DR SHRADDHA RATHI
MANDIBULAR DISTAL
EXTENSION DENTURE
ORAL
DESTRUCTIV E CHANGES
COM BI N ATI O N
SYNDROME
MAXILLARY COMPLETE DENTURE
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 Five Potential Changes Which Lead
1972;27:140-50. 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 Desjardins RP. J Prosthet Jr,
Dent 1979;41:124-8. 6 Additional Changes Observed in Combination Syndrome
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;75:107-13.
Lower Implant Supported Prosthesis
MAXILLARY DENTURE
NEW ERA
COMBINATION SYNDROME
IMPLANT
SUPPORTED MANDIBULAR DENTURE
MECHANIC
Increased displacing forces to the upper denture from
S
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 Changes to a ruminatory
pattern
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
Wennerberg 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 success— STABILITY !
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
