# Single Complete Denture > Single complete denture in BDS Prosthodontics: occlusal plane correction, combination syndrome features and managing natural opposing teeth. - Canonical URL: https://prepelephant.com/topics/bds/prosthodontics/single-complete-denture - Exam / course: BDS · Subject: Prosthodontics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Single Complete Denture", PrepElephant, https://prepelephant.com/topics/bds/prosthodontics/single-complete-denture ## Direct answer A complete denture opposing natural teeth is prosthodontics' most one-sided contest: intact periodontal ligaments deliver forces the denture-bearing mucosa cannot answer, so the artificial arch loses bone, the natural teeth extrude, and the occlusal plane tilts unless the operator corrects it first. The typical case is a maxillary complete denture against a mandible retaining its six anterior teeth with posterior saddles or bare distal extensions — the exact anatomy of combination syndrome, described by Kelly in 1972: premaxillary bone loss, papillary hyperplasia of the palatal mucosa, supraeruption of the lower anteriors, enlargement of the maxillary tuberosities and loss of occlusal vertical dimension. Prevention and treatment run on the same principles — establish posterior mandibular support, correct the occlusal plane before setting teeth, arrange a forgiving occlusal scheme, and review the prosthesis on a recall calendar, because the opposing natural teeth never stop reminding the ridge who is stronger. ## What you must remember - **The mismatch in one line:** natural teeth with periodontal ligament proprioception concentrate force; mucosa-borne denture bone resorbs under it — the maxillary ridge pays for every unbalanced contact. - **Combination syndrome (Kelly, 1972; expanded by Saunders):** anterior maxillary ridge resorption, inflammatory papillary hyperplasia of the palate, extrusion of mandibular anterior teeth, fibrous enlargement of maxillary tuberosities, and reduced occlusal vertical dimension. - **Occlusal plane first:** the plane of the remaining lower teeth is corrected by enameloplasty, restorative build-ups, onlays or extraction of hopeless teeth before maxillary teeth are set against it. - **Posterior support is the anchor:** replacing mandibular posterior teeth — by removable partial denture or implants — is the single most effective preventive act, because unsupported anterior biting drives the syndrome. - **Occlusal scheme:** reduced cusp angles or lingualised teeth arranged for balanced contacts spread load and discourage the anterior shear that hammers the premaxilla. - **Denture design defences:** broad coverage, generous post dam, meticulous border seal, and thin posterior palatal borders; a night guard or denture-saver protecting the arch when the patient grinds natural teeth against acrylic. - **Recall with intent:** six-monthly to yearly reviews for relines as the maxillary ridge resorbs faster than in bilateral denture wearers. ## Working through a classic presentation A 58-year-old wears a five-year-old maxillary denture against six sound lower incisors and bilateral distal extension saddles he stopped wearing. The picture is textbook: the anterior maxillary ridge is flabby and resorbed, the palate shows velvety papillary change, the lower incisors have drifted down and forward, both tuberosities have fibrous enlargement, and the face has closed vertically. Treatment begins at the bottom: the mandibular partial denture is re-established (or implants placed) so posterior support exists before anything new is made. The supraerupted incisors are assessed — selective grinding, or extraction if hopeless — to level the occlusal plane. The maxillary denture is then remade with a broad base, the flabby anterior ridge managed by a minimal-pressure or window impression technique, lingualised teeth set for balanced occlusion, and the papillary hyperplasia treated with tissue conditioning and hygiene before final impressions. The case succeeds or fails on the posterior support, which is why it comes first. ## Where students slip The commonest failure is treating the resorbing anterior maxilla as a denture-fit problem — relining repeatedly while the true driver, absent posterior mandibular support, keeps grinding the premaxilla away; examiners construct whole viva chains from that single oversight. The second is listing combination syndrome features incompletely: the five-item list (premaxilla loss, papillary hyperplasia, incisor extrusion, tuberosity enlargement, vertical dimension loss) is asked verbatim, and dropped items are dropped marks. The third is occlusal plane amnesia — setting beautiful teeth against a tilted plane guarantees early failure regardless of base quality. ## Frequently asked questions ### What is combination syndrome and who described it? Kelly (1972), with Saunders' later additions: the tissue changes seen when an edentulous maxilla is opposed by natural mandibular anterior teeth lacking posterior support. ### List the characteristic features of combination syndrome. Loss of premaxillary alveolar bone, inflammatory papillary hyperplasia of the palate, supraeruption of lower anterior teeth, fibrous enlargement of maxillary tuberosities, and loss of occlusal vertical dimension. ### Why is the mandibular occlusal plane corrected before maxillary teeth are set? The natural teeth's plane dictates where the denture teeth must meet; correcting it first — by grinding, restorations or extraction — prevents steep interferences and anterior shear on the premaxilla. ### How does loss of posterior mandibular support drive maxillary destruction? With only anterior contacts, all functional load transfers to the premaxilla under the denture, resorbing bone and displacing soft tissue, while the lower incisors extrude unopposed. ### Which occlusal scheme suits a single complete denture against natural teeth? Low cusp angle or lingualised teeth arranged for balanced, broadly distributed contacts, sparing the maxillary ridge concentrated horizontal shear.