Essay - combination syndrome

Question 1

What is combination syndrome

Answer 1

Dental condition seen in its with completely edentulous maxilla opposed by preserved mandibular anterior teeth

Question 2

What are the components of CS indicated by Kelly

Answer 2

• Loss of bone from anterior part of maxillary ridge
• Overgrowth of tuberosities
• inflammatory papillary hyperplasia
• Extrusion of lower anterior teeth
• Loss of bone under denture bases

Question 3

Other challenges associated with this:

Answer 3

• Lower teeth could be tilted, worn, retained roots etc - difficult to produce an even occlusal plane with the denture
• rapid wear of acrylic teeth
• rapid resorption of upper anterior alveolar boone = looseness of denture
• High risk of denture fracture
• FWS may be an issue

Question 4

Long-term maintenance of this pt:

Answer 4

• Frequent relining upon loosening of denture due to alveolar resorption
• Maintain ohi of natural teeth
• Monitor pt for signs of CS
• Replacement of denture more frequently

Question 5

List tx options for this patient

Answer 5

• C/-
• C/P (acrylic or coco)
• C/ cantilever bridges
• Retain roots and over denture
• Full mouth clearance and C/C
• Implant retained denture

Question 6

Why provide an upper denture only

Answer 6

• Patient can accept shortened dental arch - unlikely to wear lower partial denture anyway

Question 7

Impression method with upper denture with fibrous ridges

Answer 7

Likely to be fibrous ridges - carry out window technique with a mucostatic material as to not displace the tissue

Question 8

Issues with providing a lower denture

Answer 8

• Teeth may be of poor prognosis but pt doesn’t want them removed - consider acrylic to add to it
• Poor compliance as no aesthetic component - waste of time and resources

Question 9

Why consider bridges as a lower prosthesis

Answer 9

• No issue with compliance
• Long span issue, can a premolar withstand force of a molar ?
• Pt selection - good OH and good prognosis tooth as an abutment

Question 10

When to consider full mouth clearance?

Answer 10

• Lower natural teeth have poor prognosis

- may be easier to just produce C/C if severely displaced teeth as there is better control over occlusal plane

Question 11

Canine over denture

Answer 11

If adequate support from canines can carry this out

• Better retention of the denture
• Prevents resorption of the bone via loading from the retained root

Question 12

Implant retained denture

Answer 12

• Pt selection important - bone, med hx
• Usually 4 implants are used
• Loading of bone prevents resorption
• Good retention

Question 13

What impression technique is used for fibrous ridges?

Answer 13

• Selective pressure technique
• Window cut out in the tray where the displaceable tissue is
• This prevents distortion of the displaceable tissue