Modalities of treatment for the combination syndrome

Anterior Hyperfunction by Mandibular Anterior Teeth: A Narrative Review

"Combination syndrome", defined by Kelly in 1972, is a challenging condition observed in a patient with an edentulous maxilla and a partially edentulous mandible with only mandibular anterior teeth. "Anterior hyperfunction syndrome" is regarded as a synonym of combination syndrome and was first described in 1994. Although these terms have been well known, the definition of "anterior hyperfunction" has not been described yet. This narrative review focused on anterior hyperfunction and discussed the etiology and the clinical managements. An electronic bibliographic search for this literature review was conducted in addition to the review of our clinical cases. The previous reports indicated that combination syndrome with all five features was rarely observed. The patients with anterior hyperfunction generally showed the loss of posterior occlusal supports and the loss of vertical dimension of occlusion. To manage anterior hyperfunction, these conditions should be improved using conventional removable prostheses and implant-supported prostheses. Anterior hyperfunction is attributed to mandibular anterior teeth and some interventions for mandibular anterior teeth are required in many cases. Additionally, it must be noted that implant-supported prostheses may lead to anterior hyperfunction. In conclusion, comprehensive approaches for the remaining teeth and the prostheses will be required to manage this complex condition.

Full mouth rehabilitation of partially and fully edentulous patient with crown lengthening procedure: a case report

BACKGROUND

In order to restore severely attrited teeth properly, surgical intervention in the form of a crown-lengthening procedure may be required. And also, proper diagnosis and treatment sequencing is critical to obtain a successful results. Adequate diagnostic wax-up ensures good esthetics and healthy periodontal tissue.

CASE DESCRIPTION

This clinical case report describes a diagnostically based protocol for restoration on mandibular anterior teeth with crown lengthening procedure and the treatment of partially edentulous mandible combined with an edentulous maxilla. In addition, the effort to prevent the combination syndrome was described.

CLINICAL IMPLICATION

An interdisciplinary diagnosis and examination through visualization of the desired results ensure conservative and more predictable outcome.

Management of biomechanical complication of implant-supported restoration of a patient with combination syndrome: a case report

Combination syndrome (CS) is a pathologic condition of the stomatognathic system characterized by an edentulous maxilla with an atrophic anterior ridge, maxillary papillary hyperplasia, hypertrophic maxillary tuberosities, super-erupted mandibular anterior teeth, as well as atrophic mandibular posterior ridges. This condition can present a challenging situation to the clinician who needs to assemble evidence from all aspects of dentistry to formulate an appropriate treatment plan. One of the possible treatment choices for the fully edentulous patient with a CS is a full-arch implant-supported reconstruction for both maxilla and mandible. The purpose of this study is to illustrate and discuss a biomechanical complication-fractured maxillary meso bar in a patient with CS, and to present a description of how this complex case was corrected and successfully completed. The analysis of implant-supported and implant-retained full arch restorations in edentulous patients with CS is presented and treatment recommendations are given. A necessity of individualized approach for every implant reconstruction case, especially complicated with a CS, is suggested.

Screwless Fixed Detachable Partial Overdenture Treatment for Atrophic Partial Edentulism of the Anterior Maxilla

This is a case report of the restoration of a partially edentulous atrophic anterior maxilla and atrophic mandibular posterior ridges. This case report demonstrates one method for successful treatment of partial edentulism at No. 7 to 10, where interlock attachments on natural cuspids and mini dental implants support an acrylic-based screwless fixed detachable partial denture to provide lip support and masticatory function in the anterior maxilla. The presenting qualities of this case were similar to combination syndrome.

Combination syndrome: classification and case report

Combination syndrome (CS) is a dental condition that is commonly seen in patients with a completely edentulous maxilla and partially edentulous mandible with preserved anterior teeth. This syndrome consists of severe anterior maxillary resorption combined with hypertrophic and atrophic changes in different quadrants of maxilla and mandible. This makes it a challenging condition in dentistry that requires significant experience along with advanced restorative and surgical skills. The causes of maxillary bone resorption and ways to correct it are discussed in this article. Conventional treatment with full upper and partial lower dentures for the CS patients is not always adequate or satisfying for patients and it often requires multiple remakes due to continuing bone resorption. Dental implant rehabilitation challenges conventional treatment with bone-anchoring techniques to provide improved retention and stability for implant-retained and supported prostheses. This article presents a successful implant treatment of the partially edentulous maxilla in CS patient. The author proposes a new classification of the combination syndrome that includes a multitude of CS cases with partial and complete maxillary and mandibular edentulism. The necessity of a multi-disciplinary approach for early prevention and treatment of this complex condition is emphasized.

Metastatic calcification of the nasal septum presenting as an intraoral mass: a case report with a review of the literature

Metastatic calcification is a pathologic condition characterized by deposition of calcified product in otherwise normal tissues as a result of hyperphosphatemia with or without concurrent hypercalcemia. Metastatic calcification presenting clinically as an oral lesion is extremely rare. To date, only 7 cases of metastatic calcification involving the oral soft tissues have been described. This report describes a case of metastatic calcification of the nasal septum presenting as a mass of the anterior maxillary vestibule in a patient with end-stage renal disease. The case reported is only the second example with nasal septum involvement. A brief review of the clinical and histopathologic features of previously reported intraoral cases is also presented.

Impression technique for nonosseous free-tissue transfer reconstruction after cranioorbitomaxillary resection: A clinical report

The use of vascularized free-tissue transfers has given the head and neck surgeon the ability to offer enhanced oncologic therapy with less risk of exposing vital structures to the aerodigestive tract. Resulting free-flap tissue consistencies and contours inhibit the successful use of routine impression techniques. The technique described in this clinical report uses a previously reported procedure to obtain an accurate impression of residual palatal and free-flap structures. The significance of this technique is that it improves the tissue reproduction of surgically closed palatal defects.