Abstract
Combination syndrome (or what also can be called anterior hyper function syndrome) is referred to these cases with an edentulous maxilla opposed by a partially dentate mandible. This syndrome presents a considerable challenge to the prosthodontist due to progressive destructive changes that are associated with it. These associated signs and symptoms render the prosthetic management more difficult, and even though it is more reliable to use dental implants to support and retain the prostheses, some cases still need the conventional prosthetic treatments for medical or economic reasons. This clinical report presents the prosthodontic management of a combination syndrome patient.
Highlights
One of the most challenging dental management is the oral rehabilitation of cases with an edentulous maxilla opposed by remaining natural mandibular anterior teeth
The definition of the combination syndrome according to the Glossary of Prosthodontic Terms is; the characteristic features that occur when an edentulous maxillae is opposed by natural mandibular anterior teeth and a mandibular bilateral extension-base removable partial denture, including loss of bone from the anterior portion of the maxillary ridge, hyperplasia of the tuberosities, papillary hyperplasia of the hard palate’sprosth mucosa, supra-eruption of the mandibular anterior teeth, and loss of alveolar bone and ridge height beneath the mandibular removable partial denture base, it has another name like anterior hyperfunction syndrome [2]
The success of the prosthetic rehabilitation in such patients depends on the achievement of stability, retention and proper support for the prosthesis to interfere with the combination syndrome mechanism and associated major causative factors like; the great magnitude of forces, the unsuitability of the denture foundation, and the unfavourable occlusal contact produced by the remaining natural teeth
Summary
One of the most challenging dental management is the oral rehabilitation of cases with an edentulous maxilla opposed by remaining natural mandibular anterior teeth. Treatment carried out Evaluation of the space availability and preparation of 32, 31, 41 and 42 to receive metal copings: Primary impressions of the maxillary and mandibular arches were taken with alginate impression material (Kromopan, Lascod, Illinois, USA). Both impressions were disinfected and poured to produce study casts. A trial setting of artificial acrylic teeth was done to assess the available space (Figure 3) Another impression of the current maxillary prosthesis was made using alginate and poured to produce opposing cast to articulate against the lower study cast. The intaglio surface of the mandibular overdenture around the abutments was relined using side-chair hard relining material (KOOLINERTM Hard Denture Reline Material, GC, USA) to increase the intimate contact between the prostheses and the abutments (Figures 7 and 8)
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