CPD article Continued »
anteriors with fixed bridgework, or implant supported, before resorption and fibrous replacement takes place. Periodontal patients are the most challenging, as investing in good restorative treatment on question- able teeth involves considerable skill, both in terms of commu- nication and multidisciplinary restorative techniques. Acceptance of conventional
treatment options can be aided by provision of hybrid Maryland bridges or aesthetic (no visible clasping) cobalt chrome dentures and periodontal splints. The hybrid Maryland bridge
involves minor preparation of the abutment teeth to accept rests and guide planes. Crucially with this type of Maryland an adhesive cement is not required and a simple glass ionomer can be used (see Figs 6 and 7). Arcylic dentures, while useful
as interim prostheses and to allow a patient to become accus- tomed to managing a denture, are rarely capable of providing adequate stability and posterior support. If bone resorption is to be kept to a minimum, it is essential that lateral movement of the denture is prevented, this is most predictably achieved with a well-designed RPD using guide planes and lock-in rest seats. Where necessary, undercuts
can be created on teeth for clasps using composite resin. The RPD must extend onto the most resorption resistant areas – the retromolar pads and buccal shelves (see Fig 8). As noted by Jameson5, hyper- function of the remaining anterior teeth should be avoided through correct adjustment, and mainte- nance of the occlusion. In the next article we will look at
how the CS patient can be managed both by conventional means and with the help of dental implants.
®
This article was submitted by Edinburgh Dental Specialists. To contact EDS for further information or advice on managing similar cases, email
Tele-dentist@edinburghdentist.com
58 Scottish Dental magazine
CPD questions and answers:
1. Combination Syndrome includes:
a. Loss of bone from the anterior part of the maxillary ridge b. Overgrowth of the tuberosities
c. Papillary hyperplasia in the hard palate. d. Extrusion of the lower anterior teeth e. The loss of bone under the free end saddle denture bases f. All of the above.
2. Theories for Enlargement of the tuberosities include: a. Negative pressure under a tipping denture b. Naturally large tuberosities
c. They don’t enlarge, everything gets smaller.
3. The prevalence of CS in a ‘maxillary denture opposed by natural anterior teeth’ population is: a. 10 per cent b. 24 per cent c. 75 per cent d. 7 per cent.
4. The minimum number of posterior teeth for a stable shortened arch is proposed as: a. Two premolars in occlusion on each side b. One premolar in occlusion on each side c. Two premolars and one molar in occlusion on each side d. The six anterior teeth only.
5. Which of the following is a suitable preventive measure: a. Daily fluoride mouth rinse
b. Maintaining roots in posterior mandible and anterior maxillae for “over denture” abutments
c. Removing any questionable teeth as soon as practical d. Replace all missing teeth with dental implants.
To gain one hour of verifiable CPD, simply visit:
www.surveymonkey.com/s/Combinationsyndrome
REFERENCES:
1. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. Kelly.E,
J.Prosthet Dent, 1972
2. Prevalence of the combination syndrome among denture patients. Shen.K ,
J.Prothet Dent, 1989
3. Vertical position, rotation and tipping of molars without antagonists Kiliaridis et al, Int J Pros 2000
4. A review of the shortened dental arch concept focusing on the work by the Kayser/Nijmegen group
Kanno and Carlsson, J.Oral Rehab 2006
5. Combining fixed and removable restorations with linear occlusion in treating combination syndrome: a discussion of treatment options Jameson WS, Gen Dent. 2003.
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