Press Stud Retained Detachable Cheek Plumper

ABSTRACT

Esthetics play a very important role in a person’s professional and social life. Emphasis on facial esthetics has become an integral part of dental treatment. Cheeks are an important factor in determining facial estheticsdue to their extreme visibility. Cheek plumper is a cheek lifting prosthesis that enhances the support of sunken cheeks and provides better esthetics. This clinical report highlights a technique for fabrication of an intraoral detachable press stud retained cheek plumpers.

Keywords:Cheek lifting device, Cheek plumper, Press stud attachment

Introduction

Ageing is associated with loss of teeth, resorption of the alveolar process, and reduced tonicity of the facial muscles, leading to sunken cheeks and an unesthetic appearance.¹ The appearance of the lower half of the face is determined by the contour of the jaw bones, underlying teeth, and the soft tissues and muscles surrounding the teeth. The edentulous state is associated with loss of teeth, resorbed alveolar ridge, reduced muscle tonicity and hollow cheeks.² Although denture flange do provide support to the circum-oral muscles but adequate support by cheek lifting appliance is needed to improve the appearance of the patient by reducing the sagging of cheeks and improve muscle tone in some cases.³ A conventional cheek plumper is a single-unit prosthesis with an extension near the premolar molar region that supports the cheeks.Demerits of such design are:

• Excessive weight which could hamper retention of the maxillary complete denture
• Can result in muscle fatigue.
• Can destabilize the maxillary denture
• Could interfere with masseter muscle and coronoid process of the mandible
• Difficult to insert the denture due to excessive weight.
• Can’t be used in patients with limited mouth opening.^4,5

This problem can be solved with the fabrication of denture with detachable cheek plumper creating dentures that are in harmony and dignity with the aging individual, which will not eradicate but compliment the stigma of aging in them.⁶ Detachable cheek plumpers are those that have separate components attached to the denture flange. Detachable cheek plumpers have various attachments like magnet retained or press stud fasteners retained which can be easily detached or attached to the denture flange.

CASE REPORT

A male patient, aged 72 years, reported to the Department of Prosthodontics at Bharati Vidyapeeth Dental College & Hospital (Navi-Mumbai) with the chief complaint of missing teeth in upper and lower arch and with the expectation of improving the facial appearance. Clinical examination revealed completely edentulous maxillary and mandibular arches, and extraoral findings of wrinkling of skin and flaccidity of facial muscles, resulting in sunken cheeks (Fig. 1).

Since the patients were seeking improvement in the facial appearance, a treatment plan was formulated involving the insertion of conventional complete denture with press stud retained detachable cheek plumpers for maxillary denture. Preliminary impressions were made with modeling plastic impression compound (Y-Dents Impression Compound; MDM Corporation) and poured in dental plaster, after which custom impression trays were fabricated withaut opolymerized acrylic resin. Border molding was done with green stick modeling plastic impression compound (Pinnacle Tracing Sticks; Dental Products of India). Definitive impressions were made with zinc oxide eugenol impression paste (Impression Paste; Dental Products of India) and the jaw relation was recorded.

For the try in appointment waxed-up dentures were first tried for occlusion and esthetics, followed by fabrication of wax patterns for cheek plumper. A roll of softened modeling wax was adapted over the buccal flanges of the maxillary denture on either side in the premolar-molar region. The adapted wax was inspected extraorally for adequacy of cheek support and contour and it was ensured that they did not cause occlusal interference, instability of dentures, or unnecessary tensing of facial muscles. The dentures and cheek plumpers were fabricated separately using heat-polymerized acrylic resin (Figure 2a,b & c).

Figure 2 (a, b, c) Showing cheek plumpers with final finished and polished maxillary denture.

Press stud fasteners were incorporated for retention. During the insertion of the dentures, adequate clearance of the cheek plumpers from the occlusal table was verified (Figure 3).

The patient was given instructions regarding the attachment and detachment of the cheek plumpers and asked to be present for regular follow-up evaluations. Within a week, the patient expressed satisfaction in mastication and phonetics and his esthetic dilemma was reduced with use of detachable press stud fastenerretained cheek plumper (Figure 4).

Figure 4 (a) Pre-operative, (b) Complete denture insertion done without cheek plumper, (c) Complete denture insertion done with cheek plumper

Discussion

Denture esthetics have advanced ahead than mere selection of teeth on the factors of form, shape, color, arrangement and sex, it is more of harmonization of artificial with natural.⁷ Teeth loss in posterior region results in loss of support to cheeks, which tend to move medially to meet laterally expanding tongue. Cheek contour change as a result of loss of vertical dimension of occlusion due to anterior teeth loss. Loss of subcutaneous fat, buccal pad of fat and elasticity of connective tissue produce the slumped cheeks, seen in aged.⁸

Corrections of slumping of cheeks can be accomplished by various methods like reconstructive plastic surgery, injecting the botulinum toxin (BOTOX) in the facial muscles and different types of prosthesis.⁹ The plastic surgery is a traumatic procedure which leaves behind the post-surgical scar, sometimes contra-indicated in old patients suffering from systemic diseases.¹⁰ The conventional cheek plumper has the major problem of retention and stability of maxillary denture due increased size and weight of the denture. It can also lead to muscle fatigue due to continuous use. Cheek plumpers provide a noninvasive and cost-effective treatment option for the improvement of facial appearance in patients with sunken cheeks. This treatment helps improve esthetics and the psychological well-being of patients.
Conclusion

Cheek plumpers are straightforward to fabricate and provide a noninvasive and cost-effective treatment option for the improvement of facial appearance in patients with sunken cheeks. This treatment helps improve esthetics and the psychological well-being of patients. Detachable cheek plumpers provide increased patient comfort, leading to greater patient acceptance of the prosthesis. In situations where the desired cheek muscle draping cannot be achieved in patients with sunken cheeks, mandibular cheek plumpers can be successfully inserted in addition to maxillary cheek plumpers in order to improve the overall facial appearance.

References