The document discusses the challenges of oral rehabilitation in cases of combination syndrome, a condition characterized by severe anterior maxillary resorption and associated issues in dental management. Conventional treatments, like full upper and partial lower dentures, often fall short due to ongoing bone resorption, necessitating advanced techniques such as the modified window technique and the use of implant-supported overdentures for better outcomes. Recent studies indicate that mandibular implant-supported fixed prostheses can achieve excellent long-term results when opposing a maxillary complete denture.

1. Bushra Hussein Ali BDS
Supervised by:
Haitham Tawfeek Ms.C
(Prosthodontist)

2. Challenge
One of the most challenging dental
management is the oral rehabilitation of
cases with lost teeth
which is known as
Kelly syndrome
Anterior hyper
function

3. History
kelly in 1972 was the first to
coin the term combination
syndrome for this oral condition
and its associated clinical feature
Combination
syndrome

4. Combination Syndrome
Is a dental condition that is commonly seen in patients with a
completely edentulous maxilla and partially edentulous mandible
with preserved anterior teeth.

5. The Problem
Chronic
occlusal
trauma
Slow
resorption
Replace
with
fibrous
tissue

6. Several problems may face the prosthodontist while
managing such a case:
Concentration occlusal load on
remaining natural teeth for
properioception
1
Loss of bone in the
maxillary anterior
region

7. Downward movement of pos
terior part of maxillary
denture and formation of
flabby tissue.
2
Overgrowth of the
tuberosities

8. Ridge resorption in mand.
edentulous area
3
Loss of the
alveolar bone
under a partial
denture in the
mandible

9. Supraeruption of lower
anteriors
4
Extrusion of the
remaining natural
mandibular anterior
teeth

10. In another word, This syndrome consists of severe anterior maxillary
resorption combined with hypertrophic and atrophic changes in different
quadrants of maxilla and mandible.
This makes it a challenging condition in dentistry that requires significant
experience along with advanced restorative and surgical skills.

11. Conventional treatment:
Conventional treatment with full
upper and partial lower dentures
for the CS patients is not always
adequate or satisfying for patients
and it often requires multiple
remakes due to continuing bone
resorption.

12. The success of the prosthetic rehabilitation:
depends on the achievement of stability, retention and proper support
Stability
retention

13. Major causative factor
Magnitude the forces
Unsuitability of the denture
foundation
Unfavourable occlusal
contact

14. Other objectives
•The occlusal scheme should be at a proper vertical
and centric relation position.
•Anterior teeth should be used for cosmetic
and phonetic purpose only.
•Patient education and frequent recall and
maintenance care are essential, if the
development of this insidious syndrome is to
be avoided.

15. Treatment
Modified window technique for the upper arch
To manage the problem of flabby ridge

17. Altered cast technique for the
lower arch to Improve tissue
support for the distal
extension bases

18. Other treatment options
Using a Mandibular overdenture
provided better prognosis especially
when mandibular anterior teeth were
structurally or periodontally
compromised
Using a mandibular
implant-supported
overdenture

19. Finally excellent long-term results with mandibular
implant supported fixed prostheses, opposing
maxillary complete denture
Implant supported fixed
prosthesis

20. Insert the title of your subtitle Here
Conclusion
Combination syndrome is a challenge for
every dentist and need a great skills
because of difficulty of gaining stability,
retention and support.
The recent studies show that long-term
results can get by using mandibular
implant supported fixed prostheses,
opposing maxillary complete denture.

21. Thank you