Occlusal plane problems are often not evaluated adequately. They can be left untreated or improperly treated. This article reviews one such problem known as Combination Syndrome. The treatment method described involves using a fixed mandibular prosthesis over implants that have been placed immediately after dental extractions.
Successful outcomes depend on thorough evaluation and proper diagnosis of a patient’s oral condition. Once the starting point has been determined and the final outcome is designed, the treatment plan merely becomes the method of reaching the desired result.
Combination syndrome was first described by Kelly 1 as destructive changes in hard and soft tissues of patients with complete maxillary denture opposing an unstable bilateral free-end mandibular partial denture. 2,3 The long-term result is extrusion of the remaining mandibular anterior teeth and the alveolar process surrounding them with loss of posterior mandibular bone. The plane of occlusion becomes reversed. Papillary hyperplasia of the hard palate develops. The premaxilla becomes atrophic as a result of the force exerted on this soft bone during occlusion. The maxillary tuberosity develops hypertrophy, creating a limited interarch space.
If not corrected, the unstable occlusion can result in progressive posterior mandibular atrophy leading to greenstick fractures. The method of reestablishing a proper occlusal relationship is discussed in this article using a conventional maxillary denture and fixed mandibular implant restoration to correct the occlusal issues.