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.[]
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.