Restoring masticatory function in a patient with severe microstomia using rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis

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

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.

Digital Workflow for a Scleroderma Patient with Microstomia: A Clinical Report

Making impressions in patients with microstomia is often rather problematic due to their restricted mouth opening. Herein, this report describes a novel digital workflow for making impressions with computer-aided design and computer-aided manufacturing (CAD/CAM) custom sectional trays for a 58-year-old female patient with scleroderma and microstomia. CAD/CAM custom sectional trays were made based on digital dentition models from another case with similar arch scale. After the sectional impressions were obtained, the sectional casts were scanned and digitally aligned to form the final dentition models. The removable partial dentures were designed on the final digital models and printed using a 3D printer. This procedure was executed with a successful prosthetic outcome that included good fit and acceptable esthetics. The patient also reported a high level of satisfaction.

Rehabilitation for a scleroderma patient with severe microstomia using digital and conventional methods

BACKGROUND

Microstomia is a principal clinical symptom in patients with scleroderma. It is characterized by an abnormally small mouth opening, which makes traditional prosthetic rehabilitation difficult.

METHODS

First, the primary impression and jaw relation record were acquired using an intraoral scanning technique and the primary diagnostic dentures were fabricated using 3-dimensional printing (3DP). The definitive impression and jaw relation were obtained and digitally scanned. The second diagnostic denture was also made to confirm the esthetic and occlusal effects. Next, the adjusted dentition parts were scanned and milled from a cross-linked polymethyl methacrylate disk. In addition, the titanium alloy frameworks were also fabricated using 3DP. With flasking, the milled dentition parts were inserted and the definitive dentures were finally fabricated and delivered to the patient.

RESULTS

The authors constructed the definitive removable partial dentures successfully using the digital methods of intraoral scanning, computer-aided design, and 3DP.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

These digital methods provide an alternative option for prosthetic rehabilitation in scleroderma patients with severe microstomia.