Combination Syndrome in Patients with Mandibular Implant Supported Overdenture and Conventional Maxillary Denture - A Systematic Review

European Journal of Prosthodontics and Restorative Dentistry (2025) 33, 399–408

Patient Outcomes Combination Syndrome Implant-Supported Overdentures Maxillary Dentures Bone Resorption

Combination Syndrome in
Patients with Mandibular
Implant Supported
Overdenture and
Conventional Maxillary
Denture - A Systematic
Review

Arthi Veerasamy*

(BDS PGDipHealSc MHealSc PhD
DClinDent MRACDS (Pros))

Elvira C. Ham *

(BBiomedSc)

Jamie J. Gian *

(BDS)

Nicha Nivatvongs*

(BDS)

Vincent Bennani*

(DDS Cert AdvPros Cert AdvImpl PhD)

Address for Correspondence
Arthi Veerasamy *
Email: arthi.senthilkumar@otago.ac.nz
* Sir John Walsh Research Institute, Faculty of
Dentistry, University of Otago, 310 Great King
Street North, Dunedin North, Dunedin 9016, New
Zealand

Objectives: Implant-supported mandibular dentures are increasingly preferred for edentulous mandibles due to their superior function, stability, and patient satisfaction. However, when opposed by a conventional maxillary complete denture (CD), it remains unclear whether this configuration contributes to Combination Syndrome. This systematic review investigates the presence and clinical features of Combination Syndrome in such cases. Methods: A systematic search of Scopus, Ovid Medline, Web of Science, and Embase was conducted for studies published between 1994 and 2024. Of 133 initially identified articles, six met the inclusion criteria. These included four cohort studies, one cross-sectional study, and one randomised controlled trial, involving 141 participants. Results: Common findings included anterior maxillary bone loss, loss of posterior occlusion, and reduced retention of the maxillary denture—often linked to excessive anterior contact. Some studies reported increased ridge resorption with implant-supported overdentures, while others found no significant differences compared to conventional dentures. Conclusion: Due to the limited number and quality of available studies, no definitive conclusion can be drawn regarding the prevalence of Combination Syndrome in this prosthetic arrangement. Further well-designed clinical studies are needed to clarify its long-term implications.

Combination Syndrome (CS), also known as anterior hyperfunction syndrome, occurs when a fully edentulous maxilla opposes natural mandibular anterior teeth1. This syndrome can lead to significant complications, including anterior maxillary ridge resorption, overgrowth of tuberosities, papillary hyperplasia of the hard palate, extrusion of mandibular anterior teeth, and loss of bone and ridge height beneath mandibular removable partial denture bases1. Such complications can jeopardize the long-term success of prosthetic treatments2.

Received: 04.02.2025 Accepted: 22.06.2025

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