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

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10.1922/EJPRD_2897Veerasamy10

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• Arthi Veerasamy
• Elvira C. Ham
• Jamie J. Gian
• Nicha Nivatvongs
• Vincent Bennani

Abstract

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

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

Authors

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

ABSTRACT
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.

INTRODUCTION
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
doi: 10.1922/EJPRD_2897Veerasamy10

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