|Year : 2022 | Volume
| Issue : 4 | Page : 416-421
Fabrication of a detachable cheek plumper on a removable partial denture using a custom-made assembly
Ankita Srivastava, Pradeep Sherigar, Nayana Prabhu
Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
|Date of Submission||05-Feb-2022|
|Date of Decision||27-May-2022|
|Date of Acceptance||10-Jun-2022|
|Date of Web Publication||29-Aug-2022|
Dr. Pradeep Sherigar
Department of Prosthodontics and Crown & Bridge, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104
Source of Support: None, Conflict of Interest: None
Esthetics remain an inseparable aspect affecting the mental health of a person. On losing teeth, patients suffer from a lack of confidence, and in the majority of cases, it affects their mental well-being. Mental health and social interaction are integral entities for evaluating the quality of life. A prosthodontist should aim to provide the best possible version of rehabilitation to the patient. However, constraints such as affordability, willingness, and acceptance of the patient always affect the suggested treatment plan. Many modifications have been done previously using attachments on the complete denture but not on a removable partial denture. This case report demonstrates a patient who was partially edentulous, had sunken cheeks, and was concerned about her facial appearance. In the presented case, an alternative method of the fabrication of cheek plumper on a removable partial denture was done to provide an esthetic restoration. For the construction of the prosthesis, a lumbar puncture needle was used, which was soldered to Adams clasps, to support the cheek plumper on the removable partial denture. The prosthesis improved the facial shape of the patient and provided a youthful appearance. The patient was happy and contented with the treatment outcome.
Keywords: Adams Clasp, Lumbar Puncture Needle, Partially Edentulous Arch, Soldering
|How to cite this article:|
Srivastava A, Sherigar P, Prabhu N. Fabrication of a detachable cheek plumper on a removable partial denture using a custom-made assembly. J Int Oral Health 2022;14:416-21
|How to cite this URL:|
Srivastava A, Sherigar P, Prabhu N. Fabrication of a detachable cheek plumper on a removable partial denture using a custom-made assembly. J Int Oral Health [serial online] 2022 [cited 2023 Mar 24];14:416-21. Available from: https://www.jioh.org/text.asp?2022/14/4/416/355020
| Introduction|| |
Esthetics are a subjective parameter based on ethnicity, race, occupation, age, and affordability. A loss of teeth is trailed by a series of events known as a transitional phase. It includes a loss of support to the facial tissues and a decrease in the muscle tone, followed by muscular dystrophy. These consequences occur mainly due to the functional impairment and reduction of alveolar processes, which results in recessed, collapsed, and hollow cheeks, the deepening of philtrum, and the drooping of the lips. The poor facial visage lowers morale and creates a negative psychological impact., A prosthodontist plays an imperative role in restoring these physiological and psychology-related changes wherein the challenge is not only to meet the functional demand but also the esthetic desires.
Occasionally, even perfectly extending flanges of the denture cannot provide sufficient fullness to the mouth; therefore, to support the foundation tissues, the addition of an extra bulk of denture material is done. However, this can make the prosthesis heavy and cause muscle fatigue and discomfort to the patient. Increased weight in the complete denture compromises denture esthetics, retention, stability and can cause malalignment of the prosthesis. These problems can be overcome by fabricating a removable assembly. The cheek is supported by teeth, alveolar bone, and the balance between the horizontal and vertical forces of the oral musculature.,, In order to restore, the prosthesis should be inconspicuous and in harmony with the physiology of the perioral tissues.
Other viable options to accomplish facial fullness exist, including cosmetic and plastic surgeries, but these are invasive and extremely costly with unpredictable results. Some serious complications such as paralysis, allergies, or asymmetry have been documented because of the absorption of the filler materials, e.g., Botox (BTX-A), Restylane, or Juvederm, autologous fat injection., Ergo, there is an unwelcoming and lingering fear of undergoing surgery. Not only the surgery but also the anxiety related to the postsurgical scarring makes such decisions difficult.
The aim of this case report was to make a removable partial denture (RPD) incorporating a manually fabricated removable cheek plumper providing the fullness of the face and a pleasing appearance to the patient, without hampering the patient comfort or causing muscular exhaustion.
| Case Report|| |
A 40-year-old woman visited the Department of Prosthodontics, Manipal College of Dental Sciences, Manipal, with a chief complaint of missing teeth in the upper and lower jaw and poor facial appearance with sunken cheeks on both sides. On examination, it was noticed that the patient was completely edentulous with respect to the mandible and partially edentulous with respect to 11, 12, 21, 22, 23, and 24. All teeth were lost because of a poor periodontal health. Extraoral examination showed a long face with collapsed cheeks; intraoral examination revealed generalized gingival recession in the maxillary arch [Figure 1]A–C. The patient was unwilling to undergo any periodontal treatment because of a lack of money and time. Because the patient was more concerned about the esthetics, accordingly, a removable cheek plumper was planned to augment the facial form.
|Figure 1: Preoperative images: (A) front profile; (B) right profile; (C) left profile|
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The treatment plan was to make a RPD with respect to 12, 11, 21, 22, 23, and 24 with a cheek plumper and single complete denture for the lower arch.
| Fabrication|| |
A RPD for the maxilla was fabricated with Adams clasps, and a lower single complete denture was made in a conventional manner. These Adams clasps were made over the first molars on either side to aid in the retention of the cheek plumper on the RPD. For the fabrication of custom-made assemblies, a lumbar puncture needle of 18 gauge with a diameter of 1.2 mm was taken. Lumbar puncture needle consists of two parts: one is the spinal needle and the other is the stylet. The stylet was removed and the hollow spinal needle was soldered to the Adams clasp [[Figure 2]A–C]. The spinal needle was sectioned and soldered to the bridge in between the two arrowheads of the Adams clasp. This acted as tubing for inserting the attachment [Figure 2C]. A 1-mm diameter wire was inserted into the tube and bent in a U-shape, which ended into a loop. This loop was created to act as a retentive tag for the acrylic resin.
|Figure 2: Fabrication of a customized cheek plumper using a spinal needle part of the lumbar puncture needle: (A) lumbar puncture needle; (B) spinal needle; (C) a custom-made cheek plumper assembly with a soldered spinal needle and an U-shaped wire as an attachment|
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To construct the cheek plumper, the vestibular depth was recorded both labio-lingually and mesiodistally using a mix of a low fusing impression compound (DPI Pinnacle Functional impression compound, Dental Products of India, Mumbai, India) and green stick compound (DPI Pinnacle tracing sticks, Dental Products of India, Mumbai, India) in the ratio of 2:1. This area is dynamic; therefore, to mold the cheek plumper and record this area precisely, the facial muscles were activated by performing outward, upward, and inward cheek movement, by executing sucking, pursing, yawning, and smiling functions. Speech and phonetics were also assessed to detect any interference with the normal functions. After try in the casts were demounted from the articulator, and wax-up was done [Figure 3]A and B, [Figure 4]A.
|Figure 3: (A) and (B) Mounted cast with a customized cheek plumper assembly|
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|Figure 4: Processing of the partial denture prosthesis and attachment: (A) wax-up of maxillary cast with the attachment on Adams clasp; (B) and (C) separate processing of the cheek plumper|
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The cheek plumpers were then processed and cured separately in a small flask [Figure 4]B and C. A plumper was made using polymethylmethacrylate (DPI, Heat Cure, Dental Products of India, Mumbai, India) and was trimmed and polished. They were tried again in the patient’s mouth to see the contour, comfort, and adaptation [Figure 5]. At the time of prosthesis delivery, the patient was explained about the insertion, removal, and cleaning of the prosthesis along with oral hygiene instructions. As the cheek plumper is detachable and made of the same material as the dentures, so, it can be cleaned in the similar manner, thereby, removing the biofilm formed during its usage. The use of denture cleanser is also advised as denture hygiene is essential for the long life of the prosthesis. It is also vital to maintain the oral hygiene as the patient is periodontally compromised. The patient was recalled after 1 week, 1 month, and 6 months for the follow-up. She was advised to remove the cheek plumper attachments from the prosthesis while eating if it causes any disruption. The patient was happy and satisfied with the outcome of the prosthesis [Figure 6]A and B.
|Figure 5: A customized cheek plumper assembly attached to the removable partial denture|
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| Discussion|| |
Usually, a cheek plumper prosthesis is fabricated over a complete denture where various attachments can be used, which can be either fixed or removable. Attachments such as magnets, cribs, tic-tac pins, acrylic block, hollow acrylic extensions, cobalt-chromium (Co-Cr), press studs, orthodontic elastic module, snaps, clips, friction locks, and wire retained cheek plumper have been used in the past.,,,,,, As fixed attachments increase the weight of the prosthesis and cause muscular exhaustion, removable attachments are preferred.
This case was challenging as the depressions were located above the ala-tragus plane, which made it obligatory to attach the cheek plumper to the maxillary prosthesis. Subsequently, this prosthesis was constructed on the RPD unlike in the previous literature where the attachments were located on the complete denture. The patient was poor and was unable to come frequently for periodontal treatment; thus, the maxillary denture was fabricated in accordance with the remaining dentition. A detachable cheek plumper was constructed on the RPD to improve the esthetic outcome. This technique of modifying the attachment is simple, inexpensive, and noninvasive. A strategic placement of the plumper was needed as the premolars and molars were present on either side. The absence of anterior teeth aided in the retention of the prosthesis, so Adams clasp acted as an adjunct retainer and held the custom-made attachment in place.
Nevertheless, all attachments come with their own set of drawbacks such as the breakage of stud attachment, loss of magnetism, corrosion, additional weight, food entrapment, [12, 13, 16] patient discomfort, requirement of manual dexterity, or obstruction of the occlusal table but they are more acceptable to the patients than surgeries.
Moreover, in this particular patient, if the masticatory function and nutritional status improve with these new dentures, the patient may not need the cheek plumper. Else, a permanent and long-lasting solution would be to fabricate a crown or bridge with a precision attachment on the buccal or mesiodistal aspect for attaching the removable cheek plumper.
The soldered attachment can break or get distorted in the long run. The patient should be recalled once in 3 months to assess the condition of the prosthesis, its attachments, as well as the remaining dentition.
This report describes a simple, methodical, cost-effective technique to improve facial esthetics in a partially edentulous patient with the help of a customized cheek plumper.
| Conclusion|| |
This clinical report depicts a fabrication of removable cheek plumper with manually constructed custom assembly for attachment. It is an innovative procedure using biocompatible polymethylmethacrylate, lumbar puncture needle, metal clasp, and soldering technique for the fabrication of the custom-made attachment. It can be used as an alternative solution for cases with sunken cheeks and partially edentulous arches. A cheek plumper provides a pleasant appearance, thereby boosting the self-confidence of the patient and improving their quality of life.
We would like to thank our batch mates and colleagues for taking the photographs. We would also like to thank the nonteaching staff for their constant help and efforts in the smooth conduction of the clinical work.
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest.
AS = conception and design, execution of the work, and article writing, PS = conception and design, methodology, article writing, and approval of the final version, and NP = supervision and approval of the final version.
Ethical policy and institutional review board statement
Patient declaration of consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her names and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Data availability statement
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]