„ A large group of patients with C

C--2 Class according to

Eichner classification have a problem with prosthetic

Combination Syndrome base.

„ Patients wearing complete maxillary denture and

y Kelly
by y
removable partial denture in mandible with posterior
lack of teeth (alar lack) show very often the group of
symptoms called Kelly Syndrome or Combination
Syndrome or Anterior Hyperfunction Syndrome.
Department of Prosthodontics, Geriatric Dentistry
Poznan University of Medical Sciences, Poland

„ This Kelly Syndrome consists of 5 symptoms

concerning maxillary and mandibular prosthetic base.
Clinical symptoms
„ This syndrome was first described by Kelly in 1972
of Combination Syndrome by Kelly
in Journal of Prosthetic Dentistry.

„ In same cases not all symptoms are present and

therefore the name of the syndrome is disputed.

1. Loss of bone in the anterior region of maxillary alveolar ridge

1. „ This part of alveolar ridge consists exclusively of soft

tissues (fiberous alveolar ridge) which sometimes shows
Loss of bone in the anterior region marked mobility.
of maxillary alveolar ridge
„ A curling
li alveolar
l l ridg
rid
idge, without
ith t a bone
b base
b is
i similar
i il tto a
cock’s crest.

„ The loss of bone in the anterior region of an edentulous

maxilla is caused by an overloading of this part of the
dental arch that is opposite the mandibular anterior theeth.

1
1. Loss of bone in the anterior region of maxillary alveolar ridge
„ In this situation the complete maxillary denture loses its
stability, which leads to vertical prosthesis mobility resulting
in several symptoms referred to as the combination
syndrome.
1. Loss of bone in the anterior region of maxillary alveolar ridge
„ The lack of sufficient support for upper denture leads
to its mobility on the prosthetic base, which may be
visible from outside.
„ Because of that problem it is necessary to analyze the
anatomic and functional state of the patient’s oral
cavity in order to maintain his/her functional efficacy
and to prevent further destruction of the prosthetic
base.
1. Loss of bone in the anterior region of maxillary alveolar ridge
„ In contrast to natural teeth, which are connected with
the bone by the periodontium an edentulous alveolar
ridge is not physiologically prepared for substantial
loading
loading.
„ Periodontium allows the transfer of chewing forces to
the alveolar ridge and permits the transformation of
pressing forces into pulling forces, involving the
periodontium collagen fibers in this process.
1. Loss of bone in the anterior region of maxillary alveolar ridge
„ When the mandibular arch is significantly larger than
the maxillary arch, a greater risk of vertical prosthesis
mobility is observed, which causes the atrophy of bone
in the anterior region of the maxilla.
maxilla
„ That risk is especially high when the patient has a
tendency for protrusive occlusion which leads to
greater prosthesis mobility in the anterior region.
2.
Overgrowth of the tuberosities
(maxillary tubers)
2
2. Overgrowth of the tuberosities (maxillary tubers) 2. Overgrowth of the tuberosities (maxillary tubers)

„ This symptom is caused by the increased vacuum in „ In some patients hypertrophy of maxillary tubers
the region of the maxillary tubers resulting from the affects also the bone structures.

mobility of the denture during its contact with the
opposing teeth in the anterior part of the mandibular
arch.
„ Fibrous hypertrophy of maxillary tubers is often
observed.
„ Such tubers are unstable and create problems in
denture preparation.
preparation
„ The occlusal plane is located at a lower level, close to
the mandibular alveolar ridge.
„ Sometimes there is no space to place artificial
posterior molars or premolars in the dentures.

2. Overgrowth of the tuberosities (maxillary tubers)

„ Overgrown tubers reduce space for the tongue in the

3.
posterior region and are responsible for the patient’s
Extrusion of the mandibular anterior teeth
difficult adaptation to the dentures.

„ Patients with overgrown tubers tend to display a smile

that reveals more lateral maxillary teeth than anterior
maxillary teeth, which is called a negative smile.

3. Extrusion of the mandibular anterior teeth 3. Extrusion of the mandibular anterior teeth

„ This is a result of the lack of sufficient stimulation required „ To ensure proper treatment of such patients the dentist
by the periodontium of the anterior mandibular teeth. should correct the height of the teeth in the anterior

„ The contact between the teeth and a complete denture part of the dental arch.
supported by an edentulous ridge is not sufficient and may
„ Extrusion of mandibular teeth exerts increased
lead to extrusion of the mandibular anterior teeth (the
pressure on the anterior part of an edentulous ridge in
Godon symptoms).
the maxilla and can overload the residual ridge
„ The mean range of extrusion of these teeth in patients with causing atrophy of bone.
C-2 lack of teeth (Eichner classification) is 1
1--1.5mm during
a period of 3 years.

3
3. Extrusion of the mandibular anterior teeth

„ The treatment of patients with C

C--2 lack of teeth
requires specific clinical procedures correcting the
position of artificial teeth, correction of occlusion and
articulation and systematic clinical examination to
eliminate prosthesis mobility.

4. Loss (resorption) of alveolar bone under partial removable denture

in mandible

4. „ It is caused predominantly by changes in the alveolar

bone of the residual ridge and by occlusal forces that
The loss of alveolar bone
affect the prosthetic base unphysiologically.
under a partial removable denture
„ The saddles of dentures should distribute those forces
in the mandible
evenly on the edentulous prosthetic base.

4. Loss (resorption) of alveolar bone under partial removable denture

in mandible

„ Dentures supported only by the mucosa of the residual

5.
alveolar ridge increase the risk of bone atrophy, which
Papillary hyperplasia on the hard palate
can be reduced by systematic examinations of the
patient and correcting occlusion to eliminate any
denture instability on the base.

„ Although it is believed that incorrect occlusion and

articulation lead to the atrophy of alveolar bone under
the denture, Kelly has not observed this correlation.

4
5. Papillary hyperplasia on the hard palate 5. Papillary hyperplasia on the hard palate

„ Papillary hyperplasia, also known as stomatitis
papillomatosus, is manifested by a slight or bright
reddening covering the total area of prosthesis
adhesion on the hard palate.
„ This symptom is a result of the vacuum under the
maxillary denture, especially in the area of incorrectly
performed relief of palatal tissues (deep relief can
create a suction chamber).
„ This hyperplasia can also occur as a result of incorrect
relief made on the area of soft tissues (only
nonresiliant tissues should be relieved).
„ This syndrome is found in 48
48.8%
8% of patients with
a complete upper denture who do not wear a lower
alar partial denture.

5. Papillary hyperplasia on the hard palate 5. Papillary hyperplasia on the hard palate

„ 26.6% of patients who wear a complete maxillary
denture and a partial mandibular denture suffer from
this syndrome (Calrlsson, Badr and Unger)
„ Because the above symptoms appear together very
rarely many authors do not consider it correct to refer
to this problem as a syndrome.
„ Other symptoms have also been observed.
„ In 1979 Saunders, Gillis and Desjardins suggested
extending the range of symptoms that characterize this
syndrome by adding the following features:
- loss of the correct vertical dimension of occlusion
- incorrect occlusal plane
- patient’s poor adaptation to dentures
- occurrence of granuloma fissuratum
- changes in the periodontium of existing natural teeth

5. Papillary hyperplasia on the hard palate

„ Based on many observations of patients with Kelly

syndrome, Koczorowski noticed frequent defects of
complete removable dentures such as:
- excessive abrasion of acrylic teeth in the anterior
part of the denture
- fracture in the complete denture between
the artificial central incisors
- sudden defects of acrylic incisors (fracture or loss)