A 42-year-old male patient reported to Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India requesting replacement of his missing teeth. On intraoral examination, the patient had completely edentulous maxillary and mandibular arches. He had lost his teeth over a period of 3 years because of periodontal problems and was edentulous for the past 2 years. The patient was conscious about his sunken cheeks and desired a prosthesis that would make his face look fuller and healthier. He was leading a socially isolated life due to the psychological stress of his appearance. Treatment plan was formulated, keeping the patient’s demand in mind. It was decided to give the patient maxillary and mandibular complete dentures with intraoral closed faced magnet retained cheek plumpers for the maxillary denture. Primary impressions of maxillary and mandibular arches were made using impression material (Y Dents, MDM Corporation, Delhi). Custom trays were made using autopolymerizing acrylic resin. Border molding was done using low fusing impression compound (DPI Pinnacle, The Bombay Burmah Trading Corporation Limited, Mumbai, India) and wash impression was made with medium body addition silicone impression material (Aquasil, Dentsply/ caulk). Jaw relations were recorded. For the try-in appointment waxed denture was first tried for occlusion and esthetics. At the same appointment, cheek plumpers were made in wax and were attached to the upper waxed-up denture. Then it was evaluated to give the patient a fuller appearance. A dramatic change in the appearance with and without wax-up cheek plumper was observed and it was immediately accepted by the patient. The waxed plumper was separated from the waxed-up denture. After that flasking and dewaxing procedures were completed separately for the final pros-thesis and cheek plumpers. The mold space was packed with heat-polymerizing acrylic material (DPI, Mumbai, India) and curing procedures were performed according to the manufacturer’s instructions. After deflasking, the cured final prosthesis and plumpers were retrieved. Trimming, finishing, and polishing procedures were performed. Then a pair of commercially available magnets (cobalt-samarium, Ambika Corporation, New Delhi, India), 5 mm in diameter and 2 mm in thickness was employed to retain the cheek plumper with final prosthesis (). Provision for placement of magnets in the flange of the final prosthesis and in the cheek plumper was made and positioned with the help of autopolymerizing resin (, & ). Complete polymerization was ensured by placing in a pressure pot and finishing and polishing was then carried out. The attachment of plumper to the prosthesis was first checked outside the patient’s mouth ( & ). The prosthesis along with the plumper was then checked in the patient’s mouth for comfort, function and esthetics ().\nThe patient was educated about the positioning of the plumper to the prosthesis. The patient’s demands were fulfilled ( & ). He was called for regular check up to evaluate any soreness or looseness of dentures.
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.