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AMRITA INSTITUTE OF MEDICAL SCIENCESAMRITA SCHOOL OF DENTISTRYBy Dheeraj Sudhir I Amrita School OfBy Dheeraj Sudhir I Amri...
MANDIBULARMANDIBULARDISTALDISTALEXTENSIONEXTENSIONDENTUREDENTUREORALDESTRUCTIVE CHANGESCOMBINATION SYNDROMEMAXILLARYCOMPLE...
 1. Loss of bone from theanterior part of the maxillaryridge.2. Overgrowth of thetuberosities.3. Papillary hyperplasia in...
 1. Loss of verticaldimension of occlusion.2. Occlusal planediscrepancy.3. Anterior spatialrepositioning of themandible.4...
Early loss of bone in the anterior part of maxilla Posteriorly,enlarged fibrous tuberosities Migration of the occlusalplan...
 Negative pressure within the maxillary denture Stress Re-direction Decreased antagonistic force on mandibularanteriors...
 • Avoid combination of complete maxillary denturesopposing class I mandibular RPD.• Retaining weak posterior teeth as ab...
 Positive occlusal support for mandibular RPD Rigid and stable design Use of anterior teeth Status of artificial poste...
 Implant supportedfixed prosthesis Maxillary Osseointegratedimplants. Augmentation ofmaxillaCP Thiel et al1996;75:107-1...
MAXILLARYMAXILLARYDENTUREDENTURENEW ERANEW ERACOMBINATIONCOMBINATIONSYNDROMESYNDROMEIMPLANTIMPLANTSUPPORTEDSUPPORTEDMANDIB...
MECHANICSMECHANICSIncreased displacing forces to the upper denture fromthe lower implant supported denture The forcecomes ...
As the chewing pattern changes, theAs the chewing pattern changes, thefeatures of the ideal occlusalfeatures of the ideal ...
THE SCENARIO IN SHORT…THE SCENARIO IN SHORT…Ineffective masticationVery unretentive upper denture.The ruminatory pattern o...
SOLUTIONSSOLUTIONS Principles of good retention and stability Designing of the occlusion Implants on the upper jawWenne...
TREATMENT STRATEGIES &TREATMENT STRATEGIES &PRINCIPLESPRINCIPLES The principle is to design and provide anocclusion that ...
OCCLUSAL DESIGNINGOCCLUSAL DESIGNING The occlusal prescription provided is amajor factor in determining the size of thefo...
CONCLUSIONCONCLUSION Almost inevitable tissue changes occur in thepatients wearing upper complete and lower partialdentur...
Combination syndrome revised
Combination syndrome revised
Combination syndrome revised
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Combination syndrome revised

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Combination syndrome revised

  1. 1. AMRITA INSTITUTE OF MEDICAL SCIENCESAMRITA SCHOOL OF DENTISTRYBy Dheeraj Sudhir I Amrita School OfBy Dheeraj Sudhir I Amrita School OfDentistryDentistry
  2. 2. MANDIBULARMANDIBULARDISTALDISTALEXTENSIONEXTENSIONDENTUREDENTUREORALDESTRUCTIVE CHANGESCOMBINATION SYNDROMEMAXILLARYCOMPLETEDENTUREScenario Of combination Syndrome
  3. 3.  1. Loss of bone from theanterior part of the maxillaryridge.2. Overgrowth of thetuberosities.3. Papillary hyperplasia inthe hard palate.4. Extrusion of the loweranterior teeth.5. The loss of bone underthe partial denture bases. Ellsworth kelly J Prosthet Dent1972;27:140-50.Five Potential Changes Which Leadsto Combination Syndrome
  4. 4.  1. Loss of verticaldimension of occlusion.2. Occlusal planediscrepancy.3. Anterior spatialrepositioning of themandible.4. Poor adaptation of theprostheses.5. Epulis fissuratum.6. Periodontal changes. Saunders TR, Gillis RE Jr,Desjardins RP. J Prosthet Dent1979;41:124-8.   6 Additional Changes Observed inCombination Syndrome
  5. 5. Early loss of bone in the anterior part of maxilla Posteriorly,enlarged fibrous tuberosities Migration of the occlusalplane Migration of natural teeth Poor estheticsMigration of denture Inflammatory papillary hyperplasiaon the palateEllsworth kelly J Prosthet Dent 1972;27:140-50PROPRIOCEPTION
  6. 6.  Negative pressure within the maxillary denture Stress Re-direction Decreased antagonistic force on mandibularanteriors Loss of vertical dimension ill fitting denture
  7. 7.  • Avoid combination of complete maxillary denturesopposing class I mandibular RPD.• Retaining weak posterior teeth as abutments bymeans 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.  
  8. 8.  Positive occlusal support for mandibular RPD Rigid and stable design Use of anterior teeth Status of artificial posterior teethSaunders TR, Gillis RE Jr, Desjardins RP. J Prosthet Dent 1979;41:124-8.
  9. 9.  Implant supportedfixed prosthesis Maxillary Osseointegratedimplants. Augmentation ofmaxillaCP Thiel et al1996;75:107-13.  Lower Implant Supported Prosthesis
  10. 10. MAXILLARYMAXILLARYDENTUREDENTURENEW ERANEW ERACOMBINATIONCOMBINATIONSYNDROMESYNDROMEIMPLANTIMPLANTSUPPORTEDSUPPORTEDMANDIBULARMANDIBULARDENTURE
  11. 11. MECHANICSMECHANICSIncreased displacing forces to the upper denture fromthe lower implant supported denture The forcecomes in excess to the retention provided by upperdenture Significant change In the chewing patternVertical chewing pattern Changes to aruminatory pattern
  12. 12. As the chewing pattern changes, theAs the chewing pattern changes, thefeatures of the ideal occlusalfeatures of the ideal occlusalprescription also changesprescription also changes
  13. 13. THE SCENARIO IN SHORT…THE SCENARIO IN SHORT…Ineffective masticationVery unretentive upper denture.The ruminatory pattern of masticationUnable to exert any control over the mandibleAs the lower denture becomes more retentive…….Wennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.  
  14. 14. SOLUTIONSSOLUTIONS Principles of good retention and stability Designing of the occlusion Implants on the upper jawWennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.  
  15. 15. TREATMENT STRATEGIES &TREATMENT STRATEGIES &PRINCIPLESPRINCIPLES The principle is to design and provide anocclusion that is ideal for the important criteriaof denture success—STABILITY !The basic equations are:-Force > Retention = InstabilityForce < Retention = StabilityWennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.  
  16. 16. OCCLUSAL DESIGNINGOCCLUSAL DESIGNING The occlusal prescription provided is amajor factor in determining the size of theforce applied to the dentures The patients masticatory patterns definesthe retentive capacity of the denturesWennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.  
  17. 17. CONCLUSIONCONCLUSION Almost inevitable tissue changes occur in thepatients wearing upper complete and lower partialdentures. The dentist should plan the treatment modalitieswith care and institute them with caution. The patient should be educated well about the factthat the longest life of the prosthesis can only beattained by frequent visits and maintenance care

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