Sindrome Combinado De Kelly

The combination syndrome: A literature review
Sigvard Palmqvist, LDS, Odont Dr,a Gunnar E. Carlsson, LDS, Odont Dr, Dr Odont hc,b and ¨ Bengt Owall, LDS, Odont Dr, Dr Med hcc School of Dentistry, University of Copenhagen, Copenhagen, Denmark; and School of Dentistry, Goteborg University, Goteborg, Sweden ¨ ¨
Although combination syndrome is recognized by many clinicians, documented observationsseem to be rare. The aim of this article was to critically review the literature regarding combination syndrome to evaluate the evidence for this concept. A search of the dental literature with Medline/PubMed through July 2002, focusing on the combination syndrome and related features, was undertaken and combined with a hand search of older references and textbooks on removable prosthodontics. (JProsthet Dent 2003;90:270-5.)

oss of bone of the anterior edentulous maxilla when opposed by natural mandibular anterior teeth is 1 of several features of the combination syndrome. Although recognized by many clinicians, documented observations seem to be rare. The Glossary of Prosthodontic Terms1 defines combination syndrome as “the characteristic features that occur when an edentulous maxillais opposed by natural mandibular anterior teeth, including loss of bone from the anterior portion of the maxillary ridge, overgrowth of the tuberosities, papillary hyperplasia of the hard palatal mucosa, extrusion of mandibular anterior teeth, and loss of alveolar bone and ridge height beneath the mandibular removable partial denture bases, also called anterior hyperfunction syndrome.” EllsworthKelly2 was the first person to use the term “combination syndrome.” He followed a small group of patients wearing a complete maxillary denture opposed by mandibular anterior teeth and a distal extension distal removable partial denture (RPD). Of the 6 patients followed up for 3 years, all showed a reduction of the anterior bone in the maxilla along with enlarged tuberosities. For 5 patients therewas an increased bone level of the tuberosities. Kelly2 blamed the mandibular RPD and the lack of a posterior seal in the maxillary denture for these changes. He discussed “excessive bony resorption under the mandibular removable partial denture bases” but provided no values. Kelly2 discussed various possibilities to avoid combination syndrome, including extraction of the mandibular teeth, but didnot advocate this solution. Instead, he proposed using the roots of anterior mandibular teeth to support an overdenture. He also mentioned the option of using endodontic ima

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plants to preserve questionable roots for support in the posterior part of the mandible. A few years later, further characteristics were added to the combination syndrome: loss of vertical dimension of occlusion,occlusal plane discrepancy, anterior spatial repositioning of the mandible, poor adaptation of the prostheses, epulis fissuratum, and periodontal changes.3 However, these changes are not generally associated with combination syndrome. In spite of his emphasis on the negative role of the mandibular RPD, Kelly2 wrote: “The early loss of bone from the anterior part of the maxillary jaw is the key to theother changes of the combination syndrome.” This view was previously published in The American TextBook of Prosthetic Dentistry4 in 1907 in the following manner: “One of the most commonly observed cases of this sort (localized adsorption) is that in which a full upper plate denture is antagonized only by six or eight lower natural teeth, there being no teeth posterior to this point, adsorption ofthe alveolar process in the maxilla in front occurring as a result of the undue pressure on it.” Clinicians have recognized a number of the aforementioned features in some patients, but documented observations are rare. About 25 years after the publication of Kelly’s2 article, a review of sequelae of treatment with complete dentures argued that there was a lack of evidence for the combination...