-:- Brief reports of: clinicalprocedures in treatment ofindividualpatieuts
A sectional complete denture for a patient with microstomia
J. F r a s e r McCord, D.I).S., B.D.S., F.D.S., D.R.D., R.C.S.Ed.,* K e n n e t h W. T y s o n , B.D.S., F.I),S., R.C.S.,**
and I a n S. Blair***
University ~>t'Edin:)urgh. Edinburgh, Scotland
F o r many patients with orofacial malignancies, com-
bined clinics of oncoli)gists, oral surgeons, and prosthodon-
fists should determine t r e a tm e n t plans with the patients'
well-being in mind. On ~ome occasions, however, the prosth-
odontist is not consulted before surgical treatment.
This clinical report outlines such a situation and high-
lights a successful option in the prosthodontic treatment of
an edentulous patient with surgically-induced microstomia_
TREATMENT PROCEDURES
The patient was a 50 y e a r - o l d edentulous woman who had
been edentulous for 20 years and had worn complete
dentures successfully. Three months previously the patient
had undergone surgery for the removal of a squamous cell
carcinoma in the left cheek near the angle of the mouth. Ra- F i g . 1. I,eft side of face shows scarring near left angle of
diation therapy was administered postoperatively. Healing mouth.
was uneventful except f~)r some scarring on the left cheek and
a surgically induced microstomia (Fig. 1) that precluded in-
sertmn of the patient's dentures. The patient was referred to pilla and palatal raphe with 1.5 mm tinfoil (corresponding to
the Prosthetic Department to see whether some form of res- the junctional area (if the sectional tray). The maxillary oc-
toration could be made. clusiim rim and try-in were accomplished conventionally,
Plaster was poured b:to the ti:~sue surface of the patient's except that they were sectioned in the rc idline.
maxillary dent(ire to obtain a cast on which sectmnal trays The completed sectional denture was designed in two
could be made. (If the dentures contain tissue surface halves; with the left side fitting into a bevelled recess in the
undercuts, a denture duplication technique 1 using elasto- right side to give a more accurate location. Both halves were
merle impression materials may be used to obtain a mold of joined rigidly by a stainless steel post that inserted into three
the fitting surface.) tubes within the complete denture palate (Figs. 3 and 4). The
A maxillary .~ectiona~ impression tray (Fig. 2) was made post, which was removable, was attached to the right max-
and a master cast was poured from the assembled final im- illary incisor, which served both as a toolh and as a handle
pression. A duplicate c:~st was relieved over the incisive pa- for the posl. The technique was as follows.
The right side of the denture contained a recess to accom-
modate an extension of the left side (Fig. 3). The right side
*Lecturer, Department ol Prosthetic Dentistry. was ttasked and packed first_ Before this was done, the left
**Senior Lectur(.r, Department of Prosthetic Dentistry. half of the wax try-in was removed and two sections of
***Chief Techni,:ian, l)epartment (~f"Prosthetic Dentistry. stainless stc~el tubing (1 mm internal diamel~er) were posi-
A ( ' L I N I C A L R E P O R T should be no longer than three to four double-spaced,
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T H E J O U R N A L OI,' P R O S T H E T I C D E N T I S T R Y 645
MCCORD, TYSON, AND B L A I R
F i g . 4. View of finished denture.
F i g . 2. Sectional trays: section B "locks" into section A in
keyed recesses (arrows).
F i g . 5. Assembly of denture. Stainless steel post attached
to right central incisor fits into tubes on right and left halves
of denture to secure two halves together.
A dental stone cast was poured and the left side of the
denture was waxed up on this cast. Thereafter it was flasked,
packed, and finished.
When both halves of the denture were assembled, a chan-
nel was removed from the projection of the left section of the
F i g . 3. Plan of sectional denture. LHS, Left hand side; denture and stainless steel tubing 1 m m in internal diame-
RHS, right hand side. ter was positioned so t h a t it was in line with the two tubes
of the right section as determined by the anteriorly inserted
post (Figs. 3 through 6).
tioned in the waxwork of the right side of the try-in (Fig. 3), The socket of the right central incisor was relieved with
aligned with 1 m m stainless steel wire t h a t passed through 0.001 inch tin foil. The stainless steel post had an anterior
the center of the right central incisor tooth space. To ensure retentive loop to provide retention for the central incisor,
the stability of these tubes during wax removal and process- which was attached with tooth-colored autopolymerizing
ing, two stainless steel wires were soldered at right angles to acrylic resin. The tinfoil was removed after curing.
each of the tubes. These wires would be e m b e d d e d in plas-
DISCUSSION
ter during processing, thus ensuring t h a t the tubes did not
move during flasking. After deflasking and finishing of the The manufacture and use of sectional trays have been de-
right side, the soldered stainless steel wires were cut off. The scribed by Arcuri et al. 2 and complete dentures incorporat-
polished semidenture was replaced on the master cast and ing obturators have been made in sectional form. Only S m i t h
duplicated by using reversible hydrocolloid (CROFORM, et al. ~ reported a sectional denture as an aid for repaired
Davis Schottlander & Davis, London, England). maxillofacial defects. In essence, this contained two, two-
646 J U N E 1989 V O L U M E 61 NUMBER 8
SECTIONAL COMPLETE l) ENTURE
mouth. In other circumstances, the opposite side could be
used.
Providing a complete maxillary denture served two pur-
poses; (1) it restored self-esteem in a patient who was
embarrassed by her inability to use a conventional denture,
and (2) the use of a tissue-conditioner helped to alleviate her
postradiation palatal mucositis.
Although no mandibular denture wa,,, provided, the pa-
tient was able to function adequately.
We thank Mrs. H. Breakell for her assistance in the preparation
of this manuscript.
REFERENCES
F i g . 6. Frimta] view with denture in place in patient's
I. Duthie N, Lyon FF, Yemm R. A copying t e c h r i q u e for replacement of
mouth.
complete dentures. Br Dent J 1978;147:248-52.
2. Arcuri MR, mike L, Deets K. Maxillary sectional impression t r a y
technique for microstomic patients. Quintessence Dent Technol
studded (left and right) sections with a joining acrylic resin ] 986;10:627 9.
3. Smith PG, Muntz HR, Thawley SE. Local myocutaneous a d v a n c e m e n t
overlay to solidly connect the four studs. This technique re- flaps. Alternatives to cross-lip a n d distant flaps in the reconstruction of
stored esthetics but restricted tongue space. ablative lip defects. Arch Otolaryngol 1982;1(18:'714-8.
This clinical report described a sectional denture tech-
Reprint requests to:
nique that did not restrict the tongue space of the patient. DR. J. FRASER MCCORD
Within a day, the patient managed insertion and removal of UNIVERSITY OF EDINBURGH
DEPARTMENT OF PROSTHETIC DENTISTRY
her denture. The right central incisor was selected as the post
23 GEORGE IV BRIDGE
handle/removable tooth because the patient was right- EDINBURGH EH1 1 EN
handed and had normal facial tone on the right side of the SCOTLAND
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THE JOURNAL OF PROSTHETIC DENTISTRY 647
