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10801 West 87th Street, Overland Park, KS 66214

ADVANCING THE ART AND SCIENCE OF DENTISTRY

Dr. EDward M. Amet has been helping patients in Overland Park, Kansas with combination syndrome due to the placement position of dental implants. Contact Reconstructive and Implant Dental Center at 913-492-2233 today to learn more and schedule a visit with our prosthodontist. We look forward to helping you create a healthier, happier smile!

THE RELATIONSHIP OF COMBINATION SYNDROME AND PLACEMENT POSITION OF DENTAL IMPLANTS

Combination Syndrome is normally considered a description of a dental condition that is the result of long-term use of a few (usually six) remaining lower anterior teeth (#22-27), and a complete upper denture with no other natural remaining teeth, and a lower free-end Kennedy class I removable partial denture. The normal biting pressure or forces are directed from the remaining lower six teeth and transmitted through the upper anterior denture, with resulting resorption of bone and slow auto-rotation and tilting of the denture (upward and backward) with the upper anterior teeth becoming less visible and the upper posterior teeth becoming more visible as the denture is rotated from function with bone loss of the premaxilla.

This same condition can and will result with dental implants if they are placed only in the anterior position of the lower jaw and not united with an implant connecting bar that provides cantilevered posterior support to the lower overdenture and upper complete denture. A common example that leads to the condition is the use of two, three, or four single implants placed in the lower anterior portion of the lower jaw to stabilize a loose lower complete denture. Mini-implants are also often placed in the lower anterior jaw to stabilize a lower loose complete denture. The immediate result of placing the four to six mini-implants or two, three, or four standard implants is greater comfort but with declining stability and bone loss of both jaws in many patients over time.

When there are lower anterior dental implants, there may be seven characteristics associated with this syndrome: 1. Bone loss in the premaxilla. 2. Dropping of the posterior maxilla (tuberosities). 3. Bone loss around the lower anterior implants. 4. Posterior bone loss in the mandible under the prosthesis. 5. Papillary hyperplasia of the maxilla. 6. Decreased occlusal vertical dimension. and 7. Facial aesthetics often altered dramatically.

The changes in facial aesthetics from the resulting combination syndrome can be a challenge to restore with traditional or implant dentistry, as the prosthetic solutions are limited, the age of the patient can often be a limitation, and financial costs may be of concern. The surgical technique for the minimal number of anterior implants, (four to six mini-implants or two to four standard implants), placed in the anterior portion of the lower jaw usually has a decreased treatment time and cost for the patient with initial lower denture stability, but with results that vary over time with bone loss of both the upper and lower jaws. One such case is presented below after the placement of four standard implants resulting in implant-caused Combination Syndrome.

COMBINATION SYNDROME CAUSED BY DENTAL IMPLANTS
 

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Pre-Operative Radiograph

 

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Three Year Follow-up Photographs

 
Changes in bone volume often occur in a patient’s upper jaw when there are four to six mini-implants or two to four standard implants placed in the lower anterior jaw. Functional loading of both implants and tissue occurs from chewing with the removable lower overdenture attached to anterior implants. The forces are directed toward the anterior maxillary ridge resulting in one of the classic characteristics associated with combination syndrome, or bone loss in the premaxilla. The alveolar bone loss is shown as the difference in bone height at the six months and three-year post-operative photographs in pictures three to four.
 

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Three Year Follow-up Photographs

 

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Three Year Follow-up Photographs of Prosthesis

 
Changes in a patient’s bone volume often occurs in the upper jaw after placing four to six mini implants or two to four standard implants in the lower anterior jaw. The noticeable changes will also be seen in the lower posterior ridge with concomitant looseness of the lower implant supported overdenture. Functional loading occurs from chewing with the removable lower overdenture attached to anterior implants. The forces are directed toward the anterior maxillary ridge and reciprocating forces are directed from the upper denture to the lower prosthesis and posterior areas under the implant supported overdenture. The result is another of the classic characteristics associated with combination syndrome, bone loss in the posterior mandible. The alveolar bone loss is not as apparent clinically as is the looseness in the lower overdenture, as it rotates and rocks between the osseointegrated implants and the soft tissue in the posterior lower jaw.
 

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Immediate Post-Operative Radiograph

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Three Year Post-Operative Radiograph

 
When the changes occur in a patient’s upper jaw after placing four to six mini-implants or two to four standard implants in the lower anterior jaw, noticeable changes will also be seen in the lower posterior ridge with concomitant looseness in the lower implant supported overdenture. The looseness is caused by functional loading from chewing with the removable lower overdenture attached to anterior implants. The chewing forces are directed toward the anterior maxillary ridge and reciprocating forces from the upper denture are directed toward the lower posterior areas under the implant supported overdenture. This results in another of the classic characteristics associated with combination syndrome, bone loss in the posterior mandible. The alveolar bone loss shown is the difference in posterior bone contour at the six months and three year post-operative photographs.
 

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