Kelly's Combination Syndrome PDF

Leila Jahangiri, BDS, DMD, MMSc Advanced Prosthodontics Definition: Kelly JPD 1972 1. Loss of bone from the anterior part of the maxillary ridge 2. Overgrowth of the tuberosities 3. Papillary hyperplasia in the hard palate Leila Jahangiri, BDS, DMD, MMSc., Chair Department of Prosthodontics 4. Ext...

Leila Jahangiri, BDS, DMD, MMSc Advanced Prosthodontics Definition: Kelly JPD 1972 1. Loss of bone from the anterior part of the maxillary ridge 2. Overgrowth of the tuberosities 3. Papillary hyperplasia in the hard palate Leila Jahangiri, BDS, DMD, MMSc., Chair Department of Prosthodontics 4. Extrusion of the lower anterior teeth 5. Excessive resorption of posterior mandible Contemporary Reference Loss of bone from the anterior part of the maxillary ridge Cause: Excessive Forces Flabby Ridge Overgrowth of the tuberosities Cause: unknown Papillary hyperplasia in the hard palate Extrusion of the lower anterior teeth Cause: Use of denture adhesive and trauma Cause: Lack of posterior occlusion Case by Dr. Edward Amet 1 Leila Jahangiri, BDS, DMD, MMSc Advanced Prosthodontics Excessive resorption of posterior mandible Cause: Lack of lower RPD wear Combination Syndrome Completely edentulous maxilla Partially edentulous mandible typically Kennedy class I Complete upper denture vs. natural dentition Bone loss anterior maxilla Numbness and pain Lack of fit of dentures Poor occlusion Papillary hyperplasia “Loss” of esthetics Negative pressure, tuberosity overgrowth Bone F orce Flabby anterior maxillary ridge • Moderate intermittent forces on the bony ridges stimulate bone and preserve bony ridge FORCE Enlarged tuberosities • Excessive forces are damaging and cause resorption Extruded mandibular teeth 2 Leila Jahangiri, BDS, DMD, MMSc Advanced Prosthodontics Resorption in anterior maxilla • Dislodgment of the maxillary denture • Papillary hyperplasia • Pressure on anterior nasal spine in severe cases • Numbness or pain in the anterior maxilla as a result of pressure on incisive nerve • Poor esthetics and lack of lip support Poor Occlusion • Disturbed posterior occlusion • Dentures drop down, it is thought that the negative pressure together with the space created in the maxillary denture cause tuberosity overgrowth Extrusion of lower anterior teeth • Esthetics become poorer and patients show none of the upper anterior teeth and too much lower teeth • Patient doesn’t wear lower partials because the changes in occlusion causes excessive forces and resorption in the mandibular posterior ridges Prevention to become a combination Syndrome Success Prevention of further bone loss Restoration of Posterior Occlusion [Anything to avoid this combination] • Retain roots/teeth in the anterior maxilla • Retain roots/teeth in the posterior mandible • Overdenture in the mandible (implant or teeth) • Implant fixtures in the posterior mandible or anterior maxilla 3 Leila Jahangiri, BDS, DMD, MMSc Advanced Prosthodontics • Tuberosities reduction 1. Prevention of further bone loss • Treatment of papillary hyperplasia 2. Restoration of posterior occlusion • Flabby ridge reduction in the anterior maxilla 2. Restoration of Posterior Occlusion 1. Prevention of further bone loss • Placement of implant fixtures “sleepers” • Augmentation and implant placement Provide well made, retentive and stable prosthesis: • Retentive prosthesis: Border molded maxillary and mandibular Retentive clasps /components on lower partials Provide well made, retentive and stable prosthesis: Stable prosthesis: 1. Prosthetic teeth that provide minimal wear Metal occlusals Porcelain teeth 2. Removable partials with attachments (more stable) GOOD Prevention of further bone loss OK! Restoration of posterior occlusion 3. No anterior guidance on maxillary denture, even if esthetics is compromised 4 Leila Jahangiri, BDS, DMD, MMSc Advanced Prosthodontics In treatment option of restoration of posterior occlusion the etiology or cause is not fully In treatment option of prevention of further bone loss, the etiology is addressed by: Addressed, treatment is compromised 1. Providing equal or nearly equal forces 1. Some bone resorption will take place 2. Replacement of missing bone 2. Unequal forces still exist 5