer 27

* Mesial surface may need re-contouring or restoration or extraction * Consider orthodontic uprighting (3rd molar extraction)

Question 28

Molar uprighting (3)

Answer 28

* Places abutment in better position for preparation * Distributes forces under loading through long axis of tooth (helps prevent/eliminate mesial bony defects) * Enables replacement of optimum occlusion

Question 29

Tilter molar abutments: non-rigid attachment (3)

Answer 29

* Allows slight movement - short span * Keyway in distal of premolar to avoid intrusion of molar (mesial seating action) * Must prepare box in distal of premolar preparation * (To accommodate the female / keyway)

Question 30

Non-Rigid Connectors - Indications: (4)

Answer 30

* Pier Abutment FPD * Long span FPD with multiple abutments * Non-parallel abutments – Tipped molar * Planning for failure

Question 31

Replacement / Restoration of Anterior Teeth: Anterior Guidance (2)

Answer 31

* The custom incisal guide provides a record of the incisal guidance that has been established with provisional restorations or a diagnostic wax-up. * The custom incisal guide table provides a record for the lab to create the desired anterior guidance in the produced prostheses

Question 32

Class III Partial Edentulism Location and extent of the edentulous area: substantially compromised *1 or both arches; compromised support of abutment teeth *Posterior maxillary or mandibular edentulous area --- teeth *Any edentulous areas including anterior and posterior areas of --- teeth

Answer 32

> 3 teeth or 2 molars 3 or more

Question 33

Class III Partial Edentulism Abutment Condition: substantially compromised / fair prognosis *Insufficient tooth structure to retain or support intracoronal or extracoronal restorations – -- sextants *More substantial localized adjunctive therapy (perio, endo, ortho treatments) – -- sextants

Answer 33

3 3

Question 34

Class III Partial Edentulism Occlusion: substantially compromised (2)

Answer 34

*Entire occlusion must be re-established, but without any change in the occlusal vertical dimension. *Class II molar and jaw relationships are present

Question 35

Class III Partial Edentulism Residual Ridge Morphology:

Answer 35

Class III Complete Edentulism

Question 36

Class 3 partially edentulous patients (2)

Answer 36

* Any edentulous areas including anterior and posterior areas of 3 or more teeth * Maxillary canine and 2 contiguous teeth

Question 37

Class III Partially Edentulous * Edentulous area(s) are located in ... * The abutment condition is substantially compromised due to the need for ... * The occlusion is substantially compromised because ...

Answer 37

both arches and multiple locations within each arch. extracoronal restorations. There are teeth that are extruded and malpositioned. re-establishment of the occlusal scheme is needed without a change in the occlusal vertical dimension

Question 38

Class IV: Partial Edentulism Location and extent of the edentulous area: severely compromised (1)

Answer 38

*Any edentulous area or combination of edentulous areas requiring a high level of patient compliance.

Question 39

Class IV: Partial Edentulism Abutment Condition: severely compromised *Abutments in --- sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations. *Abutments in --- sextants require extensive adjunctive therapy (ie, periodontal, endodontic, or orthodontic procedures). *Abutments have --- prognoses

Answer 39

4 or more 4 or more guarded

Question 40

Class IV: Partial Edentulism Occlusion: severely compromised (2)

Answer 40

*Entire occlusion must be reestablished, including changes in the occlusal vertical dimension *Class II division 2 and Class III molar and jaw relationships are seen

Question 41

Class IV: Partial Edentulism Residual Ridge Morphology:

Answer 41

Class IV Complete Edentulism

Question 42

Classification System for the Completely Dentate Patient Class I Class II Class III

Answer 42

Ideal or minimally compromised Moderately compromised Substantially compromised Severely compromised

Question 43

Classification System for the Completely Dentate Patient Diagnostic Criteria (2)

Answer 43

1. Tooth Condition 2. Occlusal Scheme

Question 44

Class I: Dentate patient Tooth Condition and Occlusal Scheme * Ideal or minimally compromised tooth condition * No localized adjunctive therapy required * Pathosis that affects the coronal morphology of ---; --- sextant

Answer 44

three or less teeth one

Question 45

Class I: Dentate patient Tooth Condition and Occlusal Scheme * Ideal or minimally compromised occlusal scheme (3)

Answer 45

* No pre-prosthetic therapy required * Contiguous, intact dental arches * Class I molar and jaw relationships

Question 46

Class II: Dentate patient Moderately compromised tooth condition *Insufficient tooth structure to retain or support intracoronal or extracoronal restorations – --- sextant (pin-retained core / post-core) *Pathosis that affects the coronal morphology of --- teeth in a sextant *Pathosis can be in --- sextants and can be in opposing arches *Teeth require localized adjunctive therapy, i.e., periodontal, endodontic or orthodontic procedure for a single tooth or in a single sextant

Answer 46

one 4 or more 2

Question 47

Class II: Dentate patient Moderately compromised occlusal scheme (4)

Answer 47

*Occlusal scheme requires localized adjunctive therapy * Enameloplasty on premature occlusal contacts *Anterior guidance is intact *Class I molar and jaw relationships

Question 48

Class II Dentate Pt * 1 sextant exhibits -- defective restorations with an esthetic component * Additional variables of (2) increase the complexity of diagnosi

Answer 48

3 gingival architecture and individual tooth proportions

Question 49

Class III: Completely Dentate Patient Substantially Compromised Tooth Condition * Insufficient tooth structure to retain or support intracoronal or extracoronal restoration— -- sextants * Pathosis that affects the coronal morphology of --- teeth in --- sextants * Pathosis can be in --- sextants in the same arch and/or in opposing arches * Teeth require more substantial localized adjunctive therapy, i.e., periodontal, endodontic or orthodontic procedures for teeth in --- sextants

Answer 49

2 4 or more 3 or more 3 2

Question 50

Class III: Completely Dentate Patient * Substantially Compromised Occlusal Scheme (1)

Answer 50

* Occlusal scheme requires major therapy to maintain the entire occlusal scheme without any change in the occlusal vertical dimension

Question 51

Class IV: Completely Dentate Patient Severely Compromised Tooth Condition *Insufficient tooth structure to retain or support intracoronal or extracoronal restorations – --- sextants *Pathosis affects coronal morphology of --- teeth in all sextants *Teeth in --- sextants require extensive adjunctive therapy (perio, endo, or ortho

Answer 51

3 or more ≥ 4 ≥ 4

Question 52

Class IV: Completely Dentate Patient Severely Compromised Occlusal Scheme (3)

Answer 52

*Occlusal scheme requires major therapy to re-establish the entire occlusal scheme including any changes in the occlusal vertical dimension *Class II, Division 2 malocclusion *Class III molar and jaw relationships

Question 53

How to Use the PDI classification in the Clinic Summary of the PDI Information and Worksheets can be found in axiUm under “Links” Classification needs to be established in axiUm under: (2)

Answer 53

* Removable Prosthodontic Consults and * Fixed Prosthodontic Consults