Combination syndrome revised
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This document discusses combination syndrome, which occurs when a complete maxillary denture is opposed by a mandibular removable partial denture. This can lead to bone loss in the maxilla, enlargement of the mandibular tuberosities, and poor denture stability. Implant-supported prostheses and paying careful attention to occlusion design and retention are recommended to prevent these issues.
Combination syndrome revised
- 1. AMRITA INSTITUTE OF MEDICAL SCIENCES AMRITA SCHOOL OF DENTISTRY By Dheeraj Sudhir I Amrita School OfBy Dheeraj Sudhir I Amrita School Of DentistryDentistry
- 3. MANDIBULARMANDIBULAR DISTALDISTAL EXTENSIONEXTENSION DENTUREDENTURE ORAL DESTRUCTIV E CHANGES COMBINATIO N SYNDROME MAXILLARY COMPLETE DENTURE Scenario Of combination Syndrome
- 4. 1. Loss of bone from the anterior part of the maxillary ridge. 2. Overgrowth of the tuberosities. 3. Papillary hyperplasia in the hard palate. 4. Extrusion of the lower anterior teeth. 5. The loss of bone under the partial denture bases. Ellsworth kelly J Prosthet Dent 1972;27:140-50. Five Potential Changes Which Leads to Combination Syndrome
- 5. 1. Loss of vertical dimension of occlusion. 2. Occlusal plane discrepancy. 3. Anterior spatial repositioning of the mandible. 4. Poor adaptation of the prostheses. 5. Epulis fissuratum. 6. Periodontal changes. Saunders TR, Gillis RE Jr, Desjardins RP. J Prosthet Dent 1979;41:124-8. 6 Additional Changes Observed in Combination Syndrome
- 6. Early loss of bone in the anterior part of maxilla Posteriorly, enlarged fibrous tuberosities Migration of the occlusal plane Migration of natural teeth Poor esthetics Migration of denture Inflammatory papillary hyperplasia on the palate Ellsworth kelly J Prosthet Dent 1972;27:140-50 PROPRIOCEPTION
- 7. Negative pressure within the maxillary denture Stress Re-direction Decreased antagonistic force on mandibular anteriors Loss of vertical dimension ill fitting denture
- 8. • Avoid combination of complete maxillary dentures opposing class I mandibular RPD. • Retaining weak posterior teeth as abutments by means of endodontic and periodontic techniques. • An Over denture on the lower teeth. Saunders TR, Gillis RE Jr, Desjardins RP. J Prosthet Dent 1979;41:124-8.
- 9. Positive occlusal support for mandibular RPD Rigid and stable design Use of anterior teeth Status of artificial posterior teeth Saunders TR, Gillis RE Jr, Desjardins RP. J Prosthet Dent 1979;41:124-8.
- 10. Implant supported fixed prosthesis Maxillary Osseo integrated implants. Augmentation of maxilla CP Thiel et al 1996;75:107-13. Lower Implant Supported Prosthesis
- 13. MECHANICSMECHANICS Increased displacing forces to the upper denture from the lower implant supported denture The force comes in excess to the retention provided by upper denture Significant change In the chewing pattern Vertical chewing pattern Changes to a ruminatory pattern
- 14. As the chewing pattern changes, theAs the chewing pattern changes, the features of the ideal occlusalfeatures of the ideal occlusal prescription also changesprescription also changes
- 15. THE SCENARIO IN SHORT…THE SCENARIO IN SHORT… Ineffective mastication Very unretentive upper denture. The ruminatory pattern of mastication Unable to exert any control over the mandible As the lower denture becomes more retentive……. Wennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.
- 16. SOLUTIONSSOLUTIONS Principles of good retention and stability Designing of the occlusion Implants on the upper jaw Wennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.
- 17. TREATMENT STRATEGIES &TREATMENT STRATEGIES & PRINCIPLESPRINCIPLES The principle is to design and provide an occlusion that is ideal for the important criteria of denture success—STABILITY ! The basic equations are:- Force > Retention = Instability Force < Retention = Stability Wennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.
- 18. OCCLUSAL DESIGNINGOCCLUSAL DESIGNING The occlusal prescription provided is a major factor in determining the size of the force applied to the dentures The patients masticatory patterns defines the retentive capacity of the dentures Wennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.
- 19. CONCLUSIONCONCLUSION Almost inevitable tissue changes occur in the patients wearing upper complete and lower partial dentures. The dentist should plan the treatment modalities with care and institute them with caution. The patient should be educated well about the fact that the longest life of the prosthesis can only be attained by frequent visits and maintenance care