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.