FACIAL ESTHETICS IN COMPLETE DENTURE – A CASE REPORT
Patient with completely edentulous maxillary and mandibular arches undergo many esthetic consequences among which sunken appearance of cheek has a great psychological effect. Prosthetic rehabilitation of such patients requires restoring the lost cheek support. This article describes various techniques that have been used in the past to fabricate cheek plumper and presents a case report in which an innovative, simple and effective method was used for the fabrication of detachable cheek plumper
Keywords: Complete denture, esthetics, cheek plumper, die pins
Complete denture prosthetic replacement in present scenario no longer confines to the replacement of missing teeth. It includes facial esthetics also. Denture flanges if properly extended and contoured can help to achieve facial esthetics by supporting lips and cheeks. However, in cases of patients with hollow cheeks, extra support has to be provided. Cheeks due their extreme visibility are an important factor in determining facial esthetics. Slumped or hollow cheeks can add years to a person’s age and can have a detrimental psychological effect on the patient.1 In such cases, cheek plumper can be given.
Cheek plumper, also known as cheek lifting appliance, is a prosthesis for supporting and lifting the cheek to provide required support and esthetic that will increase the self esteem of the patient by providing a youthful appearance.2 It can be used in patients who have excessive slumping of cheeks due to tooth loss.3 It is especially useful in young patients who have lost all their teeth and part of the maxillary bone as a result of traumatic injury.3
A cheek plumper can be of two types: detachable or undetachable. The undetachable or conventional cheek plumper is a single unit prosthesis with extensions on either side in the region of the polished buccal surfaces of the denture and are continuous with the rest of the denture. Detachable cheek plumper on the other hand is the prosthesis in which plumper part can be detached from the complete denture. This can be achieved by magnets or custmoized attachments.
The purpose of this article is to explain a simple and innovative technique of fabricating detachable cheek plumper prosthesis with the use of die pins.
A 55 year old male patient reported to the department of prosthodontics, DAV dental college, yamunanagar with the chief complaint of missing teeth (Fig.1). On examination, patient had completely edentulous upper and lower arches. He was edentulous for past 2 years. Extraoral examination showed slumped cheeks. The patient was conscious about the slumped cheeks and desired a prosthesis which will make his face look fuller. Keeping patient’s demand in mind, the treatment plan was formulated. It was decided to give the patient maxillary and mandibular complete dentures with detachable cheek plumper for the maxillary denture.
Fig. 1.Pre-operative extraoral view
1) Preliminary Impressions:The preliminary impression of the maxillary and mandibular arch was made in the conventional manner using impression compound
2) Secondary Impressions: The preliminary casts were obtained, over which special trays were fabricated using auto polymerizing resin (DPI Dental products), keeping them 2mm short of the sulcus. The border moulding was carried out conventionally using low fusing impression compound and the final impression was recorded with zinc-oxide eugenol impression paste.
3) Jaw Relations and teeth arrangement: Master cast was obtained on which denture bases were made. Occlusal rims were fabricated on the denture bases and maxillomandibular relations were recorded. Articulation was done followed by teeth arrangement.
4) Try In: For the try in appointment, waxed denture were first tried for occlusion and esthetics. Wax templates for cheek plumper were attached to the maxillary denture in the distobuccal region and were adjusted accordingly to give patient a fuller appearance.
5) Acrylization:After taking patient consent, waxed plumper was separated from trial denture and acrylization of dentures and cheek plumper were done in conventional way.Finished and polished dentures were tried in the mouth.