|Year : 2019 | Volume
| Issue : 1 | Page : 25-30
A magnetically retained cheek plumper in a maxillary single complete denture: A clinical report
Sri Ram Venkatachalapathy, Gopi Naveen Chander, Padmashini Gnanam
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
|Date of Web Publication||18-Feb-2019|
Sri Ram Venkatachalapathy
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Facial esthetics plays an important role in determining the psychology of patients. The loss of oral structures primarily affects the appearance in the lower half of the face. There are an increased rate of resorption of the alveolar ridges and a decrease in the muscle tonicity, both of which leads to sinking of cheeks. Rehabilitating a completely edentulous patient not only dentally but also facially will bring about an esthetic change. This leads to an increase in the patient's self-confidence and their social interactions. This clinical report introduces a simple noninvasive cost-effective technique to improve the dental and facial appearance using a detachable cheek plumper which is attached to the denture by neodymium close-field magnets.
Keywords: Detachable cheek plumper, metal mesh-reinforced denture, neodymium close-field magnets
|How to cite this article:|
Venkatachalapathy SR, Chander GN, Gnanam P. A magnetically retained cheek plumper in a maxillary single complete denture: A clinical report. J Interdiscip Dentistry 2019;9:25-30
|How to cite this URL:|
Venkatachalapathy SR, Chander GN, Gnanam P. A magnetically retained cheek plumper in a maxillary single complete denture: A clinical report. J Interdiscip Dentistry [serial online] 2019 [cited 2019 Jul 15];9:25-30. Available from: http://www.jidonline.com/text.asp?2019/9/1/25/252524
| Clinical Relevance to Interdisciplinary Dentistry|| |
- A detachable cheek plumper was advocated to improve the patient's facial profile and to reduce the weight of the final prosthesis
- Metal mesh reinforcement was done in the maxillary complete denture to withstand the force transmitted from mandibular natural dentition
- The resultant prosthesis was also easy to insert and remove without any hindrance. In case of dislodgment of the cheek plumper, the magnets present in it will automatically re-position it in its appropriate position to improve patient midfacial profile.
| Introduction|| |
Aging is associated with loss of teeth which will eventually result in resorption of the alveolar ridges. Gradual and steady resorption of the alveolar bone causes a decrease in the tonicity of the facial muscles. The fullness of the cheeks is primarily determined by the support provided by internal structures, i.e., teeth and ridges. Loss of teeth and associated bone causes the cheeks to shrink inwards resulting in an unaesthetic facial appearance. Age also reduces the concavity and pout of the upper lip and fattens the philtrum. The nasolabial groove deepens which produces a sagging look in the middle third of the face, while atrophy of the subcutaneous and buccal pads of fat hollows out the cheeks. Other factors such as patient weight loss and heavy tooth attrition also produce orofacial changes.
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. Replacement of the lost teeth only enhances dental esthetics but fails to achieve facial esthetics. Restoring the shrunken cheeks to their natural fullness can be done by adding extra support to the denture flange area. This can be done using cheek plumper or cheek lifting appliance. Fixed cheek plumper prosthesis was advocated to rectify hollowed out cheeks, by increasing the thickness of the buccal flange on either side of the denture or by placing additional row of teeth on the buccal side of posterior part of the denture. This can differ based on different clinical scenarios.
Fabrication of a single-piece denture with cheek plumper has its own limitation(s) which includes difficulty during insertion and removal in patients with limited mouth opening. Furthermore, the extra weight of the prosthesis will affect the retention of the denture and will interfere with the muscle function during mastication and phonation. The buccal corridor space is severely affected in fixed cheek plumper prosthesis. To overcome this problem, a detachable cheek plumber has been advocated. This technique offers more advantages in terms of ease of use (attaching and detaching the cheek plumper from the denture) and maintenance of oral hygiene.
This clinical report illustrates the use of customized neodymium close-field magnets to support a detachable cheek plumper in maxillary mesh-reinforced single complete denture opposing natural mandibular dentition.
| Case Report|| |
A 52-year-old male patient reported to the Department of Prosthodontics at SRM Dental College and Hospital, Ramapuram, Chennai, Tamil Nadu, India. His chief complaint included missing maxillary and mandibular teeth and the need to improve his overall facial appearance. Extraoral examination revealed wrinkling of facial skin and slumping of the cheeks [Figure 1]. On intraoral examination, the patient had a completely edentulous maxillary arch and a partially edentulous mandibular arch with missing 31 (Kennedy's Class IV) [Figure 2]. Mandibular teeth were supraerupted and generalized attrition was present. On radiographic evaluation using cone-beam computed tomography, it was seen that the maxillary ridge was resorbed (Atwood's Class V). The patient was conscious of his overall facial appearance and desired to have a prosthesis which would make his face look fuller and healthier.
Considering the patient's economic status, a treatment plan was formulated and the treatment procedure was explained to the patient. For the maxillary arch, a single complete denture was advised either with a metal denture base (Co-Cr or Ti) or reinforced with a metal mesh. To improve the patient's facial appearance, a detachable cheek plumper was advocated. This cheek plumper could be attached using stud attachments or magnets (neodymium close-field magnets). To replace the missing 31, a choice of fiber-reinforced composite or removable partial denture was advised.
The advantages and disadvantages of the treatment plan were explained to the patient. The patient opted for a mesh-reinforced single complete denture with detachable cheek plumper using magnets in the maxillary arch and a removable partial denture for the mandibular arch. Metal mesh reinforcement in the denture base will weigh less when compared to that of metal denture base (Co-Cr). Magnets used in the prosthesis also will have superior advantage than stud attachments. Reorienting the cheek plumper is more comfortable in magnets compared to stud attachments as the magnetic forces of attraction will automatically reorient it to its appropriate place. Patient's consent was obtained before commencing the treatment.
- In the first appointment, primary impression of the maxillary arch was made using impression compound (Samil™ impression compound) and mandibular impression was made using irreversible hydrocolloid (Zelgan Plus Alginate Impression Material, Dentsply)
- Custom tray was fabricated for maxillary arch using light polymerized acrylic resin (Poly Tray, Delta)
- At the second appointment, border molding was done in the maxillary arch using green stick compound (DPI Pinnacle Tracing Sticks) and the final impression was made with zinc oxide-eugenol impression paste (DPI Impression Paste)
- Vertical and centric jaw relations were recorded and mounting was done
- Teeth setting was done (Acry Rock, Ruthenium Dental Products). Care was taken by placing the maxillary posterior tooth more buccally to support the cheek muscles
- The patient was recalled for wax try in verification [Figure 3]. During this appointment, the occlusion and the dental esthetics were examined. After obtaining the patient's consent, the trial dentures were waxed up for processing
- Both the maxillary and mandibular waxed up dentures were flasked using a conventional flask and clamp using Type II gypsum product (Golden Stone, Golden Stone Ramaraju Traders, Chennai). De-waxing was done using a boiling-out machine (Labormat SD, Dreve-Dentamid GMBH, Germany) and any residual wax was manually removed using the hand shower of the same machine
- A thin layer of separating medium (Cold Mold Seal, DPI) was carefully painted over the stone of both flask halves
- Metal mesh was placed over the maxillary cast after de-waxing [Figure 4]. Acrylic resin (DPI Heat Cure) was mixed with monomer (DPI Heat Cure) in 3:1 ratio, and the resin was packed in the dough stage into the mold space. Trial closure was done to remove excess resin using a hydraulic press (Hydraulic Press P400, SIRIO Dental SRL) to ensure even flow of the resin to all the areas. This was repeated until no flash was observed. The flask was then tightened to 100 N using the same hydraulic press machine and bench curing was done for 20 min
- Polymerization was done using conventional heat curing technique (74°C for 1½ h). Once the dentures were processed, the flasks were bench cooled for 30 min. Deflasking was done to retrieve the denture using a hammer and plaster knife
- The finished and polished dentures were inserted into the patient's mouth and checked for sharp margins and over extensions. Post denture instructions given to the patient.
When the patient's extraoral appearance was evaluated, a slumped appearance of the cheek still existed [Figure 5]. The patient was advised to wear the denture for 1 week to give time to get used to the prosthesis. At the first recall appointment, the patient was still unhappy about his facial appearance. Wax pattern for the detachable cheek plumper was fabricated and placed on both the sides of the buccal flange extending from the first premolar to mesial surface of second molar [Figure 6] and [Figure 7]. Diligent examination was done to ensure that there were no occlusal interferences. Care was taken to ensure that the denture still retained its stability, and there was no unnecessary tensing of facial muscles.
|Figure 5: Extraoral view of finished prosthesis before incorporation of cheek plumper|
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Patient extraoral appearance was examined. After satisfactory results were obtained, the maxillary cheek plumpers were fabricated using acrylic resin (DPI Heat Cure). The processed acrylic cheek plumpers were trimmed, polished, and reoriented to the denture base. Magnets (neodymium closed field magnet) were incorporated on both sides of the buccal flange of the maxillary complete denture and also at the corresponding portion in the cheek plumper [Figure 8] using auto polymerizing acrylic resin (DPI Cold Cure). The final maxillary single complete denture with detachable cheek plumper was inserted into patient's mouth [Figure 9] and examined. There was a considerable improvement in the extraoral facial esthetics. The cheek plumpers did not affect the speech, retention, and stability of the dentures. The patient was satisfied about his facial appearance [Figure 10]. Instructions were given on how to use cheek plumpers. The strong magnetic pull helped in orienting the cheek plumpers to the correct position. The patient was advised to remove the cheek plumper during eating as it might interfere with mastication. The patient was recalled for review after 1 day, 1 week, and 1 month and recall appointment scheduled every 6 months.
| Discussion|| |
The conventional method of treating a slumped cheek is to increase the thickness of the buccal flange or by placing an additional row of teeth to achieve fullness of the cheek. However, this can affect the retention and stability of the denture and also cause muscle fatigue. In this case report, a detachable cheek plumper was advocated to improve the patient's facial profile and to reduce the weight of the final prosthesis. Kamakshi et al. have described a magnetically retained detachable cheek plumper to enhance the facial profile in patients with shrunken cheeks. The author used neodymium close-field magnets for retention. Keni et al. described a technique to support shrunken cheeks with a detachable cheek plumper using customized attachments made of Co-Cr alloys and orthodontic separators. Muthuvignesh advocated a fixed cheek plumper for rehabilitation in Bell's palsy patients. Virdiya et al. described various attachments for detachable cheek plumpers in conventional complete denture prosthesis. Nariman et al. used push buttons as a retentive aid for detachable cheek plumpers.
Metal mesh reinforcement was done in the maxillary complete denture to withstand the force transmitted from mandibular natural dentition. Metal mesh is light in weight, less expensive and less technique sensitive compared to conventional cast metal denture base. Metal mesh used in this study is made of NPG alloy; it is 0.25 mm thin, very flexible, easily adapted into any shape and can be easily layered between acrylic.
The resultant prosthesis was also easy to insert and remove without any hindrance. Earlier studies were done with studs for the retention of the check plumper. However, magnets have the advantage of being small and cost-effective. The automatic resetting of the cheek plumper into the desired position due to the magnetic force is also beneficial. Placement and removal of the cheek plumper are also easy for the patient. The most common problem encountered in single complete denture is fracture of the prosthesis due to excess force transmitted from the opposing natural dentition, and this can be prevented by reinforcement. A metal mesh added to the prosthesis will withstand these forces.
| Conclusion|| |
A cheek plumper is an additional prosthetic aid which improves the patient's facial esthetics by restoring the facial contour and improves their overall psychological well-being. A detachable cheek plumper is easy to fabricate, cost-effective, noninvasive and maintains patient comfort. Although there are various attachments available for fabrication of a detachable cheek plumper such as press or push buttons, magnets, and orthodontic separators, each has their own pros and cons. This technique describes the fabrication of a cheek plumper retained by the use of magnets to improve the facial esthetics in a patient with shrunken cheeks. By advocating this treatment to the patient, his lost smile is reincarnated, and comfort, function, and facial appearance improved.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]