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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 875-877  

Management of shrunken cheeks by hollow buccal cheek plumper prosthesis


Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Date of Submission20-Oct-2020
Date of Acceptance23-Oct-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Parthasarathy Natarajan
Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_688_20

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   Abstract 


Aging and a long period of edentulousness causes resorption of the maxillary residual ridge, resulting in narrowing of the arch and loss of facial muscle support that leads to the sunken appearance of cheeks. In completely edentulous patients, though the conventional complete denture does offer provision to the muscles encircling the mouth, yet the cheek plumber prosthesis is required to improve the muscle tone. This case report highlights the advantages and the sequential steps required in the indigenous method of fabricating a hollow cheek plumper appliance for a completely edentulous patient with a sunken appearance.

Keywords: Cheek lifting appliance, completely edentulous, hollow cheek plumper, ridge resorption, shrunken cheeks


How to cite this article:
Natarajan P, Kumar SM, Natarajan S, Raza FB. Management of shrunken cheeks by hollow buccal cheek plumper prosthesis. J Pharm Bioall Sci 2021;13, Suppl S1:875-7

How to cite this URL:
Natarajan P, Kumar SM, Natarajan S, Raza FB. Management of shrunken cheeks by hollow buccal cheek plumper prosthesis. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Sep 23];13, Suppl S1:875-7. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/875/317624




   Introduction Top


Aging and a long period of edentulousness causes resorption of the maxillary residual ridge resulting in narrowing of the arch and loss of facial muscle support that leads to the sunken appearance of cheeks.[1] Besides age-related factor, loss of subcutaneous fat and elasticity of connective tissue causes the collapsed cheek appearance.[1] Poor facial esthetics would further add to the age factor also has a negative psychological impact.[2]

Modification of drooped cheek appearance can be done either by invasive or noninvasive approach. The invasive approach includes different strategies such as reconstructive plastic surgical procedures and infusing the botulinum (BOTOX) in the facial muscles.[3] Whereas, the non-invasive management of sunken cheek can be done using prosthetic method. The plastic surgical procedure is a hideous method that may result in a postoperative scar and at times contraindicated in old patients experiencing various medical ailments.[3]

In completely edentulous patients, though the conventional complete denture does offer provision to the muscles encircling the mouth, yet the cheek plumber prosthesis is needed to improve the muscle tone.[4] Cheek plumper, otherwise called the cheek lifting appliance, is fundamentally the prosthesis for assisting and lifting the cheeks. This case report describes the sequential steps required in the fabrication of cheek plumper prosthesis for a completely edentulous patient with a sunken appearance.


   Case Report Top


A 65-year-old male came to the department for replacement of missing teeth and complained of sunken cheek appearance on either side. On examination, the patient has a completely edentulous maxillary and mandibular arch with a sunken buccal cheek [Figure 1]. The treatment plan decided was complete denture prosthesis with buccal cheek plumper on either side of the maxillary denture to improve esthetics.
Figure 1: The patient with sunken cheek appearance

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The primary impression was taken with impression compound, and the primary cast was made with dental plaster. Self-cure acrylic resin special tray was fabricated, and border molding was completed using green stick compound, and the final impression was taken with zinc oxide eugenol impression paste. Record base was fabricated with self-cure acrylic resin, and occlusion rims were constructed. During the jaw relation procedure, it was found that the occlusal rim does not provide enough support for the cheek muscles. To improve the esthetics, the extra waxes were added on both sides of the occlusal rims near the first molar region until it provided enough support to the cheek muscles [Figure 2]. It was verified that the extra waxes did not cause dislodgment of record bases. Semi-anatomic teeth were selected according to the patient age, sex, and personality. The trial denture base was tried in the patient; the esthetics, phonetics, and jaw relation were verified. Facial esthetics was checked whether the wax buccal pad provided necessary esthetics without dislodging the wax trial denture base during functional movements of the cheek muscles. To reduce the weight of the prosthesis, the wax in the buccal pad was scooped out creating an open bulb with the border's thickness of 1.5 mm around the periphery [Figure 3]. The routine flasking, dewaxing, packing, and curing procedures were done. After deflasking, the complete denture was retrieved, trimmed, and polished. Since the open bulb could lead to food accumulation, the shellac base plate was used to form the lid for the buccal pouch [Figure 4]. After the extension and stability of maxillary complete denture with buccal pouch was checked in the patient mouth, lid with the shellac base plate material was replaced with heat cure acrylic, which was sealed with the hollow cheek plumper using self-cure acrylic resin [Figure 5].
Figure 2: Extra wax filled up in the buccal area

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Figure 3: Hollowed buccal pouch

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Figure 4: Shellac lid seal

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Figure 5: Finished prosthesis

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The maxillary complete denture with closed hollow bulb cheek plumper, and the mandibular complete denture was inserted [Figure 6]. The esthetics, the phonetics, and the stability of the prosthesis were checked. The patient was reviewed at 24 h, and the complete denture was found to be satisfactory both in esthetics and function.
Figure 6: Pre- and post-operative view

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   Discussion Top


The esthetic plays a crucial role in the overall satisfaction of the complete denture wearers. The maxillary arch bone resorption in the posterior region along with the resorption of the zygomatic arch leads to sunken cheeks. The conventional complete denture cannot provide adequate support to the cheek muscle; hence, modification of the buccal flange of the prosthesis is necessary.[5]

In the present case report, the need for a buccal pouch was identified during jaw relation. The wax was added until the necessary esthetics achieved by supporting sunken cheeks. The stability of the record base was checked by the functional movements. Again the retention, stability, and esthetics were verified in the wax try-in procedure.

Considering the age, dexterity, and mouth opening of the patient, the complete denture was made as a single piece hollow buccal cheek plumper. To decrease the bulk of the prosthesis, the cheek plumper was made hollow; thereby, retention of the maxillary denture was not compromised.[6] The stability of the complete denture was improved in this technique since the prosthesis was made according to the functional movements of muscles during mastication, speech, and swallowing.[7]

In previous case reports, the hollowness of the complete denture was achieved either by putty or lost salt technique.[8],[9] However, both the techniques have disadvantages in determining the adequate dimension of the hollowness of the denture during the processing. It leads to either excess or inadequate thickness of the denture border, excessive material results in perforation of the prosthesis, or less material leads to increased weight to the denture.[10] Furthermore, removal of putty after processing of the denture would be difficult.[10] Similarly, in the lost salt technique, the stability of salt in the required position during the processing of denture is questionable, often leading to displacement.[9] In this case report, the indigenous wax carve out technique was used to make hollowness of buccal pouch to avoid the disadvantages of both putty and lost salt technique. The buccal pad wax was scooped out uniformly to the dimensions of 1.5 mm thickness over the periphery so that adequate strength as well as maximum hollowness of the plumper was obtained. The denture and buccal pouch processed as a single unit avoid dimensional changes inherited in processing the prosthesis as a two piece. Moreover, the two-piece prosthesis needs an attachment system that has disadvantages of increased the cost and wearing out of attachment in due course of time which needs replacement. To prevent food lodgment, the lid was covered over the bulb to maintain cleanliness and reduce prosthesis weight.


   Conclusion Top


Prosthodontic treatment of an edentulous patient never limits to just substitution of missing teeth. Patients are progressively requesting improvement in esthetics toward the finish of the treatment. This case report highlights the advantages and fabrication of the indigenous method of making hollow buccal cheek plumper prosthesis in modification to the conventional complete denture.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Pietrokovski J, Starinsky R, Arensburg B, Kaffe I. Morphologic characteristics of bony edentulous jaws. J Prosthodont 2007;16:141-7.  Back to cited text no. 1
    
2.
Kudsi Z, Fenlon MR, Johal A, Baysan A. Assessment of psychological disturbance in patients with tooth loss: A systematic review of assessment tools. J Prosthodont 2020;29:193-200.  Back to cited text no. 2
    
3.
Carruthers J, Carruthers A. Botulinum toxin in facial rejuvenation: An update. Dermatol Clin 2009;27:417-25.  Back to cited text no. 3
    
4.
Pudi S, Kota S, Karthik KV, Kaladi SR, Gade RR. An innovative technique using a stainless steel double die pin retained cheek plumper in complete denture esthetics: A case report. Cureus 2019;11:e6197.  Back to cited text no. 4
    
5.
Albaker AM. The oral health-related quality of life in edentulous patients treated with conventional complete dentures. Gerodontology 2013;30:61-6.  Back to cited text no. 5
    
6.
Caculo SP, Aras MA, Chitre V. Hollow dentures: Treatment option for atrophic ridges. A clinical report. J Prosthodont 2013;22:217-22.  Back to cited text no. 6
    
7.
Kapur KK, Soman S. The effect of denture factors on masticatory performance. Ii. Influence of the polished surface contour of denture base. J Prosthet Dent 1965;15:231-40.  Back to cited text no. 7
    
8.
Gardner LK, Parr GR, Rahn AO. Simplified technique for the fabrication of a hollow obturator prosthesis using vinyl polysiloxane. J Prosthet Dent 1991;66:60-2.  Back to cited text no. 8
    
9.
Aggarwal H, Jurel SK, Singh RD, Chand P, Kumar P. Lost salt technique for severely resorbed alveolar ridges: An innovative approach. Contemp Clin Dent 2012;3:352-5.  Back to cited text no. 9
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10.
Radke U, Mundhe D. Hollow maxillary complete denture. J Indian Prosthodont Soc 2011;11:246-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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