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Int Poster J Dent Oral Med 9 (2007), No. 4     15. Dec. 2007

Int Poster J Dent Oral Med 2007, Vol 09 No 04, Poster 382

Prosthetic rehabilitation of a patient with scleroderma- induced microstomia

A clinical report

Language: English

Authors:
Anca Jivanescu, DMD, PhD Assistant Prof., Departement of Prosthodontics
Dorin Bratu, Professor
Meda Negrutiu, Lecturer
Faculty of Dentistry, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania

Date/Event/Venue:
12-14 April
12 th Congress of the Bass

Poster Award
Istanbul, Turkiye

Introduction

Scleroderma is a multi-system connective tissue disease that may induce facial region's bone resorption which hampers the normal mouth aperture. Nutrition and hygiene problems, with effects on the oral mucosa and dentition, often result. The limited mouth aperture complicates adequate dental treatment.

Objectives

A 50 year old female patient presented at the Faculty of Dentistry Timisoara, Departement of Prosthodontics with an advanced stage of scleroderma. She was completely edentulous at the maxilla and was asking for a complete denture. Clinical examination revealed a rigid face , with reduced vertical dimension of occlusion and severe skin and mucosal fibrosis. The muscular tonus was decreased, the cheek is in tension, the lips presented reduced mobility. (Fig.1) The hands presented typically deformation for these illness with presence of the Raynaud phenomenom, which causes locomotor handicap.(Fig.2) The maximum intercomisural diameter with open mouth was 38mm, and the amplitude of the opening was 18mm.?(Fig.3) Intraoral examination revealed a ridge with average size and retentivity.

Fig.1. Facial appearance of the patient before treatment Fig.2 Specifically deformation of the hands and fingers

Fig.3. Reduced mouth opening(microstomia)

Material and Methods

After a rigorous clinical examination, the therapeutic decision was for a flexible maxillary complete denture, as a long lasting provisionally prosthetic solution. The preliminary impression was realized with a sectorial impression technique. A standard tray was used, which was sectioned in the middle with a disc(No 946.104 Komet, Brasseler, Gmbh) and two alginate sectorial impressions(Palgaflex Kulzer) were taken. Afterwards the palatine vault was marked with putty silicon( Zetaplus-Zhermack).(Fig.4) The preliminary impression required adjustements, after which the first individual tray was made. A fluid silicon(Oranwash-Zhermack) impression was taken, without being able to border molding.(Fig.5). The impression served to create a more adaptable individual tray of a smaller size. After the border molding and impression taking the final model was poured (Fig.6). The intermaxillary relationships were taken with ocluzal rims only in the frontal area because the opposite arch was a shortened dental arch. The technical steps for the fabrication of the flexible complete denture were: the flasking and thermoplastic injecting, using the Injektor R3-C machine, and Flexite plus material from the Flexite Company(Fig.7,8). The temperature regime was 238 C degrees for 20 minutes, and the injecting was for 3 seconds at 7,2atm. The flexible complete denture has a small flexibility degree but still allows insertion and removal with no difficulty into the oral cavity.(Fig.9) After the insertion of the complete denture, the facial appearance of the patient was considerably improved .(Fig.10). The patient was instructed to have regular follow -ups and to maintain her oral hygiene.


Fig.4. Preliminary sectional impression Fig.5. Final impression

Fig.6. Final cast Fig.7.Try-in

Fig.8. Falsking and injecting the try-in Fig.9. The Injektor R-3C

Fig.10. The Flexite Plus complete denture Fig.11. Facial appearance of the patient after prosthetic rehabilitation


Results

After a 6 month period of accommodation, the patient was recalled in order to complete the long term prosthetic rehabilitation with a complete denture with metallic frame and hinge on the medial line. Unfortunately, because of the severe complications from the scleroderma, the patient was not able to complete the treatment.

Conclusions

Severe reduce of the oral cavity opening of the patients with systemic scleroderma is challenging for the prosthetic rehabilitation. This poster presented clinical and technical steps involved in fabrication of a flexible complete denture in case of a female patient with scleroderma induced microstomia .

Literature

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This Poster was submitted by Anca Jivanescu, DMD, PhD Assistant Professor.

Correspondence address:
Anca Jivanescu, DMD, PhD Assistant Professor
Departement of Prosthodontics
Faculty of Dentistry
University of Medicine and Pharmacy "Victor Babes"
Anghel Saligny str. No.17
300588 Timisoara
Romania
tel./fax: 0040256463314