Discussion
For the examined patient, the preliminary maxillary impression was made
with intraoral scanner, which is challenging issue in edentulous arches
due to record displaceable soft
tissues(8). During scanning procedure,
there are some difficulties in capturing the frenula and vestibular
sulcus, in stitching separate pictures because of the insufficient
landmarks such as remaining teeth and the great data file size after the
completion of the edentulous maxillary arch scan
(11). This method has some advantages in
comparison to PVS without trays for the preliminary impressions. The
weight of gypsum may be destroyed impression while pouring the cast and
imprecise cast may not reflect the soft tissues accurately that will
have a negatively effect on retention and stability of definitive
prosthesis (8). Kim et al applied
intraoral scanning for definitive impression to a patient with an
excessively tight reconstructed lip. Digitalization of the complete
denture fabrication process can simplify the complicated treatment and
laboratory process of the conventional methods
(12). In our report, the intraoral
scanning was only used for the preliminary impression, while sectional
trays applied for definitive ones. This allowed lengthening the tray
borders to the vestibular depth and functionally register peripheral
tissues by border molding. ZOE impression paste used as the final
impression material in order to facilitate assembling of tray sections
after removing from the mouth. Saygili et al. used both digital and
conventional techniques for the edentulous patient with microstomia. A
collapsible denture base for the posterior and a rounded triangular one
for the anterior region with stud attachment were fabricated for the
maxilla (8).
In the present report, commissuroplasty surgical intervention and mouth
stretching exercises which have been recommended by Naylor
(13), facilitated the treatment process.
The patient’s malformed hands did not allow the use of collapsible
denture base. In the try-in appointment, the patient was educated and
she was able to insert interim integrated denture bases in her mouth by
rotating it 90˚. Thus, conventional complete denture was fabricated as
the definitive restoration. Integrated denture base found to have
several advantages for the patient such as good retention and stability
compared to the sectional dentures, easy manipulation particularly for
patient with disabled hands, less price and good maintenance. Accurate
recording of mobile soft tissues for final impressions of edentulous
arches will allow us be a step closer to a fully digital complete
denture fabrication workflow(8).
Conclusion
Adjunct therapies can be implemented prior to the fabrication of
complete dentures in patients with microstomia. Intraoral scanners can
be also used in patients with an excessive gag reflex or allergic
reactions to the impression materials or microstomia patients.
Consent statement
Written informed consent was obtained from the patient to publish this
report in accordance with the journal’s patient consent policy.
Conflicts of Interest
The authors declare no conflict of interest.