Combination syndrome revisited

In The Name of God

Dr. Azade Tadayon FardDept. of Prosthodontics, Shahid

Beheshti University of Medical Sciences

Combination Syndrome -Revised

• Introduction• Combination

Syndrome• Etiology• Treatment Strategies• Clinical Case• Summary

Overview

3

Introduction

Single Denture

Single Maxillary Denture

Classification1) Full natural dentition2) RPD3) FPD4) Complete Denture5) Overdenture

Sharry J, Complete Denture Prosthodontics. Mc Graw-Hill Book Company, St Louis. 1974 4

5

Main Sources of Problems

1) Physiologic and Biological Differences Between tissues

2) Occlusal Plane Of the remaining teeth

Koper A, The maxillary complete denture opposing natural teeth: Problems and some solutions. The Journal of Prosthetic Dentistry, 1987, 57(6): 704-707

Fayyaz A, Sadr SJ, Clinical Problems in Single Dentures. 1992, 20-294

Combination Syndrome (CS)

o Kelly’s syndromeo Anterior hyper function

syndrome

SwensonSharryKelly

Sharry J, Complete Denture Prosthodontics. Mc Graw-Hill Book Company, St Louis. 1974 Kelly E, Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. The Journal of Prosthetic Dentistry, 1972, 27(2): 140-150

24%

Jameson WS. Various clinical situations and their influence on linear occlusion in treating combination syndrome: a discussion of treatment options. Gen Dent.2003;51:443–447. Shen J, Prevalence of the “combination syndrome” among denture patients.

The Journal of Prosthetic Dentistry, 1989,62(6): 642-644 6

Ant. Maxillary Bone

Resorption

Five Potential Changes that Lead to CS (By Kelly 1972)

Papillary Hyperplasia

Tuberosity Down Growth

Mandibular Bone

Resorption

Lower Ant. Teeth

Extrusion

Kelly E, Changes caused by a mandibular removable partial denture opposing a

maxillary complete denture. The Journal of Prosthetic Dentistry, 1972, 27(2): 140-150

7

Six Additional Changes Observed in CS;

by Saunders

Saunders TR, Gillis RE, Desjardins RP. The maxillary complete denture opposing the mandibular bilateral distal-extension partial denture: Treatment considerations. The

Journal of Prosthetic Dentistry 1979;41(2):124-128.

Poor Prosthesis Adaptation

Occlusal Plane

Discrepancy

Ant. Reposition

ing of Mandible Periodon

tal Changes

Loss of VDO

Epulis Fissurat

um

8

Tolstunov L, Combination syndrome: classification and case report. Journal of oral Implantology 2007; 33(3), 139-151

9

MANDIBULAR DISTAL

EXTENSION RPD

ORAL DESTRUCTIVE CHANGES

COMBINATION SYNDROME

MAXILLARY COMPLETE DENTURE

Common Scenario

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Classification; 2008 (Tulstunov)

I. Completely Edentulous Maxilla

I. Ant.

lower teeth

II. Fixed full

lower dentiti

on

III. Ant. and 1 post.

quadrant


11

II. Anterior Edentulous Maxilla

I. Ant.

lower teeth

II. Fixed full

lower dentit

ion

III. Ant.

and 1 post.

quadrant Tolstunov L, Combination syndrome: classification and

case report. Journal of oral Implantology 2007; 33(3), 139-151

12

Ant. and 1 post. non-

occluding

quadrant

III. Partially Edentulous Maxilla

(teeth in 1 post. Quadrant)

Ant. lower teeth

Fixed full

lower dentit

ion

Ant. and 1 post. occludi

ng quadrant


13

Etiology

14

? ? ?

Posterior Mandible

AnteriorMaxilla

2 Schools of

Thought

Kelly E, Changes caused by a mandibular removable partial denture opposing a

maxillary complete denture. The Journal of Prosthetic Dentistry, 1972, 27(2): 140-150

Saunders TR, Gillis RE, Desjardins RP. The maxillary complete denture opposing the mandibular bilateral distal-extension partial denture: Treatment considerations. The

Journal of Prosthetic Dentistry 1979;41(2):124-128. 15

Problem List • Decreased Retention• Decreased Stability• Decreased Support• Esthetic Compromise• Underlying Tissue

Changes• Masticatory Problems

Watt DM, Mac Gregor AR, Designing Complete Dentures, 1986

Jacobson TE, KroI AJ.A contemporary review of the factors involved in complete dentures. Part II: stability. J PD l983; 49(2):165-72.

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Treatment Goals/Objectives

18

Treatment Strategies

o Prosthetic

o Surgical

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Prosthetic Options

A. Conventional Prosthetics

oNo TreatmentoProstheticsoExtractionoNon-Extraction

• Stable Prosthesis

• Stable OcclusionLoad Distribution

Kapil S Pal, Shriprasad Sarapur. Combination Syndrome: A Review of

Classification and Treatment Modalities: J Res Adv Dent 2015; 4:1:11-17.

20

2 General Rules

As The Chewing pattern changes, the Occlusal Considerations also change.

Wennerberg A, Carlsson GE, Jemt T. Influence of occlusal factors on treatment outcome: a study

of 109 consecutive patients with mandibular implant-supported fixed prostheses opposing maxillary complete dentures. Int J

Prosthodont 2001;14:550-521

3. Biologic over dentures4. Periodic follow-ups

1. Tissue management through accurate impression techniques

2. Splinted lower Anterior teeth

5. Occlusal Designing

22


Schmitt S. Combination syndrome: A treatment approach. The Journal of

Prosthetic Dentistry 1985; 54(5):664-71.23

Linear Occlusion


Balanced Occlusion

24

B. Implant Prosthetics

1) Implants in the Maxilla

Ned Tijdschr, et al. An implant-supported overdenture in an edentulous upper jaw. 2011;118(11):577-82

25

New Era Combinat

ion Syndrom

e

Maxillary Complete Denture

Mandibular Implant-

Supported Overdenture

or Fixed Prosthesis

2) Implants in the anterior mandible

Barber et al (JOMFS 1990; 1283-1287) Maxson et al (JPD 1990; 554-558) Sybille et al (IJP 1996; 58-64) Jacobs B et al (JPD 1993: 70; 135-140) Abd El-Dayem et al (Implant Dent. 2007 :421-9) Henry et al (IJP 1999: 12; 492-497) 26

Wennerberg A, Carlsson GE, Jemt T. 2001;14:550-5. 27

3) Implants in the posterior mandible

Bortolini S, Natali A, Implant Retained Removable Partial Dentures:

An 8-Year Retrospective Study. Journal of Prosthodontics20(2011) 168–172

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Controversies

Deogade S, The Combination Syndrome: An Evaluation Of Literature Review. Int. Journal of Dental Practice & Medical Sciences 2012

Kamble Vikas B,Combination syndrome –revisited. Journal of pearl dent 2012

Carlsson, Palmquist. Combination syndrome: Literature review. 2003

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o Number of Implantso Supra-structure Designo Maxillary Bone Resorptiono Antagonistic Teetho Incidenceo Cantilever

Rutkunas V, et al. Maxillary complete denture outcome with two-implant supported mandibular overdentures. A systematic review. Stomatologija. 2008;10(1):10-15.

Raghoebar GM, et al. A systematic review of implant-supported overdentures in the edentulous maxilla, compared to the mandible: how many implants? Eur J Oral Implantol. 2014 ; S191-201.

Ohkubo C,Does the presence of antagonist remaining teeth affect implant overdenture success? A systematic review. J Oral Rehabil. 2010;37(4):306-12.

Tymstra N1,Maxillary anterior and mandibular posterior residual ridge resorption in patients wearing a mandibular implant-retained overdenture. J Oral Rehabil. 2011 Jul;38(7):509-16.

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CLINICAL CASE

31

Watson RM. Impression technique for maxillary fibrous ridge. Br Dent J 1970; 128: 552.

Window Impression Technique32

Summary

36

Any Questions?

Any Suggestions?

Any Comments?

37

Combination syndrome revisited

Health & Medicine

Transcript of Combination syndrome revisited