SRRDGPosterPrize

Elizabeth King
James Owens

Flexible and Sectional Complete

Dentures with Magnetic Retention
for a Patient with Microstomia − A
Case Report
Abstract: This case report describes treatment for a patient with microstomia and the development of the index of oral access for
restorative dental treatment (IOA).
CPD/Clinical Relevance: An understanding of the causes of microstomia and challenges encountered when treating microstomia patients
with an index to aid diagnosis and treatment planning.
Dent Update 2016; 43: 212–213

Microstomia is the congenital, developmental
or acquired reduction in size of the oral
aperture to a degree where function and
aesthetics are compromised. Causes include:
 Congenital craniofacial abnormalities;
 Systemic or autoimmune diseases affecting
the connective tissues;
 Fibrosis following head and neck irradiation;
 Submucous fibrosis; and
 Scarring following peri-oral surgery or
trauma.
Treatment often involves oral
opening devices and, less commonly, surgery,
however, the majority of microstomia-related
diseases are irreversible and/or progressive and
therefore patients are often left with functional
and aesthetic impairments.
Provision of removable prostheses
for such patients is challenging due to the Successful dental rehabilitation was achieved
reduced elasticity and altered anatomy of using maxillary and mandibular complete
the oral tissues. Furthermore, restricted oral sectional dentures with flexible substructures
opening can make it considerably difficult, and rigid superstructures retained by magnets
if not impossible, for patients to insert and (Figures 4−7).
remove conventional dentures. The utilization Management of microstomia
of modern flexible materials and use of
sectional denture design can help overcome
these problems.
Case report
The patient presented with
surgically induced microstomia following
treatment for squamous cell carcinoma (SCC)
of the lower lip using a bilateral Karapandzic Figure 1. SCC lower lip pre-operatively − patient
flap resection and reconstruction (Figures 1−3). to undergo bilateral Karapandzic flap procedure.1

Elizabeth King, BDS(Hons), MFDS

RCS(Ed), Specialist Trainee in Restorative
Dentistry and James Owens, BDS(Wal),
FDS RCS(Edin), MSc(Brist), FDS(Rest
Dent), MRD RCS(Edin) FHEA,
Consultant/Honorary Senior Lecturer
in Restorative Dentistry and Oral
Rehabilitation, Morriston Hospital
Swansea, Swansea, UK. Figure 2. Diagram of Karapandzic flap.2

212 DentalUpdate April 2016

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Figure 3. Microstomia post-operatively.
Figure 4. Flexible and sectional dentures with
magnetic retention between bases − mandibular
flexible base and rigid superstructure.
Figure 5. Flexible and sectional dentures with
magnetic retention between bases − maxillary
flexible base and rigid superstructure.
a objective treatment planning and enhance inter-clinician communication.
IOA 0 − Normal  Access to all areas of the mouth for all restorative treatment
possible
 Modification of impression technique or prosthetic design not
required
IOA 1 − Mild  Access to molar teeth restricted − complex treatment (endodontic
treatment/indirect restorations) may be compromised or not
possible
 Minor modification of impression technique required to enable
impression-taking
 Minor modification to prosthetic design required to enable
insertion and removal
IOA 2 − Moderate  Access to molar teeth for restorative treatment not possible
 Access to premolar teeth restricted − complex treatment
(endodontic treatment/indirect restorations) may be compromised
or not possible
 Access to incisors and canines for all treatment possible
 Modification of impression trays required to enable impression-
taking
 Modification to prosthesis design required to enable insertion and
removal
IOA 3 − Severe  Access to incisor and premolar teeth restricted − complex
treatment (endodontic treatment/indirect restorations) may be
compromised or not possible
 Impression-taking severely compromised and significant
modification to trays and technique required to enable impression-
taking
 Significant and complex adjustments to prosthetic design required
IOA 4 − Extreme  Access to all restorative treatment not possible
 Impression-taking not possible
 Prosthetic rehabilitation modification not possible
Table 1. Index of oral access (IOA) for restorative dental treatment developed to improve record-
keeping, aid diagnosis and treatment planning, help monitor disease progression, encourage more

Figure 6. (a, b) Patient successfully inserting maxillary flexible base and rigid superstructure. Figure 7. Dentures in situ.

involves multiple specialties within Medicine
and Dentistry, however, there is currently no
recognized method of communicating the
severity of microstomia amongst clinicians.
Included in this report is a microstomia
severity index developed to aid clinicians
in diagnosing, recording and monitoring
the severity of microstomia, and to encourage
more objective treatment planning for this
patient group (Table 1).
References
1. Karapandzic M. Reconstruction of lip defects by local
arterial flaps. Br J Plast Surg 1974; 27(1): 93−97.
2. Cura C, Cotert HS, User A. Fabrication of
a sectional impression tray and sectional
complete denture for a patient with
microstomia and trismus: a clinical report.
J Prosthet Dent 2003; 89(6): 540−543.

April 2016 DentalUpdate 213