Comparison of the Surface Roughness of CAD/CAM Metal-Free Materials Used for Complete-Arch Implant-Supported Prostheses: An In Vitro Study.

The roughness of the intra-oral surfaces significantly influences the initial adhesion and the retention of microorganisms. The aim of this study was to analyze the surface texture of four different CAD-CAM materials (two high-performance polymers and two fifth-generation zirconia) used for complete-arch implant-supported prostheses (CAISPs), and to investigate the effect of artificial aging on their roughness. A total of 40 milled prostheses were divided into 4 groups (n = 10) according to their framework material, bio.HPP (B), bio.HPP Plus (BP), zirconia Luxor Z Frame (ZF), and Luxor Z True Nature (ZM). The areal surface roughness "Sa" and the maximum height "Sz" of each specimen was measured on the same site after laboratory fabrication (lab as-received specimen) and after thermocycling (5-55 °C, 10,000 cycles) by using a noncontact optical profilometer. Data were analyzed using SPSS version 28.0.1. One-way ANOVA with multiple comparison tests (p = 0.05) and repeated measures ANOVA were used. After thermocycling, all materials maintained "Sa" values at the laboratory as-received specimen level (p = 0.24). "Sz" increased only for the zirconia groups (p = 0.01). B-BP exhibited results equal/slightly better than ZM-ZF. This study provides more realistic surface texture values of new metal-free materials used in real anatomical CAISPs after the manufacturing and aging processes and establishes a detailed and reproducible measurement workflow.

Influence of the Use of Transepithelial Abutments vs. Titanium Base Abutments on Microgap Formation at the Dental Implant-Abutment Interface: An In Vitro Study.

This in vitro study aimed to assess the presence of microgaps at the implant-abutment interface in monolithic zirconia partial implant-supported fixed prostheses on transepithelial abutments versus Ti-base abutments. METHODS: Sixty conical connection dental implants were divided into two groups (n = 30). The control group consisted of three-unit bridge monolithic zirconia connected to two implants by a transepithelial abutment. The test group consisted of monolithic zirconia three-unit restoration connected to two implants directly by a titanium base (Ti-base) abutment. The sample was subjected to thermocycling (10,000 cycles at 5 °C to 55 °C, dwelling time 50 s) and chewing simulation (300,000 cycles, under 200 N at frequencies of 2 Hz, at a 30° angle). The microgap was evaluated at six points (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, and distolingual) of each implant-abutment interface by using a scanning electron microscope (SEM). The data were analyzed using the Mann-Whitney U tests (p > 0.05). RESULTS: The SEM analysis showed a smaller microgap at the implant-abutment interface in the control group (0.270 µm) than in the test group (3.902 µm). Statistically significant differences were observed between both groups (p < 0.05). CONCLUSIONS: The use or not of transepithelial abutments affects the microgap size. The transepithelial abutments group presented lower microgap values at the interface with the implant than the Ti-base group in monolithic zirconia partial implant-supported fixed prostheses. However, both groups had microgap values within the clinically acceptable range.

Coverage error and shade-match accuracy in three ceramic gingival systems.

STATEMENT OF PROBLEM: Research into the coverage error (CE) of gingival systems that have been expanded by using ceramic specimens created by mixing basic colors is lacking. PURPOSE: The purpose of this in vitro study was to compare the CEs of 3 ceramic gingival color systems that have been expanded with basic-color mixtures from a sample of 360 White participants and to classify the participants according to the accuracy of the shade match achieved with each system. MATERIAL AND METHODS: L*a*b* color coordinates were recorded in 3 zones of attached gingiva for 360 White participants with healthy gingival tissue (187 men and 173 women). The CEs were calculated for 3 ceramic gingival systems that had been expanded with specimens obtained by mixing the basic colors in consecutive order, the color percentages in each mixture having been altered by 10% increments. The systems were Heraceram (Kulzer GmbH) (n=51); Vita VM9 (Vita-Zahnfabrik) (n=41); and IPS Style (Ivoclar AG) (n=41). The participants were classified into 3 groups according to how well the selected shade matched their gingival color (excellent, acceptable, or poor). The data were analyzed using a 1-way ANOVA with a randomized block design and the homogeneity of proportions test (α=.05). RESULTS: Statistically significant differences were found between the CEs of the 3 expanded gingival systems in the 3 zones where gingival color was measured (P<.001). The expanded Heraceram system had the smallest CE (ΔE00: minimum 2.66 in the middle zone and maximum 2.95 at the mucogingival line). In the 3 gingival zones, the expanded IPS Style system produced the largest percentage of participants with a poor shade match (ΔE00: minimum 71.4% at the mucogingival line and maximum 75.8% at the free gingival margin), while the expanded Heraceram system had the lowest percentage of participants with a poor shade match (ΔE00: minimum 33.3% in the middle zone and maximum 41.7% at the mucogingival line). CONCLUSIONS: The CEs calculated for the expanded Vita VM9 and IPS Style ceramic gingival color systems exceeded the clinical acceptability thresholds in the 3 zones examined. According to the ΔE00 formula, the gingival color of at least 33% of participants matched poorly with the expanded systems studied.

Accuracy between 2D Photography and Dual-Structured Light 3D Facial Scanner for Facial Anthropometry: A Clinical Study.

(1) Background: Facial scanners are used in different fields of dentistry to digitalize the soft tissues of the patient's face. The development of technology has allowed the patient to have a 3-dimensional virtual representation, facilitating facial integration in the diagnosis and treatment plan. However, the accuracy of the facial scanner and the obtaining of better results with respect to the manual or two-dimensional (2D) method are questionable. The objective of this clinical trial was to evaluate the usefulness and accuracy of the 3D method (a dual-structured light facial scanner) and compare it with the 2D method (photography) to obtain facial analysis in the maximum intercuspation position and smile position. (2) Methods: A total of 60 participants were included, and nine facial landmarks and five interlandmarks distances were determined by two independent calibrated operators for each participant. All measurements were made using three methods: the manual method (manual measurement), the 2D method (photography), and the 3D method (facial scanner). All clinical and lighting conditions, as well as the specific parameters of each method, were standardized and controlled. The facial interlandmark distances were made by using a digital caliper, a 2D software program (Adobe Photoshop, version 21.0.2), and a 3D software program (Meshlab, version 2020.12), respectively. The data were analyzed by SPSS statistical software. The Kolmogorov-Smirnov test revealed that trueness and precision values were normally distributed (p > 0.05), so a Student's t-test was employed. (3) Results: Statistically significant differences (p ≤ 0.01) were observed in all interlandmark measurements in the 2D group (photography) to compare with the manual group. The 2D method obtained a mean accuracy value of 2.09 (±3.38) and 2.494 (±3.67) in maximum intercuspation and smile, respectively. On the other hand, the 3D method (facial scanner) obtained a mean accuracy value of 0.61 (±1.65) and 0.28 (±2.03) in maximum intercuspation and smile, respectively. There were no statistically significant differences with the manual method. (4) Conclusions: The employed technique demonstrated that it influences the accuracy of facial records. The 3D method reported acceptable accuracy values, while the 2D method showed discrepancies over the clinically acceptable limits.

Study of attached gingiva space color according to gender and age in Caucasian population.

OBJECTIVE: To describe the color of the healthy attached gingiva adjacent to the maxillary incisors and to evaluate the effect of age and gender on CIELAB color coordinates. MATERIALS AND METHODS: The study included 216 Caucasian individuals (129 females and 87 males) divided into three age groups. A SpectroShade Micro spectrophotometer was used to register color coordinates at 2.5 mm apical of the zenith of the upper central incisors. Descriptive and inferential statistical analysis was performed. RESULTS: The minimum and maximum coordinates in which the CIELAB natural gingival space is delimited are: L* minimum 40.4 - L* maximum 61.2; a* minimum 17.0 - a* maximum 30.2; b* minimum 9.8 - and b* maximum 21.9. There are statistically significant differences between males and females for coordinates L*, a* and b* in the attached gingival area selected. Age had a significant effect on coordinate b* (p = 0.000). CONCLUSIONS: Statistically significant differences were found between the L*, a* and b* color coordinates of the attached gingiva between men and women, although the color difference is below the clinical acceptance threshold. The attached gingiva takes on a bluish color as the patients get older, which means that the b* coordinate decreases. CLINICAL SIGNIFICANCE: With a prosthodontic approach, knowledge of the CIELAB natural attached gingival coordinates based on the patient's age and gender will facilitate the clinician's work in selecting the appropriate color. The CIELAB system values found can be used as a gingival shade guide reference.

Outcome measurements and quality of randomized controlled clinical trials of tooth-supported fixed dental prostheses: A systematic review and qualitative analysis.

STATEMENT OF PROBLEM: The lack of consensus regarding a standardized set of outcome measurements and noncompliance with current reporting guidelines in clinical trials of tooth-supported fixed dental prostheses (FDPs) hamper interstudy comparability, compromise scientific evidence, and waste research effort and resources in prosthetic dentistry. PURPOSE: The primary objective of this systematic review was to identify all primary and secondary outcome measurements assessed in randomized controlled trials (RCTs) of tooth-supported FDPs. Secondary objectives were to assess their methodological quality by using the Cochrane Collaboration's risk of bias tool (RoB, v2.0) and their reporting quality by means of a standardized 16-item CONSORT assessment tool through published reports. MATERIAL AND METHODS: An electronic search was conducted in MEDLINE, EMBASE, and Cochrane library to identify all RCT-related articles published in the past 10 years. Differences in RoB were tested with the Pearson chi-square test, and those in CONSORT score with the Student t test. RESULTS: A total of 64 RCTs from 79 publications were deemed eligible. The diversity of outcome measures used in the field is apparent. Twenty percent of the included studies had a low RoB, 79% showed some concerns, and 1% had a high RoB. The mean ±standard deviation CONSORT compliance score was 22.56 ±3.17. Trials adhered to the CONSORT statement reported lower RoB than those that did not adhere (P<.001). RCTs with a low RoB reported more comprehensive adherence to CONSORT guidelines than those with some concerns (MD 4 [95% CI 1.52-6.48]; P=.004). CONCLUSIONS: A standardized core outcome reporting set in clinical research on tooth-supported FDPs remains evident. Adherence to the CONSORT statement continues to be low, with some RoB concerns that can be improved.

Clinical Study of the 3D-Master Color System among the Spanish Population.

PURPOSE: To study whether the shades of the 3D-Master System were grouped and represented in the chromatic space according to the three-color coordinates of value, chroma, and hue. MATERIALS AND METHODS: Maxillary central incisor color was measured on tooth surfaces through the Easyshade Compact spectrophotometer using 1361 participants aged between 16 and 89. The natural (not bleached teeth) color of the middle thirds was registered in the 3D-Master System nomenclature and in the CIELCh system. Principal component analysis and cluster analysis were applied. RESULTS: 75 colors of the 3D-Master System were found. The statistical analysis revealed the existence of 5 cluster groups. The centroid, the average of the 75 samples, in relation to lightness (L*) was 74.64, 22.87 for chroma (C*), and 88.85 for hue (h*). All of the clusters, except cluster 3, showed significant statistical differences with the centroid for the three-color coordinates (p <0.001). CONCLUSIONS: The results of this study indicated that 75 shades in the 3D-Master System were grouped into 5 clusters following coordinates L*, C*, and h* resulting from the dental spectrophotometer Vita Easyshade compact. The shades that composed each cluster did not belong to the same lightness color dimension groups. There was no special uniform chromatic distribution among the colors of the 3D-Master System.

Natural Tooth Color Estimation Based on Age and Gender.

PURPOSE: Assessment of the predictability of tooth color coordinates according to the CIELab system to estimate the color of the maxillary central incisor based on patient age and gender. MATERIAL AND METHODS: The tooth color of one of the maxillary central incisors of 1361 Caucasian Spanish individuals aged 16 to 89 years, male and female, was measured using the Easyshade compact spectrophotometer. Color coordinates L*, C*, h*, a*, and b* were recorded according to age and gender. RESULTS: The results obtained show that differences in age account for 45% of the total variation of the L (lightness) coordinate; 21% of the variation in coordinate a*, and 17% of the variation in coordinate b* is due to the same reason. At a confidence level of 95% it may be proposed that the mean estimated color difference (ΔEab *) between real natural color and that predicted by the linear regression model is between 6.4 and 6.9 units. CONCLUSIONS: In this sample of Caucasians from Spain, teeth became darker yellow and more reddish with increasing age. The L* coordinate is most strongly related to tooth color in aging.

CAD/CAM Conic Crowns for Predictable Retention in Implant-Supported Prostheses.

PURPOSE: To evaluate CAD/CAM conic crowns to obtain a reversible and predictable retention in implant-supported prostheses. MATERIALS AND METHODS: Five 1- to 8-degree CAD/CAM abutments and their respective copings (n = 40) were designed and manufactured to measure the retention strength (in N) on a Zwick/Roell testing frame. RESULTS: The mean retention strength values found, in descending order of cone angle, were as follows: 8 degrees, 21.02 N; 7 degrees, 23.16 N, 28 N, and 36.40 N; 6 degrees, 40.46 N; 5 degrees, 66.36 N; 4 degrees, 61.23 and 76.12 N; 3 degrees, 93.44 N, 103.21 N, and 112.04 N; 2 degrees, 154.20 N; and 1 degree, 204.74 N, 261 N, and 293.40 N. These data describe a high-intensity ratio with a curvilinear trend that can be used to develop predictive models. CONCLUSION: With the limits of this study, it can be concluded that retention strength increased as the cone angle decreased. The data described a curve from which two predictive models were developed to find retention strength from the cone angle used and the cone angle that would be needed to deliver a given retention strength. This study is the first step in searching for an alternative to cemented and screw-retained implant-supported prostheses and new retaining elements in implant-retained prostheses.

Correlation of natural tooth colour with aging in the Spanish population.

OBJECTIVES: To analyse natural tooth colour in the Spanish population according to the colour coordinates lightness (L*), chroma (C*), hue (h*), red-green axis (a*) and yellow-blue axis (b*) in order to quantify the correlation and changes of tooth colour with age and sex. METHODS: Natural tooth colour was measured in a sample of 1,361 Spanish participants of both sexes distributed within an age range of 16 to 89 years. The Easyshade Compact spectrophotometer was used and the CIELAB and CIELCh systems were followed. RESULTS: Pearson's bivariate correlations between age and colour coordinates were highly significant for L* (r=-0.674, P≤0.001), h* (r=-0.468, P≤0.001) and C* (r=0.417, P≤0.001). The correlation between age and colour coordinates was stronger for men than for women, for all colour coordinates. The results showed that C*, b* and a* increased by 0.60, 0.56 and 0.26 units/year on average, respectively, whereas L* and h* decreased progressively with age (by 0.60 units/year, on average), and colour differences increased in a systematic way as the gap between the ages being compared grew wider. CONCLUSIONS: The strongest correlation was found between age and L*, then between age and h* (both inverse relationships) and then between age and a*, C* and b* (direct relationships). In addition, a similar degree of change in the colour coordinates L*, C* and h* (of 0.60 units/year on average) was observed for natural tooth colour. Knowledge of the chromatic range of natural teeth may help to choose colour for the replacement of missing elements.

Study of the most frequent natural tooth colors in the Spanish population using spectrophotometry.

PURPOSE: To identify the most frequent natural tooth colors using the Easyshade Compact (Vita -Zahnfabrik) spectrophotometer on a sample of the Spanish population according to the 3D Master System. MATERIALS AND METHODS: The middle third of the facial surface of natural maxillary central incisors was measured with an Easyshade Compact spectrophotometer (Vita Zahnfabrik) in 1361 Caucasian Spanish participants aged between 16 and 89 years. Natural tooth color was recorded using the 3D Master System nomenclature. The program used for the present descriptive statistical analysis of the results was SAS 9.1.3. RESULTS: The results show that the most frequent dental color in the total sample studied is 3M1 (7.05%), followed by the intermediate shade 1M1.5 (6.91%) and 2L1.5 (6.02%). CONCLUSION: According to the research methodology used, and taking into account the limitations of this study, it can be proposed that the most frequent color among the Spanish population is 3M1; the most common lightness group is 2; the most frequent hue group according to the 3D Master System is M and the most frequent chroma group is 1.5.

A clinical study relating CIELCH coordinates to the color dimensions of the 3D-Master System in a Spanish population.

STATEMENT OF PROBLEM: The 3D-Master System comprises 26 physical shade tabs and intermediate shades. Determining the relationship among all the groups of lightness, chroma, and hue of the 3D-Master System (Vita Zahnfabrik) and the L*, C*, and h* coordinates is important, because according to the manufacturer, 2 Toothguide 3D-Master shades need to be mixed in a 50:50 ratio to create an intermediate shade. PURPOSE: The purpose of the study was to relate the lightness, chroma, and hue groups of the 3D-Master System with the polar coordinates of the CIELAB chromatic space, L*, C*, and h*, and to quantify the shades tabs and intermediate shades of the 3D-Master System according to color coordinates. MATERIAL AND METHODS: The middle third of the facial surface of a natural maxillary central incisor was measured with an Easyshade Compact spectrophotometer (Vita Zahnfabrik) in 1361 Spanish participants aged between 16 and 89 years. Natural tooth color was recorded in the 3D-Master nomenclature and in the CIE L*, C*, and h* coordinates system. The program used for the present descriptive statistical analysis of the results was SAS 9.1.3. RESULTS: In the L* variable, the minimum was found at 47.0 and the maximum at 91.3. In the C* variable, the minimum was found at 5.9 and the maximum at 49.8, while for h*, the minimum was 67.5 degrees and the maximum 112.0 degrees. CONCLUSIONS: Despite the limitations of this study, the 3D-Master System was found to be arranged according to L*, C*, and h* coordinates in groups of lightness, chroma, and hue. The corresponding groups of lightness, chroma, and hue can be estimated on the basis of L*, C*, and h* coordinates.

Differences between the human eye and the spectrophotometer in the shade matching of tooth colour.

OBJECTIVES: The aim of this work was to assess the agreement between instrumental and visual colour matching. METHODS: Shade selection with the 3DMaster Toothguide (Vita-Zahnfabrik) was performed for 1361 maxillary central incisors and compared with the shade obtained with the EasyShade Compact (Vita-Zahnfabrik) spectrophotometer. RESULTS: We observed a greater correlation between the objective method and the subjective one in the colour dimension of lightness (Kappa 0.6587), followed by hue (Kappa 0.4337) and finally chroma (Kappa 0.3578). CONCLUSION: The colour dimension in which the greatest agreement is seen between the operator and the spectrophotometer is value or lightness. CLINICAL SIGNIFICANCE: This study reveals differences between the measurement of colour via spectrophotometry and the visual shade selection method. According to our results, there is better agreement in the value or lightness colour dimension, which is the most important one in the choice of tooth colour.

Dental profile of a community of recovering drug addicts: Biomedical aspects. Retrospective cohort study

Objectives: to obtain a biomedical oral profile of a community of adult drug addicts in treatment by analysing their dental health, with a view to determining whether the state of their oral health could be attributed primarily to their lifestyle and the direct consequences of drug abuse on their overall condition, rather than to the effects of the drugs used. Experimental Design: the study was conducted under the terms of an agreement between the Complutense University of Madrid's (UCM) Odontology Faculty and the City of Madrid's Substance Abuse Institute. Seventy drug addicts and 34 control group subjects were examined. The study assessed oral hygiene habits, systemic pathology, type of drugs used and the duration of use, oral pathology, oral health indices, risk of caries based on saliva tests, oral candidiasis and periodontal microbiology. Results: statistically significant differences (p<0.05) were found between the test and control groups for practically all the variables analysed. In the drug users group, dental hygiene was wanting, systemic and oral pathology prevailed and the decayed/missing/filled teeth or surface (DMFT/S) indices denoted very poor buccodental health. The saliva tests showed a substantial risk of caries and candidiasis rates were high. By contrast, with a single exception, the microbiological studies detected no statistically significant difference between drug users and control groups periodontal flora. Conclusions: drug-dependent patients had poor oral health and a significant increase in oral pathology, essentially caries and periodontal disease. Their risk of caries was high and the presence of candidiasis was representative of their poor general and oral health. Drug users' poor buccodental condition was more closely related to lifestyle than to drug abuse itself (AU)

Dental profile of a community of recovering drug addicts: Biomedical aspects. Retrospective cohort study.

OBJECTIVES: to obtain a biomedical oral profile of a community of adult drug addicts in treatment by analysing their dental health, with a view to determining whether the state of their oral health could be attributed primarily to their lifestyle and the direct consequences of drug abuse on their overall condition, rather than to the effects of the drugs used. EXPERIMENTAL DESIGN: The study was conducted under the terms of an agreement between the Complutense University of Madrid's (UCM) Odontology Faculty and the City of Madrid's Substance Abuse Institute. Seventy drug addicts and 34 control group subjects were examined. The study assessed oral hygiene habits, systemic pathology, type of drugs used and the duration of use, oral pathology, oral health indices, risk of caries based on saliva tests, oral candidiasis and periodontal microbiology. RESULTS: Statistically significant differences (p<0.05) were found between the test and control groups for practically all the variables analysed. In the drug users group, dental hygiene was wanting, systemic and oral pathology prevailed and the decayed/missing/filled teeth or surface (DMFT/S) indices denoted very poor buccodental health. The saliva tests showed a substantial risk of caries and candidiasis rates were high. By contrast, with a single exception, the microbiological studies detected no statistically significant difference between drug users and control groups periodontal flora. CONCLUSIONS: Drug-dependent patients had poor oral health and a significant increase in oral pathology, essentially caries and periodontal disease. Their risk of caries was high and the presence of candidiasis was representative of their poor general and oral health. Drug users' poor buccodental condition was more closely related to lifestyle than to drug abuse itself.

Protocolo actual en la terapia de la periimplantitis / Current protocol in periimplatitis therapy

La periimplantitis es un proceso patológico inflamatorio de los tejidos que rodean al implante que cursa con una pérdida ósea progresiva e irreversible. El objetivo del tratamiento de la periimplantitis es conseguir la eliminación de la infección bacteriana, una reducción de la profundidad de la bolsa y una ausencia de sangrado al sondaje; así como prevenir la pérdida de tejidos de soporte mediante una terapia de apoyo adecuada. En los procedimientos profesionales para el control de la infección se incluye la retirada de los depósitos bacterianos de los componentes del implante y la supraestructura. Sin embargo, en ocasiones hay que recurrir a terapia quirúrgica, que consiste en crear el acceso para la limpieza y descontaminación de la superficie del implante (AU)

Peri-implantitis is an inflammatory disease of the tissues surrounding the implant that leads to a progressive and irreversible bone loss. The treatment for peri-implantitis aims to achieve the elimination of bacterial infection, a reduction in the depth of the bag and an absence of bleeding on probing, as well as preventing the loss of support tissues by means of an appropriate support therapy. Professional procedures for infection control include the removal of bacterial deposits from the components of the implant and the superstructure. However, there is sometimes a need to resort to surgical therapy, which consists of creating access for cleaning and decontaminating the surface of the implant (AU)

¿Qué tratamiento podemos elegir para rehabilitar pacientes con Síndrome de Combinación? / What treatment can we use for the rehabilitation of patients with Combination Syndrom?

Introducción: El término de “Síndrome de Combinación” fue definido por Ellswoth Kelly en 1972, cuando tras realizar un estudio con casi 500 pacientes portadores de prótesis removible, observó que había una serie de características que se repetían en algunos de los pacientes que portaban una prótesis completa superior ocluyendo con una prótesis parcial inferior, siendo la mandíbula edéntula tipo clase I de Kennedy. En concreto, agrupó cinco características para definir el síndrome, siendo lo esencial que presentaban, una gran reabsorción del maxilar anterior, una hipertrofia de las tuberosidades maxilares y una extrusión del sector dentario mandibular. Posteriormente, Tolstunov planteó una clasificación del síndrome mucho más abierta en la que incluían más pacientes con la característica común de la reabsorción anterior del maxilar y la extrusión del sector anterior mandibular. Paciente y método: Se presenta el caso de una paciente con Síndrome de Combinación, portadora de una prótesis parcial removible superior. Para plantear llevar a cabo el plan de tratamiento de la manera más indicada, se realiza una revisión bibliográfica en los buscadores Pubmed y Compludoc. Posteriormente se diseñará, atendiendo a las características del tipo de síndrome, un plan terapéutico que restaurara tanto la función como la estética de la paciente. Conclusión: Tras la bibliografía consultada y nuestra experiencia clínica, entre las diferentes alternativas restauradoras que se pueden plantearen pacientes con Síndrome de Combinación, se ha considerado como primera opción, un tratamiento fijo implanto- soportado (AU)

Introduction: The term “Combination Syndrome “was defined by Ellsworth Kelly in 1962 when, after carrying out a study involving almost 500 patients wearing a removable prosthetis, it was observed that there were a serious of characteristics that repeated in some patients wearing a complete upper prosthesis occluding with a partial lower prosthesis, the endetulous mandible being Kenndyclass I. Specifically, the syndrom was defined by a grouping of five characteristics, the mainone being significant reabsorption of the upper maxillary anterior, hypertrophy of the maxillary tuberosity and extrusion of the mandibular dental section. Subsequently, Tolstunov suggested a much broader classification of the syndrome including more patients with the common characteristics of the anterior reabsorption of the maxillary and the extrusion of the anterior mandibular section. Patient and method: The case was presented of a patient with Combination System, wearing a removable partial upper prosthesis. To come up with the treatment plan indicated, a bibliographic search was carried out in the Pubmed and Compludoc search engines. Next a therapeutic plan to restore both function and aesthetics was designed to suit the characteristics of the type of syndrome. Conclusion: After consulting the bibliography and according to our clinical experience, among the restorative options for patients with Combinato in Syndrome, the first optionis considered to be a fixed supported implant treatment (AU)