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.

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

12. MAXILLARYMAXILLARY
DENTUREDENTURE
NEW ERANEW ERA
COMBINATIONCOMBINATION
SYNDROMESYNDROME
IMPLANTIMPLANT
SUPPORTEDSUPPORTED
MANDIBULARMANDIBULAR
DENTURE

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