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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 46-49

Detachable hollow cheek plumper with salivary reservoir – An innovative method to improve esthetics and function in a conventional complete denture


Department of Prosthodontics and Crown & Bridge, Goa Dental College and Hospital, Bambolim, Goa, India

Date of Submission04-Jan-2022
Date of Decision13-Feb-2022
Date of Acceptance16-Feb-2022
Date of Web Publication9-Mar-2022

Correspondence Address:
Amanda Nadia Ferreira
Department of Prosthodontics and Crown & Bridge, Goa Dental College and Hospital, Bambolim, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcdoh.jpcdoh_1_22

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  Abstract 


The feeling of dryness in the mouth is referred to as xerostomia. Multiple factors can lead to xerostomia ranging from physiologic conditions like aging, to radiotherapy given for the treatment of oral carcinoma. Xerostomic patients are not able to tolerate conventional complete dentures. In most geriatric individuals due to aging, there is bone resorption and loss of soft-tissue elasticity, which may result in sunken cheeks. This case report describes the rehabilitation of a totally edentulous patient with xerostomia and sunken cheeks using a simple innovative design and technique of fabricating a hollow cheek plumper with a built-in salivary reservoir for better denture acceptability.

Keywords: Hollow cheek plumper, salivary reservoir, xerostomia


How to cite this article:
Sharma P, Ferreira AN, Aras M, Chitre V. Detachable hollow cheek plumper with salivary reservoir – An innovative method to improve esthetics and function in a conventional complete denture. J Prim Care Dent Oral Health 2022;3:46-9

How to cite this URL:
Sharma P, Ferreira AN, Aras M, Chitre V. Detachable hollow cheek plumper with salivary reservoir – An innovative method to improve esthetics and function in a conventional complete denture. J Prim Care Dent Oral Health [serial online] 2022 [cited 2022 May 27];3:46-9. Available from: http://www.jpcdoh.org/text.asp?2022/3/2/46/339306




  Introduction Top


Primary care practitioners often treat geriatric patients with several age-related chronic diseases and disabilities. Several of these medical conditions result in medication-induced xerostomia due to the high intake of medications and polypharmacy.[1] Radiation-induced xerostomia, is also a common complaint for 90% of patients with oral cancers.[2]

Xerostomia is associated with oral dryness, loss of taste, dysphagia, increased dental caries, and periodontal disease. In xerostomic edentulous patients, these issues are aggravated as the absence of saliva diminishes the retention of complete dentures and makes the denture-bearing mucosa prone to inflammation and ulceration.[3] Aging has a tremendous impact on facial esthetics as bone resorption and loss of tissue elasticity may result in sunken cheeks. Conventional complete denture flanges help restore facial contours but fail to mimic the fullness of the cheeks.

This clinical report describes the rehabilitation of a xerostomic completely edentulous geriatric patient with an innovatively designed complete denture.


  Case Report Top


A 68-year-old patient was referred by a general physician to the department of prosthodontics, as the patient had difficulty in eating and talking and was unhappy with his facial esthetics. He gave a medical history of carcinoma of the left lateral border of the tongue, for which he had undergone surgery and radiotherapy 5 years ago. Clinical examination revealed completely edentulous upper and lower ridges, dry mouth, angular cheilitis, and sunken cheek on the left side [Figure 1]. After careful consideration of the patient's chief complaint, it was decided to rehabilitate the patient with complete dentures, which had a detachable hollow cheek plumper and a built-in salivary reservoir.
Figure 1: (a) Extraoral view of the patient. (b) Maxillary edentulous arch. (c) Mandibular resorbed edentulous arch. (d) Angular cheilitis and dry lips

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Clinical and laboratory procedures

Maxillary and mandibular impressions were made in the conventional manner. Jaw relations were recorded and the neutral zone technique was used for the resorbed mandibular ridge. Teeth were set within the confines of the neutral zone, and the waxed dentures were tried in the patient. Wax was arbitrarily added to the left buccal flange of the maxillary denture to support the sunken cheeks by acting as a cheek plumper. Press stud fasteners (Pony Snap Fasteners) were incorporated as detachable aids for the retention of the cheek plumper [Figure 2]. The waxed trial denture and cheek plumper were invested separately and dewaxed in the conventional manner. Two-millimeter thick modeling wax was adapted on the two portions of the cheek plumper to ensure ideal thickness of acrylic resin around the planned hollow cavity.
Figure 2: (a) Waxed trial denture. (b) Waxed cheek plumper attached with press stud fasteners

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To achieve the hollow cavity, a temporary spacer was first fabricated using addition silicone impression material – putty consistency (Zetaplus, Zhermack) – and subsequently replaced with a replicated chocolate spacer (Cadbury, Dairy Milk) which was fabricated in accordance with the temporary putty spacer. At trial closure, the temporary putty spacer was evaluated to determine the hollow cavity obtained. The hollow space was then filled with chocolate spacer [Figure 3]. After acrylization, the cheek plumper was deflasked and finished and polished in the usual manner.
Figure 3: (a) Invested cheek plumper. (b) Dewaxed cheek plumper. (c) Putty index of the hollow space. (d and e) Packed with chocolate spacer during final closure

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The chocolate spacer was retrieved by creating an escape hole and flushing it out with an air-water syringe. The hollow cavity was air-dried, sealed with autopolymerizing acrylic resin, and verified to be hollow. The cheek plumper cavity was filled with 1.5-ml artificial saliva (E saliva) through a 0.8-mm release hole made at the most dependent point on the cheek plumper [Figure 4]. During denture insertion, adequate clearance of the cheek plumper from the occlusal table was verified. The patient was taught how to attach/detach the cheek plumper and fill the salivary reservoir. The patient was extremely pleased with his innovatively designed dentures [Figure 5].
Figure 4: (a) Cheek plumper verified to be hollow by the water test. (b) Finished and polished maxillary denture. (c) Cheek plumper cavity filled with artificial saliva

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Figure 5: Postoperative view of the patient

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  Discussion Top


Primary care practitioners should approach geriatric patients from a holistic viewpoint. Various aspects of geriatric health can be addressed through collaboration with other specialties. Elderly patients often report several chronic illnesses and the medications of which can lead to xerostomia. Xerostomia can be managed to an extent by increasing the frequency of water intake, improving diet, and sugar-free chewing gums or lozenges which help increase the salivary output.[2] Sunken cheeks, is another common finding in geriatric patients due to the reduction of subcutaneous fat, buccal fat pad, and loss of tonicity of the connective tissues.[4],[5] While these esthetic corrections can be achieved by reconstructive plastic surgery and Botox,[6] most patients are reluctant to commit to additional surgical procedures.

Various methods have been described in the literature to incorporate a salivary reservoir in complete dentures.[7],[8] Salt technique and the putty technique have been advocated separately to make hollow dentures, but they have their own disadvantages. In the salt technique, the hollow space may collapse due to the force exerted during flask closure. In the putty or clay technique, the difficulty lies in the removal of the rigid material.[9]

The novelty of the present technique is the use of a chocolate spacer, which is economical, easily available, and retrievable. Trial closure with the putty index enables the creation of space for the spacer, thereby preventing additional pressure during final closure. Speech is also not hampered as the salivary reservoir is incorporated in the cheek plumper and not in the palate and enabled sustained release of salivary substitute into the patient's mouth without affecting daily routine. This design has several advantages of being detachable from the complete denture and hence can be easily removed for filling the reservoir with salivary substitute as well as maintaining cleanliness. Press stud button attachments are economical, easily available, and patient compliant. The plumper prosthesis by merit of its hollow design, does not add any additional weight to the complete denture prosthesis, and acts as an in-built salivary reservoir by employing the space afforded by the cheek plumper, thus concurrently enabling comfort and esthetics.

Primary care practitioners need to be aware of the myriad aspects of geriatric health. Effective primary care management of geriatric patients requires multidisciplinary and comprehensive health screening, so that the unique needs of the elderly are met.[10]


  Conclusion Top


A detachable hollow cheek plumper prosthesis with a built-in salivary reservoir can be used as an effective solution to improve the esthetics of an edentulous patient with xerostomia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Storbeck T, Qian F, Marek C, Caplan D, Marchini L. Dose-dependent association between xerostomia and number of medications among older adults. Spec Care Dentist 2021. Online ahead of print. [doi: 10.1111/scd. 12662].  Back to cited text no. 1
    
2.
Wang K, Tepper JE. Radiation therapy-associated toxicity: Etiology, management, and prevention. CA Cancer J Clin 2021;71:437-54.  Back to cited text no. 2
    
3.
Tanaka A, Kellesarian SV, Arany S. Xerostomia and patients' satisfaction with removable denture performance: Systematic review. Quintessence Int 2021;52:46-55.  Back to cited text no. 3
    
4.
Aggarwal P, Gupta MR, Pawah S, Singh A. An innovative technique to improve complete denture aesthetics using cheek plumper appliance: A case report. Int J Oral Health Med Res 2016;3:51-4.  Back to cited text no. 4
    
5.
Martone AL. Effects of complete dentures on facial esthetics. J Prosthet Dent 1964;14:231-55.  Back to cited text no. 5
    
6.
Agarwal A, Aeran H, Tuli AS, Bhatnagar N. BOTOX – An innovative treatment modality in dentistry: A review. Int J Oral Health Dent 2018;4:17-21.  Back to cited text no. 6
    
7.
Upadhyay SR, Kumar L, Rao J. Fabrication of a functional palatal saliva reservoir by using a resilient liner during processing of a complete denture. J Prosthet Dent 2012;108:332-5.  Back to cited text no. 7
    
8.
Arora V, Kumar D, Legha VS, Kumar KA. Management of xerostomia patient with salivary reservoir designed in upper complete denture and lower cast partial denture. J Contemp Dent 2014;4:56.  Back to cited text no. 8
    
9.
Aggarwal H, Jurel SK, Singh RD, Chand P, Kumar P. Lost salt technique for severely resorbed alveolar ridges: An innovative approach. Contemp Clin Dent 2012;3:352-5.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Jahan F. The role of primary care physician in geriatric care. Divers Equal Heal Care 2016;13:245.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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