Title: “Kelly’s Syndrome”- prevention, using Implant Supported Hybrid Denture: Clinical Considerations

The prosthetic rehabilitation of patients with an edentulous maxilla opposing mandibular anterior natural teeth is one of the most challenging situations that a clinician encounters. Occlusal forces from the opposing natural teeth may cause fractures in the maxillary prosthesis and also result in residual ridge resorption of the edentulous maxilla. Prosthodontists try overcoming this Combination syndrome by careful treatment planning, which may require a multi-disciplinary approach involving surgical intervention followed by metallic denture base prosthesis, implant supported fixed prosthesis, implant supported overdentures etc. Even conventional prosthodontic techniques with special consideration for flabby tissues, over denture prosthesis and removable cast partial denture may be used. Choice of treatment modality is made by keeping in mind that the requirement of stability and retention of the prosthesis must be balanced along with the preservation of the health of the remaining oral tissues for every patient. With the presence of extreme gagging reflex, the treatment may become even more complicated. This article describes and illustrates the two stage surgical and prosthetic treatment of a patient with an edentulous maxilla opposing mandibular anterior natural teeth. The extreme gagging reflex from maxillary conventional complete denture and the occlusal forces from the mandibular anterior natural teeth compelled the clinician to adapt a different treatment plan which included placement of 4 endosseous implants in maxilla followed by fabricating a maxillary fixed screw retained hybrid prosthesis, and 4 implants in posterior mandible for implant supported Fixed Partial Denture.