Kelly's combination syndrome and its management

about combination syndrome

1. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture Author: Ellsworth Kelly, DDS Journal of Prosthetic Dentistry, Volume 27, Issue 2, Page 140-150 Year: 1972 Journal Club-2

2. Contents Introduction The Combination syndrome Pathogenesis of Combination Syndrome Histological changes in Combination syndrome Study Questions Materials and Methods Results Discussion Clinical features Prevention of Combination Syndrome Management Critical evaluation of the article Conclusion References 11 September 2024 2

3. Introduction “The making of a maxillary or mandibular complete denture as distinguished from a set of complete dentures.” – GPT 10 Prevalence: 1 in 4 patients with maxillary CD & mandibular RPD. 11 September 2024 3

4. 11 September 2024 4 The Combination Syndrome KELLY’S SIGNS OF COMBINATION SYNDROME

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7. Histological changes in Combination syndrome F labby tissue and the hard tissue over the tuberosities are indistinguishable. M ature, dense, fibrous connective tissue with dense bundles of collagen fibers, relatively few cellular elements and very few inflammatory cells. A vascular with an overlying hyperplastic epithelium. M ature epulis fissuratum has the same histology. 11 September 2024 7

8. Materials and Methods 11 September 2024 8 Study setting: Out patient, Department of Prosthodontics, School of Dentistry, University of California Study design: Case Series Sample size: 20 Inclusion criteria: All patients receiving single complete dentures. Immediate maxillary CD with class 1 Lower RPD.

9. D ata Collection 11 September 2024 9

10. Methodology 11 September 2024 10

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13. Results 11 September 2024 13

14. Discussion All of the subjects  well satisfied with their prosthesis. B etter than average follow-up 11 September 2024 14

15. 11 September 2024 15 SAUNDERS ET AL (1979) SIX ADDITIONAL FEATURES ASSOCIATED WITH COMBINATION SYNDROME

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17. Prevention of Combination Syndrome Saunders et al, 1979 proposed to “Develop an occlusal scheme that discourages excessive occlusal pressure on the maxillary anterior region, in both centric and eccentric positions” 11 September 2024 17

18. Prevention of Combination Syndrome Kelly advocated these measures to prevent degenerative changes leading to the progression of Combination syndrome: Retain weak posterior teeth I mplants Lower overdenture 11 September 2024 18

19. Prevention of Combination Syndrome 11 September 2024 19 LINEAR OCCLUSION BY WILLIAM S. JAMESON (2001) SHORTENED DENTAL ARCH CONCEPT BY A.F. KAYSER (1981) BROAD COVERAGE OF THE RESIDUAL RIDGE

20. Management of Combination Syndrome 11 September 2024 20

21. Summary 11 September 2024 21 During impression making  Cover as much basal area as possible. Cover retromolar pad and buccal shelf area in mandible. Special impression techniques for flabby ridges should be followed so that these tissues are at rest when dentures are placed. During Jaw relations  Make centric relation record at VDR, if linear occlusal scheme is to be followed. Teeth should be either arranged according to shortened dental arch concept or linear occlusion concept . Follow Saunders philosophy.

22. Critical Evaluation of the article Title of the article gives an insight of the study. The author is qualified. The language of the article is objective. Case series with follow up of 3 years. Less sample size is employed, hence it was concluded to be a preliminary report . 11 September 2024 22

23. Conclusion Almost inevitable degenerative changes develop in the edentulous regions of wearers of complete upper and partial lower dentures. Ill-fitting dentures have been blamed for all of the lesions of the edentulous tissues, yet the most perfect denture will be ill-fitting after bone is lost from the anterior part of the ridge. Removable dentures need periodic attention at least as often as the natural teeth. 11 September 2024 23

24. References Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. Journal of Prosthetic dentistry. 2003 Sep 1;90(3):213-9. The glossary of prosthodontic terms. J Prosthet Dent 2023;81:39-110. Jameson WS. The use of linear occlusion to treat a patient with combination syndrome: A clinical report. Journal of Prosthetic Dentistry. 2001 Jan 1;85(1):15-9. Käyser AF. Shortened dental arches and oral function. Journal of oral rehabilitation. 1981 Sep;8(5):457-62. Shen K, Gongloff RK. Prevalence of the ‘combination syndrome’ among denture patients. J Prosthet Dent 1989;62:642-4. Saunders TR, Gillis RE Jr, Desjardins RP. Th e maxillary complete denture opposing the mandibular bilateral distal-extension partial denture: Treatment considerations. J Prosthet Dent 1979;41:124-8. Palmqvist S, Carlsson GE, Owall B. Th e combination syndrome: A literature review. J Prosthet Dent 2003;90:270-5. Langer Y, Laufer BZ, Cardash HS. Modalities of treatment for the combination syndrome. J Prosthodont 1995;4:76-81. 11 September 2024 24

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