- Patients may present with small mouths, or limited mouth opening due to trauma, surgical interventions, sclerodermia, scars or muscular and Temporo-mandibular disorder (TMD).
- Limited access due to a small mouth or due to limited mouth opening is an important diagnostic factor when treating patients with dental implants in the posterior region.
- In the anterior region limited access does not usually interfere with regular treatment.
Most patients’ mouth opening readily permits access for routine prosthodontic and surgical treatment interventions. Limited mouth opening or microstomia is encountered in patients with a small mouth and patients exposed to sclerodermia, diffuse systemic sclerosis, oro-facial trauma or surgical resections for neoplastic disease, temporo-mandibular disorder (TMD).
Limited mouth opening results in limited access for surgical and prosthetic treatment, including dental implants. Therefore, information about mouth opening is an important diagnostic factor when treating patients with dental implants in the posterior region. In the anterior region, limited access does not usually interfere with regular treatment.
One cannot provide a lower limit for a mouth opening which would prevent from choosing an implant-based rehabilitation. To rehabilitate a patient with limited access different techniques (mostly tips and tricks) have been described; however mostly addressing impression techniques for full arch prostheses. The labial orientation of the implant axis, subsequently compensated by angulated abutments or superstructures, can provide a solution to the access difficulties. However, for single-tooth therapy this angulation is not always an option because neighbouring teeth can hinder proper equipment handling.
Before treatment starts, one should carefully acquire all information necessary if treatment can be carried out successfully, including possibilities for maintenance. When in doubt, one should refrain from dental implant treatment and consider other, less invasive, treatment options or perhaps perform no treatment at all.