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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 39-43

A novel approach of rehabilitation of a microstomia patient with sectional hinged dentures


Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India

Date of Submission07-Jan-2020
Date of Acceptance14-Mar-2020
Date of Web Publication30-Apr-2020

Correspondence Address:
Dr. J Brintha Jei
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai - 600 089, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jid.jid_65_19

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   Abstract 


When the mouth opening is restricted, it can hinder the successful dental treatment. This limited mouth opening may be due to some surgical treatment, oral submucous fibrosis, temporomandibular joint disorder, burns, space infections, trauma, neoplasm, radiotherapy, and scleroderma. This case report describes the simplified prosthodontic management of a completely edentulous patient with limited mouth opening by providing sectional maxillary and mandibular dentures joined by hinges.

Keywords: Hinged denture, microstomia, restricted mouth opening, sectional denture


How to cite this article:
Kumar C S, Jei J B, Murugesan K, Muthukumar B. A novel approach of rehabilitation of a microstomia patient with sectional hinged dentures. J Interdiscip Dentistry 2020;10:39-43

How to cite this URL:
Kumar C S, Jei J B, Murugesan K, Muthukumar B. A novel approach of rehabilitation of a microstomia patient with sectional hinged dentures. J Interdiscip Dentistry [serial online] 2020 [cited 2020 May 27];10:39-43. Available from: http://www.jidonline.com/text.asp?2020/10/1/39/283538




   Clinical Relevance to Interdisciplinary Dentistry Top


Limited mouth opening for a completely or a partially edentulous patient is a challenging situation for the dentist.This case report describes the simple treatment option to manage the microstomia.


   Introduction Top


Prosthetic rehabilitation will be problematic for patients with limited mouth opening. The mouth opening can be limited due to cleft lips, burns, trauma, surgical treatment of oral and facial carcinoma, scleroderma, Plummer–Vinson syndrome, oral submucous fibrosis, trismus, masticatory system damage, and temporomandibular joint dysfunction syndrome.[1] Several techniques and methods were followed from the impression technique to the final denture to manage the restricted mouth opening.[2],[3] Among this techniques sectional dentures play a major role in the management of patients with limited mouth opening. Various authors had reported the use of sectional dentures and had overcome the difficulty of patients.[4] Hence, this case report describes the technique and method of making split movable complete dentures for an edentulous patient with limited mouth opening.


   Case Report Top


A female patient aged 74 years was reported to the Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu. Her chief complaint was missing teeth in her upper jaw and lower jaw for the past 6 years, and she wanted her missing teeth to be replaced by fabrication of complete denture [Figure 1].
Figure 1: Preoperative image

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On examination, it was found that the patient had reduced mouth opening of 25 mm. The cause of restricted mouth opening in this case seems to be developmental, and all the other causes were ruled out from the medical and dental history. Hence, the treatment plan was made to provide sectional maxillary and mandibular impression procedures and followed with fabrication of hinged maxillary and mandibular sectional complete dentures. The consent from the patient was obtained for the above treatment before the procedure was made. The technique described in this case report is a cheaper choice as compared to other expensive attachments, as we used acrylic denture base to construct the sectional denture. The patient agreed to this treatment plan as it is a very cost-effective technique.

Procedure

  • The primary impression was made with impression compound (Pyrex, India) using small size edentulous stock tray (SS impression tray, India). For maxillary impression, the stock tray was sectioned into two parts in the mid-region [Figure 2], whereas the mandibular impression was made without sectioning after disinfection [Figure 3]. The primary cast was poured with dental plaster (Gemstone, India)
  • Wax spacer (Pyrex, India) of 2-mm thickness was prepared over the primary cast, and special trays were fabricated with self-cure acrylic resin (DPI Heat Cure, India) over the primary cast
  • The special trays were sectioned into two parts in the middle and the stainless steel press buttons (Geox press button, India) with the female part attached on either side of section on the palatal area of the outer surface of the maxillary special tray [Figure 4]. Moreover, the male portion of the buttons was placed on the female portion once they obtain the snugly fit separation medium applied around the acrylic part near the button, and later, the self-cure resin was manipulated to a bar form and secured over the button [Figure 5]. Once the curing was completed, the resin bar can be removed along with the male part of the button. This helps later to secure the tray
  • In the mandibular special tray, the section was made in the midline passing through the middle of the handle, and the stainless steel button male part attached to one part and female part attached to the other part [Figure 6]
  • Border molding was performed for maxillary and mandibular special trays in sections with low-fusing compound (DPI, India). The final impression was made with elastomeric impression material (Aquasil, Dentsply, USA) [Figure 7] and [Figure 8]
  • The sectioned trays were secured by locking the press buttons
  • The secondary cast was prepared using dental stone (Gemstone, India)
  • Sectioned denture bases were fabricated and rejoined in the midline using nylon strips (KM Traders, India) [Figure 9] and [Figure 10]
  • Wax occlusal rims (Pyrex, India) were fabricated for the maxillary and mandibular arches, and jaw relation was recorded [Figure 11]
  • Teeth arrangement was done by acrylic teeth (Acryrock, Ruthinium, Italy). Moreover, try-in was performed in the patient's mouth [Figure 12]
  • During wax-up, slots were prepared on the palatal surface of the maxilla and on the lingual surface of the mandible to engage the hinges
  • Flasking and dewaxing were done in conventional method. After dewaxing, the stainless steel butt hinges (Movado, USA) were maintained in the counter with cyanoacrylate resin
  • After that, separating media was applied except the hinges and processing was carried out using heat cure acrylic resin (DPI Heat Cure, India) by conventional method. After processing, the dentures were retrieved, finished, and polished [Figure 13] and [Figure 14]. After final polishing, the maxillary denture base was split in the midline and the posterior palatal seal was maintained in the maxillary denture by continuing the midline section till the last molar, and a horizontal section was continued from the midline toward the right side beyond the last molar that was around 8 mm before the posterior palatal seal area
  • For the mandible, the split was made on the midline. Denture insertion was carried out in the patient's mouth [Figure 15]. The patient was educated regarding the insertion and removal of dentures. Post insertion instructions were given to the patient to maintain the dentures
  • The patient was recalled for review after 24 h to check the maintenance and adaptability of the patient with the dentures. Further follow-up was carried out at the interval of 1 week and after every 3 months for 1 year. The patient's response to the dentures was satisfactory and good.



   Discussion Top


Various authors had explained different techniques in the literature for the fabrication of sectional complete dentures using various methods and mechanisms for joining the sectioned dentures for managing microstomia patients. According to McCord et al., the sectioned dentures were secured by stainless steel post,[5] whereas Cheng et al. used a sectional impression tray technique for making impression, and the authors customized the hinge for joining the sectioned removable mandibular complete denture.[6] Suzuki et al. customized a telescopic system with Co–Cr–Ti alloy using cast on technique.[7] Various other mechanisms were used such as acrylic resin dovetail connections, lingual and palatal midline hinges, cast iron–platinum magnetic attachment, press buttons, bolt and pin locking levers, and acrylic resin block with parallel pins.[8],[9],[10] However, in this case report, two stainless steel butt hinges of 0.5-mm thickness and 5-mm width were placed in the maxillary denture in the midline: one in the anterior palatal area and the other near the junction of vertical and horizontal section made 8 mm before the posterior palatal seal area. The posterior seal was maintained in the maxillary denture by continuing the midline section till the last molar, and a horizontal section was continued from the midline toward the right side beyond the last molar. In the mandibular denture, a hinge of 0.5-mm thickness and 2.5-mm width of stainless steel hinge was placed in the anterior part of the lingual surface. Hence, when surgeries or active open devices are not able to manage microstomia, then modified impression techniques and modified design of prosthesis can facilitate the rehabilitation in microstomic patients. Hence, this can provide better function, esthetics, health, and on the whole, the well-being of the patient.
Figure 2: Sectioned maxillary primary impression

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Figure 3: Mandibular primary impression

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Figure 4: Maxillary special tray with press button female component

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Figure 5: Assembled maxillary special tray with press button male component

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Figure 6: Assembled mandibular special tray

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Figure 7: Maxillary border molding and secondary impression

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Figure 8: Mandibular border molding and secondary impression

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Figure 9: Maxillary denture base with nylon strip

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Figure 10: Mandibular denture base with nylon strip

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Figure 11: Jaw relation in the patient's mouth

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Figure 12: Wax trial

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Figure 13: Processed maxillary denture

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Figure 14: Processed mandibular denture

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Figure 15: Postoperative view

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   Conclusion Top


The conventional prosthetic management in the completely edentulous patients will be disturbed by the minimal mouth opening (when the opening is less than the normal opening 35–40 mm). Hence, to overcome the clinical difficulties of limited mouth opening, a cautious treatment planning and designing of the prosthesis using modified impression technique and modified sectional dentures can be advocated. The major advantages of this technique are simplified tray design, ease in fabrication, nonusage of convoluted machineries, or joining devices. The press buttons and the stainless steel hinges are easily available and are easy to maintain. Even this technique has its own disadvantages such as increased time, materials, and patient appointments. However, the long-term success was obtained by periodic review, maintenance, and patience acceptance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Satpathy A, Gujjari AK. Complete denture in a microstomia patient. J Clin Diagn Res 2015;9:ZD16-8.  Back to cited text no. 1
    
2.
Kumar S, Arora A, Yadav R. Foldable denture: For microstomia patient. Case Rep Dent 2012;2012:1-3.  Back to cited text no. 2
    
3.
Sharma A, Arora P, Wazir SS. Hinged and sectional complete dentures for restricted mouth opening: A case report and review. Contemp Clin Dent 2013;4:74-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Watanabe I, Tanaka Y, Ohkubo C, Miller AW. Application of cast magnetic attachments to sectional complete dentures for a patient with microstomia: A clinical report. J Prosthet Dent 2002;88:573-7.  Back to cited text no. 4
    
5.
McCord JF, Tyson KW, Blair IS. A sectional complete denture for a patient with microstomia. J Prosthet Dent 1989;61:645-7.  Back to cited text no. 5
    
6.
Cheng AC, Wee AG, Morrison D, Maxymiw WG. Hinged mandibular removable complete denture for post-mandibulectomy patients. J Prosthet Dent 1999;82:103-6.  Back to cited text no. 6
    
7.
Suzuki Y, Abe M, Hosoi T, Kurtz KS. Sectional collapsed denture for a partially edentulous patient with microstomia: A clinical report. J Prosthet Dent 2000;84:256-9.  Back to cited text no. 7
    
8.
Prasad R, Bhide SV, Gandhi PV, Divekar NS, Madhav VN. Prosthodontic management of a patient with limited mouth opening: A Practical Approach. JIPS 2008;2:83-6.  Back to cited text no. 8
    
9.
Prithviraj DR, Ramaswamy S, Romesh S. Prosthetic rehabilitation of patients with microstomia. Indian J Dent Res 2009;20:483-6.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Kumar B, Fernandes A, Sandhu PK. Restricted mouth opening and its definitive management: A literature review. Indian J Dent Res 2018;29:217-24.  Back to cited text no. 10
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15]



 

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