 The word esthetics is derived from the Greek word

“AISTHETIKOS” meaning perceptive. It pertains to the sense

of beautiful or the science which deduces from nature and
taste, the rules and principles of art.
 Denture esthetics is not a new term in the field of dentistry. It
is defined as the effect produced by a dental prosthesis that
affects the beauty and attractiveness of a person
 As Jamieson stated, “fitting the personality of the aged patient
is often more difficult than fitting the denture to the mouth.” If
the psychology of the patient is not considered, one’s best
efforts fail to provide results.
 The natural dentition or dentures provides support to the facial
musculature which is responsible for the external form of the
lips and cheeks. If the lips and cheeks are unsupported,
muscles become weak and do not function properly which
leads to wrinkling of skin and sagging of lips and cheeks that
can add years to a person’s age and hence have a detrimental
psychological effect on the patient’s professional and social
life.
 Muscles the prosthodontist is particularly concerned
with are
 Orbicularis oris,
 Zygomaticus triangularis
 Buccinator muscle
When the muscle complex is not held in proper
physiologic position, the face drops and patient assume
“DENTURE LOOK”
 Cheek plumper, also known as cheek lifting appliance, is a
prosthesis used for supporting and lifting the cheek to provide
the required support and esthetic that will increase the self
esteem of the patient by providing a youthful appearance.
 It can be used in patients who have excessive slumping of
cheeks due to tooth loss.
 It is especially useful in young patients who have lost all their
teeth and part of the maxillary bone as a result of traumatic
injury.
 A cheek plumper can be of two types:
 Detachable

 undetachable.
 A conventional cheek plumper is a single-unit prosthesis with
an extension near the premolar molar region that supports the
cheeks.
 Such devices are an integral part of the contour of maxillary
denture flanges designed by over contouring denture flanges in
the mediolateral and anteroposterior directions within
physiologic limits.
 economical
 non-invasive
 improves aesthetics
 Excessive weight which could hamper retention of the
maxillary complete denture.
 Can result in muscles fatigue.

 Can destabilize the maxillary denture

 Could interfere with masseter and buccinator muscle

function and coronoid process of the mandible.
 Difficult to insert the denture due to excessive weight.

 Can’t be used in patients with limited mouth opening.

 These are separate components attached to the denture flange.
 In such detachable prostheses, the plumper can be detached
from and reattached to the complete denture by the patients
themselves.
 Because of their detachability, they are easy to insert, remove,
and clean
 Press stud
 Magnet
 orthodontic elastic modules,
 wire-retained cheek plumpers
Advantages of press button retained cheek
plumpers (Rupal J. Shah et al., 2014)
 Small & light weight
 Snug fit
 Inexpensive
Disadvantages of press button retained cheek
plumpers (Rupal J. Shah et al., 2014)
 Poor corrosion resistance
 Food lodgments
 If only one button is used to attach the plumper,
rotation of the plumpers can occur while function.
Therefore two push buttons in each plumper are
preferred for better stability.
Advantages of magnet retained cheek plumpers
 Small size
 Automatic reseating ,
 ease of placement & removal and cleaning.

Disadvantages of magnet retained cheek plumpers

 Poor corrosion resistance
 Harmful effects of magnetic field on the health of
the oral tissues
 Loss of magnetic property over a period of time
may requiring frequent replacement
 Individuals with marked resorption of the alveolar process and
decreased muscle tonicity
 Maxillofacial defects
 Facial paralysis.
Advantages of Die pin retained cheek plumpers
 Precise fit
 No rotation or movement while function or
insertion/removal of prosthesis
 Good strength
 Corrosion not reported
 Can be used in patients with compromised
dexterity.
 Accumulation of food.
 Patient discomfort resulting from the additional weight and
bulk of the dentures,
 The requirement of manual dexterity of patients to ensure
accurate attachment.
 The susceptibility of magnetic attachments to corrosion and
loss of magnetism of the press stud fasteners to breakage
REVIEW OF LITERATURE
  In this article, the technique used implements the concept
of neutral zone to precisely determine the amount of
space available for the cheek plumper.
 The simple friction lock attachments that retained the
cheek plumpers on the prosthesis were also fabricated
after determining the space available in the appropriate
areas.
Bhushan P, Aras MA, Coutinho I, Rajagopal P, Mysore AR, Kumar S. Customized Cheek Plumper with
Friction Lock Attachment for a Completely Edentulous Patient to Enhance Esthetics: A Clinical Report.
Journal of Prosthodontics. 2017 Jan 1.
 During the trial of denture waxed denture, wax was added
arbitrarily onto the buccal flange area of the maxillary denture
in the premolar and molar regions to evaluate changes in the
patient’s facial esthetics.
 For recording the area available for the cheek plumpers, a thin
film of tissue conditioner separator was applied on the planned
area for the plumper (in the premolar and molar regions) and
was followed by an application of a tissue conditioner.
 The patient was then asked to perform movements like
opening and closing of the mouth and lateral movement of the
mandible to record the amount of space actually available in
the coronoid region and corono-maxillary space for
incorporation of the cheek plumper.
 The patient was also asked to activate all muscles by
performing functions like movement of the cheek, muscles of
facial expression, licking, smiling, sucking, pursing of lips,
and whistling.
 Additionally phonetic, water sipping, and swallowing
exercises were administered to mold the tissue conditioner to
record the specific area
 Following the complete polymerization of the tissue conditioner, the
recording was retrieved, and the tissue conditioner extending onto the
peripheral seal area was reduced by 2 mm to keep it away from the
denture borders.
 A putty index of the customized, molded tissue conditioner was made
using addition silicone
• Following finishing and polishing, the flexible cheek plumper was
fitted on the denture. The complete denture with the plumper was
tried in the patient’s mouth for stability, esthetics, retention, and
function

 This article concluded that, rather than arbitrary wax up , basic

anatomy, physiology, and the patient’s psychology play important
roles and this information was used to fabricate an efficient and
effective prosthesis.
• This clinical report describes a technique for fabricating detachable
mandibular and maxillary cheek plumpers with 2 different types of
attachment mechanisms in two complete edentulous patients
• Clinical examination revealed completely edentulous maxillary and
mandibular arches, and extraoral findings of wrinkling of skin and flaccidity
of facial muscles, resulting in sunken cheeks

Virdiya NM, Palaskar JN, Wankhade J, Joshi N. Detachable cheek plumpers with different attachments for
improving esthetics in a conventional complete denture: A clinical report. The Journal of Prosthetic Dentistry. 2016
Oct 27.
• Preliminary impressions were made with modeling plastic impression
compound and poured-in dental plaster, after which custom impression
trays were fabricated with autopolymerized acrylic resin.

• Border molding was done with green stick modelling plastic

impression compound

• Definitive impressions were made with zinc oxide eugenol impression

paste, the jaw relation was recorded, and the tooth arrangement was
evaluated.
 Wax patterns for the cheek plumpers were fabricated during the
clinical evaluation stage.
 A roll of softened modeling wax was adapted over the buccal flanges
of the maxillary denture on either side in the premolar molar region.
 The adapted wax was inspected extraorally for adequacy of cheek
support and contour.
 Because the definitive wax patterns of the maxillary cheek plumpers did
not provide adequate support to the cheek below, mandibular cheek
plumpers were planned to ensure adequate fullness in the lower half of the
cheek.
 The dentures and cheek plumpers were fabricated
separately using heat-polymerized acrylic resin.
 For the first patient, magnets (Permag Products Pvt
Ltd) were incorporated into the buccal flanges of the
dentures and cheek plumpers with autopolymerizing
acrylic resin
  This clinical report illustrates the use of customised
cobalt chromium attachments to support a detachable
cheek plumper prosthesis in a completely edentulous
patient with hollow cheeks.
 After that cheek plumper made in wax and were
attached to the maxillary denture and were evaluated
to give patient a more fuller appearance.
The waxed plumper was separated from the waxed
denture.
Keni NN, Aras MA, Chitre V. Customised attachments retained cheek plumper prosthesis: A case report. The
Journal of Indian Prosthodontic Society. 2012 Sep 1;12(3):198-200.
 Prefabricated attachments were waxed in the complete denture
in place of the plumper prosthesis
 Steps in fabrication of the attachments
 Autopolymerising acrylic resin was used to form pattern for
the attachment.
 Attachment consisted of a flat rectangular thin base connected
by a neck to two balls of 3 mm diameter. The width of
rectangular base was kept slightly short of the width of the
plumper prosthesis.
 The attachments were cast using chrome cobalt alloy. They
were polished on all surfaces except the one which would be
waxed in the denture as the surface irregularities aid in better
retention of attachment to the denture base.
 Acrylisation was done in conventional way.
 Upper denture was acrylised with the attachments placed
on the buccal surface of denture.
 The finished and polished dentures were tried in the
mouth.
 The waxed plumper prosthesis was repositioned over the
attachment and required corrections were done .
 Wax pattern of plumper was invested and acrylised.
 The acrylised plumpers were tried in the mouth and
orthodontic separators were placed in the plumper part which
corresponded to the attachments in the denture to get snap fit.
 For this, concavities were made in the plumper part.
 Separators were placed over the attachments. These were then
picked using autopolymerising acrylic resin in the plumper
part.
 These separators allowed close approximation of the plumper
with the denture and also facilitated removal from the denture
This case report concluded that the customised attachments
retained cheek plumper prosthesis successfully restored the
contour of cheek improving esthetics and psychological well
being of the patient.
  This clinical report discusses a simple non
invasive technique to provide support for
sunken cheeks using detachable acrylic cheek
plumpers, retained using iron–neodymium
close-field magnets. Magnets retained cheek
plumper is a modification of the conventional
technique of supporting the slumped tissues.

Marwah MK, Harshakumar K, Ravichandran R et al. Detachable magnet retained cheek plumpers to enhance complete denture
esthetics - a case report. Int J Health Sci Res. 2016; 6(7):389-393.
 After try-in cheek plumpers were made in wax
and attached to waxed up maxillary denture
for trial in the same appointment. Significant
change was seen in the appearance after
attaching cheek plumper and the patient also
accepted it readily.
 Following try-in, cheek plumpers were
removed from the waxed up denture and both
plumpers and denture were processed
separately using heat cure acrylic resin
 After deflasking cured denture and plumpers
were retrieved, trimmed, finished, and
polished. Two pairs of commercially available
neodymium iron boron magnets (Ne-Fe-B) of
size 5mm* 2mm was used to attach plumpers
to the complete denture.
 Provision for the placement of magnet was made on
the buccal surface of the flange of complete denture
and the intaglio surface of the plumpers. Magnets
were positioned using auto polymerizing acrylic
resin and complete polymerization was ensured by
placing it in pressure pot. After inserting the
complete dentures, plumpers were attached in such
a manner that they did not interfere with opening,
closing and lateral movements of the mandible.
 Cheek plumpers are straightforward to fabricate and provide a
noninvasive and cost-effective treatment option for the improvement
of facial appearance in patients with sunken cheeks. This treatment
helps improve esthetics and the psychological well-being of patients.
 Detachable cheek plumpers provide increased patient comfort, leading
to greater patient acceptance of the prosthesis.
 In situations where the desired cheek muscle draping cannot be
achieved in patients with sunken cheeks, mandibular cheek plumpers
can be successfully inserted in addition to maxillary cheek plumpers in
order to improve the overall facial appearance.
 Recent study states that, rather than arbitrary wax up , basic anatomy,
physiology, and the patient’s psychology play important roles in
construction of cheek plumpers.
 The Journal of Prosthetic Dentistry. 2016 Oct 27.
 Virdiya NM, Palaskar JN, Wankhade J, Joshi N. Detachable cheek plumpers with different
attachments for improving esthetics in a conventional complete denture: A clinical report. The
Journal of Prosthetic Dentistry. 2016 Oct 27.
 Keni NN, Aras MA, Chitre V. Customised attachments retained cheek plumper prosthesis: A
case report. The Journal of Indian Prosthodontic Society. 2012 Sep 1;12(3):198-200
 Bhushan P, Aras MA, Coutinho I, Rajagopal P, Mysore AR, Kumar S. Customized Cheek
Plumper with Friction Lock Attachment for a Completely Edentulous Patient to Enhance
Esthetics: A Clinical Report. Journal of Prosthodontics. 2017 Jan 1. REFERENCES
 Bains JW, Elia JP. The role of facial skeletal augmentation and dental restorationin facial
rejuvenation. Aesthet Plast Surg 1994;18:243-6.
 . Tautin FS. Denture esthetics is more than tooth selection. J Prosthet Dent1978;40:127-30.
 . Zarb G, Hobkirk JA, Eckert SE, Jacob RF. Prosthodontic treatment for edentulous patients:
complete dentures and implant-supported prostheses.13th ed. St Louis, Mo: CV Mosby;
2013:39-40.
 arsen SJ, Carter JF, Abrahamian HA. Prosthetic support for unilateral facialparalysis. J Prosthet
Dent 1976;35:192-201.
 Lazzari JB. Intraoral splint for support of the lip in Bell’s palsy. J Prosthet Dent1955;5:579-81.
 6. Unger JW, Stroster T. Modification of the maxillary complete denture inthe management of
unilateral facial paralysis. Quintessence Int 1989;20:51-4.
 Shah RJ, Chaturvedi AT, Prajapati HG, Malek FG, Darji BJ, Katyayan PA.Enhancement of patient
aesthetics using detachable cheek plumpers incomplete dentures: case series. Sch J Med Case
Rep 2014;2:615-7.
 Punia V, Mishra R, Khandelwal M, Verma N, Handa M. Magnet retained detachable cheek
plumper: innovation personified-a case report. Int J Prosthet Dent 2013;4:16-20.
 Kamakshi V, Anehosur GV, Nadiger RK. Magnet retained cheek plumper to enhance denture
esthetics: case reports. J Indian Prosthodont Soc 2013;13:.
 Deogade SC. Magnet retained cheek plumper in complete denture esthetics: a case report. J
Dent (Tehran) 2014;11:100-5.
 . Keni NN, Aras MA, Chitre V. Customised attachments retained cheek plumper prosthesis: a
case report. J Indian Prosthodont Soc 2012;12:198-200.