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Ogino Y, Ayukawa Y. Anterior Hyperfunction by Mandibular Anterior Teeth: A Narrative Review. Healthcare (Basel) 2023; 11:2967. [PMID: 37998459 PMCID: PMC10671450 DOI: 10.3390/healthcare11222967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
"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.
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Affiliation(s)
- Yoichiro Ogino
- Section of Fixed Prosthodontics, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan;
| | - Yasunori Ayukawa
- Section of Fixed Prosthodontics, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan;
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
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Al-Angari N, Algarni S, Andijani A, Alqahtani A. Various classes of removable partial dentures: A study of prevalence among patients attending a dental and educational institute in Riyadh, Saudi Arabia. Saudi Dent J 2021; 33:656-660. [PMID: 34803315 PMCID: PMC8589594 DOI: 10.1016/j.sdentj.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Knowledge about the most prevalent types of Kennedy classifications is of great value and will enlighten dental students, dental technicians, and practitioners regarding the treatment needs of their patients, ultimately leading to better treatment outcomes. The aim was to determine the prevalence of various Kennedy classifications among patients attending clinics at the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Dental Center, National Guard Health Affairs, who were seeking treatment for partial edentulism. METHODS An observational cross-sectional study was conducted by visualizing cast models for partially edentulous patients. Kennedy classification, age, gender, and treatment design were recorded from the lab request sheets that were attached to the casts in the labs at both the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Dental Center, National Guard Health Affairs. The statistical analyses were performed with SPSS version 20.0 utilizing frequency and Pearson's and Spearman's correlation tests. RESULTS Kennedy Class I (45.0%) was the most prevalent pattern in both dental arches, followed by Class III (26.2%). Next was Class II (23.3%), while Class IV was the least prevalent (5.4%). CONCLUSION Kennedy Class I was the most noted classification in our patient population. As age increases, there is an increased tendency toward Class I and II.
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Affiliation(s)
- Nadia Al-Angari
- Department of Prosthodontics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saeed Algarni
- Department of Prosthodontics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Anas Andijani
- Department of Prosthodontics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulwahab Alqahtani
- Department of Dental Services FM, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Bagga R, Robb ND, Fenlon MR. An investigation into the prevalence of combination syndrome. J Dent 2019; 82:66-70. [PMID: 30769080 DOI: 10.1016/j.jdent.2019.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of Combination Syndrome, and to investigate if provision of a mandibular removable partial denture has any influence on the prevalence of Combination Syndrome. METHOD Patients attending Kings College London Dental Institute, Guys Hospital who wore maxillary conventional complete dentures opposing mandibular anterior teeth only, with or without mandibular partial dentures were examined by one examiner. Oral health, residual alveolar ridge and denture quality were assessed. Features putatively associated with Combination Syndrome were recorded. Patient ratings of dentures were recorded. RESULTS 99 patients were recruited who were wearing maxillary removable complete dentures opposing only mandibular anterior teeth. Of these, 64 patients wore mandibular removable partial dentures and 35 patients did not. Only 8 patients displayed two features of Combination Syndrome and 38 patients displayed one feature of Combination Syndrome, excessive resorption of the anterior maxillary sextant. These findings are not compatible with previous research which suggested that the five features of Combination Syndrome were prevalent in patients wearing maxillary complete dentures opposing mandibular anterior teeth. CONCLUSIONS Evidence supporting the existence of Combination Syndrome was not discovered in this research. Prevalence of Combination Syndrome appeared to be low or non-existent. Patient treatment modalities and teaching in relation to Combination Syndrome may need to be modified.
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Affiliation(s)
- Rita Bagga
- King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, Floor 26, Guy's Hospital, London, SE1 9RT, United Kingdom.
| | - Nigel D Robb
- School of Dentistry and Oral Health, Gold Coast Campus, Griffith University, Qld 4222, Australia.
| | - Michael R Fenlon
- King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, Floor 22, Guy's Hospital, London, SE1 9RT, United Kingdom.
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Khuder T, Yunus N, Sulaiman E, Ibrahim N, Khalid T, Masood M. Association between occlusal force distribution in implant overdenture prostheses and residual ridge resorption. J Oral Rehabil 2017; 44:398-404. [PMID: 28295492 DOI: 10.1111/joor.12504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/29/2022]
Abstract
This study aimed to investigate residual ridge resorption (RRR) of anterior and posterior maxillary and mandibular edentulous ridges, in patients treated with mandibular implant overdentures (IOD) and compare with conventional complete denture (CD) wearers, and to determine at each location, the association of RRR with the occlusal forces distribution and other patients' variables. The anterior and posterior RRR of IOD (six males, 17 females) and CD (12 males, 11 females) groups were determined using baseline and follow-up dental panaromic radiographs (DPT) (mean intervals 4 ± 1·8 years). The bone ratios were calculated using proportional area: anatomic to fixed reference areas and mean difference of ratios between the intervals determined RRR. The ridge locations included anterior and posterior maxillary and posterior mandibular arches. The T-Scan III digital occlusal system was used to record anterior and posterior percentage occlusal force (%OF) distributions. There were significant differences in anterior and posterior %OF between treatment groups. Two-way anova showed RRR was significant for arch locations (P = 0·005), treatment group (IOD versus CD) (P = 0·001), however, no significant interaction (P = 0·799). Multivariate regression analyses showed significant association between RRR and %OF at anterior maxilla (P = 0·000) and posterior mandible (P = 0·023) and for treatment groups at posterior maxilla (P = 0·033) and mandibular areas (P = 0·021). Resorption was observed in IOD compared to CD groups, with 8·5% chance of less resorption in former and 7·8% in the latter location. Depending on arch location, ridge resorption at various locations was associated with occlusal force distribution and/or treatment groups (implant prostheses or conventional complete dentures).
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Affiliation(s)
- T Khuder
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur
| | - N Yunus
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur
| | - E Sulaiman
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur
| | - N Ibrahim
- Department of Oro-Maxillofacial and Medical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - T Khalid
- Department of Restorative Dentistry, School of Dentistry, Cardiff University, Cardiff, UK
| | - M Masood
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Kilicarslan MA, Akaltan F, Kasko Y, Kocabas Z. Clinical evaluation of maxillary edentulous patients to determine the prevalence and oral risk factors of combination syndrome. J Dent Sci 2014. [DOI: 10.1016/j.jds.2012.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Resende CMBMD, Ribeiro JAM, Dias KDC, Carreiro ADFP, Rego MPPD, Queiroz JWND, Barbosa GAS, Oliveira ÂGRDC. Signs of Combination Syndrome and removable partial denture wearing. REVISTA DE ODONTOLOGIA DA UNESP 2014. [DOI: 10.1590/1807-2577.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Combination Syndrome (CS) is a pathological condition observed in maxillary complete denture (CD) and mandibular removable partial denture (RPD) wearers. Purpose: The aim of this study was to observe and measure the prevalence of CS signs in treatment-seeking wearers of maxillary CD associated or not with RPD (mandibular Kennedy Class I). The association between RPD wearing and the number of CS clinical signs was also evaluated. Material and method: The sample included 62 patients seen at the Department of Dentistry, Federal University of Rio Grande do Norte (UFRN). A clinical oral examination was conducted to assess the presence of specific clinical signs of CS as described by Kelly (1972): bone resorption in the maxillary anterior region, tuberosity overgrowth, palatal papillary hyperplasia, extrusion of mandibular anterior teeth and bone resorption in the mandibular posterior region. The chi-square test at the 95% level of significance was used to test the association between dependent and independent variables. Result: Mandibular resorption was the most frequent complication (93.5%). There was a statistically significant difference between RPD wearers and non-wearers with regard to extrusion of mandibular anterior teeth (p = 0.045). Conclusion: Within the limitations of the present study, a high prevalence of CS clinical signs was observed, but no association between RPD wearing and syndrome characteristics was found.
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Guerrero CA, Marin D, Galvis AI. Evolución de la patología oclusal. Una revisión de la literatura. JOURNAL OF ORAL RESEARCH 2013. [DOI: 10.17126/joralres.2013.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sakar O, Sulun T, Bilhan H, Ispirgil E. Does the presence of anterior mandibular teeth increase the incidence of denture stomatitis? J Prosthodont 2012; 22:174-8. [PMID: 22984815 DOI: 10.1111/j.1532-849x.2012.00924.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare the frequency of denture stomatitis (DS) under maxillary complete dentures (CDs) in patients with opposing mandibular distal extension removable partial dentures (RPDs) and CDs. MATERIALS AND METHODS Participants included 365 maxillary CD wearers (241 women, mean age 70.5 ± 13.2 years; 124 men, mean age 71.5 ± 10.4 years) from 7 rest homes in Istanbul. A total of 268 had mandibular CDs; 97 had mandibular distal extension RPDs. Two independent, calibrated examiners performed oral examinations. Presence of maxillary denture-related stomatitis and the effect of risk factors on DS were evaluated and recorded. RESULTS The frequency of palatal DS (Newton I-III) was 45.1% (n = 121) in the mandibular CD group and 49.5% (n = 48) in the mandibular distal extension RPD group, a statistically insignificant difference (p= 0.4). Factors significantly associated with palatal DS were maxillary denture age (p= 0.02), reduced occlusal vertical dimension (p= 0.04), and nocturnal denture wear (p= 0.03). CONCLUSION In this study, DS beneath maxillary CDs did not differ between mandibular distal extension RPD and CD wearers. The presence of mandibular anterior teeth did not influence the occurrence of palatal DS.
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Affiliation(s)
- Olcay Sakar
- Department of Prosthodontics, Istanbul University Faculty of Dentistry, Istanbul, Turkey
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Sülün T, Sakar O, Bilhan H, Ispirgil E. The effect of mandibular anterior teeth on the hypermobile tissue in the anterior part of the maxilla. Arch Gerontol Geriatr 2011; 55:12-5. [PMID: 21669467 DOI: 10.1016/j.archger.2011.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 05/08/2011] [Accepted: 05/09/2011] [Indexed: 11/25/2022]
Abstract
The absence of posterior occlusal contacts may result in increased anterior occlusal contacts and forces between natural mandibular dentition and artificial maxillary dentition. The impact of natural mandibular anterior teeth on the development of hypermobile tissues in the anterior part of the edentulous maxillary alveolar ridge was investigated in this study. The study group consisted of 410 patients with maxillary complete dentures and various mandibular dentitions from seven rest homes in Istanbul. The data; including hypermobile tissue in the anterior part of the maxilla, occlusal relationship, nocturnal wear, denture age, and duration of the maxillary full edentulism period were recorded. A chi-square test was performed to analyze the effects of following data: Existence of mandibular anterior teeth, poor adaptation of the dentures, nocturnal wear, types of occlusal contacts, and gender, on the resorption of the anterior part of the maxilla. To examine the effects of the presence of anterior mandibular teeth and early maxillary edentulism on bone resorption in the anterior part of the maxilla, a logistic regression analysis was performed. The results reveal that patients with edentulous maxilla and natural mandibular anterior teeth are approximately twice more likely to show risk of hypermobile tissue in the anterior part of the maxilla than are full edentulous patients. Further, edentulous periods exceeding 30 years in maxilla seem to increase this risk approximately 4 times.
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Affiliation(s)
- Tonguç Sülün
- Istanbul University Faculty of Dentistry, Department of Prosthodontics, 34390 Capa, Istanbul, Turkey.
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