ISSN :0975-8437

CASE REPORT
Innovative method for fabrication of sectional impression trays for a patient having microstomia
Prince Kumar, Harkanwal Preet Singh, Ashish Kumar, Chandni Jain
ABSTRACT
Prosthetic rehabilitation of microstomia patients presents difficulties at all stages as the maximal oral opening is smaller than the size of a complete denture. Several techniques have been described for use when either standard impression
trays or the denture itself becomes too difficult to place and remove from the mouth. This article describes a different
design for the fabrication of maxillary sectional trays to enable easier and efficient impression making in a patient with
limited oral opening.
Key words: Microstomia; Sectional tray; Denture; Rehabilitation

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2012 Volume 4 Issue 2

For mandibular impression procedure conventional tray was

made as it could be easily placed in the mouth by rotating the
tray 90 degrees and inserting. Border molding was done and
medium body wash impression was made. Maxillo-mandibular relations were recorded followed by try in of waxed dentures. Maxillary and mandibular complete dentures were fab-

Case Report
A 58 year old male with limited oral opening caused by scleroderma sought treatment at the prosthodontic clinic at ITS
Dental College for mandibular and maxillary dentures. On
examination he had limited mouth opening with maximum
diameter 27mm and 11.4mm circumference (Figure 1, Figure
2). Maxilla and mandible were completely edentulous and
mild xerostomia was reported. Various treatment options
were discussed and the patient agreed for the fabrication of

upper and lower complete dentures using sectional trays for

impressions as the mouth opening was restricted. Preliminary
impressions were made with irreversible hydrocolloid. Smaller
size tray was used and flanges of stock trays were adjusted to
take the impressions. Casts were poured in plaster. A special
tray with 1mm full arch wax spacer was fabricated on primary
casts. A sectional maxillary impression tray was designed with
right and left sections that could be detached and then joined
together in the correct original position. For mandibular arch
conventional trays were made. Special tray was made using
auto-polymerizing acrylic resin (Meliodent; Bayer UK Ltd.,
Newbury, United Kingdom). Using a thin cutting disk, tray was
sectioned along the midline creating two equal halves (Figure 3). A notch was placed in the handle of the left section of
the tray corresponding to projection on the right section of
the tray (Figure 4). The stiff metallic tongue blades were used.
Blades were cut of desired length and were bend on both the
end. The bent ends were lubricated with petroleum jelly and
they were placed on the tray at desired location. Auto polymerizing acrylic resin was mixed and placed on tray such that
only bent ends were completely covered by acrylic (Figure 5).
On both halves of tray two crevices were formed each, once
the tongue blades were removed (Figure 6). It was rechecked
for fit. Once tongue blade were placed there was no movement and the tray was closely approximated (Figure 7). The
placement of the crevice was such that it did not hinder with
the border molding and impression procedure. Border molding was performed for each half separately after checking
the extensions in mouth (Figure 8). For secondary impression
light body addition silicone was used. The trays were placed
in the mouth. The left tray was removed and was loaded with
impression material. The left tray was then placed back. After
the left impression, the right section of the tray was removed
loaded with material and placed in the mouth. The trays were
removed individually from mouth and were re-approximated
outside the mouth (Figure 9).

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Introduction
Microstomia is defined as an abnormally small oral orifice1
which can be due to various factors such as orofacial burns,
carcinoma, cleft lip, trauma, scleroderma, genetic disorders,
surgery, head and neck radiation, reconstructive lip surgeries,
connective tissue disease, fibrosis of masticatory muscles or
facial burns. Hardening of the skin around the mouth causes
the oral opening to become limited.2 Moreover, fibrosis of the
salivary glands results in dryness in the mouth. The literature
contains reports on the fabrication of a foldable, posterior
section with molar and premolar teeth and a second denture base on which anterior teeth were arranged.1 McCord et
al described a maxillary complete denture consisting of two
pieces joined by a stainless steel rod with a diameter of 1mm
fitted behind the central incisors.3 The different management
techniques to aid prosthetic rehabilitation include surgery but
this may leads to usual scar formation which further reduce
mouth opening.4 Prosthetic rehabilitation of these patients
presents difficulties right from the preliminary impressions to
insertion of the prostheses. In prosthetic treatment, the loaded impression tray is the largest item requiring the intra-oral
placement. During impression procedures, wide mouth opening is required for proper tray insertion and alignment which
is not possible in patients with restricted mouth opening.4,5
The overall bulk and the height of impression trays make the
recording of impressions exceptionally difficult if not impossible because the paths of insertion and removal of impressions
are compromised by lack of clearance. A modification of the
standard impression procedure is often necessary to accomplish this fundamental step in the fabrication of a successful
prosthesis. This clinical report presented a different design for
the fabrication of maxillary sectional trays for a patient with
limited oral opening caused by scleroderma.

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I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S

2012 Volume 4 Issue 2

Kumar et al

Figure1. Preoperative Restricted mouth opening (27 mm) of patient, Figure 2. Sectioned maxillary special tray Figure 3. Anterior
notch for stabilizing the tray, Figure 4 & Figure 5. Tongue blades for posterior stabilization of tray, Figure 6. Crevices for tongue
blade, Figure 7 & Figure 8. Sectioned maxillary special tray, Figure 9. Separately border molded sections of the tray, Figure 10 &
Figure 11. Maxillary secondary impression in light body addition silicone, Figure 12. Completed dentures.
ricated using conventional technique & delivered to patient
(Figure 10). At the insertion appointment patient was instructed about the insertion and removal of dentures. Oral hygiene
instructions were reinforced and Periodic recall appointments
were scheduled.
Discussion
Scleroderma is an autoimmune multi-systemic disease associated with vascular abnormalities, connective tissue sclerosis
and autoimmune changes. Almost all patients have vascular
symptoms that usually predate the development of the fibrotic connective tissue change. Oral manifestations of scleroderma include: microstomia, xerostomia, periodontal disease,
widened periodontal space, and bone resorption at the angle
of mandible.6 Limited oral opening can pose a major dental
problem and the general difficulties of reduced access becomes even more apparent when providing prostheses. The
overall bulk of the height of impression tray makes recording
impression exceptionally difficult if not impossible because
the paths of insertion and removal of impressions are compromised by the lack of clearance. Various pins, bolts, and Lego
pieces have been used for the locking mechanism of sectional

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impression trays fabricated for patients with limited oral openings.7,8 A sectional stock tray system for making preliminary
impressions was described by Luebke.9 Impression making
using sectional trays may be easier for patients with constricted oral openings because the two halves can be inserted independently, removed separately and reassembled extra orally.
Improved fit of the tray was possible for the individual dental
arch because the two halves separately fitted to each side of
the arch thus achieving better anatomical adaptation to the
soft tissues. Several stock and custom tray designs have been
described in literature.9,10 Sectional impression trays have
been fabricated using: Recesses, Orthodontic screws, Lego
blocks (Lego systems inc., Enfield, CT), Dowel plug holes and
a screw joint for rigid connection, Locking levers, Interlocking
tray segments, Flexible impression tray with silicone putty.
Most important requisite when sectional trays are used is
provision of mechanism which can aid accurate adaptation
and stability of the two section of the tray to each other intraorally and extra orally. Also the technique used should not be
complicated and should allow easy manipulation and should
decrease patient trauma. Anterior and posterior lock is both

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Innovative method for fabrication of sectional impression trays

important for better stability. The given technique for sectional tray fulfills all these criteria. Presence of interlocking in the
handle aid in anterior re-approximation whiles the tongue
blade help in posterior re-approximation and stability. Also
this technique is easy and requires less chair side time for fabrication. However, this design of the connection line along the
midline of the foldable pieces of the tray helped ensure stability between them.

10. Ohkubo C, Ohkubo C, Hosoi T, Kurtz KS. A sectional stock

tray system for making impressions. The Journal of prosthetic
dentistry. 2003;90(2):201-4.

Conclusion
Making impressions is an important step in construction of
complete denture. It is more challenging in microstomia patients. However, use of sectional special tray can be beneficial
and should be advocated whenever the need arises.

Address for Correspondence

Dr. Prince Kumar MDS,
ITS Dental College,
Ghaziabad,
Uttar Pradesh, India.
Email: poojagupta20032007@gmail.com

References
1. Prithviraj D, Ramaswamy S, Romesh S. Prosthetic rehabilitation of patients with microstomia. Indian Journal of Dental
Research. 2009;20(4):483.
2. Benetti R, Zupi A, Toffanin A. Prosthetic rehabilitation for a
patient with microstomia: a clinical report. The Journal of prosthetic dentistry. 2004;92(4):322-7.
3. Fraser McCord J, Tyson KW, Blair IS. A sectional complete
denture for a patient with microstomia. Journal of Prosthetic
Dentistry. 1989;61(6):645-7.
4. Cura C, Serdar Cotert H, User A. Fabrication of a sectional
impression tray and sectional complete denture for a patient
with microstomia and trismus: a clinical report. The Journal of
prosthetic dentistry. 2003;89(6):540-3.

5. Baker PS, Brandt RL, Boyajian G. Impression procedure for

patients with severely limited mouth opening. The Journal of
Prosthetic Dentistry. 2000;84(2):241-4.

2012 Volume 4 Issue 2

6. Langer Y, Cardash HS, Tal H. Use of dental implants in the

treatment of patients with scleroderma: a clinical report. The
Journal of prosthetic dentistry. 1992;68(6):873.
7. Suzuki Y, Abe M, Hosoi T, Kurtz KS. Sectional collapsed denture for a partially edentulous patient with microstomia: a clinical report. Journal of Prosthetic Dentistry. 2000;84(3):256-9.
8. Fernandes AS, Mascarenhas K, Aras MA. Custom sectional
impression trays with interlocking type handle for microstomia
patients. Indian Journal of Dental Research. 2009;20(3):370.
9. Luebke RJ. Sectional impression tray for patients with constricted oral opening. The Journal of prosthetic dentistry.
1984;52(1):135-7.

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Authors Affiliations
1. Prince Kumar MDS, 2 Harkanwal Preet Singh MDS, 3. Ashish
Kumar BDS, Postgraduate Student, ITS Dental College, Ghaziabad, Uttar Pradesh, 4. Chandni Jain MDS, Private Practitioner,
Jabalpur, Madhya Pradesh, India.

How to cite this article

Kumar P., Singh H.P., Kumar A., Jain C.: Innovative method for
fabrication of sectional impression trays for a patient having
Microstomia.Int. J. Dent.Clinics. 2012;4(2): 57-59.

Source of Support: Nil

Conflict of Interest: None Declared

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