Digital Workflow for a Scleroderma Patient with Microstomia: A Clinical Report

Abstract

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.

Impression technique modification and oral contracture release surgery for orthodontic treatment in a patient with severe microstomia due to recessive dystrophic epidermolysis bullosa

“…Others reports in patients with microstomia looking for oral rehabilitation, especially in scleroderma, include the use of modified impression techniques 8 and digital union of impressions taken with sectional trays. 9 In our case, our first attempt to obtain the dental cast with a customized acrylic tray produced a hemorrhagic bulla in the commissure, due to the size of the tray and the rigidity of the material. This situation was avoided with the second design, due to the flexibility of the tray given by the thermoformed sheet, the putty addition silicone, and the use of three acrylic bands instead of just one big rigid structure.…”

“…Most of the publications reporting impression techniques in patients with EB are for oral rehabilitation, including the use of flexible topical fluoride gel application tray, 12 custom made acrylic trays 13 or intraoral scanner 10 ; but none of them are used for orthodontic treatment. Others reports in patients with microstomia looking for oral rehabilitation, especially in scleroderma, include the use of modified impression techniques 8 and digital union of impressions taken with sectional trays 9 …”

“…Previous studies have described that 80% of the patients with RDEB present severe microstomia with less than 30 mm of maximal mouth opening, caused by scarring of the buccal and labial mucosa and commissures 4‐7 . Several publicatons describe modified impression techniques to obtain a dental cast from patients with microstomia, mostly patients with scleroderma requiring oral rehabilitation 8,9 . The present case reports the technique used in a patient with severe RDEB referred for orthodontic treatment with aligners.…”

“…[4][5][6][7] Several publicatons describe modified impression techniques to obtain a dental cast from patients with microstomia, mostly patients with scleroderma requiring oral rehabilitation. 8,9 The present case reports the technique used in a patient with severe RDEB referred for orthodontic treatment with aligners.…”

Digitally designed and manufactured sectional custom tray for a patient with microstomia: A case report

“…17 Utilizing CAD-CAM technology for custom tray fabrication represents an efficient, simpler way compared to conventional techniques. 13,18,19 Modification of custom tray design is necessary when it comes to patients with microstomia. Several authors have described creative techniques for fabricating sectional trays in a conventional manner.…”