RESTORING NOT JUST TEETH BUT FACIAL ESTHETICS:

CHEEK PLUMPER: A CASE REPORT

Dr. Divya Dahiya1, Dr. Anamika Ahlawat2 , Dr. Rangesing Rathwa3, Dr.
Neeraj kumar4

1
(Professor), Dept. Of Prosthodontics, PGIDS, Rohtak)
2,3,4
(Post-graduate student, Dept. of Prosthodontics, PGIDS, Rohtak)

Abstract
Complete Denture is an artificial appliance which restores natural functions and
esthetics caused by loss of natural teeth. This clinical report describes a technique
to improve support for sunken cheeks using magnet retained detachable acrylic
cheek plumpers. Magnet retained cheek plumper help to enhance facial appearance
by supporting the slumped cheeks. However, further follow-up may be necessary
to ascertain the long-term usefulness of the magnet-retained prosthesis, because of
corrosion and further loss of magnetism.

Key Words: Cheek Plumper; Esthetics; Magnets

Introduction
Complete Denture is an artificial appliance which restores all the lost natural teeth
in an edentulous mouth and restores the mastication, phonetics and esthetics. The
first objective of complete denture prosthesis is mastication. Second objective is
restoration of the esthetics, concerned with the artistic phase of the prosthesis. It
relates to the ability of the prosthesis to construct or create the natural looking
substitutes for the lost natural alveolar processes and teeth and to reproduce by
artistic sense and skillful technique to restore the lost facial contour as well[1].

Denture flanges if properly extended and contoured can help to achieve facial
esthetics by supporting lips and cheeks. However, in cases of patients with hollow
cheeks, extra support has to be provided. Cheeks due their extreme visibility are an
important factor in determining facial esthetics. Slumped or hollow cheeks can add
years to a person’s age and can have a detrimental psychological effect on the
patient.1In such cases, cheek plumper can be given. Cheek plumper, also known as
cheek lifting appliance, is a prosthesis for supporting and lifting the cheek to
provide required support and esthetic that will increase the self esteem of the
patient by providing a youthful appearance. It can be used in patients who have
excessive slumping of cheeks due to tooth loss. It is especially useful in young
patients who have lost all their teeth and part of the maxillary bone as a result of
traumatic injury[2,3,4].

A cheek plumper can be of two types: detachable or

undetachable. The undetachable or conventional cheek plumper is a single unit
prosthesis with extensions on either side in the region of the polished buccal
surfaces of the denture and are continuous with the rest of the denture. Detachable
cheek plumper on the other hand is the prosthesis in which plumper part can be
detached from the complete denture. This can be achieved by magnets or
customized attachments[11].

This paper reports an innovative technique of plumping the cheeks using cheek-
plumper which are attached to the conventional complete denture, using magnets.

Case Report

A 65 year old male patient( fig 1) reported to the department of prosthodontics,

PGIDS , Rohtak with the chief complaint of missing teeth . On examination,
patient had completely edentulous upper and lower arches. He was edentulous for
past 4 years. Extraoral examination showed slumped cheeks. The patient was
conscious about the slumped cheeks and desired a prosthesis which will make his
face look fuller. Keeping patient’s demand in mind, the treatment plan was
formulated. It was decided to give the patient maxillary and mandibular complete
dentures with magnet retained detachable cheek plumper for the maxillary
denture.
Fabrication Technique:

1) Preliminary Impressions: The preliminary impression of the maxillary and

mandibular arch was made in the conventional manner using impression
compound (fig 2)

2) Secondary Impressions: The preliminary casts were obtained, over which

special trays were fabricated using auto polymerizing resin (DPI Dental products),
keeping them 2mm short of the sulcus. The border moulding was carried out
conventionally using low fusing impression compound and the final impression
was recorded with zinc-oxide eugenol impression paste for mandibular arch and
using light body elastomeric material for maxillary arch (fig 3).

3) Jaw Relations and teeth arrangement: Master cast was obtained on which
denture bases were made. Occlusal rims were fabricated on the denture bases and
maxillomandibular relations were recorded . Articulation was done(fig 4) followed
by teeth arrangement( fig 5).

4) Try In: For the try in appointment, waxed denture were first tried for occlusion
and esthetics. Wax templates for cheek plumper were attached to the maxillary
denture in the distobuccal region and were adjusted accordingly to give patient a
fuller appearance(fig 6) . A wash impression with light body impression material
was also taken by placing the wax templates against the distobuccal region for
better adapatability(fig 7).

.
5) Acrylization: After taking the patient's consent, the waxed plumper was
separated from trial denture and acrylization of dentures(fig 9, 10) and cheek
plumper(fig 8) were done in the conventional way. Dentures were finished and
polished (fig 11a,b) and were tried in the patient 's mouth( fig 12). After inserting
the dentures along with cheek plumper the patient's esthetics was improved
remarkably and he was quite satisfied with his new appearance(fig 13).
Discussion
In order to mimic the fullness of the cheeks, a cheek plumper is often used and
known as the cheek lifting appliance. It is variously cited in literature for providing
support to the cheek wherever and whenever deficient. This prosthesis is basically
for supporting and plumping the cheek to provide a youthful appearance. Its use in
Maxillofacial Prosthodontics is well documented. However it can also be used in
patients who have an unusually excessive slumping of the cheeks as a result of
teeth loss.

A Conventional Cheek Plumper would be a part of the complete maxillary

denture prosthesis forming single unit prosthesis with extensions on either side in
the region of the polished buccal surfaces of the denture and are continuous with
the rest of the denture[8,10].

Disadvantages of conventional cheek plumper: The conventional cheek plumper

if not made hollow could add excessive weight to the upper denture thus bringing
it down by force of gravity. The buccal extension could interfere with massater
muscle and the coronoid process of the mandible and hence destabilize the upper
denture especially during eating. The extensions could result in muscle fatigue and
the only way to relieve it would be for the patient to remove the upper denture
which might not always be desirable. The excessive medio-lateral width of the
denture in the region of the cheek plumper could result in difficulty in inserting the
denture and this would be more of a problem for patients with smaller mouth
opening[5-8].

Advantages of magnet retained cheek plumper:

The magnets have a small size and hence can be placed within the denture and the
cheek plumper without being obtrusive and produce strong attractive forces
between the hollow plumper portion and the steel encased magnet within the
buccal tissue surface of the denture. It can be introduced in the mouth after the
insertion of the denture as two separate portions each of which are marked for
convenience. It can be removed from the mouth during eating and when excessive
muscle fatigue is there. It also allows for ease of placement and cleaning and
automatic reseating.

Disadvantages of magnet retained cheek plumper are:

Poor corrosion resistance, alleged harmful effects of magnetic field on the health
of the oral tissues and loss of magnetic property over a period of time and hence
requiring frequent replacement[8,9].

Conclusion
Giving the patient magnet retained cheek plumper the authors made an attempt to
restore cheek fullness within that comfort and function would permit and boost the
self-esteem of the patient by improving his appearance.

References
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