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MAXILLARY COMPLETE DENTURE MANDIBULAR MANDIBULAR DISTAL DISTAL EXTENSION EXTENSION DENTURE DENTURE
MAXILLARY
COMPLETE
DENTURE
MANDIBULAR
MANDIBULAR
DISTAL
DISTAL
EXTENSION
EXTENSION
DENTURE
DENTURE
MAXILLARY COMPLETE DENTURE MANDIBULAR MANDIBULAR DISTAL DISTAL EXTENSION EXTENSION DENTURE DENTURE ORAL DESTRUCTIVE CHANGES COMBINATION SYNDROME

ORAL

DESTRUCTIVE

CHANGES

MAXILLARY COMPLETE DENTURE MANDIBULAR MANDIBULAR DISTAL DISTAL EXTENSION EXTENSION DENTURE DENTURE ORAL DESTRUCTIVE CHANGES COMBINATION SYNDROME

COMBINATION

SYNDROME

MAXILLARY COMPLETE DENTURE MANDIBULAR MANDIBULAR DISTAL DISTAL EXTENSION EXTENSION DENTURE 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
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 Lead to Combination Syndrome

1. Loss of vertical dimension of occlusion. 2. Occlusal plane discrepancy. 3. Anterior spatial repositioning of
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
PROPRIOCEPTION

Early loss of bone in the anterior part of maxilla

PROPRIOCEPTION Early loss of bone in the anterior part of maxilla Posteriorly, enlarged fibrous tuberosities Migration

Posteriorly,

enlarged fibrous tuberosities

PROPRIOCEPTION Early loss of bone in the anterior part of maxilla Posteriorly, enlarged fibrous tuberosities Migration

Migration of the occlusal

plane

PROPRIOCEPTION Early loss of bone in the anterior part of maxilla Posteriorly, enlarged fibrous tuberosities Migration

Migration of natural teeth

PROPRIOCEPTION Early loss of bone in the anterior part of maxilla Posteriorly, enlarged fibrous tuberosities Migration

Poor esthetics

Migration of denture

PROPRIOCEPTION Early loss of bone in the anterior part of maxilla Posteriorly, enlarged fibrous tuberosities Migration

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

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

• 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

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
Implant supported
fixed prosthesis
Maxillary Osseo
integrated
implants.
Augmentation of
maxilla
CP Thiel et al
1996;75:107-
13.

Lower Implant Supported Prosthesis

MAXILLARY MAXILLARY DENTURE DENTURE NEW ERA NEW ERA COMBINATION COMBINATION SYNDROME SYNDROME IMPLANT IMPLANT SUPPORTED SUPPORTED

MAXILLARY

MAXILLARY

DENTURE

DENTURE

MAXILLARY MAXILLARY DENTURE DENTURE NEW ERA NEW ERA COMBINATION COMBINATION SYNDROME SYNDROME IMPLANT IMPLANT SUPPORTED SUPPORTED
MAXILLARY MAXILLARY DENTURE DENTURE NEW ERA NEW ERA COMBINATION COMBINATION SYNDROME SYNDROME IMPLANT IMPLANT SUPPORTED SUPPORTED

NEW ERA

NEW

ERA

COMBINATION COMBINATION

SYNDROME SYNDROME

MAXILLARY MAXILLARY DENTURE DENTURE NEW ERA NEW ERA COMBINATION COMBINATION SYNDROME SYNDROME IMPLANT IMPLANT SUPPORTED SUPPORTED
MAXILLARY MAXILLARY DENTURE DENTURE NEW ERA NEW ERA COMBINATION COMBINATION SYNDROME SYNDROME IMPLANT IMPLANT SUPPORTED SUPPORTED
MAXILLARY MAXILLARY DENTURE DENTURE NEW ERA NEW ERA COMBINATION COMBINATION SYNDROME SYNDROME IMPLANT IMPLANT SUPPORTED SUPPORTED

IMPLANT

IMPLANT

SUPPORTED

SUPPORTED

MANDIBULAR

MANDIBULAR

DENTURE

DENTURE

MAXILLARY MAXILLARY DENTURE DENTURE NEW ERA NEW ERA COMBINATION COMBINATION SYNDROME SYNDROME IMPLANT IMPLANT SUPPORTED SUPPORTED

MECHANICS

MECHANICS

Increased displacing forces to the upper denture from

the lower implant supported denture

MECHANICS MECHANICS Increased displacing forces to the upper denture from the lower implant supported denture The

The force

comes in excess to the retention provided by upper

denture

MECHANICS MECHANICS Increased displacing forces to the upper denture from the lower implant supported denture The

Significant change In the chewing pattern

Vertical chewing pattern ruminatory pattern

MECHANICS MECHANICS Increased displacing forces to the upper denture from the lower implant supported denture The

Changes to a

MECHANICS MECHANICS Increased displacing forces to the upper denture from the lower implant supported denture The

As the

As

the chewing

chewing pattern

pattern

changes, the

changes,

the features

features of

of the

the

ideal occlusal

ideal

occlusal prescription

prescription

also changes

also

changes

THE SCENARIO

THE

SCENARIO ININ

SHORT…

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

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

TREATMENT

STRATEGIES

&& PRINCIPLES

PRINCIPLES

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.

OCCLUSAL DESIGNING

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

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