A 42-year-old male patient was referred to the Department of Prosthodontics and Crown and Bridge, Mahatma Gandhi Dental College and Hospital, Sitapura, Jaipur, India. The patient complained of missing right eye which was enucleated following an accidental traumatic injury []. Consequent to this, patient worded dark glasses specs for almost 1 year but at the same time, he was suffering from severe emotional trauma in terms of facial esthetics and social acceptance. Hence, the patient was seeking artificial eye replacement. On examination, defect with a shrunken orbit and intact tissue bed were observed. As the patient was economically very poor, the modified stock ocular prosthesis was advised. The treatment procedure and its limitations were explained to the patient to allay apprehension and elicit cooperation.\nA transparent, vesseled stock eye was selected with a close resemblance of the iris of the stock ocular prosthesis with that of the natural eye using both daylight and artificial light.\nAn ophthalmic socket was anesthetized with topical anesthetic followed by light lubrication of same side eyebrow and eyelashes to make the procedure more comfortable.\nA customized impression tray with injector was fabricated by joining hub of 10 ml syringe with perforated head of disposable plastic spoon using an adhesive. Later customizing and smoothening of corners of perforated head part according to the dimensions of anopthalmic socket of defect side was done [].\nThe primary impression of an ophthalmic socket was made using customized injector, by injecting the light viscosity addition elastomeric impression material (Virtual, Light body, Ivoclar Vivadent, India) slowly (to avoid any air bubbles), first into the depth below the upper eyelid and then into the lower. The patient was instructed to close his eye so that the excess material could flow out through perforations in the trays. While the material sets, instructions were given to the patient to do various eye movements in following order-moving eye laterally, followed by up and down motion and finally in a circular motion After the impression material had set, it was carefully removed from the anophthalmic socket The impression was checked to ensure that all the surfaces are recorded and there is no porosity present. This was followed by beading and boxing (Beading and Boxing wax, MP Sai Enterprises, India) of impression []. Investing with Type IV dental stone (Kalrock, Kalabhai, India) was done to obtain a primary cast Customization of the stock ocular prosthesis was done by selectively grinding and making it 2 mm short all around the margins of primary cast Border molding and secondary impression of the patient's anopthalmic socket was made by modified wax (sticky wax and utility wax in the ratio of 1:2). The objective was to obtain complete peripheral contact and proper curvature [] Centralization of the iris was checked by asking the patient to look straight ahead to a distant object, keeping in mind the symmetry with the iris of the adjacent unaffected left natural eye of the patient Now this wax modified stock ocular prosthesis was removed gently from the anophthalmic socket and was used to make sectional putty (Aquasil, Soft putty, Dentsply India Pvt. Ltd.) indexed mold (indexing of the first section was done so as to allow correct orientation of the second half of the mold) using putty viscosity addition elastomeric impression material []. This mold was used later for processing of definitive ocular prosthesis After the putty material had set, the two halves of putty mold were separated and the wax modified stock ocular prosthesis was retrieved so as to keep the mold space ready for processing of definitive ocular prosthesis []. Holes were made on second half of the mold to release excess resin to flow out The Modified wax was completely removed from the wax modified stock ocular prosthesis, which was followed by placing back of same ocular prosthesis into the first half of the sectional putty indexed mold in such a manner that inner surface faces upward []. Proportioning of clear and tooth colored auto-polymerizing methyl methacrylate resin (Dental Product of India (DPI), self-cure tooth molding powder and liquid, India) of appropriate shade was done in such a manner that resultant mixer matches with the color of the sclera of the unaffected eye of the patient. This resultant mixer was poured over the inner surface of wax modified stock ocular prosthesis []. Final packing was completed by tightening of second putty mold over the first mold. Excess material flows out through holes prepared and were removed. Acrylization was done by keeping sectional putty indexed mold into pressure pot at 30 psi for 20 min for complete polymerization, preventing any excess unreacted monomer, essential to prevent any untoward irritation or sensitivity and thereby a rejection of the prosthesis by the patient. This also enables the minimization of porosities and gives a good finish to the prosthesis as the eye socket is extremely sensitive and the residual conjunctiva and related structures react to any surface roughness and irregularities After complete acrylization, sectional putty indexed mold were opened and definitive ocular prosthesis retrieved []. The prosthesis was inspected for imperfections. Finishing and polishing were done to get a glass like finish to achieve maximum adaptation and overall success of the prosthesis []. The ocular prosthesis was washed with warm water and soap and inserted into the patient's anophthalamic socket and evaluated critically for lid drape, contour, and dimension\nThe final outcome of the prosthesis was ascertained from the satisfied look on the face of the patient and from the follow-up a week later. Instructions regarding ocular prosthesis were given as follow:\nCareful handling of the prosthesis with clean hands Removal of the prosthesis once a day, if necessary, and to wash it under warm water with a soft clean cloth and mild soap Cautioned to keep the eye moist by placing it in water if it's not in the anophthalmic socket, and never to allow it to come in contact with alcohol, or solvent of any kind Examination of anophthalmic socket once in a year or instantly when there is any irritation To improve the movement of the eyelids and the sparkle and sheen of the prosthesis, its beneficiary to use silicone base lubricant or mineral oil or safflower oil.[]
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.