Combination syndrome was first described by Kelly 1972.

also called Anterior hyperfunction syndrome

1. 2. 3. 4. 5.

characteristic features that occur when an edentulous maxilla is opposed by natural mandibular anterior teeth, including: loss of bone from the anterior portion of maxillary ridge; overgrowth of tuberosities; papillary hyperplasia of the hard palate mucosa; extrusion of mandibular anterior teeth and loss of alveolar bone and ridge height beneath the mandibular removable partial denture base.

 1. 2. 3. 4. 5. 6.

Saunders et al observed six additional changes in 1979: Loss of vertical dimension of occlussion Occlusal plane discrepancy Anterior spatial repositioning of the mandible Development of epulis fissuratum Poor adaptation of the prosthesis Periodontal changes

Different theories: 1. anterior resorption first:

Proposed by Kelly 1972

2. posterior resorption first:

Proposed by McGivney and Castleberry

1995

Some researchers conveyed that mandibular implant-supported overdenture could generate increased forces on the maxillary ridge encouraging its resorption anteriorly resulting in one or all the symptoms of the combination syndrome
Lechner and Mamman 1995,Thiel et al 1996, Suzuki et al and Narhi et al 2000

Bone resorption

Great force

Denture Fracture

Remaining teeth
Impaired Esthetics No balanced occlusion Steep incisal guidance

Unorganized occlusal plane

A single denture that occludes against natural teeth must often be the loser
Kaddah et al 1998

These changes do not occur in all patients with upper single CD

Three main factors: 1. Magnitude of force acting on the CD 2. Instability of the denture foundation 3. Lack of occlusal balance

Other factors: age,sex and max-mand relationship

Palmqvist et al 2003 concluded that it does not meet the criteria to be accepted as a medical syndrome as single features occurred, but to what extent or in which combination, was never clarified.

Avoid the situation

Retain maxillary roots for overdenture

Well constructed RPD

Tooth supported overdenture

Maximize area covered by denture base

Occlusal adjustment
Swensons technique

 Yurkstas technique

Soft lining of both dentures Type of food Decreasing occlusal table width Tooth material Extent of replacement of teeth

Balancing occlusion with no anterior contact in centric and minimal in eccentric

Working & balancing side contacts Protrusive contact

Proper selection of cusp height and occlusal anatomy

Implant prosthodontics

Thank you
Thank you