Management of Edentulous Microstomia Patient: A Case Report and Classification System

Table 1

Classification systems based on diagnosis and management for microstomia patients.

Class	IOA severity	Vertical mouth opening	Accessibility/visibility	Treatment options	Prosthetic fabrication difficulty	Manual dexterity
DM-1	Mild	Minimally compromised: 31-35 mm	(i) Denture-bearing areas of the mouth are fully accessible and visible; (ii) Impressions and JRR can be recorded easily	(i) Conventional removable dentures; (ii) Implant-supported prosthesis; (iii) Flexible dentures	Not technique sensitive	Adequate
DM-2	Moderate	Moderately compromised: 21-30 mm	(i) Denture-bearing areas of the mouth have moderately compromised accessibility and visibility; (ii) Moderately difficult to record impressions and JRR (modification of the tray/technique is required)	(i) Surgical correction; (ii) Prosthodontic mx: (1) Implants supported/retained prosthesis; (2) Flangeless prosthesis; (3) Sectional complete removable dental prostheses—various cross pins, bolts, attachments, buttons, and Lego pieces can be used for the locking mechanism; (4) Swing lock denture with cobalt-chromium framework	Moderately technique-sensitive design, moderately skilled lab/technician required	Fair
DM-3	Severe	Substantially compromised: 10-20 mm	(i) All the denture-bearing areas of the mouth have substantially compromised accessibility and visibility; (ii) Extremely difficult to record impressions and JRR	(i) Surgical correction; (ii) Prosthodontic mx: Sectional collapsible complete removable dental prosthesis	Highly technique-sensitive designs, highly skilled lab/technician required	Poor
DM-4	Extreme	Severely compromised: <10	(i) Denture-bearing areas hardly visible; (ii) Impressions and JRR are not possible	Prosthetic rehabilitation not possible	—	—

DM = diagnosis and management; IOA = index of oral access; mx = management; JRR = jaw relation record; flexible trays = sectional impression trays using die pins, sectional trays with interlocking-type handle or manually dispensing silicone putty.