ffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f46494c4500010100000c484c

696e6f021000006d6e74725247422058595a2007ce00020009000600310000616373704d534654000000
0049454320735247420000000000000000000000000000f6d6000100000000d32d48502020000000000
Artificial cheek plumpers: A step ahead in denture esthetics- a
00000000000000000000000000000000000000000000000000000000000000000000000000000000000
case report
001163707274000001500000003364657363000001840000006c77747074000001f000000014626b707
400000204000000147258595a00000218000000146758595a0000022c000000146258595a0000024000
000014646d6e640000025400000070646d6464000002c400000088767565640000034c0000008676696
12
Sunil Kumar MV
, Harikesh Rao , Kanwardeep Singh
577000003d4000000246c756d69000003f8000000146d6561730000040c0000002474656368000004300
3
Sohi
000000c725452430000043c0000080c675452430000043c0000080c625452430000043c0000080c74657
Abstract
87400000000436f70797269676874202863292031393938204865776c6574742d5061636b6172642043
An elderly edentulous patient reporting to his/her dental treatment is a common occurrence these
6f6d70616e790000646573630000000000000012735247422049454336313936362d322e31000000000
days. The loss of support of the facial musculature is of great concern to the patient and carries a
000000000000012735247422049454336313936362d322e310000000000000000000000000000000000
great social stigma. This article focuses on proper support of the slumped oral musculature and
00000000000000000000
cheeks in particular by incorporating cheek plumper and also demonstrates how denture esthetics
can be achieved. The template for cheek plumper's was made by the use of cotton rolls placed in
the maxillary and mandibular buccal flanges.
Key words: Denture esthetics, cheek
plumpers.
4

Introduction with a depressed ridge form. The old dentures of the The term 'esthetics' was
coined in the year 1750 which is a patient revealed compromised retention and stability due blend
of knowledge to give beauty, in contrast to science of to under extended borders, severe occlusal
1
wear was obselogic for truth. Denture esthetics is defined
as the effect rved leading to free way
5
produced
by
a
dental
prosthesis
space of 7-8 millimeter2 (Figure that affects the beauty and 3,4). As a rational protocol
attractiveness
of theradiogra
person. The work of Thompson and ph was taken, which revealed stafne
orthopantomograph
idiopathic cyst in the Brodie on muscle group and the chain interrelationship and left mandibular
region which is most of the time asymptothat of Brown and other prosthodontists on need of
6
functional
length
muscles
to improvethe
facial
appearance
about the same and was kept under
normal matic
andof
needs
no treatment,
patient
was informed
observation. The previhas made obsolete the use of plumping to improve facial ous denture failed
1
esthetics.
with the very first step as ature resulting in poor esthetics.
to provide Denture
support esthetics
to the oralstarts
muscul
Patient was advised to stop one of the objectives of impression making. Due to aging a wearing his
old dentures or for minimum use, gum massaprosthodontist has to handle a whole lot of lossesloss of ge and oral physiotherapy was advised. teeth, alveolar process, tonicity of musculature,
3
ofskin
as well
as impairment
offunction.
The
key to esthe-consideration
the highly edematous,
elasticity
Appropriate
treatment
plan was
formulated
taking into
flabby and resorbed tic replacement to all these losses is to support and ridges with special
consideration for esthetics by support-harmonize the collapsed lower third of the face with the ing
the cheeks with buccal extension to conventional upper part with various treatment modalities
7,8
present at the complete dentures- cheek plumper's. ion hands
the
prosthodontist
Admix
makingofto
increase
the flow and
record tissues
impression material was used for primary impress- under
(b)
Unconventional
Dentures
and surrounding
tissues,
while
(a) Conventional
Dentures
minimum
pressure on
account
of monophase
condition of impression
the ridge

ffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f
46494c4500010100000c484c696e6f021000006d6e74725247422058595a
2007ce00020009000600310000616373704d53465400000000494543207
ffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f46494c4500010100000c484c696e6f021000006d6
35247420000000000000000000000000000f6d6000100000000d32d48502
e74725247422058595a2007ce00020009000600310000616373704d534654000000004945432073524742000000000000000
02000000000000000000000000000000000000000000000000000000000
0000000000000f6d6000100000000d32d4850202000000000000000000000000000000000000000000000000000000000000
00000000000000000000000000000000000000116370727400000150000
000000000000000000000000000000000001163707274000001500000003364657363000001840000006c77747074000001f
0003364657363000001840000006c77747074000001f000000014626b707
000000014626b707400000204000000147258595a00000218000000146758595a0000022c000000146258595a00000240000
400000204000000147258595a00000218000000146758595a0000022c00
00014646d6e640000025400000070646d6464000002c400000088767565640000034c0000008676696577000003d40000002
46c756d69000003f8000000146d6561730000040c0000002474656368000004300000000c725452430000043c0000080c6754
0000146258595a0000024000000014646d6e640000025400000070646d6
52430000043c0000080c625452430000043c0000080c7465787400000000436f707972696768742028632920313939382048
464000002c400000088767565640000034c0000008676696577000003d4
65776c6574742d5061636b61726420436f6d70616e790000646573630000000000000012735247422049454336313936362d
000000246c756d69000003f8000000146d6561730000040c000000247465
322e31000000000000000000000012735247422049454336313936362d322e31000000000000000000000000000000000000
6368000004300000000c725452430000043c0000080c675452430000043c
000000000000000000
0000080c625452430000043c0000080c7465787400000000436f70797269
676874202863292031393938204865776c6574742d5061636b617264204
36f6d70616e7900006465736300000000000000127352474220494543363
Figure 1:Facial
contour altered by aging and loss of muscle support Figure2: Prognathic appearance due to loss of
ffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f46494c4500010100000c4
13936362d322e3100000000000000000000001273524742204945433631
facial dimension
84c696e6f021000006d6e74725247422058595a2007ce00020009000600310000616373704d53465
3936362d322e31000000000000000000000000000000000000000000000
40000000049454320735247420000000000000000000000000000f6d6000100000000d32d4850202
0000000000000000000000000000000000000000000000000000000000000000000000000000000
000000000
00000000000000001163707274000001500000003364657363000001840000006c7774707400000
1f000000014626b707400000204000000147258595a00000218000000146758595a0000022c00000
0146258595a0000024000000014646d6e640000025400000070646d6464000002c4000000887675
65640000034c0000008676696577000003d4000000246c756d69000003f8000000146d6561730000
040c0000002474656368000004300000000c725452430000043c0000080c675452430000043c0000
080c625452430000043c0000080c7465787400000000436f70797269676874202863292031393938
204865776c6574742d5061636b61726420436f6d70616e7900006465736300000000000000127352
47422049454336313936362d322e310000000000000000000000127352474220494543363139363
62d322e31000000000000000000000000000000000000000000000000000000
Figure 3: Maxillary old denture with suction disk Figure 4: Underextended mandibular old denture

ffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f46494c4500010100000c4
84c696e6f021000006d6e74725247422058595a2007ce00020009000600310000616373704d53465
40000000049454320735247420000000000000000000000000000f6d6000100000000d32d4850202
00000000000000000000000000000000000000000000000000000000000000000000000000000000
0000000000000001163707274000001500000003364657363000001840000006c77747074000001f
000000014626b707400000204000000147258595a00000218000000146758595a0000022c0000001
ffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f46494c4500010100000c4
46258595a0000024000000014646d6e640000025400000070646d6464000002c4000000887675656
84c696e6f021000006d6e74725247422058595a2007ce00020009000600310000616373704d53465
40000034c0000008676696577000003d4000000246c756d69000003f8000000146d6561730000040
40000000049454320735247420000000000000000000000000000f6d6000100000000d32d4850202
c0000002474656368000004300000000c725452430000043c0000080c675452430000043c0000080
0000000000000000000000000000000000000000000000000000000000000000000000000000000
c625452430000043c0000080c7465787400000000436f70797269676874202863292031393938204
00000000000000001163707274000001500000003364657363000001840000006c7774707400000
865776c6574742d5061636b61726420436f6d70616e7900006465736300000000000000127352474
1f000000014626b707400000204000000147258595a00000218000000146758595a0000022c00000
22049454336313936362d322e31000000000000000000000012735247422049454336313936362d3
0146258595a0000024000000014646d6e640000025400000070646d6464000002c4000000887675
Figure 5: Orthopantomograph of the patient Figure 6: Cotton rolls being used as template
22e31000000000000000000000000000000000000000000000000000000
65640000034c0000008676696577000003d4000000246c756d69000003f8000000146d6561730000
040c0000002474656368000004300000000c725452430000043c0000080c675452430000043c0000
080c625452430000043c0000080c7465787400000000436f70797269676874202863292031393938
204865776c6574742d5061636b61726420436f6d70616e7900006465736300000000000000127352
47422049454336313936362d322e310000000000000000000000127352474220494543363139363
material was used as final impression material with Clinical report
62d322e31000000000000000000000000000000000000000000000000000000

appropriate spacer design of Modified Bernard-Levin for A 65-year-old male edentulous patient
with goodffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f46494c4500010100000c4
general maxillary arch, which was modified from the routine health, conscious of his
84c696e6f021000006d6e74725247422058595a2007ce00020009000600310000616373704d534654
appearance
and psychologically Bernard Levin by including the spacer on mid palatine well, with
0000000049454320735247420000000000000000000000000000f6d6000100000000d32d485020200
the history
of
ill fitting lower complete denture raphae in the spacer
design and conventional full
00000000000000000000000000000000000000000000000000000000000000000000000000000000
9
reported
to the department of prosthodontics, Jaipur Dent- mandibular
arch. Characterization of
spacer for
00000000000001163707274000001500000003364657363000001840000006c77747074000001f000
central incisor
with
al
College,
Jaipur
for
complete
denture
prosthesis.
His
notching and crowding in
000014626b707400000204000000147258595a00000218000000146758595a0000022c0000001462
mandibular
anterior
teeth
were
prior
concern
for
the
denture
was
functional
purpose
but incheek
also plumper's
58595a0000024000000014646d6e640000025400000070646d6464000002c4000000887675656400
Figure 7: Patient with old dentures Figure 8: Patient with new trial dentures
without
10
incorporated.
To
eliminate
vertical
and
lateral
forces
addition
he
also
insisted
on
improving
his
00034c0000008676696577000003d4000000246c756d69000003f8000000146d6561730000040c000
esthetics.
Histo- monoplane teeth were selected whose cuspal anatomy was ry revealed that he
0002474656368000004300000000c725452430000043c0000080c675452430000043c0000080c6254
was edentulous
for the past 9 years and altered for enhanced esthetics, while the teeth
52430000043c0000080c7465787400000000436f70797269676874202863292031393938204865776
c6574742d5061636b61726420436f6d70616e79000064657363000000000000001273524742204945
arrangement
was wearing his previous denture since 6 years. On were followed according to
4336313936362d322e31000000000000000000000012735247422049454336313936362d322e3100
11
Pound's triangle.
At the try in examination one of the major finding was poor esthetics,
0000000000000000000000000000000000000000000000000000
appointment, treatment modality for loss of buccal pad of unsupported oral musculature and
slumped cheeks with fat in cheek region was decided. Cotton rolls were placed in prognathic
appearance (Figure 1,2). On intra oral examina- the distosuperior aspect and distoinferior aspect
of maxilltion suction disk mark was observed in anterior maxilla ary and mandibular buccal flanges
123
7
Professor and Head, Professor,
PG Student, Department of Prosthodontics, Jaipur Dental
respectively Figure 6. leading to edematous and flabby tissue in the surrounding These cotton
College, Jaipur, India. Correspondence: Dr. Sunil Kumar MV, email:
areas. The ridge was low well rounded in maxillary
rolls acted
further
modeling
drsunilmv@hotmail.com
Figureas
9:templates
Patient withfor
new
trail denture
with cheek plumper's Figure 10:Cheek plumper's being made
arch wax addition to the buccal flange. Cheek fullness
hollow and vestiwhile the mandibular arch was
134
135
flabby in anterior region bular tension was evaluated and patient approval was taken

ffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f46494c4500010100000c484c696e6f021000006d6
e74725247422058595a2007ce00020009000600310000616373704d534654000000004945432073524742000000000000000
ffd8ffe000104a4649460001020100c800c80000ffe20c584943435f50524f46494c450
0010100000c484c696e6f021000006d6e74725247422058595a2007ce000200090006
0000000000000f6d6000100000000d32d4850202000000000000000000000000000000000000000000000000000000000000
000000000000000000000000000000000001163707274000001500000003364657363000001840000006c77747074000001f
16.
Tautin FS. Denture esthetics is more than
12.
Matvias F00310000616373704d53465400000000494543207352474200000000000000000000
. Maxillofacial procedures. In
teeth selection. J Prosthet Dent 1978;40:127-30.
000000014626b707400000204000000147258595a00000218000000146758595a0000022c000000146258595a00000240000
Marrow RM, Rudd00000000f6d6000100000000d32d48502020000000000000000000000000000000000
KD, Rhoads JE (eds): Dental
nd
00000000000000000000000000000000000000000000000000000000000001163707
17.
Lombardi RE. The principle of visual
Laboratory Procedure,
Complete Dentures. 2 edn
00014646d6e640000025400000070646d6464000002c400000088767565640000034c0000008676696577000003d40000002
274000001500000003364657363000001840000006c77747074000001f00000001462
perception and their clinical application to denture
491
St Louis, CV Mosby, 1986: pp 488
46c756d69000003f8000000146d6561730000040c0000002474656368000004300000000c725452430000043c0000080c6754
esthetics. J Prosthet Dent 1973;29:358.
13. .
Verma N. 6b707400000204000000147258595a00000218000000146758595a0000022c000000
Enhancing appearance in
52430000043c0000080c625452430000043c0000080c7465787400000000436f707972696768742028632920313939382048
146258595a0000024000000014646d6e640000025400000070646d6464000002c400
complete dentures
using magnet retained cheek
65776c6574742d5061636b61726420436f6d70616e790000646573630000000000000012735247422049454336313936362d
plumpers. J Indian000088767565640000034c0000008676696577000003d4000000246c756d69000003f
Prosthod Soc 2004;4(2):35-38.
322e31000000000000000000000012735247422049454336313936362d322e31000000000000000000000000000000000000
8000000146d6561730000040c0000002474656368000004300000000c72545243000
14.
Clair F, Picard
Jr. Complete denture
000000000000000000
0043c0000080c675452430000043c0000080c625452430000043c0000080c74657874
esthetics J Prosthet
Dent 1958;8:252 -259
00000000436f70797269676874202863292031393938204865776c6574742d5061636
15.
Waliszewski
M. Restoring dentate
b61726420436f6d70616e790000646573630000000000000012735247422049454336
appearance: A literature
review for modern
complete denture313936362d322e31000000000000000000000012735247422049454336313936362d
esthetics. J Prosthet Dent
2005;93:386-94. 322e31000000000000000000000000000000000000000000000000000000
Figure 11: Maxillary and mandibular old and new denture
Figure 12: Patient with completed new
denture

for the same (Figure 7,8,9). Cheek plumper's was made food entrapment and could result in
muscle fatigue. These hollow (Figure 10) so as to prevent the excessive weight in limitations can
be eliminated by selective trimming of the the maxillary denture which can result in denture
dislodg- areas at the massetric notch and the coronoid notch areas. ement by forces of gravity,
12,13
ted
in the
the dentures
routine fashion(Figure
which
essentially
self esteem
of the patient over weighs
while
were fabrica- 11,12).
But definitely
themost
greater
degree boosts
of esthetic
improvement
few limitations it offers.
Discussion Denture esthetics have gone a step ahead than mere Conclusion selection of teeth
on the factors of form, shape, color, arran- Proper mold and shade selection of denture teeth is but
one gement and sex, it is more of harmonization of artificial part of denture esthetics. Correct
positioning of anterior
14,15
with the natural.
Aging causes tissue atrophy, folds and teeth for lip support, providing additional
support for slum-creases of face become exaggerated which is due to loss of ped cheeks,
reestablishing correct vertical dimension with support by the alveolar bone and teeth in particular
16
leading proper teeth selection creates excellent denture esthetics. to collapse of lower third of the
face. There is deepening of Denture esthetics is an art in the hands of a denture artist- nasolabial
fold, drooping of corner of mouth, loss of the prosthodontist who applies his skills and beauty
fundavermilion border, depression of lips with exaggerated mentals to develop his esthetic tastes.
16
3
An attempt
laterally
expanding
was made
tongue.
wrinkling.
Cheek contour
Teeth loss
change
in posterior
as a ateregion
the stigma
resultsofinaging
loss of
in here
him. to
result
create
of
dentures
that were
in harmony
and dignity
ofanterior
support teeth
to theloss.
cheeks,
tend to move
loss
of vertical
dimension
of occlusion
due to
Losswhich
of subcutaneous
fat,medially
buccal
to meet
the aging gentleman,
which would
compliment,
eradic the slumbed 1. Young HA.
pad
of References
fat and elasticity
of connective
tissuenot
produce
Denture Esthetics. J Prosthet Dent 1956;6:748
3
55.
cheeks, seen in aged.

2. Glossary of prosthodontic terms. J Prosthet Dent

The goal of complete denture prosthesis should deal

10-92 .
2005;94:
support
of the slumped tissue by either increasing 3. Martone AL. Effects of complete dentures on facial
with
ness
thick of flange of maxillary and mandibular denture, esthe
tics. J Prosthet Dent April 1964;14:231-55. vestibular fornix should
the
be filled with appropriate facial 4. Atwood DA. Post extraction changes in the adult mandible contour and
some authors have reported arranging second as illustrated by micro radiographs of mid saggital
sections row of teeth only for esthetic reasons. Occlusal rim adjust-and serial cephalometric
roentgenograms. J Prosthet Dent ment as precisely carried out for proper anterior posterior
denture wearers' complains. Stomatologija, Baltic
rest
and function.
Correct vertical
helps
1963;13:810-24.
placement
of teethdimension
and cosmetic
effect should
be studied at 5. Laurina L.
and Maxillofacial Journal 2006;8:61-64.
Dental
physiological
muscle
length
and
elimination
of
restore
Construction faults associated with complete
6. Tero WM, Crean J. Not all radiolucent images are
17
pseudo
prognathic
appearance.
patholo
gical lesions (stafne cyst) Report of two cases: Dental
For plumping of cheeks and to eliminate the tedious
2006;XII(II):22-27.
News
of
minor correction of modeling7.wax,
cotton
rolls
work
Larsen
SJ. Prosthetic
support for unilateral facial paralysis. J placed in
were
distosuperior and distoinferior aspect of maxill- Prosthet Dent 1976;35:192-01. ary and mandibular
denture bases respectively. These 8. Lazzari JB. Intraoral splint for support of the lip in bell's cotton
templates which are readily available in every palsy J Prosthet Dent 1955;5:579-81. dental practice
are used as guideline for adding modeling 9. Tarun M, Bharath Vishal
M, Chittranjan
B, technique
Ramu Reddy M.
Anthropoidal
pouch
wax in the buccal vestibule to act as cheek plumper. Distosuperior
andresorbed
distoinferior
not effect
the
salvation for
ridges.aspects
Indian J does
Dent Assoc
2010;2(1):131-33.
10. Fenton Aaron H. Selction and arranging prosthetic
retention as it was not over filled and to prevent
occlusion
for edentulous patients In Zarb-Bolender:
teeth
and
dislodg-of denture due to gravity they were made
ement
Prosth treatment for edentulous patients Complete
odontic
Such cheek
th
13 plumper's on conventional denture have
Dentu
- Implant Supported Prostheses 12 edn St Louis
res
and
hollow.
limitation in oral sub mucous fibrosis cases and also
Mosby, 2004;303-05.
th
extension
can interfere with the masseter muscle,
buccal
11. Rahn AO, Heartwell CM. Textbook of complete denture 5 frenum and coronoid process leading to
buccal
destabilization and
edn . B.C Decker, Inc2002:318-19.

136