JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 139-143

Esthetic rehabilitation and management of sunken cheeks by using detachable cheek plumpers in a conventional complete denture with different attachments


Department of Prosthodontics and Crown and Bridge, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India

Date of Submission14-Jan-2021
Date of Decision06-Apr-2021
Date of Acceptance27-Apr-2021
Date of Web Publication17-Jan-2022

Correspondence Address:
Dr. Aditi S Kumbhalwar
Indira Renu Apartments, Canal Road, Gokulpeth, Nagpur - 440 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_1_21

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   Abstract 


Long-term loss of teeth due to aging can cause loss of muscle tonicity of the face. This results in unesthetic appearance, functional impairment, and disturbed psychosocial life. Sunken cheek is one among the main findings of long-term edentulous patients. It can be managed with a conventional denture prosthesis. However, in some cases, additional support could also be required. Cheek plumper prosthesis manages the slumped appearance of cheeks by providing extra support. It restores the facial esthetics; thereby enhancing the self-esteem of the patient. This case report describes the management of patients with sunken cheeks and their esthetic rehabilitation by using maxillary cheek plumpers attached with stainless steel coated neodymium magnet and push-button attachments to the conventional complete denture.

Keywords: Cheek plumper, complete denture, detachable cheek plumper, magnet, push buttons, sunken cheek


How to cite this article:
Gade JR, Kumbhalwar AS, Johari SV, Agrawal MJ. Esthetic rehabilitation and management of sunken cheeks by using detachable cheek plumpers in a conventional complete denture with different attachments. J Int Clin Dent Res Organ 2021;13:139-43

How to cite this URL:
Gade JR, Kumbhalwar AS, Johari SV, Agrawal MJ. Esthetic rehabilitation and management of sunken cheeks by using detachable cheek plumpers in a conventional complete denture with different attachments. J Int Clin Dent Res Organ [serial online] 2021 [cited 2022 May 28];13:139-43. Available from: https://www.jicdro.org/text.asp?2021/13/2/139/335866




   Introduction Top


Appearance is an important aspect of social interaction and self-image. It can get affected by the loss of teeth which brings along with it the disabilities related to the impairment of masticatory function and facial disfigurement. When cheeks and lips are unsupported, muscles do not function properly and become weak. As a result skin wrinkles and the lips and cheeks sag.[1] Furthermore, certain factors such as early loss of posterior teeth, thinning of the tissues, and weight loss may cause concavities below the malar bone or slumped cheeks, which affect esthetics making the patient look much older than their chronological age and hence have a negative psychological impact on the patient.[2]

Cheek augmentation or malar augmentation with dermal fillers is a quick treatment that restores height, definition, and fullness to the cheek area. This being an invasive technique is not considered as a treatment option by old patients. Also due to the higher cost of the derma fillers patients do not opt for this treatment.[3] A removable complete denture is the most common treatment modality to replace an edentulous maxilla or mandible. However, in most cases, the denture flanges do not give adequate support to the facial muscles. This can be achieved by using cheek plumper or cheek lifting appliances which enhance the support of sunken cheeks to provide better esthetics.[4],[5] Use of plumper prosthesis in maxillofacial prosthodontics is well documented and has been described for improving esthetics and the psychological profile of patients.[6]

Conventional cheek plumper is single-unit prosthesis with an extension near the premolar-molar. Such prostheses are an integral part of the contour of denture flanges. However, the increased weight and bulk of conventional cheek plumpers make their insertion challenging and also hampers the retention of complete dentures. Moreover, they cannot be used in patients with limited mouth opening. To overcome these problems, detachable cheek plumpers have been advocated. They offer more advantages in terms of ease of use such as easy retrieval when desired by the patient.[7]

Different types of attachments for its use with cheek plumpers have been reported such as magnet, push-button, buccal tube, and springs.[8] This case report describes the management of patients with sunken cheeks and their esthetic rehabilitation by using maxillary cheek plumpers attached with stainless steel coated close field magnet and push-button attachments to the conventional complete denture.


   Case Reports Top


Two male patients reported to the Department of Prosthodontics with the chief complaint of missing teeth as well as unpleasant facial look. Due to psychological stress about the appearance, they had a disturbed social life. Both the patients wanted prosthesis for the replacement of missing teeth along with enhanced facial appearance. The patients had lost their teeth due to poor periodontal conditions. A written patient's consent forms were obtained before commencing the treatment.

Case 1

A 54-year old male patient lost his teeth for 7 years and was edentulous for the past 3 years. Intraoral examination revealed completely edentulous maxillary and mandibular ridges. Extraoral examination revealed sunken cheeks along with flaccidity of facial muscles [Figure 1].
Figure 1: preoperative facial view showing sunken cheeks (case 1)

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A treatment plan was formulated considering all the findings. A conventional complete denture was planned for missing teeth and detachable cheek plumpers were planned to enhance the sunken appearance of the cheeks. The primary impression of the maxillary and mandibular ridge was made with medium-fusing impression compound (Y Dents, MDM Corporation, Delhi, India) and custom trays were fabricated by using autopolymerizing acrylic resin (DPI Ltd, India). Border molding procedure was performed with low fusing impression compound (DPI Pinnacle, The Bombay Burmah Trading Corporation Limited, Mumbai, India) and secondary impression were made with zinc oxide eugenol impression paste (DPI Impression paste, India). Horizontal and vertical jaw relations were recorded. Other clinical and laboratory steps were completed for a conventional complete denture till try-in stage.

In the try-in appointment, the patient was evaluated esthetically with the waxed-up maxillary and mandibular complete dentures on. Due to insufficient support, the fabrication of cheek plumpers was planned. Modeling wax (Pyrax, India) was used to fabricate waxed-up maxillary cheek plumpers for try-in. It was decided to use neodymium NdFeB magnet having Ni-Cu-Ni protective coating (ART IFACT, India) with 8 mm diameter ×2.5 mm thickness as an attachment [Figure 2].
Figure 2: stainless steel coated neodymium magnet (8 mm × 2.5 mm)

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Case 2

A 62-year-old male patient had lost his teeth over a period of 5 years and was edentulous for the past 4 years. On intraoral examination, completely edentulous maxillary and mandibular ridges were found. On extraoral examination, sunken cheeks along with wrinkling of skin were noted. The sunken appearance was more prominent on the left cheek [Figure 3].
Figure 3: preoperative facial view showing sunken cheeks (case 2)

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Similar steps were carried out for the fabrication of conventional complete denture till try-in procedure. In this case, Alu wax (Maarc, India) was used to fabricate waxed-up maxillary cheek plumpers. Stainless steel push buttons (Silver SS tich button, India) were used as an attachment. The male part of push button was incorporated into the plumpers and the female part was incorporated into the denture base [Figure 4].
Figure 4: push button with male part incorporated into the plumper and female part incorporated into the denture base

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In both cases, the cheek plumpers were attached to the maxillary waxed-up complete denture on both the sides of the buccal flanges at the first and second molar regions [Figure 5]. The dimensions of waxed-up plumpers were adjusted and flushed with the denture base. Thorough examination revealed no occlusal interferences [Figure 6]. It was ensured that the dentures retained its stability and there were no unnecessary tension on the facial muscles. The prostheses were then verified by the patients for comfort and appearance. A positive change in the facial look was observed and the prostheses were accepted by the patients.
Figure 5: cheek plumpers attached to the maxillary waxed-up complete denture

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Figure 6: absence of occlusal interferences

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The waxed-up maxillary cheek plumpers were then attached to the waxed-up maxillary denture base with magnets and push buttons for each case and again verified into the patient's mouth for fullness and occlusal discrepancy. The waxed-up plumpers were then separated from the waxed-up denture. Conventional flasking and dewaxing procedures were completed separately for the maxillary and mandibular complete dentures and cheek plumpers. The mold space was packed with heat-polymerizing acrylic resin (DPI, Mumbai, India) and the curing procedure was performed according to the manufacturer's instructions. The cured maxillary and mandibular complete dentures and cheek plumpers were retrieved [Figure 7]. Trimming, finishing, and polishing of the prostheses were performed. After finishing and polishing, holes were made on the right and left posterior buccal flanges of the heat-polymerized maxillary denture base corresponding to the dimension and position of the attachments [Figure 8]. The magnet and pushbuttons were incorporated into the holes and sealed with auto-polymerizing acrylic resin [Figure 9]a and [Figure 9]b.
Figure 7: the cured maxillary and mandibular complete dentures and cheek plumpers

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Figure 8: holes made into the plumpers corresponding to the dimension of attachment

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Figure 9: (a) magnet incorporated and sealed into the holes using auto-polymerizing acrylic resin in denture base. (b) Magnet incorporated and sealed into the holes using auto-polymerizing acrylic resin in cheek plumpers

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The finished maxillary complete denture attached with cheek plumpers and the mandibular complete denture [Figure 10]a and [Figure 10]b were inserted into the patient's mouth and examined. There was a considerable improvement in the facial esthetics and sunken cheeks were managed significantly. The cheek plumpers neither affected the retention or stability of the dentures nor the speech. Both the patients were completely satisfied with their new look [Figure 11]a and [Figure 11]b. Instructions were given regarding cleaning, retrieval, insertion, and maintenance of the prostheses. Postdenture insertion recall was done after 1 day, 1 week and 1 month. Further recall appointments were scheduled every 6 months but no complications were noted.
Figure 10: (a) the finished maxillary complete denture attached with cheek plumpers and the mandibular complete denture (case 1). (b) The finished maxillary complete denture attached with cheek plumpers and the mandibular complete denture (case 2)

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Figure 11: (a) postoperative facial view (case 1). (b) Postoperative facial view (case 2)

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   Discussion Top


Conventional cheek plumpers are single-unit prostheses with extensions on either side of the posterior flange of the denture base. Its continuous use may lead to muscle fatigue and decreased retention of the prosthesis. Muscle fatigue can be prevented if the patient has the option of removing cheek plumpers when experiencing discomfort.[2] Therefore a detachable plumper prosthesis was planned in both cases to reduce the weight of the prosthesis and to facilitate easy placement and removal.

In this clinical report, only the maxillary cheek plumpers were fabricated. The advantage of fabricating maxillary cheek plumpers alone was reduced weight and bulk of the prostheses. However, mandibular cheek plumpers can also be fabricated. It can be used in patients with complex maxillofacial defects, reduced muscle tonicity, or severe resorption of the alveolar process.

Neodymium magnets also known as NdFeB magnets or Neo Magnets coated with Nickle (Ni-Cu-Ni) were used in this case report. They are made from an alloy of Neodymium, Iron, and Boron. They have an extremely high magnetic saturation, good resistance to demagnetization, and the highest value of energy production.[9] A triple-layered coating (Ni-Cu-Ni) provides shiny and corrosion-resistant protection to the magnets.[10] They facilitate automatic reseating because of the magnetic force and easy detachment of the plumper prosthesis making it easy to clean. They can provide a constant amount of retentive force even after more number of insertion and removal cycles of the prosthesis.[2] Also, magnets provide snug fit between the denture base and cheek plumper. The disadvantages of magnets are high cost and loss of magnetic field over time.[1]

Push buttons used in the second case are made from Austenitic stainless steel alloy. Austenitic stainless steel alloys are ideal for applications in saltwater conditions such as saliva. They can be used in high and low temperatures and hence have an excellent corrosion-resistant properties. The advantages of using pushbuttons as attachments are that they are economical, easily available and due to their smaller dimension they are easy to incorporate in the denture flange. Other advantages include easy insertion and removal, easy to clean, and low maintenance. They are lightweight and can be easily replaced if needed. The only disadvantage is that they are brittle and can break if not handled properly. Furthermore, the retentive properties of the male and female part of the push button can degrade after frequent use over a period of time making it unsuitable as an attachment.[6],[8]

Both magnet and pushbuttons provide simplicity of the clinical and laboratory procedures. Corrosion was not reported in both cases even after 6 months follow-up. Clinicians must choose the appropriate attachment according to the flange and keeping in mind the thickness and height of the denture and dexterity of the patient. The periodic patient recall is essential to evaluate the attachments and their replacement when required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kamakshi V, Anehosur GV, Nadiger RK. Magnet retained cheek plumper to enhance denture esthetics: Case reports. J Indian Prosthodont Soc 2013;13:378-81.  Back to cited text no. 1
    
2.
Rewari A, Dabas N, Sanan R, Phogat S, Phukela SS, Vigarniya M. Esthetic rehabilitation using magnet-retained cheek plumper prosthesis. Case Rep Dent 2020;2020:2769873.  Back to cited text no. 2
    
3.
Dange SP, Manjarekar N. Cheek plumper: Giving hollow cheek the fullness back. Int J Sci Res 2017;6:274-75.  Back to cited text no. 3
    
4.
Deogade SC. Magnet retained cheek plumper in complete denture esthetics: A case report. J Dent (Tehran) 2014;11:100-5.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
Bharathi B, Poovani S, Sheety G, Shreya S. Complete dentures with detachable cheek plumper - A case report. Int J Sci Res 2019;8:44-46.  Back to cited text no. 6
    
7.
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;117:592-6.  Back to cited text no. 7
    
8.
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;3:51-4.  Back to cited text no. 8
    
9.
Bhat VS, Shenoy KK, Premkumar P. Magnets in dentistry. Arch Med Health Sci 2013;1:73-9.  Back to cited text no. 9
  [Full text]  
10.
Riley MA, Walmsley AD, Harris IR. Magnets in prosthetic dentistry. J Prosthet Dent 2001;86:137-42.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]



 

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