introduction: partial denture .This was first identified


when edentulous maxilla is opposed by partially
edentulous mandible with anterior teeth remaining and bilateral distal
extension removable partial denture ,it results in a condition called
combination syndrome 1 .The distinct signs of the combination
syndrome are bone loss from premaxilla ,papillary hyperplasia of the hard
palate mucosa,overgrowth of the maxillary tuberosities   ,mandibular antertrior teeth become supra erupted
, loss of bone beneath the mandibular removable 
partial denture .This  was first identified
by Ellesworth Kelly and he coined the term “combination syndrome” .He studied 6
patients for 3 years who were edentulous in maxilla and partially dentate in
mandible with anterior teeth and distal extension removable partial denture .He
described three key features in these patients a) bone loss in anterior maxilla
b) overgrowth of tuberosities and c)bone loss under mandibular distal extension
rpd 2 .This condition commonly develops in patient who wear
maxillary complete denture opposed by mandibular anterior teeth.This explains
the pathogenesis of combination syndrome as anterior teeth cause trauma to pre
maxillary hard and soft tissues which leads to bone loss and hyperplasia of the
palatal mucosa. Due to loss of opposing occlusion ,mandibular teeth over erupts
and splayed and loss of mandibular posterior teeth leads to over eruption of
tuberosities .A part from the these signs, there’s  loss of OVD and occlusal plane discrepancy
and anterior spatial repositioning of the mandible 3 ,4 .

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According to
Kelly the classical combination syndrome consists of ”early loss of bone from
the anterior part of the maxilla ”  but
in some cases of combination syndrome 
there is bone loss under mandibular removable partial denture and
overgrowth of tuberosities .Len Tolstunov proposed a clinical relevant
classification for the different types of combination syndrome patients .this
classification has 3 main classes which are determined by anterior maxillary
resorption resulting from trauma by anterior mandibular teeth  and 10 modifications which are based on”
mandibular” condition 5.

This article
has discussed the common patterns of combination syndrome in patients presenting
to prosthodontic department of KCD and the treatment options available for
treating these patients.

Materials and Method

After getting
approval from ethics research committee of prosthodontic department  ,Khyber college of dentistry, cross –sectional
study was carried out.The data was collected from the patients who were either
completely edentulous or partially dentate with only posterior one or two teeth
present in maxilla ,in mandible they had full natural or restored dentition or kennedy
class 1 ,with or without dentures in both arches ,they presented for
prosthodontic treatment at the department.

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