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Microstomia presents a challenge for the patient and dental provider. This report describes a partial digital workflow for the fabrication of a mandibular complete denture for a patient with microstomia. Computer‐aided design and computer‐aided manufacturing technology was utilized to 3D print a sectional custom tray with a unique design. The sectional custom tray was used to make a conventional border molded impression of the edentulous arch to fabricate a flexible complete mandibular denture for a 58‐year‐old female patient with scleroderma and microstomia. This treatment resulted in a successful prosthetic outcome and high patient satisfaction. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This study describes prosthetic rehabilitation an edentulous patient with microstomia. Maxillary preliminary and definitive impression were made by intraoral scanning and custom 2‐piece impression tray respectively to fabricate conventional denture. [ABSTRACT FROM AUTHOR]

Introduction: Epidermolysis bullosa (EB) is a group of genetic disorders characterized by fragility of the skin and mucosal membranes. Dystrophic EB (DEB) is caused by mutations in the gene coding for type VII collagen. Among the most frequent oral manifestations in Recessive DEB (RDEB) are oral ulcers and blisters, absence of tongue papillae and palatal rugae, ankyloglossia, oral vestibule obliteration, and microstomia. The following report describes a modified impression technique used in a patient with severe RDEB and severe microstomia to obtain models for orthodontic treatment with aligners. Case Report: A 25‐year‐old female patient with severe RDEB was referred for orthodontic treatment. Severe microstomia (8 mm), hindered the use of conventional trays or intraoral scanners to design the aligners. Therefore, a contracture release surgery in combination with a modified impression technique was performed to obtain an optimal impression and subsequent aligners for orthodontic treatment. Discussion: This case presents an alternative strategy to provide orthodontic treatment with aligners in patients with severe microstomia due to severe RDEB. Reports of orthodontic treatment in people living with EB, especially in RDEB, are still rare, with few publications about fixed braces, early teeth extraction and removable devices, and none using aligners. Most of the impression techniques reported are aimed at oral rehabilitation. The multidisciplinary approach and impression technique reported should broaden the alternatives of orthodontic techniques provided to patients with EB and severe microstomia. Conclusions: This article describes an oral contracture release surgery and modified impression technique for obtaining good quality impression for the design of orthodontic aligners in patients with severe microstomia due to severe RDEB. [ABSTRACT FROM AUTHOR]

Introduction: Scleromyxedema is a rare primary cutaneous mucinosis characterized by numerous firm, waxy, confluent papules. Recently, intravenous immunoglobulin (IVIG) is accepted by many authors as the first‐line treatment option for severe cases. We report a 69‐year‐old male patient who has been suffering from scleromyxedema, with reduced mouth opening. He has been on a high‐dose IVIG regime for 5 years. Methods: The patient stated that he had difficulty in wearing and removing his dentures because of reduced mouth opening lately. Before considering to add any other immunosuppressants to his regime, we injected 1500 IU of hyaluronidase in total in one session periorally. The patient has been told open his mouth maximum and photographs have been taken before injections and after one month. We used a photo measurement application when evaluating microstomia to increase accuracy. We also took punch biopsies in order to evaluate effect of hyaluronidase histopathologically before and one month after injections. Results: One month later, he was able to reattach and remove his dentures without adding any adjuvant immunosuppressants other than hyaluronidase. Mouth opening was increased in measurements and histopathologically, mucin deposition, fibroblastic proliferation, and perivascular lymphocytic infiltration were decreased. Conclusions: We think hyaluronidase is a safe, easily accessible, and effective treatment option for microstomia caused by scleromyxedema. [ABSTRACT FROM AUTHOR]

Making impressions in patients with microstomia is often rather problematic due to their restricted mouth opening. Herein, this report describes a novel digital workflow for making impressions with computer‐aided design and computer‐aided manufacturing (CAD/CAM) custom sectional trays for a 58‐year‐old female patient with scleroderma and microstomia. CAD/CAM custom sectional trays were made based on digital dentition models from another case with similar arch scale. After the sectional impressions were obtained, the sectional casts were scanned and digitally aligned to form the final dentition models. The removable partial dentures were designed on the final digital models and printed using a 3D printer. This procedure was executed with a successful prosthetic outcome that included good fit and acceptable esthetics. The patient also reported a high level of satisfaction. [ABSTRACT FROM AUTHOR]

Agnathia is a rare congenital malformation with unknown etiology characterized by absence of the mandible, microstomia, and tongue aplasia, often found to have other anomalies including holoprosencephaly. The purpose of this paper was to describe the symptoms and imaging of a case of isolated agnathia and to conduct a comprehensive literature review of reported patients with isolated agnathia. Case reports of isolated agnathia are very rare, with most infants as stillborn. We report a child's management of isolated agnathia with microstomia and tongue aplasia. A literature review was performed with focus on diagnosis, airway, and feeding management of isolated agnathia. Polyhydramnios was a common pregnancy complication reported in 25 out of the 39 patients in the case study. Five infants were stillborn, while 23 died within the neonatal period. Of the deceased infants within the neonatal period, 19 died within minutes to hours while four died within days to weeks. There are nine patients with agnathia that survived past infancy. The results of this study suggest that isolated agnathia is a rare malformation which requires a multi‐disciplinary approach for airway and feeding management. [ABSTRACT FROM AUTHOR]

Aim: To report the rehabilitation of a female patient, 40 years old, with a microstomia.Case Report: The Z-plasty surgery was performed in the region of the labial commissure to increase the mouth opening. In the mandible, two implants were installed in the interforaminal region and an overdenture with bar/clip attachment system was made. The maxilla was atrophic, with the presence of two bone sites in the intermaxillary suture region: the first one anterior to the incisive foramen and the second one in the middle of the hard palate. Two implants were placed without a graft in those sites. The conventional maxillary denture was converted into an overdenture with ball attachments system.Conclusion: Based on the presented case, with a 2-year follow-up, it can be concluded the validity of the use of the techniques of surgeries to increase the mouth opening, implants in intermaxillary suture and overdentures as rehabilitation therapy for patients with microstomia. [ABSTRACT FROM AUTHOR]

This clinical report describes prosthetic rehabilitation applied to an edentulous patient with microstomia. Intraoral scanning was used for preliminary impressions, edentulous models were printed using a 3D printer, custom 2‐piece impression trays for definitive impressions were made, and a 2‐piece collapsible maxillary and a conventional mandibular denture were fabricated. Intraoral scanning is a useful alternative to conventional impression techniques and can be used safely in patients with microstomia for preliminary impressions. [ABSTRACT FROM AUTHOR]

Background: Syngnathia is a congenital craniofacial disorder characterized by bony or soft tissue fusion of upper and lower jaws. Previous studies suggested some causative signals, such as Foxc1 or Bmp4, cause the disruption of maxillomandibular identity, but their location and the interactive signals involved remain unexplored. We wanted to examine the embryonic origin of syngnathia based on the assumption that it may be located at the separation between the maxillary and mandibular processes. This region, known as the maxillomandibular junction (MMJ), is involved in segregation of cranial neural crest-derived mesenchyme into the presumptive upper and lower jaws. Results: Here we investigated the role of Fgf, Bmp, and retinoid signaling during development of MMJ in chicken embryos. By changing the levels of these signals with bead implants, we induced syngnathia with microstomia on the treated side, which showed increased Barx1 and neural cell adhesion molecule (NCAM) expression. Redistribution of proliferating cells was also observed at the proximal region to maxillary and mandibular arch around MMJ. Conclusions: We propose that interactive molecular signaling by Fgfs, Bmps, and retinoids around MMJ is required for normal separation of the maxilla and mandible, as well as the proper positioning of beak commissure during early facial morphogenesis. Developmental Dynamics 246:28-40, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

A limited opening of the mouth is defined as microstomia. Microstomia is caused by burns, postoperative head and neck trauma, radiotherapy, or scleroderma. The prosthetic treatment of microstomia presents particular challenges, and patients often complain of an inability to insert or remove the prosthesis. The cause and severity of microstomia can influence the approach to treatment. Different treatment methods have been suggested, including the fabrication of two-piece partial dentures. This clinical report describes the construction of a sectional impression tray and a collapsed partial denture using a hinge attachment for a patient with microstomia. [ABSTRACT FROM AUTHOR]

Scleroderma is an autoimmune multisystem rheumatic condition characterized by fibrosis of connective tissues of the body, resulting in hardening and impairment of the function of different organs. Deposition of collagen fibers in peri-oral tissues causes loss of elasticity and increased tissue stiffness, resulting in restricted mouth opening. A maximal oral opening smaller than the size of a complete denture can make prosthetic treatment challenging. Patients with microstomia who must wear removable dental prostheses (RDPs) often face the difficulty of being unable to insert or remove a conventional RDP. A sectional-collapsible denture is indicated for the prosthetic management of these patients, but reduced manual dexterity often makes intraoral manipulation of the prosthesis difficult. A single collapsible complete denture is a better choice for functional rehabilitation of these patients. This clinical report describes in detail the prosthodontic management of a maxillary edentulous patient with restricted mouth opening induced by scleroderma with a single collapsible removable complete denture fabricated with heat-polymerized silicone soft liner and heat-cured acrylic resin. The preliminary and secondary impressions were made with moldable aluminum trays by using putty and light-body poly(vinyl siloxane) elastomeric impression material. The collapsed denture can be easily inserted and removed by the patient and also provides adequate function in the mouth. [ABSTRACT FROM AUTHOR]

ABSTRACT Excision of squamous cell carcinoma from the lower lip of a patient can result in limited mouth opening (microstomia). For any patients who have this condition, routine or general dentistry and prosthetic treatment is challenging. Traditional denture techniques tend to be unsatisfactory, due to the patients' reduced ability to open their mouth. The use of sectional and modified dentures and those with a small degree of flexibility has been reported to be useful for patients needing complete dentures. This case report presents a flexible denture base material that can be manipulated on insertion into a smaller shape that is half the original size and is completely flexible for insertion into a mouth that has limited opening. Once seated on the maxillary and mandibular residual ridges, the denture regains its original form and becomes firm and strong to allow the patient to function. This procedure offers a prosthodontic treatment option for a patient with microstomia. [ABSTRACT FROM AUTHOR]

A patient presenting with severe microstomia (PDI Class IV) was unable to insert a maxillary complete denture. Sectional final impressions were made using two impression materials and an interlocking custom tray. A folding record base was used for maxillomandibular relationship records. A novel folding maxillary denture with a custom hinge and plunger attachment to lock the denture in the open position was fabricated. The patient was able to insert the collapsed denture, open it intraorally, and enjoy successful masticatory function. [ABSTRACT FROM AUTHOR]

Microstomia presents a unique challenge to the patient. Patients with microstomia who must wear removable dental prostheses often face the difficulty of being unable to insert or remove the prosthesis because of the constricted opening of the oral cavity. A completely edentulous patient, who developed microstomia along with Raynaud's phenomenon induced by scleroderma, is presented. This clinical report describes a quick and easy method for fabrication of a sectional custom impression tray connected by press button and a sectional complete denture retained by magnets. A sectional denture that provides ease in placement and removal can be successfully used in clinical practice for treatment of microstomia patients. [ABSTRACT FROM AUTHOR]

Hardening of the skin around the mouth causes the oral opening to become limited in scleroderma patients. A maximal oral opening that is smaller than the size of a complete denture can make prosthetic treatment challenging. This clinical report presents the prosthodontic management of a total edentulous patient with microstomia induced by scleroderma. Sectional mandibular and maxillary trays and a collapsed mandibular denture were fabricated for the total edentulous patient. With the use of lingual midline hinge, the collapsed denture was successfully and easily inserted and provided adequate function in the patient's mouth. The cast hinge design reduced the overall costs and simplified the laboratory technique. [ABSTRACT FROM AUTHOR]

This article describes a new, precise, and simple method for making an impression with an individual tray for a patient with microstomia. In this method, a Pindex system on the handle of the tray was used for attaching two parts of the sectional tray. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Successful treatment of microstomia with UVA1 phototherapy in systemic sclerosis," by Angela Tewari, Trish Garibaldinos, and Richard Groves in the November 29, 2010 issue.