The document discusses microstomia, a condition where the oral opening is reduced in size either congenitally or acquired, compromising aesthetics, nutrition and quality of life. It then describes a case study where a custom hinged and locking prosthesis using rapid prototyping was created for a patient with severe microstomia from facial burns. Impressions were made using sectional trays and a mandibular framework was cast with a retentive mesh. The prosthesis improved masticatory function and the patient was reviewed for adjustments. Alternative treatment options and challenges with microstomia cases are also outlined.

1. The Journal of Prosthetic Dentistry
Year- 2018
Volume-119
Issue-6
Page No’s- 887 to 892
Ibrahim Tulunoglu (DDS, PhD), Meng Huan Lee (DMD), Mohammed
Louay Taifur (DMD, MS,c) and Ozlem Tulunoglu (DDS, PhDd)

3. Microstomia is the term used to describe a
congenital or acquired reduction in the size of
the oral aperture that is severe enough to
compromise aesthetics, nutrition, and quality of
life.

4.  Congenital
1. Systemic scleroderma
2. Freeman sheldon syndrome
 Acquired
1. Facial Burns
2. Post radiotherapy
3. Direct physical trauma to masticatory muscles or
TMJ.
Gulses A. Microstomia: a rare but serious oral manifestation of inherited
disorders. In: Ikehara K, ed. Advances in the study of genetic disorders.
Rijeka: InTech; 201. p. 449-72

5.  Congenital
1. More than 30% scleroderma cases show
microstomia.
 Acquired
1. 3.7 to 10.8% cases of facial burs result into
microstomia.
Gulses A. Microstomia: a rare but serious oral manifestation of inherited disorders. In: Ikehara K,
ed. Advances in the study of genetic disorders. Rijeka: InTech; 201. p. 449-72

6.  Age- 58 years old
 Sex – male
 H/O- Patient gives history of accidental burns
involving perioral tissues, nose and hands
 Clinically-
1. Limited elasticity & scaring of perioral tissues
2. Restricted mouth opening 30 X 37mm
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

7.  Diagnostic maxillary and mandibular casts were obtained by
using pediatric impression trays (Redi-Lok impression tray;
Masel) with alginate impression material (Jeltrate Alginate;
Dentsply Sirona).
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

8.  Sectional impression trays
were fabricated from a
light-polymerizing tray
material with reference
pivots in the maxillary tray
and a reference screw in
the mandibular sectional
tray
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

9.  Border molding was done with heavy-body polyvinyl
siloxane material (Imprint by 3M Dental), each section was
loaded with light-body polyvinyl siloxane material to make
the final impression
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

10.  A mandibular record base with a
custom hinge
and a conventional maxillary record
base were made.
 Teeth arrangement and clinical
evaluation of the same was done.
 A polyvinyl siloxane putty index was
prepared on the tooth arrangement to
record the positioning of the artificial
teeth on the definitive
prosthesis.
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

11.  A plastic resin pattern of the retentive mesh for the
mandibular cast metal framework was fabricated on the
scanned and digitized model by using CAD-CAM
 A custom-made pattern of the hinge, swinging arm, and lock
was prepared and casting was done.
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

12.  After the cast framework was returned from the laboratory
the same putty index was used to arrange the teeth.
 The denture bases were processed, and the swinging arm
and mandibular left canine were replaced with
autopolymerizing acrylic resin.
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

13.  The interarch relationship and occlusion were verified, and
the dentures were delivered.
 The patient was recalled at 24 hours, at 1 week, and at
3 months for minor adjustments.
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

14.  Magnetic attachments
 Prefabricated Hinges

15.  Snap Button type of attachment
 Hinge and calsps type of design (3 unit)

16.  Simple wire and band type of attachment
 Valpalst Flexible dentures for partially edentulous cases

17.  In microstomia interincisal distance is less than 40mm or
interlabial distance is less than 45mm
 Post surgical mouth exercises can improve the mouth
opening in burns patients.
 The use of sectional trays and record bases may be
essential to obtaining accurate impressions.
 Foldable prosthesis can increase the ease of denture
insertion in patients with restricted mouth opening.
Ibrahim Tulunoglu et al, Restoring masticatory function in a patient with severe microstomia using
rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92

18.  Ibrahim Tulunoglu et al, Restoring masticatory function in a patient
with severe microstomia using rapid prototyped mesh and a
custom-made hinge and swing-lock prosthesis, J Prosthet Dent
2018;119:887-92
 Gulses A. Microstomia: a rare but serious oral manifestation of
inherited disorders. In: Ikehara K, ed. Advances in the study of
genetic disorders. Rijeka: InTech; 201. p. 449-72
 Motamedi MHK, Heydari M, Heydari M, Ebrahimi A. Prevalence
and pattern of facial burns: a 5-year assessment of 808 patients. J
Oral Maxillofac Surgery 2015;73:676-82