outcomes of combination syndrome

1. In The Name of God

2. Dr. Azade Tadayon Fard
Dept. of Prosthodontics, Shahid Beheshti University of Medical Sciences

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

5. 1) Physiologic and Biological Differences
Between tissues
2) Occlusal Plane Of the remaining teeth
 Koper A, The maxillary complete denture opposing natural teeth:
some solutions. The Journal of Prosthetic Dentistry, 1987, 57(6): 70
 Fayyaz A, Sadr SJ, Clinical Problems in Single Dentures. 1992, 20-

6.  Sharry J, Complete Denture Prosthodontics. Mc Graw-Hill Book Compa
St Louis. 1974
 Kelly E, Changes caused by a mandibular removable partial denture op
maxillary complete denture. The Journal of Prosthetic Dentistry, 1972, 27(
 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 pa
The Journal of Prosthetic Dentistry, 1989,62(6): 642-644

7. 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,

8. 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
Poor
Prosthesis
Adaptation
Occlusal
Plane
Discrepancy
Ant.
Repositionin
g of
Mandible
Periodonta
l Changes
Loss of
VDO
Epulis
Fissuratu
m

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

10. MANDIBULAR
DISTAL
EXTENSION RPD
ORAL
DESTRUCTI
VE
CHANGES
COMBINATION
SYNDROME
MAXILLARY
COMPLETE
DENTURE

11. Classification; 2008
(Tulstunov)
I. Completely
Edentulous Maxilla
I. Ant.
lower
teeth
II. Fixed
full
lower
dentitio
n
III. Ant.
and 1
post.
quadrant
 Tolstunov L, Combination syndrome: classification and case
report. Journal of oral Implantology 2007; 33(3), 139-151

12. II. Anterior
Edentulous Maxilla
I. Ant.
lower
teeth
II.
Fixed
full
lower
dentiti
on
III. Ant.
and 1
post.
quadran
t
 Tolstunov L, Combination syndrome: classification and case
report. Journal of oral Implantology 2007; 33(3), 139-151

13. Ant. and 1
post.
non-
occludin
g quadrant
III. Partially
Edentulous Maxilla
(teeth in 1 post.
Quadrant)
Ant.
lower
teeth
Fixed
full
lower
dentiti
on
Ant. and 1
post.
occludin
g
quadrant
 Tolstunov L, Combination syndrome: classification and case
report. Journal of oral Implantology 2007; 33(3), 139-151

14. Etiology

15.  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

17.  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.

19. Treatment Strategies
o Prostheti
c
o Surgical

20. oNo Treatment
oProsthetics
• Stable Prosthesis
• Stable Occlusion
Load Distribution
 Kapil S Pal, Shriprasad Sarapur. Combination Syndrome: A Review
of

21. 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

22. 3. Biologic over dentures
4. Periodic follow-ups
1. Tissue management through accurate
impression techniques
2. Splinted lower Anterior teeth

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

24. Balanced Occlusion

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

26. Maxillary
Complete
Denture
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
 Henry et al (IJP 1999: 12; 492-497)

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

28. 3) Implants in the posterior
mandible
 Bortolini S, Natali A, Implant Retained Removable Partial
Dentures:
An 8-Year Retrospective Study. Journal of

29. 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

30. o Number of Implants
o Supra-structure Design
o Maxillary Bone Resorption
o Antagonistic Teeth
o Incidence
o Cantilever
 Rutkunas V, et al. Maxillary complete denture outcome with two-
implant supported mandibular overdentures. A systematic review.
 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

32. Window Impression Technique

34. Summar
y

35. Any Questions?