Fabrication of Customized Sectional Impression Trays in Management of Patients with Limited Mouth Opening: A Simple and Unique Approach

Impression making is not only important but is also the most significant step in the fabrication of any fixed or removable prosthesis. Proper impression making may be hindered by certain pathologic conditions. Reduced mouth opening is one of the common mechanical obstructions for proper orientation of the impression tray in the patient’s mouth. In patients with trismus induced by submucous fibrosis, the procedure may be even more difficult to carry out because of reduced tissue resiliency and obliteration of vestibular spaces. Use of sectional trays offers one of the alternatives to overcome the problem of restricted mouth opening. Fabrication of customized impression trays according to the patient dentition improves the accuracy of impression making. The present case reports describe the fabrication of sectional custom trays designed for dentulous patients with chronic tobacco-induced submucous fibrosis. 1. Introduction Reduced mouth opening poses a challenge and is often a daunting task for the operator to perform any intraoral procedures. Reportedly, this problem has been associated commonly with orofacial cancer surgeries, scleroderma, traumatic injuries, temporomandibular joint disorders, oral submucous fibrosis, and so forth. One of the most commonly observed pathologies associated with limited mouth opening is oral submucous fibrosis. Rajendran, in 1994 [1], reported and named this condition as “atrophia idiopathica (tropica) mucosae oris” involving oral mucosa, palate, and pillars of the fauces. Later, it was termed as oral sub mucous fibrosis. It is called by various synonyms like “diffuse oral sub mucous fibrosis,” “idiopathic scleroderma of the mouth,” “idiopathic palatal fibrosis,” “sclerosing stomatitis,” and “juxta-epithelial fibrosis” [2]. The characteristic finding observed in these patients is pale mucosa with loss of elasticity and resiliency. Formation of fibrous bands in sub mucous connective tissue was reported to be the root cause behind gradual reduction in mouth opening. Prosthetic intervention for these patients entails an accurate impression of the patient’s mouth. Difficulties in impression making encountered due to reduced access to the oral cavity can be overcome by the use of sectional trays. Various types of sectional trays held together by different mechanisms have been designed and described in the literature. Present case reports describe simple and economic methods of fabrication of two-piece custom sectional trays for patients with oral sub mucous fibrosis. 2. Case Reports 45-year-old male patient and 31-year-old