Combination Syndrome — ORE Part 1 MCQ

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HardProsthodonticsCombination SyndromeORE Part 1

A patient has a maxillary complete denture opposing a mandibular Kennedy Class I partial denture. The upper anterior teeth are flared and have become mobile. What is this phenomenon called?

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Correct answer: B — Combination syndrome (Kelly syndrome)

The clinical presentation—maxillary complete denture opposed by mandibular anterior teeth only, with anterior maxillary tooth flaring and mobility—is the hallmark of combination syndrome (Kelly syndrome), first described by Kelly in 1972. This occurs because natural mandibular anterior teeth subject the anterior maxillary ridge to excessive vertical forces, causing progressive anterior maxillary alveolar bone loss and ridge resorption, resulting in mobile, flared upper anterior teeth. The Christensen phenomenon describes condylar movements during lateral excursions. Monson sphere and curve of Spee exaggeration are occlusal geometry concepts unrelated to the pathological tissue changes here. The Dahl effect describes localized anterior alveolar resorption from localized trauma, not the systematic resorption pattern of combination syndrome.

Reference: Anterior Hyperfunction by Mandibular Anterior Teeth: A Narrative Review. PubMed Central, 2023. https://pubmed.ncbi.nlm.nih.gov/37998459/