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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 88-92

Old is gold - Modified dentures doing wonders


1 Department of Prosthodontics, Crowns and Bridge and Implants, Yamuna Institute of Dental Sciences and Research, Yamuna Nagar, Haryana, India
2 Department of Orthodontics and Dentofacial Orthopaedics, Yamuna Institute of Dental Sciences and Research, Yamuna Nagar, Haryana, India

Date of Submission20-May-2020
Date of Acceptance07-Jul-2020
Date of Web Publication31-Aug-2021

Correspondence Address:
Dr. Mukti Goel
Dr. Kansal's Dentistree, #537-p, Sec-13 Extn, Karnal, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jid.jid_37_20

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   Abstract 


Esthetics has become an integral part of prosthesis. Prosthetic rehabilitation of a completely or partially edentulous patient no longer confines to only replacement of missing teeth but has expanded to the enhancement of esthetics by various treatment modalities. Dentist needs to be updated with the various treatment options for providing proper functioning with pleasing esthetics. This article aims to provide with an easily constructed, inexpensive, and practical removable prosthesis to optimize the esthetic and functional outcomes in the special situations, while permitting cleansability of the prosthesis and supporting tissues.

Keywords: Cheek plumper, gingival recession, gingival veneer, labial prong, removable dentures


How to cite this article:
Goel M, Kansal A. Old is gold - Modified dentures doing wonders. J Interdiscip Dentistry 2021;11:88-92

How to cite this URL:
Goel M, Kansal A. Old is gold - Modified dentures doing wonders. J Interdiscip Dentistry [serial online] 2021 [cited 2021 Dec 9];11:88-92. Available from: https://www.jidonline.com/text.asp?2021/11/2/88/325108




   Clinical Relevance to Interdisciplinary Dentistry Top


The goal of the dentistry is not only related to intraoral areas but also related to extraoral features. These modified dentures completely justify the goal.


   Introduction Top


T he demand for pleasant esthetic restoration has always been a concern in dentistry. Meeting the patient's demand with the removable dentures has always been a challenge to a dentist, and any unusual morphology makes it more challenging. It is important for the dentist to consider the whole face in totality when providing a prosthesis.[1] One should remember that dental esthetics is not only confined to “white component” of restoration but also confined to the “pink component” surrounding the natural teeth.[2] This article aims to focus the satisfaction level of patients on the improvement of their esthetics with the modified conventional removable prosthesis.


   Case Reports Top


Case report 1: Modified gingival prosthesis

A 54-year-old male patient reported with a chief complaint of missing upper front teeth, recessed gums in both upper and lower arches, and inability to speak properly with unanticipated expectoration [Figure 1]. The patient had visited many dentists but expressed dissatisfaction with esthetics and phonetics because of clasps and large palatal coverage by the previous maxillary denture [Figure 2]. Orthopantomogram, as part of the radiographic examination, showed generalized bone loss, and thus, surgery as a treatment option was ruled out. Thus, it was planned to fabricate a gingival prosthesis for both arches which was modified with denture teeth for maxillary arch. Diagnostic impression was poured with the dental stone. A labial custom tray was made using self-cure methyl-methacrylate after blocking the interdental spaces from palatal and lingual side. The tray extended from incisal edges to vestibular sulcus from the first premolar of the one side to the first premolar of the contralateral side. The master impression was made with buccal approach using the polyether impression material and poured in die stone. The extension of the prosthesis was outlined on the cast [Figure 3]. The prosthesis was waxed and carefully invested [Figure 4] and [Figure 5]. After dewaxing, the mold was packed with standard heat-cured acrylic resin and processed. The prosthesis was made extremely thin and had enough flexibility to engage the undercuts. After finishing, the maxillary gingival veneer was modified by incorporating the denture teeth [Figure 6]. The resulting denture was palateless as interproximal undercuts were sufficient to provide retention needed. The patient has been wearing the prosthesis with great satisfaction from the perspective of esthetics, phonetics, expectoration, and comfort [Figure 7].
Figure 1: Recessed gums in the maxillary and mandibular arches

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Figure 2: Unaesthetic clasp visibility in previous partial denture

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Figure 3: Prosthesis extension outlined on the cast

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Figure 4: Wax-up of the prosthesis

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Figure 5: Flasking of the prosthesis

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Figure 6: Addition of denture teeth in maxillary gingival prosthesis

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Figure 7: Remarkable improvement in esthetics

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Case report 2: Cheek plumper denture

A 65-year-old completely edentulous patient with sunken flaccid appearance of cheeks reported to the clinic for the prosthesis [Figure 8]. Based on the patient's needs, complete denture was planned with buccal extensions to provide adequate support to cheeks. All the steps for conventional complete denture were followed till try-in stage. At the try-in stage, modeling wax was added on the maxillary buccal flanges in an incremental manner till the facial esthetics was found to be satisfactory. The trial denture along with the cast was duplicated using reversible hydrocolloid and poured in dental stone. A clear template of the stone cast was made with 0.5-mm thermoplastic sheet, and trial denture was flasked following the standard manner till the wax elimination stage. A heat-polymerized denture acrylic resin denture base was fabricated alongside in another flask. Vinyl polysiloxane putty was adapted over the bur roughened surface of the denture base (near the cheek plumper extensions) so as to create hollow bulb in that area only. Trial closure was followed by the processing in the usual manner. Silicone putty was removed through the distal openings made on the extensions. Holes were sealed using autoploymerizing resin, and floating test was done to ensure the light weight of the denture [Figure 9]. The patient was amazed and satisfied with the esthetics and functioning of the denture [Figure 10].
Figure 8: Sunken cheeks

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Figure 9: Flowchart of the laboratory procedures and insertion of the denture

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Figure 10: Improved esthetics with denture

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Case report 3: Labial prong denture

A 65-year-old female patient reported with the complaint of unaesthetic look and incompetence of the lips with her previously fabricated conventional complete denture [Figure 11]. Intraoral examination revealed a labially inclined premaxilla and an accompanying severe labial undercut [Figure 12]. Hence, a complete denture with modified labial flange was planned to fulfill the esthetic demand of the patient. All the steps were done in a conventional manner till the jaw relation stage. At the try-in stage, labial flange was removed completely and the two prongs were strategically created to anchor the canine eminence from the distal side. Anterior edentulous ridge was just covered by denture base over the ridge crest area. Anterior teeth were reduced to the thickness of laminates. The gingival carving was done to camouflage the naturality. After wax-up, polyvinyl siloxane putty was adapted over the cutout area of the denture to preserve the designed labial flange. Grooves were made on the outer facing of the putty for proper orientation during flasking. After this, all the conventional denture fabrication steps were followed. The patient was happy and completely satisfied with the esthetics and functioning of the denture [Figure 13] and [Figure 14].
Figure 11: Forcefully closed lips with conventional complete denture

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Figure 12: Cast showing labial inclination and severe undercut

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Figure 13: Final maxillary and mandibular dentures

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Figure 14: Happy and satisfied patient

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   Discussion Top


Functional integrity along with esthetics is an ultimate demand with any prosthesis. However, it is difficult to meet all the requirements wherein the field of play is restricted by some different morphology. Eccentric thinking can change the scenario with the help of some modifications in the conventional steps. Acrylic resin gingival veneer prosthesis can improve the esthetic, phonetic, and functional characteristics when loss of periodontal support is evident and missing teeth need to be replaced. However, care should be taken for caries control, maintenance of prosthesis, and oral hygiene.[3] The use of gingival veneers with implant-supported restorations has been discussed in the literature.[4],[5],[6] Drooping cheeks can be rectified by different methods such as reconstructive plastic surgery, injecting botulinum toxin in the facial muscles, and different types of prosthesis.[7],[8],[9] However, hollow cheek plumper is a simple, effective, and noninvasive treatment alternative to improve facial esthetics. The labial prong denture conservatively amends severe labial undercuts in the premaxilla and improves the esthetics and appearance of the patient. This clinical report describes the prosthodontic management of the patients with atypical morphology. It is important to determine not only the type of treatment but also the treatment sequence for every patient on the basis of their needs and limits. With proper case selection and treatment planning, the dentist can help the patient to enjoy the best possible treatment outcome.

Acknowledgment

We would like to acknowledge S. B.Goel, Usha Goel, Kirti Gupta, and Chirag Goel.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
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. 1
    
2.
Yalamanchili PS, Surapaneni H, Reshmarani AP. Gingival prosthesis: A treatment modality for recession. J Orofac Sci 20135:128-30.  Back to cited text no. 2
  [Full text]  
3.
Greene PR. The flexible gingival mask: An esthetic solution in periodontal practice. Br Dent J 1998;184:536-40.  Back to cited text no. 3
    
4.
Brygider RM. Precision attachment-retained gingival veneers for fixed implant prosthesis. J Prosthet Dent 1991;65:118-22.  Back to cited text no. 4
    
5.
Parel S, Balshi TJ, Sullivan DY, Cardenas ER. Gingival augmentation for osseointegrated implant prosthesis. J Prosthet Dent 1986;56:208-11.  Back to cited text no. 5
    
6.
Morgano SM, Verde MA, Haddad MJ. A fixed-detachable implant-supported prosthesis retained with precision attachments. J Prosthet Dent 1993;70:438-42.  Back to cited text no. 6
    
7.
Ahmad KA, Drummond JL, Graber T, BeGole E. Magnetic strength and corrosion of rare earth magnets. Am J Orthod Dentofacial Orthop 2006;130:275.e11-5.  Back to cited text no. 7
    
8.
Drak M, Dobrzanski LA. Corrosion of Nd-Fe-B permanent magnets. J Achiev Mater Manuf Eng 2007;20:239-42.  Back to cited text no. 8
    
9.
Kumar P, Khattar A, Goel R, Kumar A. Role of botox in efficient muscle relaxation and treatment outcome: An overview. Ann Med Health Sci Res 2013;3:131.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14]



 

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