DENTAL TECHNIQUE

Sectional collapsible complete removable dental prosthesis for

a patient with microstomia
Potchaman Sinavarat, BSc, DDS, MSca and Chuchai Anunmana, DDS, MSc, PhDb

Microstomia is a clinical con- ABSTRACT

dition affecting patients who
Patients who have unusually small mouths may have difculty in obtaining dental care and
have very small mouths due maintaining good oral hygiene. The fabrication of conventional complete removable dental pros-
to orofacial cancer surgery, theses for an edentulous patient with microstomia is challenging because of the limited access to
cleft lips, burns and trauma the oral cavity. Sectional collapsible complete removable dental prostheses were designed as
around the oral cavity, scar hinged maxillary and mandibular complete dentures that can be folded for denture delivery. This
tissue after lip surgeries, or the design also prevented denture deection during function by using the upper part of the prosthesis,
collagen group of diseases in- minimizing the possibility of breakage. (J Prosthet Dent 2015;114:627-632)
cluding submucous brosis
and scleroderma.1-3 The oral manifestation of sclero- a problem because of poor manual dexterity. A cast
derma includes thin oral mucosa, xerostomia, limited jaw cobalt-chromium framework with a lingual hinge and a
opening, recurrent mouth sores, and dysphagia. conventional swing lock has been designed as a treat-
Decreased salivary ow results in an increased caries rate, ment option.14,15
and removable dental prostheses can be problematic.4 This dental technique report describes the prostho-
Moreover, the intercommisural distance and oral aper- dontic management of a 61-year-old edentulous man,
ture can be reduced as a result of the sclerosis of the facial whose oral opening was limited (intercommissural width
skin. For most patients, this results in a maximum approximately 32 mm) as a result of scleroderma (Fig. 1).
opening of less than 40 mm. Microstomia can be seen in Simple designs of maxillary and mandibular sectional
80% of patients with systemic scleroderma. Women have
a higher risk of the disease than men.5
Restricted oral opening can be a signicant problem
for patients with microstomia when seeking dental
treatment.6,7 Furthermore, contraction of the soft tissue
around the oral cavity makes it difcult to attaining
dental care and perform good oral hygiene. As a result,
these patients are prone to edentulism. Treatment op-
tions include surgical correction to enlarge the mouth8
and dental implants,9 but if these options are not avail-
able, sectional complete removable dental prostheses can
be an alternative treatment. Various pins, bolts, attach-
ments, and Lego pieces have been used for the locking
mechanism.10-13 In some situations, joining the small Figure 1. Patient with restricted oral opening. Intercommissural width at
pieces of a sectional dental prosthesis intraorally may be maximum opening was approximately 32 mm.

a
Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
b
Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.

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628 Volume 114 Issue 5

Figure 2. Maxillary preliminary impression. A, Three sections of maxillary impression. B, Assembled impressions.

Figure 3. Sectional custom trays. A, Assembled maxillary tray. B, Stepped butt joint (arrow) prepared on left half of maxillary tray. C, Left and right
mandibular sectional trays. D, Stepped butt joint (arrow) prepared on left half of mandibular tray.

edentulous custom-made trays were used to fabricate
the sectional collapsible complete removable dental
prostheses.
TECHNIQUE
1. Make the right and left preliminary maxillary im-
pressions separately with modeling plastic
impression compound (Impression Compound;
Kerr Corp). Trim each half of the impression 4 to 5
mm away from the midline. Then reline each half
of the impression alternately with low-viscosity
polyvinyl siloxane (Silagum; DMG Chemisch-
Pharmazeutische Fabrik). Subsequently, adapt
additional modeling plastic impression compound
over the 2 halves to index the impression (Fig. 2).
2. Make a preliminary mandibular impression with
partial trays and irreversible hydrocolloid impres-
sion material (Jeltrate; Dentsply Intl). The right and
left trays should cover the mandibular midline.
3. Fabricate a sectional custom maxillary tray from the
preliminary cast. Prepare a stepped butt joint along
the midline of the sectioned tray; therefore, these 2
parts are detachable (Fig. 3A, B). Fabricate the left

THE JOURNAL OF PROSTHETIC DENTISTRY Sinavarat and Anunmana

November 2015 629

Figure 5. Mandibular occlusion rim. A, Mandibular occlusion rim with

custom-made hinge located in middle of lingual base. B, Collapsed
mandibular occlusion rim. C, Collapsed rim inserted in patient.

and right sectional custom mandibular trays

4. Mold the border of each tray segment with a green
Figure 4. Maxillary occlusion rim. A, Custom-made hinge. B, Anterior and
posterior segments of maxillary occlusion rim with custom-made hinge
(arrow) at midline of posterior part. C, Folded posterior segment. D,
Complete maxillary occlusion rim.
separately on each cast. Locate the anterior border
of the tray at the midline of the arch. Then position
the left tray segment on the right cast and verify
proper alignment before preparing a stepped butt
joint (Fig. 3C, D).
stick modeling plastic impression compound
(Impression Compound; Kerr Corp). Make a
denitive impression on both segments of the arch
at the same time with low-viscosity polysulde
(Permlastic; Kerr Corp). Place the index over the 2
parts to stabilize the trays. After the impression
material has polymerized, remove the index rst,
and then ex the trays at the junction line and

Sinavarat and Anunmana THE JOURNAL OF PROSTHETIC DENTISTRY

630
Figure 6. Finished complete removable dental prosthesis. A, Anterior segment and posterior foldable segment of maxillary denture. B, Assembled
maxillary denture. C, Foldable mandibular denture with Co-Cr lingual plate. D, Assembled mandibular denture.
subsequently remove the tray segments one by
one. Finally, pour the impressions with Type IV
dental stone (Vel-Mix; Kerr Corp).
5. Prepare the maxillary record base in 2 pieces as the
posterior and the anterior segments. Place a
custom-made hinge at the midline at 5 mm ante-
rior to the posterior border of the base. Separate
the posterior baseplate into left and right sections;
therefore, it is foldable. Fabricate the anterior
segment and place it over the posterior segment to
stabilize the posterior base. Make an occlusion rim
(Fig. 4). Fabricate the mandibular record base in
1 piece. Incorporate a custom-made hinge at the
midline of the lingual base and section the base
at the midline into left and right parts. The base is
now collapsible in the horizontal plane (Fig. 5).
6. Record the maxillomandibular relationship in
centric relation and mount the denitive casts on a
semiadjustable articulator (Hanau H2; Whip Mix
Corp).
7. Arrange the nonanatomic articial teeth (Major
Dent; Major Prodotti Dentari) with posterior
balancing ramps to obtain eccentric balanced oc-
clusion. At the trial stage, verify the occlusion,
speech function, and esthetics.
8. Make a cast cobalt-chromium lingual plate by
reducing the wax on the lingual surface of the
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 114 Issue 5
mandibular trial denture. This lingual plate rests on
the occlusal surfaces of the second premolars and
the rst molars and helps stabilize the left and right
segments during function.
9. To attach the anterior segment to the posterior
segment of the maxillary denture base, place 2 ball
attachments on the posterior base segment with a
dental surveyor to obtain parallel paths of insertion
on both sides. Adhere 2 ball caps or the female
parts on the tissue surface of the anterior denture
base with autopolymerized acrylic resin (Takilon;
Salmoiraghi Produzione Dentaria). Then nish and
polish the complete removable dental prosthesis
(Fig. 6).
10. At the delivery appointment, evaluate the denture
base extension, relieve excessive pressure of the
intaglio surface, and adjust the occlusion to derive
simultaneous tooth contact in centric and eccentric
position. Instruct the patient to operate the den-
ture assembly, and emphasize oral and denture
hygiene. Figure 7 shows the prosthesis in the oral
cavity.
DISCUSSION
Although the cast cobalt-chromium swing lock dentures
with lingual hinge as described by Wahle et al14 and
Sinavarat and Anunmana
November 2015
Figure 7. Complete removable dental prosthesis in patients mouth. A, Maxillary prosthesis. B, Mandibular prosthesis. C, Complete removable dental
prosthesis in occlusion. D, Frontal view.
Rathi et al15 were easily delivered, they were more costly
than this design because of the sophisticated laboratory
work required. This design also prevented denture
deection and possible breakage. In addition, retention
and stability were achieved during mastication. However,
because the denture base is made of acrylic resin, regular
maintenance is required to maintain the function and
integrity of the dentures. Oral exercises and mouth
stretching as recommended by Naylor and Manor16
were suggested to maintain the oral aperture and
enhance the exibility of the facial skin. This was to avoid
further brosis, which could make dental treatment
impossible.
SUMMARY
By using palatal and lingual midline hinges together with
the ball attachment and lingual plate, the sectional
collapsible complete removable dental prosthesis was
easily inserted, and the prosthesis also provided adequate
Sinavarat and Anunmana
631
function for the patient. The limitations of the treatment
procedure and the need for continuous maintenance
must be emphasized to the patient to avoid tissue ul-
ceration and further brosis.
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esthetic facial reconstruction. London: Churchill Livingstone; 2003.
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10. Al-Hadi LA, Abbas H. Treatment of an edentulous patient with surgically Corresponding author:
induced microstomia: a clinical report. J Prosthet Dent 2002;87:423-6. Dr Chuchai Anunmana
11. Benetti R, Zupi A, Toffanin A. Prosthetic rehabilitation for a patient with Mahidol University
microstomia: a clinical report. J Prosthet Dent 2004;92:322-7. Department of Prosthodontics
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1971;26:324-7. Bangkok, 10400
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with microstomia. J Prosthet Dent 1989;61:645-7. Email: chuchai.anu@mahidol.edu
14. Wahle JJ, Gardner LK, Fiebiger M. The mandibular swing-lock complete
denture for patients with microstomia. J Prosthet Dent 1992;68:523-7.
15. Rathi N, Heshmati R, Yilmaz B, Wilson W. A technique for fabricating a Acknowledgments
hinged mandibular complete dental prosthesis with swing lock for a patient The authors thank Sutas Jitchuen and Manit Choetkiertikul for their technical
with microstomia. J Prosthet Dent 2013;110:540-3. support and laboratory work.
16. Naylor WP, Manor RC. Fabrication of a exible prosthesis for the edentulous
scleroderma patient with microstomia. J Prosthet Dent 1983;50:536-8. Copyright 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.

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