CLINICAL REPORT

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Detachable cheek plumpers with different attachments forimproving esthetics in a conventional complete denture:

A clinical report

Nikita M. Virdiya, BDS,a Jayant N. Palaskar, BDS, MDS,b Jyoti Wankhade, BDS,c and Nikhil Joshi, BDS, MDSd

ABSTRACTAging is associated with loss of teeth, resorption of the alveolar process, and reduced tonicity of thefacial muscles, leading to sunken cheeks and an unesthetic appearance. Esthetics in patients inneed of complete dentures can be improved with the help of cheek plumpers to support thecheeks. They are noninvasive and straightforward to fabricate. Despite the reported success withthe sole use of maxillary cheek plumpers, in certain situations, maxillary cheek plumpers provideinadequate support to the cheeks, evident in the lower third of the face. This clinical reportdescribes a technique for fabricating detachable mandibular and maxillary cheek plumpers with 2different types of attachment mechanisms. (J Prosthet Dent 2017;117:592-596)

Facial esthetics play an impor-tant role in a person’s profes-sional and social life.1 Theappearance of the lower half ofthe face is determined by thecontour of the jaw bones,underlying teeth, and the softtissues and muscles surround-ing the teeth. The edentulousstate is associated with loss of

teeth, resorbed alveolar ridge, reduced muscle tonicity,and hollow cheeks.2

Loss of teeth followed by resorption of the alveolarridge and loss of muscle tone leads to the slumping of thecheeks, resulting in a hollowed-out, sunken appearanceand exaggeration of wrinkles because of tissue laxity. Thisaged appearance frequently affects the patient’s self-image, leading to feelings of social rejection and psy-chosocial pressures and further age-concealmentprocedures.3

Complete denture treatment includes not only thereplacement of missing teeth but also the restoration offacial appearance. Conventional complete dentures withappropriate flange extensions and positioned teethadequately support the overlying lips and cheeks. How-ever, in individuals with marked resorption of the alveolarprocess, conventional dentures fail to provide adequatesupport, necessitating additional support for the cheeks.

Cheek plumpers have been described for improvingesthetics and the psychological profile of patients with

e student, Department of Prosthodontics and Crown & Bridge, Sinhgad Ded Head, Department of Prosthodontics and Crown & Bridge, Sinhgad Dene student, Sinhgad Dental College And Hospital, Maharashtra, India.ofessor, Sinhgad Dental College And Hospital, Maharashtra, India.

maxillofacial defects and facial paralysis.4,5 Patients withfacial paralysis were provided extended denture flangesto improve support to the overlying facial tissues.6

Cheek plumpers have also been used to improveesthetics in patients with complete dentures. A conven-tional cheek plumper is a single-unit prosthesis with anextension near the premolaremolar region that supportsthe cheeks. Such devices are an integral part of thecontour of maxillary denture flanges designed by over-contouring denture flanges in the mediolateral andanteroposterior directions within physiologic limits.However, the increased weight and bulk of conventionalcheek plumpers make their insertion challenging andalso hampers the retention of maxillary complete den-tures. Moreover, they cannot be used in patients withlimited mouth opening because the additional thicknessmight hinder the insertion and/or removal of thedentures.7

Another type of cheek plumpers are those that areseparate components attached to the denture flange. In

ntal College And Hospital, Maharashtra, India.tal College And Hospital, Maharashtra, India.

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Figure 1. A, B, Patients showing sunken cheeks.

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such detachable prostheses, the plumper can bedetached from and reattached to the complete denture bythe patients themselves.8-11 Because of their detach-ability, they are easy to insert, remove, and clean.

However, maxillary cheek plumpers (conventional ordetachable) do not adequately provide fullness of cheeksin line with the angle of the mouth below the device. Tocompensate for this hollowness, the insertion ofmandibular cheek plumpers in addition to maxillarycheek plumpers was planned.

CLINICAL REPORT

Two male patients, aged 78 and 67 years, sought care atthe Sinhgad Dental College and Hospital complaining ofmissing teeth and with the expectation of improving theirappearance. Clinical examination revealed completelyedentulous maxillary and mandibular arches, andextraoral findings of wrinkling of skin and flaccidity offacial muscles, resulting in sunken cheeks (Fig. 1).

Because the patients were seeking improvement intheir facial appearance, a treatment plan was formulatedinvolving the insertion of conventional complete denturesand detachable cheek plumpers for maxillary andmandibular dentures. Preliminary impressions were madewith modeling plastic impression compound (PinnacleImpression Compound; Dental Products of India) andpoured-in dental plaster, after which custom impressiontrays were fabricated with autopolymerized acrylic resin.Border molding was done with green stick modeling

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plastic impression compound (Pinnacle Tracing Sticks;Dental Products of India). Definitive impressions weremade with zinc oxide eugenol impression paste (Impres-sion Paste; Dental Products of India), the jaw relation wasrecorded, and the tooth arrangement was evaluated.

Wax patterns for the cheek plumpers were fabricatedduring the clinical evaluation stage. A roll of softenedmodeling wax was adapted over the buccal flanges of themaxillary denture on either side in the premolaremolarregion. The adapted wax was inspected extraorally foradequacy of cheek support and contour. Because thedefinitive wax patterns of the maxillary cheek plumpersdid not provide adequate support to the cheek below (inthe mandibular region; Fig. 2A), mandibular cheekplumpers were planned to ensure adequate fullness inthe lower half of the cheek. Wax patterns for themandibular cheek plumpers were fabricated by a similarmethod (Fig. 2B) and modified to ensure that they didnot cause occlusal interference, instability of dentures, orunnecessary tensing of facial muscles (Fig. 3).

The dentures and cheek plumpers were fabricatedseparately using heat-polymerized acrylic resin. For thefirst patient, magnets (Permag Products Pvt Ltd) wereincorporated into the buccal flanges of the dentures andcheek plumpers with autopolymerizing acrylic resin(Fig. 4). For the second patient, press stud fasteners(Pony Snap Fasteners) were incorporated for retention(Fig. 5). During the insertion of the dentures, adequateclearance of the cheek plumpers from the occlusal tablewas verified. The patients were given instructions

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Figure 2. A, Patient wearing trial dentures with wax patterns for maxillary cheek plumpers attached. Cheek below maxillary trial denture showsinsufficient support. B, Maxillary and mandibular cheek plumpers attached.

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regarding the attachment and detachment of the cheekplumpers (Fig. 6) and asked to present for regular follow-up evaluations (Fig. 7).

DISCUSSION

Because of their increased size and weight, conventionalcheek plumpers present major limitations in terms of

Figure 3. Trial dentures with wax patterns for cheek plumpers.

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retention and stability in patients with maxillary den-tures. They could also cause muscle fatigue withcontinuous use.8

Muscle fatigue can be prevented if the patient has theoption of removing the cheek plumpers when experi-encing discomfort. Additionally, the limited mediolateralwidth of the oral cavity might hinder the placement ofcheek plumpers, especially in patients with microstomia.

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Figure 5. A, Press stud fasteners incorporated into buccal flange of maxillar

Figure 4. A, Maxillary denture with magnets incorporated into cameosurface of buccal flange. B, Cheek plumpers with magnets incorporatedinto surface contacting denture. C, Cheek plumpers attached to maxillarydenture.

Figure 6. Intraoral view of definitive dentures and cheek plumpersattached.

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Detachable plumper prostheses could facilitate theinsertion of dentures in such situations.

Previous studies have discussed the use of press studfasteners7,12 and magnets.7-10 Magnets have the benefitof being small, facilitating automatic reseating becauseof their magnetic forces, and being easy to remove andclean.13 Few authors have used stud attachments,orthodontic elastic modules, and wire-retained cheekplumpers.7,11 Clinicians can choose the appropriateattachment according to the thickness and height of thedenture flange and the dexterity of the patient. In thecase of the patients discussed in this report, maxillarycheek plumpers failed to provide adequate support tothe cheeks, probably because of the reduced tonicity ofthe overlying muscles and the extent of resorption of thealveolar process. Although the maxillary cheekplumpers succeeded in reducing the hollowness of thecheeks, the patients required additional support to thelower region of the cheek. Therefore, additionalmandibular cheek plumpers were inserted to provideadditional support to the cheek below the maxillaryplumper, thus reducing the overall hollowness. In

y denture. B, Press stud fasteners incorporated into cheek plumper.

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Figure 7. A, B, Patients with definitive denture and cheek plumpers (maxillary and mandibular) attached to dentures.

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situations where maxillary cheek plumpers do not pro-vide adequate cheek support, mandibular cheekplumpers can be added to improve cheek support andenhance esthetics.

However, cheek plumpers have a few drawbacks,including the accumulation of food, patient discomfortresulting from the additional weight and bulk ofthe dentures, the requirement of manual dexterity ofpatients to ensure accurate attachment, and the sus-ceptibility of magnetic attachments to corrosion andloss of magnetism and of the press stud fastenersto breakage.8,9 Therefore, periodic patient recall isnecessary to assess and, when required, replace theattachments.

SUMMARY

Cheek plumpers are straightforward to fabricate andprovide a noninvasive and cost-effective treatmentoption for the improvement of facial appearance inpatients with sunken cheeks. This treatment helpsimprove esthetics and the psychological well-being ofpatients. Detachable cheek plumpers provide increasedpatient comfort, leading to greater patient acceptance ofthe prosthesis. In situations where the desired cheekmuscle draping cannot be achieved in patients withsunken cheeks, mandibular cheek plumpers can besuccessfully inserted in addition to maxillary cheekplumpers in order to improve the overall facialappearance.

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REFERENCES

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3. Zarb G, Hobkirk JA, Eckert SE, Jacob RF. Prosthodontic treatment foredentulous patients: complete dentures and implant-supported prostheses.13th ed. St Louis: Mosby 2013. p. 39-40.

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

5. Lazzari JB. Intraoral splint for support of the lip in Bell’s palsy. J Prosthet Dent1955;5:579-81.

6. Unger JW, Stroster T. Modification of the maxillary complete denture inthe management of unilateral facial paralysis. Quintessence Int 1989;20:51-4.

7. Shah RJ, Chaturvedi AT, Prajapati HG, Malek FG, Darji BJ, Katyayan PA.Enhancement of patient aesthetics using detachable cheek plumpers incomplete dentures: case series. Sch J Med Case Rep 2014;2:615-7.

8. Punia V, Mishra R, Khandelwal M, Verma N, Handa M. Magnet retaineddetachable cheek plumper: innovation personified-a case report. Int J Pros-thet Dent 2013;4:16-20.

9. Kamakshi V, Anehosur GV, Nadiger RK. Magnet retained cheek plumper toenhance denture esthetics: case reports. J Indian Prosthodont Soc 2013;13:378-81.

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

11. Keni NN, Aras MA, Chitre V. Customised attachments retained cheekplumper prosthesis: a case report. J Indian Prosthodont Soc 2012;12:198-200.

12. Sowmya MK, Krishna PD, Nariman RH. A single complete denture with cheekplumpers to improve facial aesthetics. J Dent Res Sci Develop 2015;2:17-9.

13. Riley MA, Walmsley AD, Harris IR. Magnets in prosthetic dentistry.J Prosthet Dent 2001;86:137-42.

Corresponding author:Dr Nikita M. VirdiyaRuchi Apartments, Devidas Rd, Borivali(w)Mumbai 400103, MaharshtraINDIAEmail: virdiyaniki20@gmail.com

Copyright © 2016 by the Editorial Council for The Journal of Prosthetic Dentistry.

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