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.Abstract





Classification of combination syndrome: 3 classes and 10 modifications (10 clinical presentations of the combination syndrome).

Classification of combination syndrome (CS): 3 classes and 10 modifications. M: CS modifications (M1, M2, M3, A and B); shapes in solid heavy lines represent bone-teeth complex that undergoes changes in the particular modification of CS (maxillary and mandibular jaw/teeth shapes match, like a jigsaw puzzle); arrows: the direction of alveolar remodeling (hypertrophy) and teeth movement (super-eruption) in certain jaw regions (single arrows—moderate degree: in cases of edentulous regions opposed each other, double arrows—severe degree: in cases when an edentulous region is opposed by teeth); 3 columns represent anterior and 2 posterior stomatognathic regions; basal row represents bone (alveolar ridge), middle row represents dentition, and top row represents bone and teeth remodeling changes (atrophy, hypertrophy, extrusion) in a particular modification of CS; vertical thin solid lines: natural teeth (fixed dentition) or an implant-supported bridge in a specific region of the jaws; oval represents no change status (no bone remodeling or teeth movement) in the region of preserved posterior occlusion.
Contributor Notes
Len Tolstunov, DDS, is a private practitioner of oral and maxillofacial surgery in San Francisco, Calif, and an assistant clinical professor in the Department of Oral and Maxillofacial Surgery, University of the Pacific School of Dentistry, San Francisco, Calif. Address correspondence to Dr. Tolstunov at One Daniel Burnham Court, Suite 366C, San Francisco, CA 94109-5460.