Dental Treatment for a Patient with Pierre Robin Sequence Disease, A Case Report
Objectives: Pierre Robin Sequence (PRS), is diagnosed with a triad of retrognathia, glossoptosis, and cleft palate. PRS is usually diagnosed when a baby is born. A sixteen-year-old African American male with PRS presented to the prosthodontics clinic at NSU to receive dental treatment. His chief complaint was: “All of my teeth are broken. I need teeth for function and also to get job interviews.” According to his mother, he went through 53 surgeries during the last 16 years. Patient had all of his existing teeth severely decayed down to the gingival level, except for #12 &13 which had RCT and SSC in 2015. His vertical dimension of occlusion was collapsed. His existing teeth had a hopeless prognosis. He had a Siebert Class III ridge deficiency in the LL and LR quadrants. His periodontal diagnosis was plaque induced gingivitis with pocket depths within 2-3 mm.
Methods: After presenting all treatment options, the patient’s mother opted for maxillary and mandibular complete dentures. The patient was referred to the OMFS department to extract all remaining roots and preserve the sockets. After a three- month healing period, preliminary maxillary and mandibular alginate impressions were done. Custom trays were fabricated, border molded with green thermoplastic impression compound (Kerr), and final impressions were made with regular permlastic polysulfide (type II, Kerr). A facebow transfer and centric relation maxillo-mandibular record were done. Denture teeth mold and shade were selected in order to accomplish the denture teeth set-up wax try-in. After minor adjustments, the dentures were processed. A laboratory and clinical remount were done prior to the insertion of the dentures.
Results: Although the patient had a resorbed mandible, adequate stability of the dentures was achieved. After a number of recall appointments for adjustments, the patient was satisfied with the function, phonetics, and esthetics of the prostheses, and reported an increase in his self-confidence.
Discussion: One of the challenges of working on this patient was the fact that his mouth was very small and constricted. Pediatric trays with modifications had to be used in order to make the preliminary alginate impressions. Making the final impressions with custom trays was equally challenging. Since both arches were short in length, very small size teeth were selected. The patient suffered from xerostomia which had a negative impact in the adhesion of the denture to the soft tissue. The patient was compliant with every step of the treatment. This case was unique and different from a routine denture patient because of the patient’s micrognathia, history of cleft lip/palate and the many intraoral surgeries he had undergone to correct the defect which resulted in unusual intraoral anatomy. Unusual location of vibrating lines and also palatoglossus muscle which was attached to the tuberosity as a thick band and dislodged the maxillary denture before the adjustments.