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Case Report
Prosthodontic management of a completely
edentulous microstomia patient
Chiramana Sandeep, O. Swetha Hima Bindu, B. Sreedevi, K. Sai Prasad
Department of Prosthodontics, Sibar Institute of Dental Sciences, Thakkellapadu, Guntur, Andhra Pradesh, India

ABSTRACT
Prosthodontic management of a completely edentulous patient with microstomia is
challenging for both the operator and the patient. Limited mouth opening can be caused
by the head and neck radiation, surgically treated head and neck tumors, connective tissue
diseases, facial burns, reconstructive lip surgeries and the most common factor oral submucous
fibrosis. It is often difficult to apply conventional clinical procedures to construct dentures
for patients who demonstrate limited mouth opening, as it is difficult to insert or remove the
custom trays, denture bases and the final prosthesis is in one piece because of the constricted
opening of the oral cavity. However, with careful treatment planning and designing, many
of the apparent clinical difficulties can be overcome. This article deals with a case report
of treatment procedure and sectional prosthesis design for a patient with microstomia. All
the procedures were intended for better function, health, esthetics and overall well-being
of the patient.

Key words: Flexible tray, microstomia, oral submucous fibrosis, sectional denture,
sectional trays

INTRODUCTION replacement of missing teeth. Case history

Address for correspondence:
Dr. O. Swetha Hima Bindu,
Department of Prosthodontics,
Sibar Institute of Dental Sciences,
Thakkellapadu, Guntur - 522 509,
Andhra Pradesh, India.
E-mail: obr.bindu@gmail.com
Access this article online
Website:
www.jofs.in
DOI:
10.4103/0975-8844.132590
Quick Response Code:
Oral submucous fibrosis is a precancerous
condition, affecting any part of the oral
cavity and is caused by prolonged use
of tobacco, areca nut, spices, etc. This
condition is characterized by a burning
sensation of the mouth, stiffening of
certain areas of the oral mucosa with
difficulty in opening the mouth.
This condition hinders conventional
prosthetic treatment of edentulous
patients.[1] Particularly the fabrication of
complete denture is complicated by the
loss of resiliency of tissues, limited tongue
movements and the constant adjustments
required accommodating the changing
periphery.[2] Various treatment modalities
include surgery,[3] dynamic opening
devices called microstomia orthoses[4] and
modification of denture design.[5]
CASE REPORT
A 45-year-old male patient was referred
to Department of Prosthodontics, for
revealed that patient had a habit of
smoking two packets of cigarettes per day,
since 7 years. On extra oral examination,
the patient’s mouth opening was only
26 mm vertically and 30 mm horizontally
[Figure 1]. This posed a practical challenge
for the fabrication of the complete
dentures in a conventional way. Intraoral
examination revealed moderately resorbed
maxillary and mandibular completely
edentulous ridges. Mucosa appeared
blanched with palpable fibrotic bands
extending all over the oral mucosa up
to soft palate region. On palpation, the
mucous membrane was firm. There was a
minimal to zero resiliency of the tissues.
Mandibular primary impression and
cast
For making the mandibular impression
the smallest available stock tray (size-0)
was selected whose flanges were modified
as required until it could be inserted in
patients mouth and the impression was
made with alginate impression material
and the primary cast was obtained.

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Sandeep, et al.: Sectional denture for microstomia patient

Maxillary primary impression and cast

It was impossible to make an impression with stock
tray for maxillary arch. Hence a flexible tray was
prepared by manually dispensing silicone putty
impression material intra-orally. After dispensing, it
was carefully positioned onto denture-bearing areas
and molded to appropriate contour using functional
and manual manipulation and was kept in place until
it set completely. Later, a wash impression was made
using light body elastomer over the molded putty tray
[Figure 2]. The cast was poured by stabilizing the
flexible tray in a non-displacing mix of dental stone as
a supporting base prior to pouring it in dental plaster
to obtain the primary cast.
Figure 1: Mouth opening of the patient
Final impressions and casts
An auto polymerizing acrylic resin custom tray was
fabricated for maxillary arch, however, it could not be
introduced in the patient’s mouth in one piece therefore,
it was planned to section the tray into two halves to
insert into the mouth. Press buttons were fixed to the
handle of the sectional custom tray so that the tray
could be exactly reassembled [Figure 3]. Border molding
was done alternatively for the right and left halves of
the sectional tray using low fusing compound and final
impression of the two halves was made separately
using light body elastomer. After the impression was
completed, the sectional trays were separated intra-
orally and reassembled externally. The impression was
boxed and poured using dental stone.

A single piece auto polymerizing acrylic custom tray Figure 2: Maxillary primary impression with flexible tray
was used for mandibular arch, as it could be inserted
and removed with little difficulty. The border molding
and final impression was done conventionally. The
master cast was poured by inversion method with
dental stone.

Jaw relations and try in

For better stability permanent denture bases were
planned for recording jaw relations. Mandibular
denture base was fabricated in a conventional way,
but the maxillary denture had to be sectioned, hence
a special metallic inlay structure was designed to be
incorporated into the denture base, which consisted of
two parts, right and left that were joined length-wise by
a custom-made inlay structure at the overlapping metal
base (5 mm wide) along the midline.
Figure 3: Maxillary sectional custom tray with snap button
The right half of the wax pattern was designed to have attachments
three square inlay structures and it was fabricated on
a refractory cast obtained by duplicating the master included three square-shaped holes (2 mm wide and 2
cast. Following this, it was invested, casted, trimmed, mm high) with parallel walls. The inlay structures on
polished and returned to master cast. This entire the right half framework could precisely fit through the
assembly was duplicated to get a second refractory holes when the segments were joined with their tops at
cast, on which the left wax pattern was formed, which the same level as the surface [Figure 4].

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Sandeep, et al.: Sectional denture for microstomia patient
Figure 4: Custom made metal inlay structure right and left parts
Figure 5: Patient inserting the right and left maxillary denture
sections
Following this, maxillary permanent denture base was
fabricated incorporating the metallic inlay structure and
was sectioned with care without disturbing the seal, jaw
relations record was made and teeth arrangement was
done conventionally on a semi-adjustable articulator
developing neutrocentric occlusion. Try in was done
and was found to be satisfactory. The dentures were
processed in a conventional way.
Insertion and recall visits
At the insertion stage the patient was trained as to how
to place and remove the sectional maxillary denture.
The right segment of the maxillary denture was first
inserted into the mouth. Then the left segment was
inserted to join the right one by placing the inlay
structures into the corresponding holes [Figure 5].
Patient was given home-care instructions on the
operation of the custom-made inlay structure assembly
along with other instructions. Evaluation was done at
recall visits and adjustments were done as required.
Patient expressed immense sense of gratification with
the treatment rendered.
DISCUSSION
Microstomia or limited mouth opening condition poses
a problem during each step of prosthetic reconstruction.
Hence several methods have been put forward for
impression making which includes flexible trays,
Journal of Orofacial Sciences
Vol. 6• Issue 1• January 2014
Figure 6: Final denture insertion
modified stock trays and sectional trays with different
attachments.[6-9] And for connecting sectional dentures
cast Co-Cr hinges,[5,10] swing-lock attachments,[11,12] stud
attachments,[13] clasps[14] and magnets[15,16] were used.
In this case report, we used a simple method of snap
fit buttons attachment for maxillary sectional tray
and later the sectional denture segments were joined
by means of a custom-made inlay structure on the
overlapping metal base. This was a simple and the
cost-effective way. Patient was able to use this design,
when inserting or removing the denture with ease
[Figure 6].
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How to cite this article: Sandeep C, Hima Bindu OS, Sreedevi B,
Prasad KS. Prosthodontic management of a completely edentulous
microstomia patient. J Orofac Sci 2014;6:65-8.
Source of Support: Nil, Conflict of Interest: None declared
Journal of Orofacial Sciences
Vol. 6• Issue 1• January 2014