Management of Edentulous Microstomia Patient: A Case Report and Classification System

Abstract

Microstomia is an abnormally reduced oral aperture. In the literature, it is not classified by any particular size criteria, rather defined by its effects on function and esthetics. Prosthodontic management of edentulous patients with microstomia is a challenging task. Use of conventional methods for recording an impression and fabricating prosthesis is not effective in such patients. To fabricate well-fitting prosthesis, accuracy of impression recording important anatomic landmarks is essential. Formation of an exacting custom tray and diagnostic cast is critical for final impression accuracy. Provision of a well-fitting prosthesis in microstomia patient will restore esthetics, comfort, and function with oral and systemic patient wellbeing. This paper presents a case report of managing an edentulous microstomia patient with sectional removable prosthesis. Furthermore, it proposes a novel classification system for microstomia patients according to severity of the condition.

Use of Sectional Tray Design in Recording Edentulous Impressions for Microstomia Patients: A Case Report

“…7 Various connecting mechanisms such as hinges, snap buttons, locking levers, plastic blocks, orthodontic expansion screws, magnet systems and parallel pins have been suggested for fabricating sectional trays. 4,7 In the present case, sectional tray fabrication technique with needle hubs and acrylic resin block (for maxillary sectional tray) and dowel pins (for mandibular sectional tray) is described. The needle hubs, acrylic resin block and dowel pins are cheaper and readily available materials in any dental office.…”

“…2,3 According to the study done by Patil et al, 38.2% of the reported microstomia cases were due to postsurgical complications and 41.1% cases were due to systemic sclerosis. 4 Limited mouth opening serves a challenge right from the impression making till the insertion of the prostheses. Since, standard impression procedures are not possible to carry out due to limited mouth opening, this procedure is often cumbersome for both the patient and the operator.…”

Prosthetic rehabilitation of a patient with hemimandibulectomy by a double occlusal table prosthesis

“…In some cases, scar contraction limits the mouth opening in a more extensive manner that the placement and removal of removable appliances become difficult. 23 Therefore, a fixed guide flange prosthesis is designed in such cases, which would keep the muscles in a stressed condition, preventing scar contraction. Coutinho et al 24 used a mandibular molar tooth on which the molar band was placed and a u-shaped loop with a tube was soldered on it, which was facing the buccal surface of maxillary posterior teeth.…”

“…On both arches, the surviving teeth were found to be periodontally weak but no mobility was evident. The remaining teeth were 11,12,21,22,23,24,25,31,32,33,34,35,36,37,41,42, and 43 (Federation Dentaire Internationale (FDI) numbering system). Furthermore, the patient was habitual eating betel nuts for the past 8 years.…”

Digitally designed and manufactured sectional custom tray for a patient with microstomia: A case report

“…Abbasi et al proposed a classification system based on vertical mouth opening, accessibility, and visibility of intraoral tissues. 4 Microstomia can severely decrease a patient's quality of life, generate major esthetic concerns, and lead to poor oral hygiene. Limited mouth opening can become challenging for the patient and dental provider.…”