Keni NN, Aras MA, Chitre V Customised attachments retained cheek plumper prosthesis: a case report. J Indian Prosthodont Soc. 2012; 12:198-200 https://doi.org/10.1007/s13191-012-0132-y
Vivek J, Sweta K, Manisha K Cheek plumper denture for ‘sunken cheeks’. Int J Multidisciplinary Health Sci. 2014; 1:24-27
Virdiya NM, Palaskar JN, Wankhade J, Joshi N Detachable cheek plumpers with different attachments for improving esthetics in a conventional complete denture: a clinical report. J Prosthet Dent. 2017; 117:592-596 https://doi.org/10.1016/j.prosdent.2016.08.0211
Chandrasekar V, Singaravel Chidembaranathan A, Muthukumar B Cheek plumper: an instant, noninvasive face-lifting prosthesis – a case report. Sci Dent J. 2022; 6:152-155 https://doi.org/10.4103/SDJ.SDJ_33_22
Kamakshi V, Anehosur GV, Nadiger RK Magnet retained cheek plumper to enhance denture esthetics: case reports. J Indian Prosthodont Soc. 2013; 13:378-381 https://doi.org/10.1007/s13191-012-0200-3
Riley MA, Williams AJ, Speight JD Investigations into the failure of dental magnets. Int J Prosthodont. 1999; 12:249-54
Abdelbagi NF, Ismail IA, Awadalkreem F, Alhajj MN Detachable lip and cheek plumper for rehabilitation of facial disfigurement. Case Rep Dent. 2021; 13 https://doi.org/10.1155/2021/6668737
Sharma P, Ferreira AN, Aras M, Chitre V Detachable hollow cheek plumper with salivary reservoir. An innovative method to improve esthetics and function in a conventional complete denture. J Priamry Care Dent Oral Health. 2022; 3:46-49 https://doi.org/10.4103/jpcdoh.jpcdoh_1_22
Pudi S, Kota S, K V G Ch K An innovative technique using a stainless steel double die pin retained cheek plumper in complete denture esthetics: a case report. Cureus. 2019; 11 https://doi.org/10.7759/cureus.6197
Deogade SC Magnet retained cheek plumper in complete denture esthetics: a case report. J Dent (Tehran). 2014; 11:100-105
Rana V, Srivastava N, Kaushik N, Panthri P Cheek plumper: an innovative anti-cheek biting appliance. Int J Clin Pediatr Dent. 2016; 9:146-148 https://doi.org/10.5005/jp-journals-10005-1352
Colvenkar S, Pathipaka S, Siva Santosh Babu D Enhancing facial esthetics in a complete denture patient having sunken cheeks with a hollow fixed cheek plumper: a case report. Cureus. 2022; 14 https://doi.org/10.7759/cureus.27539
Aggarwal P, Gupta MR, Pawah S, Singh A An innovative technique to improve complete denture aesthetics using cheek plumper appliance: a case report. Int J Oral Health Med Res. 2016; 3:51-54
Venkatachalapathy SR, Chander GN, Gnanam P A magnetically retained cheek plumper in a maxillary single complete denture: a clinical report. J Interdiscip Dent. 2019; 9:25-30 https://doi.org/10.4103/jid.jid_37_18
Kunusoth R, Swayampakula H, Colvenkar S, DR, Alwala AM Management of sunken cheeks with magnet-retained cheek plumpers. Cureus. 2023; 15 https://doi.org/10.7759/cureus.36161
Fabrication of a Hollow Non-detachable Cheek Plumper by an Innovative Technique for an Edentulous Patient: Case Report Ekta Mukesh Kanojia Anjali Borle Seema Sathe Sheetal Khubchandani Dental Update 2024 51:11, 707-709.
Authors
Ekta MukeshKanojia
Postgraduate Student; Department of Prosthodontics and Crown and Bridge, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha (Maharashtra), India
Professor and Guide; Department of Prosthodontics and Crown and Bridge, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha (Maharashtra), India
Professor; Department of Prosthodontics and Crown and Bridge, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha (Maharashtra), India
Associate Professor; Department of Prosthodontics and Crown and Bridge, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha (Maharashtra), India
Facial aesthetics are important in both social and professional settings. The replacement of missing teeth should never be the exclusive goal of prosthetic rehabilitation for a patients who has lost all of their teeth. Age-related changes to the face, particularly sagging cheeks, are a worry for total denture patients with high aesthetic demands. Hence, this article outlines a straightforward, rational, reasonably priced, and non-invasive technique for creating a non-detachable cheek plumper for individuals without teeth. Also, the dual-purpose prosthesis not only restores facial aesthetics, but also replaces missing teeth.
CPD/Clinical Relevance:
A technique for creating a non-detachable cheek plumper for individuals without teeth is described.
Article
While it is easier for a dentist to focus on replacing missing teeth, it is crucial to remember that the patient's face is always visible, whereas the teeth are rarely visible. The absence of oral structures significantly impacts the appearance of the lower half of the face. For optimal aesthetics, rehabilitation must be performed in harmony with the upper half of the face. The ageing process, characterized by the flexibility of tissue and loss of subcutaneous fat, leads to sagging cheeks.1 Denture flanges often provide support to facial tissues; however, in some cases, the denture flange may be insufficient to support the facial musculature, necessitating additional support.2
According to Jamieson,3 customizing the personality of an elderly patient is often more challenging than fitting a denture into their mouth. Regardless of one's efforts, achieving satisfactory results is elusive without considering the patient's psyche. The term ‘denture aesthetics’ is not new in the field of prosthodontics; it refers to a prosthesis that influences an individual's appearance and attractiveness.4 Prosthodontists primarily focus on rehabilitation, encompassing the restoration of speech articulation, alveolar development, muscle tonicity, skin flexibility and tooth loss.
A typical cheek plumper is a single-unit prosthesis supporting the cheek and extending near the premolar–molar region. Various designs and modifications have been proposed, but previous designs have drawbacks. The external contour of the cheek plumper is not designed to work in unison with the muscles in the area where it is incorporated, often resulting in the denture coming loose during speech.5 The weight of the prosthesis may increase owing to the additional volume of acrylic and attachments. Various alternative attachments, such as magnets and custom Co-Cr attachments, have been previously employed to connect the cheek plumper to the denture.6
Magnets, while small, automatically reseatable, and easy to remove and clean, suffer from poor corrosion resistance and lose their magnetic properties over time.7 The use of NdFeB magnets could offer a closely fitting magnetic field, although their impact on pacemakers and intra-oral tissue remains uncertain. Alternatively, customized Co-Cr frameworks have been employed.8 Although Co-Cr is the most expensive, labour-intensive and heavy option for prostheses, it boasts biocompatibility, rare allergic reactions, and corrosion resistance.9
For patients unwilling to undergo reconstructive surgical treatment, cheek-plumping prostheses are a viable option.10 These prostheses can elevate the cheeks to the desired shape without causing the patient any pain, providing ample support to drooping cheeks and lips.11 The literature describes various cheek plumpers, broadly categorized as detachable and non-detachable, each with its own set of advantages and disadvantages.12 The aim of this case study is to provide treatment details of an edentulous patient using non-detachable cheek-plumper dentures.
Case presentation
A 68-year-old male patient presented with the chief complaint of missing teeth, but who was also experiencing difficulties in mastication. The patient expressed a desire to enhance his facial appearance owing to sunken cheeks. According to his history, he has been edentulous for 2 years. Intra-oral examination revealed moderately resorbed maxillary edentulous ridges and significant mandibular ridge resorption. Sunken cheeks were noted during an extra-oral examination. After discussing various options, including detachable and fixed cheek plumpers, along with their respective benefits and drawbacks, the patient chose a single prosthesis that would address both functional and cosmetic concerns.
Diagnostic and preliminary impressions were taken using impression compound for both maxillary and mandibular dentures. Custom trays were fabricated with low-fusion impression compound, and definitive impressions were made with light-body polyvinyl siloxane material. Jaw relations were recorded, and a mean value articulator was mounted. The tooth set up was completed, and extra wax was added during the try-in procedure in the molar and premolar region of the buccal flanges of the maxillary denture to assess changes in facial aesthetics. A plastic disposable straw was used to create a hollow space between the wax on both sides. Also, after applying a thin layer of tissue conditioner separator to the plumper's waxed area, applying tissue conditioner, and requesting that the patient make functional movements, the neutral zone was measured. Extra-oral appearance and neutral zone space demonstrated acceptable extent and support for the cheek plumper. The denture try-in also considered the patient's aesthetic and comfort preferences.
The patient was instructed to perform various motions, including opening and closing the lips, lateral jaw movements, and facial expressions, such as cheek movement, smiling, licking, lip pursing, sucking and whistling. These actions were aimed at determining the available space in the coronoid area and corona-maxillary space for the insertion of the cheek plumper. Additionally, phonetic exercises, water sipping and swallowing activities were employed, so that the wax was moulded to shape the tissue conditioner and accurately record the relevant areas.
During the denture fabrication process, specifically at the packing stage, a small quantity of silicone putty impression material was placed into the cavity. A straw was extended outside the cavity to secure the putty impression material in place, as illustrated in Figure 1.
Figure 1. Creating hollow space in trial denture using plastic disposable straw and silicone putty impression material.
Then, after flasking and dewaxing of the denture, the putty impression material inside the straw remained and the denture was processed (Figure 2).
Figure 2. Silicone putty impression material inside a plastic disposable straws during trial closure procedure.
The denture was constructed using heat polymerized acrylic resin, following the manufacturer's guidelines and employing the typical compression moulding method. Upon retrieval of the denture, the silicone putty impression material was easily removed by extracting the straw from the space created by the putty impression material. The result was a non-detachable cheek plumper denture (Figure 3). The area was then sealed by auto polymerized acrylic resin (Figure 4).
After finishing and polishing, the denture insertion was carried out. On recall visits after 1, 3 and 7 days, 1 and 6 months, the patient seemed to be happy with the retention and comfort of the denture, and showed no evidence of muscular fatigue. Figures 5 and 6 show the patient before and after the fabrication of the non-detachable cheek plumper.
The appearance of the face holds significant importance in both social and professional settings. Sunken cheeks can contribute to an aged facial appearance and various treatments have been suggested to address this concern.13 Correct contours and expansions of denture flanges can enhance the appearance in edentulous patients, but additional support may be needed to comfortably raise sunken cheeks. A cheek-plumper prosthesis, available in detachable and non-detachable forms, is a potential solution.14
In detachable cheek-plumpers, the plumper is independently created and affixed to dentures using methods such as die pins, magnets, snap buttons, and bespoke attachments.15 However, magnets can lose their magnetic properties over time and may corrode if not enclosed in stainless steel.16 Customized attachments add extra time to the fabrication process, and snap buttons may require sourcing from external suppliers.17 The non-detachable cheek plumper in this example was crafted using readily available clinic materials.
Initially designed as a single prosthesis attached to a maxillary denture, the cheek plumper compromised denture retention and added stress to the prosthesis, potentially causing muscle fatigue over time.18 Opting for a detachable cheek plumper, the patient received a hollow version to avoid compromising denture retention and adding excess weight.19 The hollow plumper, created using silicone putty imprint material and a disposable plastic straw, adheres to the neutral zone approach for stability and harmony with the stomatognathic system.20
However, this approach may not be suitable for patients with microstomia owing to the increased mediolateral width of dentures. The edentulous geriatric patient with sunken cheeks received a simple and easily wearable non-detachable cheek plumper denture. This type of cheek plumper, devoid of additional attachments, makes it convenient for the geriatric patient to independently wear dentures. This case report introduces an innovative technique for fabricating a non-detachable cheek plumper using a plastic disposable straw, resulting in a hollow and lightweight prosthesis. Furthermore, the success rate for creating a non-detachable hollow cheek plumber during cheek movement, smiling, licking, lip pursing, sucking, and whistling is very high and satisfactory. The cheek plumper not only enhanced the patient's visual aesthetics, but also positively impacted his psychological wellbeing.
Conclusions
This case report introduces an innovative technique for fabricating a non-detachable cheek plumper using a plastic disposable straw, resulting in a hollow and lightweight prosthesis. The cheek plumper not only enhanced the patient's visual aesthetics, but also positively impacted his psychological wellbeing.
