Combination syndrome

Is a dental condition that is commonly seen in patients with a completely edentulous maxilla and partially edentulous mandible with preserved anterior teeth

1. Combination Syndrome Bushra Hussein Ali BDS Supervised by: Haitham Tawfeek Ms.C ( Prosthodontist )

2. Challenge One of the most challenging dental management is the oral rehabilitation of cases with lost teeth which is known as Kelly syndrome Anterior hyperfunction

3. History kelly in 1972 was the first to coin the term combination syndrome for this oral condition and its associated clinical feature Combination syndrome

4. Combination Syndrome Is a dental condition that is commonly seen in patients with a completely edentulous maxilla and partially edentulous mandible with preserved anterior teeth.

5. The Problem Chronic occlusal trauma Slow resorption Replace with fibrous tissue

6. Several problems may face the prosthodontist while managing such a case: Concentration occlusal load on remaining natural teeth for properioception 1 Loss of bone in the maxillary anterior region

7. Downward movement of posterior part of maxillary denture and formation of flabby tissue. 2 Overgrowth of the tuberosities

8. Ridge resorption in mand . edentulous area 3 Loss of the alveolar bone under a partial denture in the mandible

9. Supraeruption of lower anteriors 4 Extrusion of the remaining natural mandibular anterior teeth

10. In another word , This syndrome consists of severe anterior maxillary resorption combined with hypertrophi c and atrophic changes in different quadrants of maxilla and mandible. This makes it a challenging condition in dentistry that requires significant experience along with advanced restorative and surgical skills.

11. Conventional treatment : Conventional treatment with full upper and partial lower dentures for the CS patients is not always adequate or satisfying for patients and it often requires multiple remakes due to continuing bone resorption .

12. The success of the prosthetic rehabilitation: depends on the achievement of stability , retention and proper support Stability support retention

13. Stability Support Retention Major causative factor Magnitude the forces Unsuitability of the denture foundation Unfavourable occlusal contact

14. Other objectives The occlusal scheme should be at a proper vertical and centric relation position. Anterior teeth should be used for cosmetic and phonetic purpose only. Patient education and frequent recall and maintenance care are essential, if the development of this insidious syndrome is to be avoided.

15. Treatment Modified window technique for the upper arch To manage the problem of flabby ridge

16. Altered cast technique for the lower arch to Improve tissue support for the distal extension bases

17. Other treatment options Using a Mandibular overdenture provided better prognosis especially when mandibular anterior teeth were structurally or periodontally compromised Using a mandibular implant-supported overdenture

18. Finally excellent long-term results with mandibular implant supported fixed prostheses, opposing maxillary complete denture Implant supported fixed prosthesis

19. Insert the title of your subtitle Here Conclusion Combination syndrome is a challenge for every dentist and need a great skills because of difficulty of gaining stability, retention and support. The recent studies show that long-term results can get by using mandibular implant supported fixed prostheses, opposing maxillary complete denture.

20. Thank you