An 18-year-old female patient reported to the Department of Prosthodontics for prosthetic rehabilitation of her lost left eye. On eliciting history, it was found that the patient had sustained a shrapnel injury to her left eye, which necessitated a surgical evisceration of the eye. Clinical examination revealed a completely healed left eye socket. Her right eye had normal vision. The patient had no other relevant medical history [].\nA custom ocular tray was made by pouring autopolymerizing resin into an alginate mold made with a stock ocular prosthesis. Perforations were made in the custom ocular tray to aid in retention of the impression material, and a tunnel was cut out at the center of the custom tray to which a disposable impression tip was attached to deliver the impression material[] The impression was made by injecting light bodied addition silicone material (Aquasil Dentsply) through the prepared tunnel[] []. The patient was asked to move her eyes in all directions to facilitate flow of impression material into all aspects of the socket. Then, the patient was asked to look directly at a fixed point six feet away at the level of eye allowing impression of the site with the muscles in neutral gaze position The impression was invested first in dental stone till the height of contour and when set a second pour to create a two piece split cast mold[] [] A wax conformer was fabricated by pouring molten baseplate wax into the two pieces split cast, after which it was retrieved and the sharp edges were removed.[] The rubber stopper from a plunger tip of a tuberculin syringe was used as a removable cap which was fitted into an opening made in the posterosuperior aspect of the wax conformer A bevel was placed around the margins of the cap to help in easy removal and placement []. The wax conformer was then adjusted for the satisfactory fit, contours, and comfort An iris disk cut out from a stock eye was attached to the wax conformer using a transparent grid[] [] A needle cap was attached with cyanoacrylate adhesive to the iris disk []: To assess orientation of visual axis To stabilize and secure the iris disk during dewaxing and packing. A wire was attached to the rubber cap so that the rubber cap was retained in the same position during dewaxing and packing [] The prosthesis was invested in a dental flask. Upon separation of the flask after dewaxing, the rubber cap was retained in position by the attached wire and iris disk was retained in position by the needle cap which was attached to it [Figures and ] A mixture of clear heat cure acrylic resin and zinc oxide eugenol was packed to achieve a white scleral color.[] Lost salt technique was used to create a reservoir for the lubricant in the superior aspect of body of the ocular prosthesis[] [] A modified curing protocol (reverse curing cycle) was followed to minimize the monomer content of acrylic eye.[] In this technique, the flask was placed in water at 95°C × 20 min and thereafter in boiling water for additional 20 min The ocular prosthesis was acrylized, retrieved, and finished. All residual salt crystals were flushed out through the opening for the removable cap The prosthesis was tried to check for the extent, fit, comfort, and iris position. Characterization of the scleral part of the prosthesis was done with the help of (SR Adoro) light cure stains and (Targis Power) light curing unit so as to match the natural eye. Optiglaze protective coating agent (GC America) was applied to protect the characterization [] A 0.5 mm diameter exit hole for the lubricant was created on the anterior surface of the ocular prosthesis into the limbus with the help of a suitable bur which connected the reservoir containing the lubricant The prosthesis was disinfected in cidex :2% glutaraldehyde cidex (surgikos, Johnson & Johnson co.), and it was delivered to the patient with instructions as to how to load the lubricant (carboxymethylcellulose eye drops IP 0.5%, extralube).[] [Figures –]. The removable cap is to be replaced if there is deformation or tear such that it does not fit into the access passage or there is a leakage of lubricant. Patient was instructed to clean the prosthesis with ophthalmic irrigation solution.[] The chamber was cleaned by removing the removable cap and injecting ophthalmic irrigation solution through a syringe Patient was followed up after 24 h, 1 week, 1 month, 3 months, and then every 6 months. The removable cap was replaced after 6 months due to deformation.
This clinical case report was that of a stainless double die pin retained cheek plumper in complete denture esthetics treated at JSS Dental College and Hospital, a constituent college of Jagadguru Sri Shivarathreeswara University, Mysore, Karnataka.\nA 75-year-old male patient reported to the Department of Prosthodontics and Crown & Bridge with the chief complaint of missing teeth and sought replacement due to unesthetic appearance (Figure ). He gave a history of teeth extracted over a period of two years due to periodontal problem and decay. He was edentulous since three months. On examination one of the significant findings was poor esthetics, unsupported oral musculature, and slumped cheeks. The patient required complete dentures with some form of cheek support. Based on the patient’s needs a treatment plan was formulated. It was chosen to give the patient upper and lower complete dentures with detachable cheek plumper for the maxillary denture.\nClinical procedures\nMaxillary and mandibular impressions were made using impression compound (DPI PINNACLE, Dental products of India, Mumbai) and dental plaster was poured to obtain the primary cast. Spacers were adapted over the cast and the special trays were fabricated using autopolymerizing acrylic resin. Border molding was done using low fusing impression compound (DPI PINNACLE tracing sticks, Mumbai) and final impressions were made with zinc oxide eugenol impression paste (DPI, Mumbai). Dental stone was poured over the impression to obtain the master cast. Jaw relations were recorded using modelling wax in conventional method and casts were mounted on to the three-point articulator. Teeth arrangement was done using premadent teeth and a wax set-up was tried in the mouth to check esthetics, phonetics, occlusal vertical dimension, and occlusion. At the try-in stage, cheek plumper was made using wax (Figure ) as separate portions on the buccal surface of the complete trialdenture. They were superficially appended to the buccal surfaces on the right and left side and tried in the mouth to determine the amount of desired cheek support appropriate for comfort, function, and esthetics. Trial dentures were coated with a thin layer of petroleum jelly to facilitate the easy removal of the plumpers for processing. These plumpers were located between the first molar and second molar region of the maxillary denture flange. The adjustment in the appearance with and without wax-up cheek plumper was apparent and was readily accepted. They were designed according to the intraoral space availability which was necessary to enhance the appearance and thickness which otherwise would interfere with functional movement.\nLaboratory procedures\nThe plumpers and dentures were separately acrylized in the conventional way. Denture flasking and dewaxing procedures were finished separately for the final denture and cheek plumpers. The resultant mold space (Figure ) was then packed with heat polymerizing acrylic material (Figure ) and curing procedure was completed. After curing, the cured final prosthesis and plumpers were retrieved. Trimming, finishing, and polishing procedures were performed. After finishing and polishing, slots were made in the buccal surface of the denture for the die pins and the attachment surfaces of the plumpers also trimmed to make space for sleeves. Double die pins were placed in the denture base and the sleeves were placed on the cheek plumper (Figure ). The angulations and location of the die pins and their sleeves were evaluated so that there be no discrepancy and the double die pins could easily be seated in their respective sleeves. After conforming the location double die pins were sealed with autopolymerizing resin on the denture base and sleeves on the cheek plumpers. Holes of the sleeves were blocked with wax to prevent the flow of the acrylic resin into the sleeves. Autopolymerizing resin was allowed to set properly. The sleeves were inserted into the die pins and then little acrylic resin in dough stage was carefully kept on the shaft of the pins on buccal surface of the denture base. The resin was not allowed to flow beyond the shaft of the die pins for proper insertion and removal of the sleeves from the double die pins. After the resin had set, the plumper could easily be removed. Trimming and polishing of the irregular surfaces were done and the prosthesis was delivered (Figures -).\nThe patient was educated on the use and positioning of the plumpers and dentures were delivered after evaluating them for fit and esthetics. On the recall of 48 h the patient did not possess any problems with speech or mastication.