MAXILLARY

COMPLETE
DENTURE

MANDIBULAR
DISTAL
EXTENSION
DENTURE

ORAL
DESTRUCTIVE
CHANGES

COMBINATION
SYNDROME

Scenario Of combination Syndrome

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

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

PROPRIOCEPTION

Early loss of bone in the anterior part of maxilla

enlarged fibrous tuberosities
plane

Migration of the occlusal

Migration of natural teeth

Migration of denture

Posteriorly,

Poor esthetics

Inflammatory papillary hyperplasia

on the palate
Ellsworth kelly J Prosthet Dent 1972;27:140-50

Negative pressure within the maxillary denture

Stress Re-direction

Decreased antagonistic force on mandibular

anteriors

Loss of vertical dimension

ill fitting denture

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.

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.

Implant supported
fixed prosthesis

Maxillary Osseo
integrated
implants.

Augmentation of
maxilla
CP Thiel et al
1996;75:10713.

Lower Implant Supported Prosthesis

MAXILLARY
DENTURE

NEW ERA
COMBINATION
SYNDROME

IMPLANT
SUPPORTED
MANDIBULAR
DENTURE

MECHANICS
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

ruminatory pattern

Changes to a

As the chewing pattern

changes, the features of the
ideal occlusal prescription
also changes

THE SCENARIO IN
SHORT

As the lower denture becomes more retentive

Ineffective mastication
Very unretentive upper denture.
The ruminatory pattern of mastication
Unable to exert any control over the mandible

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

SOLUTIONS

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.

TREATMENT STRATEGIES
& PRINCIPLES

The principle is to design and provide an

occlusion that is ideal for the important criteria
of denture successSTABILITY !

The basic equations are:Force > Retention = Instability

Force < Retention = Stability
Wennerberg A, Carlsson GE, Jemt T. 2001;14:550-5.

OCCLUSAL 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.

CONCLUSION

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