CPD article Advice for general dental practitioners on the planning and management of prosthodontic patients
the challenges Combination syndrome –
W
ith the growth and interest i n d e n t a l implants it is easy to think
that implantology is a faction of dentistry in its own right. This is not the case; dental implants are simply a tool to aid the restoration of the debilitated dentition when conventional dentistry no longer offers an acceptable solution. For patients with missing teeth,
the key to successful treatment has always been and will remain the prosthodontic planning and management. The “surgical implan- tologist” is a valued member of the restorative team but should not be the first thought when replacing teeth is required. Comprehen- sive multidisciplinary planning is essential. This, and the following articles
in this series, will focus on some of the challenges in planning and management of patients with problems regularly encountered in general practice. Combination syndrome (CS) is a term that was first used in pros-
“Implants should not be the first thought when replacing teeth is required”
thetic dentistry by Kelly in ı972ı to describe the situation where only six to eight lower anterior teeth remain functioning against an upper complete denture. He listed five changes that he felt may be indica- tive of a “syndrome”. These were:
ı. Loss of bone from the anterior part of the maxillary ridge 2. Overgrowth of the tuberosities 3. Papillary hyperplasia in the hard palate 4. Extrusion of the lower anterior teeth 5. The loss of bone under the free end saddle denture bases.
These changes and signs were added to later include: ı. Loss of vertical dimension 2. Occlusal plane discrepancy 3. Anterior spatial repositioning of the mandible 4. Poor adaptation of the prosthesis 5. Epullis fissuratum 6. Periodontal breakdown. (See Fig ı)
There is controversy within the profession whether these signs
Aims and objectives: • Explain what combination syndrome is
• Explain estimated prevalence and how situation develops
• Look at options to help prevent it.
Learning outcomes: • To understand why patients present with combination syndrome
• The problems that this condition will cause them • How to prevent it.
constitute a “syndrome” and it is more likely that we are simply describing anatomical changes that take place as a result of a specific pattern of tooth loss and the treat- ment choices made by the patient and the dentist. What is clear, however, is that this is a common situation which is particularly troubling for the patient and a
Scottish Dental magazine 55 Continued »
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