17Journal of Dental Research and Scientific Development | 2015 | Vol 2 | Issue 1

A single complete denture with cheek plumpers to improve facial aesthetics

MK Sowmya, Prasad D Krishna, Rushad Hosi Nariman

AbstractPresence of teeth in one arch makes it difficult for the operator to fabricate a single denture on the edentulous arch due to altered occlusal schemes, supraerupted teeth and resorbed edentulous ridges. Natural teeth should be preserved but at the same time one should be aware that the edentulous ridge may be destroyed by forces exerted against the denture support. In this case the occlusal correction of the mandibular teeth is done using an acrylic template. Along with replacement of missing teeth emphasis, should be on improvement of facial esthetics. Slumped cheeks are unaesthetic and add to the person’s age. This case shows a way to improve facial aesthetics and function in a maxillary single arch edentulous patient. The missing teeth in the lower arch were rehabilitated with fixed partial denture.

While replacing missing teeth, it is important that the prosthesis not only replaces the missing teeth but also restore the facial contour. A cheek plumper or cheek lifting appliances can restore these facial contours. The rationale for providing this appliance is that some patients have hollow cheeks and need extra support for better facial aesthetics.[4,5] Some authors used magnets as attachments, but it is seen that magnets lose their magnetism over a period and thus push buttons were used in the cheek plumpers to increase the longevity of the check plumpers.

The purpose of this article is: (1) To transfer the planned amount of odontoplasty from cast to the mouth for occlusal correction in a single complete denture patient and (2) plumping the cheeks using cheek-plumper, which are attached to the single complete denture, using push button.

Case Report

A 56-year-old male patient came to the Department of Prosthodontics, A.B. Shetty Memorial Institute of Dental Sciences with a chief complaint of missing maxillary and few mandibular teeth. Patient was also not happy with the collapse of the cheeks due to missing teeth. Keeping in mind the needs of the patient a proper diagnosis and treatment plan was followed. On clinical examination, it was seen that maxillary edentulous arch was opposed by Kennedys class III mandible.

Correspondence to: Dr. Rushad Hosi Nariman, 2nd Floor, Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore - 575 018, Karnataka, India. E-mail: rushad29@gmail.com

Introduction

When only one arch is edentulous, tooth position in the dentate arch may preclude the objectives like interocclusal distance, stable jaw relationship with bilateral tooth contacts in retruded closure. Unfavorable force distribution may cause adverse tissue changes that are going to compromise optimum function.[1] The teeth that are most prominent in the vertical plane will be subjected to selective grinding in order to ensure that a sufficient number of teeth will be in contact with the artificial ones at the same time.[2]

Single complete dentures may be opposed by: (a) Natural teeth, (b) fixed restorations, (c) a removable partial denture: Or (d) an existing complete denture. Because of the presence of longstanding uncontrolled occlusal forces, important changes in the denture foundation can occur, as the accelerated loss of the bone and the excessively displaceable tissue that come with the problem of the differential support capability to the same load. Hence, a single denture patient may have to undergo preventive surgery, occlusal adjustment of the remaining teeth. Other methods to control these forces are use of different tooth forms, use of acrylic resin teeth with cast gold occlusal surfaces, varying arrangements of teeth, use of cast denture bases, use of tissue conditioners, use of semipermanent soft liners, programs of oral tissue massage and oral hygiene.[3] A metal reinforcement to prevent any fracture of the acrylic base of the denture.

Case Report

Department of Prosthodontics and Crown and Bridge, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India

Key words: Cheek plumpers, facial esthetics, single complete denture

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E-ISSN 2348-3407DOI: 10.4103/2348-3407.149621

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Sowmya, et al.: Single complete denture with cheek plumpers

Journal of Dental Research and Scientific Development | 2015 | Vol 2 | Issue 1

checked during the try in stage [Figure 3c]. The push buttons were removed from the maxillary denture base and the cheek plumpers just before processing the denture and the plumpers. The maxillary denture and the cheek plumpers were fabricated with heat-cure acrylic resin [Figure 3d]. After finishing and polishing, the push buttons were placed back in their original positions on the denture base and the plumpers, and sealed with autopolymerizing resin. Patient was instructed on the use of plumpers and dentures were delivered after evaluating them for fit and aesthetics. On the recall of 48 h patient did not possess any problems with speech or mastication.

The maxillary ridge was firm but had reduced in size due to resorption. The mandibular teeth were malposed, tipped, and supra erupted and, as a result, the occlusion was far from harmonious and balanced. Lower right second premolar and first molar were missing from the arch [Figure 1]. Extraoral findings showed slumped cheeks.

Maxillary and mandibular diagnostic impressions were made with alginate (Neocolloid; Zhermack). Maxillary arch final impression was made using selective pressure impression procedure using green stick compound (Pinnacle tracing stick, DPI, Mumbai, India) for peripheral molding and impression with light body (Aquasil LV Light Body, Dentsply Caulk). Porcelain fused to metal restoration was planned, and tooth preparation was done accordingly for the lower missing teeth. A metal reinforcement was fabricated over the final cast to prevent any future fracture of the acrylic base of the denture. Jaw relation was recorded, and the maxillary and mandibular casts were mounted. On the evaluation, we found that there was some amount of discrepancy on the occlusal plane.

Maxillary teeth were arranged according to the contour of the maxillary rim, and the occlusal surface was aligned in a compensating curve to facilitate the development of occlusal balance. The mandibular teeth which caused interferences were modified grinding them on the cast till good intercuspation and maximum balance of the denture was achieved. Porcelain fused to metal fixed prosthesis was also fabricated according to the occlusal plane established by the maxillary denture [Figure 2a]. The modified cusps and incisal edges were marked on the mandibular cast with a pencil. A clear autopolymerizing acrylic resin (RR self-cure acrylic resin, Dentsply, India) was used to fabricate a template over the modified cast. Mark the template in the same areas where the cast has been altered [Figure 2b]. Open the area that is marked on the template by trimming it [Figure 2c]. This will create openings on the occlusal aspect of the template to indicate the position of the tooth structure before they are modified. The margin of the openings indicates the extent of tooth reduction. When the template is seated in the mouth, the natural teeth will protrude through these openings [Figure 2d]. Reduce the mandibular teeth to the margin of the openings on the template.

During the maxillary denture try in appointment, cheek plumpers were made as a separate portion in wax. These plumpers could be attached to the trial dentures with the help of push button [Figure 3a and b]. These plumpers were located at the cervical aspect between the second premolar and first molar regions of the maxillary denture flange. The push buttons were placed in the center of the plumper. The cheek plumpers were superficially attached to the buccal surface on the right and left side of the maxillary denture base and later push buttons were embedded in wax and tried. The amount of desired cheek support, function and aesthetics was

Figure 1: Intraoral pictures of maxillary and mandibular jaw

Figure 2: (a) Try in of the maxillary denture and mandibular metal fixed partial denture framework (b) mandibular cast with occlusal template (c) template cut in areas of correction (d) projecting part of the tooth to be modified

a b

c d

Figure 3: (a) Push button present on the maxillary denture (b) cheek plumpers fabricated in wax (c) trial of the cheek plumpers (d) fit in of the denture with plumpers

a b

c d

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Sowmya, et al.: Single complete denture with cheek plumpers

Journal of Dental Research and Scientific Development | 2015 | Vol 2 | Issue 1

Discussion

The case chosen for this article describes a common pattern of tooth loss that involves the completely edentulous maxillary area opposing a mandibular complement of natural teeth with missing second premolar and first molar on the right side.

The horizontal discrepancy between the arches anteriorly and posteriorly makes it difficult to direct occlusal forces to the denture bearing surface because the support is at distance from the denture tooth position.[6]

Stansbury[7] described the first functional chew in technique by using a compound maxillary rim trimmed buccally and lingually and hence that the occlusion is free in lateral excursions. Carding wax was added to the rim and patient was asked to perform eccentric movements. A functionally generated path was thus formed. Vig[8] used similar technique but used a resin fin instead of impression compound. Sharry[9] mentions a simple technique of using maxillary rim of softened wax and recording lateral and protrusive movements so that wax is abraded generating the functional paths of the lower cusps.

In comparison with other procedures reported in the literature, this procedure offers the convenience of having the preparation guide seated stably on the teeth during the process of odontoplasty. Minimal thickness of the preparation guide allows the amount of planned tooth reduction to be accurately indicated on the involved tooth surfaces. The low cost and ease of fabrication are additional advantages over other reported procedures.[10] The disadvantage of using an acrylic resin as a template is its polymerization shrinkage.

Cheek plumpers are basically for supporting and plumping the cheek to provide a youthful appearance. It is especially useful in young patients who have lost all their teeth and part of the maxillary bone as a result of a traumatic injury. However, it can also be used in patients who have an unusually excessive slumping of the cheeks as a result of teeth loss.[4,5]

Kamakshi et al.[11] used intraoral NdFeB magnets as the mode of attachment. These rare earth magnets with small enough dimensions can be used in dental applications and still provide the necessary force. Deogade[12] also used cobalt –samarium magnets to retain the cheek plumpers with the final prosthesis. Magnets can provide a constant amount of retentive force even with a number of insertion and removal cycles of prosthesis. However, the long-term durability of the magnets remains a problem. Push buttons were used in this particular case as they are economical, easily available, due

to their smaller dimension easy to incorporate them in the denture flange to retain the cheek plumpers, and laboratory procedure not cumbersome.

Conclusion

In this case, without restoring the edentulous space of teeth 45 and 46 with a bridge and the selective grinding of the remaining mandibular teeth we could not obtain stability and retention for the maxillary denture.

The most visible adverse sequelae of single denture treatment are the wearing of the natural teeth and denture fracture which are prevented in this case, by using acrylic artificial teeth and the second one by using a cast metal reinforcement.

By giving the patient’s cheek plumpers, the authors have made an attempt to restore cheek fullness to the extent that comfort and function would permit and boost the self-esteem of the patient by improving his appearance.

References1. Zarb GA, Bolender CL, Carlsson GE. Prosthodontic Treatment for

Edentulous Patient. 12th ed. Harcourt India Private Ltd. New Delhi, India: Mosby; 2004. p. 427-37.

2. Winkler S, Lauciello FR. Essentials of Complete Denture Prosthodontics. 2nd ed. U.S.A: Ishiyaku EuroAmericca Inc.; 2000. p. 417-27.

3. Ellinger CW, Rayson JH, Henderson D. Single complete dentures. J Prosthet Dent 1971;26:4-10.

4. Lazzari JB. Intraoral splint for support of lips in Bells palsy. J Prosthet Dent 1955;5:579-81.

5. Larsen SJ, Carter JF, Abrahamian HA. Prosthetic support for unilateral facial paralysis. J Prosthet Dent 1976;35:192-201.

6. Huang CC, Feng HL. Analysis of the difference in the tissue surfaces between the old and new upper complete dentures. Zhonghua Kou Qiang Yi Xue Za Zhi 2009;44:232-5.

7. StansburyCB.Singledenture constructionagainstanonmodifiednaturaldentition. J Prosthet Dent 1951;1:692-9.

8. Vig RG. A modified chew in and functional impression technique. J Prosthet Dent 1964;14:214-20.

9. Sharry JJ. Complete Denture Prosthodontics. 2nd ed. New York: McGraw-Hill; 1968. p. 299-315.

10. Tan HK. A preparation guide for modifying the mandibular teeth before making a maxillary single complete denture. J Prosthet Dent 1997;77:321-2.

11. Kamakshi V, Anehosur GV, Nadiger RK. Magnet retained cheek plumper to enhance denture esthetics: Case reports. J Indian Prosthodont Soc 2013;13:378-81.

12. Deogade SC. Magnet retained cheek plumper in complete denture esthetics: A case report. J Dent (Tehran) 2014;11:100-5.

How to cite this article: Sowmya M, Krishna PD, Nariman RH. A single complete denture with cheek plumpers to improve facial aesthetics. J Dent Res Sci Develop 2015;2:17-9.

Source of Support: Nil Conflict of Interest: No conflict of interest.

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20Journal of Dental Research and Scientific Development | 2015 | Vol 2 | Issue 1

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