CS class
CS modification
Posterior maxilla
Posterior mandible
Conventional treatment: maxilla / mandible
Suggested implant treatment of maxillary arch (based on bone availability)
I
1
Moderate hypertrophy
Moderate atrophy
FUD / bilateral distal extension RPD
Placement of 2 to 4 implants in the posterior maxilla on each side, alveoloplasty ± sinus lift; implant-retained or...
CS class
CS modification
Type of Maxillary edentulism
Type of Mandibular edentulism
Anterior Maxilla
Anterior Mandible
I
1
Completely edentulous arch
Partial edentulism with anterior teeth present only (or recently removed)
Severe atrophy
Severe hypertrophy; teeth extrusion
2
Completely edentulous arch
Fixed dentition
Severe atrophy
Severe hypertrophy
...
Glossary of Implant Terms. J Oral Implantol 2003. 29:31..
Jameson, W. S. Various clinical situations and their influence on linear occlusion in treating combination syndrome: a discussion of treatment options. Gen Dent. 2003. 51:443–447.
Kelly, E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent. 1972. 27:140–150.
Saunders...
Conclusion
A progressive anterior maxillary bone loss can be seen in cases of complete maxillary denture opposed by the distal extension RPD. A variety of similar situations when a maxillary partial denture with missing front teeth is functioning against an anterior fixed dentition or an implant-supported prosthesis (root-form, subperiosteal, ramus frame, transmandibular implant designs) can ...
Discussion
Treatment of patients with combination syndrome can be a challenge for a dental practitioner. A significant resorption of anterior maxillary alveolar ridge is often seen when mandibular molars and premolars are lost and the anterior mandibular teeth with a distal extension RPD oppose the edentulous maxilla. When the lower RPD is constantly adjusted and properly maintained as the bo...
Classification of Combination Syndrome
Kelly was the first person to use the term “combination syndrome.”5 He believed that the key to many symptoms of the combination syndrome is the “early loss of bone from the anterior part of the maxillary jaw.”3 The other consistent features of this dental condition include enlargement of maxillary tuberosities and mandibular posterior bone res...
Restorative stage
Bar type attachments are often used to connect abutment teeth or implants and provide retention for removable dentures and overdentures. Retention is achieved by using riders/clips, retention sleeves, O-rings, etc. There are several bar type attachments that are available commercially, including the Dolder Bar System, the Hader Bar System, the Acherman Clip, and others. Any ...
Operative phase
The procedure (surgical stage 1) was started with the administration of two capsules of lidocaine 2% with epinephrine 1:100 000 for the upper right quadrant. The buccal full-thickness flap from the right maxillary tuberosity to the premolar area with the anterior releasing incision was developed. The maxillary sinus was exposed by removing a small amount of anterior maxillar...
Treatment plan
During the initial surgical consultation, the overall oral condition and severe bone atrophy was discussed with the patient. The remaining tooth No. 2 was not salvageable and had to be removed. Teeth No. 12-13-14 connected in the bridge were stable. A surgical treatment with a large bone graft (hip graft) to the premaxillary region to correct severe atrophy which would require ...
Diagnosis
On the basis of the clinical and radiographic evaluation, the diagnosis of combination syndrome was made. An extended diagnosis also included a class III malocclusion, severe anterior maxillary bone atrophy between first premolars, failing tooth No. 2 (advanced periodontal condition), a functional mandibular blade implant, an extrusion of the lower front teeth, and a...
Case Report
A 76-year-old woman with Sjogren syndrome presented complaining of a poor fit of an upper denture and difficulty chewing and speaking clearly. Patient had Sjogren syndrome for the previous 20 years in a mild and controlled form. She had been using water to compensate for dryness of her mouth and was taking prednisone 10 mg every other day for the last 2 years. Otherwise, patient's...
Introduction
Combination syndrome (CS) is defined as “a condition caused by the presence of the lower anterior teeth and the absence of the posteriors and resulting in significant maxillary anterior alveolar resorption.”1 This condition often develops in cases of a complete maxillary denture opposing a bilateral distal extension mandibular partial denture2 (Figures 1 - 3). The resulting...
Abstract
Combination syndrome (CS) is a dental condition that is commonly seen in patients with a completely edentulous maxilla and partially edentulous mandible with preserved anterior teeth. This syndrome consists of severe anterior maxillary resorption combined with hypertrophic and atrophic changes in different quadrants of maxilla and mandible. This makes it a challenging condition in ...