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
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
12 th Congress of the Bass
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
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
|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
|Fig.4. Preliminary sectional impression
||Fig.5. Final impression
|Fig.6. Final cast
|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
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.
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
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This Poster was submitted by Anca Jivanescu, DMD, PhD Assistant Professor.
Anca Jivanescu, DMD, PhD Assistant Professor
Departement of Prosthodontics
Faculty of Dentistry
University of Medicine and Pharmacy "Victor Babes"
Anghel Saligny str. No.17