complete denture question.

[chato1234]

A patient wearing maxillary complete denture and mandibular bilateral distal extension removable denture (anterior natural teeth present) may show:
1) Decreased VDO
2) Prognathic appearance

Can anyone explain why prognathic appearance?
Decrease VDO is because anterior maxillary rigde gets resorbed and will will push the maxillary denture above. thereby decreasing the vertical dimension. Please correct if im wrong.

Thanks,
chato1234

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[chato1234]

I am sure lot of people are preparing for part 2 here. please share your thoughts about the answer, even if not sure!!

thanks

 

[kapadiakk]

hello,
the above condition is known as COMBINATION SYNDROME
it's very imp. for Part II, i had q. about it in my exam.
as the ant. maxilla gets resorbed & replaced by flabby tissue, the lower incisiors extrude & flare outwards
also the post. mandible (under the distal extension based RPD) gets resorbed.
one should remember that as the mandible gets resorbed it moves downwards & outwards (making it wider as it resorbs) unlike maxilla which moves upwards & inwards(making it narrower & smaller as it resorbs),
this coupled with lower incisors moving outwards & upwards creates a prognathic appearance with loss of occlusal vertical dimension.
the treatment consists of bone grafting in the anterior maxilla, implants in mandible & construction of new dentures with VDO reset as required
hope this helps all!!!!

 

[chato1234]

hello,
the above condition is known as COMBINATION SYNDROME
it's very imp. for Part II, i had q. about it in my exam.
as the ant. maxilla gets resorbed & replaced by flabby tissue, the lower incisiors extrude & flare outwards
also the post. mandible (under the distal extension based RPD) gets resorbed.
one should remember that as the mandible gets resorbed it moves downwards & outwards (making it wider as it resorbs) unlike maxilla which moves upwards & inwards(making it narrower & smaller as it resorbs),
this coupled with lower incisors moving outwards & upwards creates a prognathic appearance with loss of occlusal vertical dimension.
the treatment consists of bone grafting in the anterior maxilla, implants in mandible & construction of new dentures with VDO reset as required
hope this helps all!!!!

Dear kapadiakk,

Thank you so much for your reply. I appreciate it. I have few questions for you.

1) what does combination syndrome constitute of?
Is the term combination syndrome used for decrease in VDO & PROGNATHISM.

2) And i think prognathism is because decrease in VDO will lead to increase in freeway space, therefore patient will have to bring his mouth more forward and upward than usual to keep is lips competent/in closed positon thereby giving a prognathic appearance.
Is that the reason too?

3) why will lower anterior teeth flare outwards?

Thanks

 

[xerostomia]

Dear kapadiakk,

Thank you so much for your reply. I appreciate it. I have few questions for you.

1) what does combination syndrome constitute of?
Is the term combination syndrome used for decrease in VDO & PROGNATHISM.

2) And i think prognathism is because decrease in VDO will lead to increase in freeway space, therefore patient will have to bring his mouth more forward and upward than usual to keep is lips competent/in closed positon thereby giving a prognathic appearance.
Is that the reason too?

3) why will lower anterior teeth flare outwards?

Thanks

Combination syndrome is a group of complications that occur when pt has complete denture in maxilla opposing natural mandibular anterior teeth and a distal extension prosthesis. Since the group of complications are interlinked so these are called SYNDROME. The problem begins with bone resorbtion in anterior maxilla which is responsible for prognathic appearance in first place due to sinking of upper lip and philtrum. Subsequently.
1. flaby ridge develops in anterior max and lower teeth supra erupt and possibly flare out as well with loss of vertical dimension as well.
2. occlusal plane migrates upward in anterior region and downward in posterior region, which can cause anterior repositioning of mandible.
3. There is over growth of tuberosities.
4. Loss of bone under distal extension partial denture base.
5. Poor adaptation of prosthesis, which can add to prognathic appearance as an adaptive behaviour to retain prosthesis.
6. Epulis fissuratum in max labial sulcus
7. Papillary hyperplasia of palate
8. Poor aesthetics. Max anterior teeth completely disappear under denture and pt shows more of mandibular teeth and posterior maxillary teeth are also visible due to droping of occlusal plane downward in posterior region.
9. Periodontal changes may also accompany.

 

[gowri]

resorption of maxillary ridge occurs in upward and palatal position and resorption of mandibular antr ridge downward and lingual direction and mand postr in downward and buccal direction .This pattern of resorption result in wide maxilla and narrow mandible giving prognathic appearance.

 

[aphistis]

resorption of maxillary ridge occurs in upward and palatal position and resorption of mandibular antr ridge downward and lingual direction and mand postr in downward and buccal direction .This pattern of resorption result in wide maxilla and narrow mandible giving prognathic appearance.

Prognathic appearance has nothing to do with width or narrowness of the bones. See the previous posts in this thread for excellent explanation of the phenomenon.