Combination syndrome revisited

A series of destructive changes occurs in the jaws of patients wearing a complete maxillary denture opposed by a mandibular bilateral distal extension removable partial denture. Kelly in 1972 first identified these changes and termed them as combination syndrome, as these changes are interlinked to one another and collectively represent a syndrome. The manifestations include flabby tissue in the anterior part of the maxillary ridge, tilting of the occlusal plane posteriorly downwards, supraeruption of lower anteriors, fibrous overgrowth of tissue in maxillary tuberosities, resorption in mandibular distal extension area and decreased vertical dimension of occlusion. The basic objective of the treatment is to develop an occlusal scheme that discourages excessive occlusal pressure in the maxillary anterior region, in both centric and eccentric occlusal contacts and provides posterior occlusal support. The treatment includes conventional prosthodontic techniques with special considerations for flabby ridges, removable cast partial denture, overdenture, implant supported & implant retained prosthesis. Patient education and frequent recall and maintenance care are essential, if the development of this insidious syndrome is to be avoided.