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Background
An abnormally small oral orifice is called microstomia. 1 Microstomia may be caused by the surgical treatment of orofacial neoplasms, maxillofacial trauma, burns, plummervinson syndrome, trismus, temporomandibular joint disorders, cleft lips, radiotherapy, oral sub mucousfibrosis, any damage to the oral musculature or scleroderma. 2 Microstomia due to any aetiological factor presents difficulties to the prosthodontist right from the primary impression making till the insertion of prosthesis. 3
Various techniques and modifications have been proposed for the treatment of patients with microstomia. This case presents an easy and handy technique for the fabrication of custom tray and split maxillary complete denture.
Case presentation
A 63-year-old woman reported to the Department of Prosthodontics with difficulty in chewing because of loss of her teeth and wanted a replacement of the missing teeth by means of a complete denture. The patient was completely edentulous with limited mouth opening because of submucous fibrosis. Severity of oral submucous fibrosis (OSMF) was classified as S3 M3 according to OSMF classification based on clinical features and functional staging. 4 Treatment plan included final impression making with sectional custom trays and fabrication of maxillary sectional denture.
Investigations
Stage | Relevance |
CLINICAL STAGING | |
S 1 | Stomatitis and/or blanching of oral mucosa |
S 2 | Presence of palpable fibrous band in buccal mucosa and/or oropharynx with/without stomatitis |
S 3 | Presence of palpable fibrous band in buccal mucosa and/or oropharynx, and in any other part of oral cavity with/without stomatitis |
S 4 a | Any of the above stage along with other potentially malignant disorder, for example, oral leukoplakia, oral erythroplakia etc. |
S 4 b | Any of the above stage with oral carcinoma |
FUNCTIONAL STAGING | |
M 1 | Interincisal mouth opening up to or greater than 35 mm |
M 2 | Interincisal mouth opening between 25 and 35 mm |
M 3 | Interincisal mouth opening between 15 and 25 mm |
M 4 | Interincisal mouth opening less than 15 mm |
Treatment
An informed consent was taken from the patient after informing about her oral conditions and treatment modalities. Primary impressions of maxillary and mandibular edentulous arches were made using zero size perforated edentulous metallic stock tray with alginate; after disinfection procedure with iodophore, impressions were poured with type-II dental plaster and primary casts were retrieved ( figure 1 ).
On primary casts, custom...