Combination syndrome ‫حيدر حسين عليوي‬

Destructive Problems, That May Be Encountered as a result of long term use of A Mandibular Distal
Extension Partial Denture Against A Complete Maxillary Denture.

This syndrome consists of:

1- Loss of bone from the maxillary anterior edentulous ridge. 2- Down growth of the maxillary
tuberosities. 3- Papillary hyperplasia of the tissues of the hard palate. 4- Extrusion of the lower anterior
teeth and, 5- Loss of bone beneath the removable partial denture bases.

It usually has six associated changes:

1- Loss of vertical dimension of occlusion. 2- occlusal plane discrepancy, 3- Anterior spatial resorption of
the mandible. 4- Development of epulis fissuratum. 5- Poor adaptation of the prosthesis and, 6-
Periodontal changes.

THESE RETROGRADE CHANGES ARE PROBABLY TRIGGED BY THE PATIENT’S FUNCTIONAL

HABITS

the patient tend to function on the remaining anterior natural teeth with the maxillary denture covering
the anterior residual alveolar ridge. This portion of the ridge is composed of cancellous bone and is
subject to fairly rapid resorption if excessive force is placed against it. As ridge resorption occurs and
progresses, the bony ridge is replaced by rebundant soft tissue , initiating the combination syndrome and
associated changes. A specific pattern of resorption when anterior mandibular teeth are retained and are
opposed by a complete maxillary denture. The premaxilla undergoes severe resorption and is usually
accompanied by the development of fibrous hyperplasia of the maxillary tuberosity.

Resorptive Changes Occur In The Maxillary Anterior Ridge

As bone is resorbed from maxillary anterior ridge, denture will tip upward anteriorly and downward
posteriorly. The Change In The Angulation Of The Occlusal Plane May Result In A Protrusive Or Sliding
Contact Of The Mandibular Teeth With The Denture, Which Can Contribute To The Loss Of Support For
The Remaining Natural Teeth Or Precipitate Periodontal Changes. The Labial Flange Of The Denture
Produces A Low Grade Irritation In The Surrounding Soft Tissues, Resulting In Development Of Epulis
Fissuratum, And Cause An Associated Overgrowth Of Fibrous Tissue Covering The Maxillary Tuberosities.

The Combination Syndrome Is A Result Of Three Main Factors

• the great magnitude of forces involved,

• the unsuitability of the denture foundation to resist them, and

• the particularly unfavorable occlusal relationship.