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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 12  |  Issue : 2  |  Page : 87-90

Rehabilitation of edentulous maxillary arch with hollow denture in an elderly patient with bell's palsy


1 Department of Prosthodontics, Panineeya Institute of Dental Sciences, Kamalanagar, Telangana, India
2 Department of Orthodontics, Panineeya Institute of Dental Sciences, KNR University of Health Sciences, Warangal, Telangana, India
3 Department of Oral Pathology, Panineeya Institute of Dental Sciences, KNR University of Health Sciences, Warangal, Telangana, India

Date of Submission02-Jan-2020
Date of Decision14-Mar-2020
Date of Acceptance24-Mar-2020
Date of Web Publication22-Jul-2020

Correspondence Address:
Vimal Bharathi Bolloju
Department of Prosthodontics, Panineeya Institute of Dental Sciences
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_1_20

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  Abstract 


Retention and stability are the main objectives in a complete denture fabrication. The weight of a maxillary complete denture is one of the factors that affects its retention and stability. Excessive interarch distance between the maxillary and mandibular edentulous arches increases the height and weight of the prosthesis, thus compromising the retention. Long lip length further compromises the situation. This article describes a case report of prosthetic rehabilitation of a patient with bilateral gross asymmetry due to unilateral Bell's palsy and increased prosthetic space by fabricating a light-weighted hollow denture to improve the esthetics and function.

Keywords: Bell's palsy, hollow denture, leptoprosopic


How to cite this article:
Bolloju VB, Praveen M, Jadhav S, Ragini B, Naishadham P P. Rehabilitation of edentulous maxillary arch with hollow denture in an elderly patient with bell's palsy. J Oral Res Rev 2020;12:87-90

How to cite this URL:
Bolloju VB, Praveen M, Jadhav S, Ragini B, Naishadham P P. Rehabilitation of edentulous maxillary arch with hollow denture in an elderly patient with bell's palsy. J Oral Res Rev [serial online] 2020 [cited 2020 Aug 6];12:87-90. Available from: http://www.jorr.org/text.asp?2020/12/2/87/290499




  Introduction Top


Bell's palsy is a unilateral paralysis of the facial nerve that affects the voluntary movement of the facial muscles compromising the esthetics and function.[1] In a prosthodontic perspective, the difficulties encountered are cheek biting, uncontrolled salivary flow, and expressionless mask-like appearance.[2],[3] All these clinical features interfere with all the prosthodontic steps, thus affecting the denture retention and stability. The long upper lip and excessive inter-ridge space further add to these clinical problems[3] by making the denture heavy. Decreasing the weight of the maxillary obturator by fabricating a hollow denture base to restore a large maxillofacial defect has been proven to be beneficial.[4],[5] Therefore, the denture base of a maxillary removable prosthesis can be made hollow to reduce its weight, thus enhancing the retention and stability.

Various techniques such as utilizing solid three-dimensional spacer, including dental stone,[4],[5],[6],[7],[8],[9] silicone putty,[10],[11],[12] modeling clay,[13],[14] or cellophane-wrapped asbestos, caramel spacer,[15] and clear template of trial denture to create gelatin cavity[16] were implemented to replace the acrylic resin with a hollow cavity in the denture base. This case report describes a technique of using addition silicone putty to create hollow space in the denture base to lessen the weight.


  Case Report Top


A 72 year old male patient (consent obtained) reported to the department of prosthodontics with a chief complaint of the replacement of missing teeth and bilateral asymmetry of the face. History revealed that the patient abruptly developed paralysis of the left side of the face 1 year ago and had been edentulous since. On extraoral examination, the clinical features observed were leptoprosopic face with bilateral gross asymmetry, drooping of the left angle of the mouth, long upper lip, and significant decrease in the muscle tonicity [Figure 1]. Intraoral examination revealed well-formed maxillary and mandibular edentulous residual alveolar ridges. Considering all the available treatment options, it was decided to fabricate a maxillary hollow complete denture and mandibular conventional complete denture.
Figure 1: Preoperative photograph showing bilaterial facial asymmetry

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  1. Conventional technique of making preliminary and final impressions was implemented
  2. During the clinical step of maxilla-mandibular relations, to enhance the esthetics with the long upper lip, the occlusal rims were adjusted which revealed the vertical dimension at rest and vertical dimension at occlusion to be more than normal
  3. Monoplane teeth were selected as the patient's neuromuscular control was poor due to the facial asymmetry
  4. Teeth arrangement was done in balanced occlusion. Then try-in done separately for anterior and posterior teeth
  5. Flasking and dewaxing were done according to the conventional procedure
  6. After dewaxing, addition silicone putty was manipulated and adapted into space available in the flask. An index was cutout from the adapted putty [Figure 2], and trial closure was done
  7. Heat-cured poly-methyl-methacrylate resin was manipulated and divided into two halves. The first half was directly adapted onto the dewaxed mold [Figure 3]
  8. Then the putty index was accurately positioned, over which the remaining heat cure acrylic resin was packed and cured at 70°C for 7–8 h
  9. Access holes were made in the retrieved denture distal to second molars and palatal to anterior teeth [Figure 4] to remove the putty index
  10. After ensuring the complete removal of putty, the access holes were closed with autopolymerizing resin, and the denture was trimmed, finished, and polished
  11. The denture was checked for seal by immersing in water to observe any air bubbles [Figure 5] and then delivered to the patient [Figure 6].
Figure 2: Putty index for the hollow space

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Figure 3: Half of heat cure polymethylmethacrylate on the dewaxed mold

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Figure 4: Access holes to remove the putty index

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Figure 5: Maxillary denture floating in water

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Figure 6: Postoperative photograph

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Merits of this technique

  1. The putty index provides uniform thickness of acrylic resin in the denture
  2. Adequate seal between two portions of acrylic resin is obtained without any leakage
  3. Economical.


Demerits of this technique:

  1. Retrieval of putty from the denture was technique sensitive, time-consuming, and tedious which required additional access holes palatal to the anterior teeth
  2. This weakens the denture making it less resistant to fractures.



  Discussion Top


Prosthodontic rehabilitation of completely edentulous maxillary and mandibular arches in patients with Bell's palsy who lack voluntary muscle control is challenging to the dentist as they pose clinical difficulties. Contemplating the economic constraints, systemic conditions, and reluctance to undergo long and extensive surgical procedures, in geriatric patients, conventional complete dentures were considered to be the best way to rehabilitate. To overshadow the esthetic challenges of facial palsy, as a palliative therapy, dentures were modified with padding for buccal flanges,[17] spring-loaded acrylic flanges,[18] and magnet retained cheek plumpers[19] to improve cheek support.

Increased weight of the denture, owing to excessive interarch distance and long upper lip, can be dampened by creating a hollow space in the denture base to enhance the retention and stability for which numerous materials and techniques were followed. This method utilizes addition silicone putty spacer as it is dimensionally stable, easy to contour, and is considered the most desirable material to fabricate light-weighted dentures.[12]

The fabricated hollow denture:

  1. Restored the function of mastication
  2. Enhanced the comfort due to its lightweight and
  3. Improved the esthetics by providing additional support to the cheek.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, et al. Clinical practice guideline: Bell's palsy executive summary. Otolaryngol Head Neck Surg 2013;149:656-63.  Back to cited text no. 1
    
2.
Emory L. The face in patient evaluation and diagnosis. J Prosthet Dent 1976;35:247-53.  Back to cited text no. 2
    
3.
Hussain S, Jayesh R, Nayar S, Aruna U, Abraham AM. Prosthodontic management of a completely edentulous patient with Bell's palsy. Indian J Multidiscip Dent 2012:2;404.  Back to cited text no. 3
    
4.
el Mahdy AS. Processing a hollow obturator. J Prosthet Dent 1969;22:682-6.  Back to cited text no. 4
    
5.
Brown KE. Fabrication of a hollow-bulb obturator. J Prosthet Dent 1969;21:97-103.  Back to cited text no. 5
    
6.
Ackerman AJ. Prosthetic management of oral and facial defects following cancer surgery. J Prosthet Dent 1955;5:413-32.  Back to cited text no. 6
    
7.
Nidiffer TJ, Shipman TH. Hollow bulb obturator for acquired palatal openings. J Prosthet Dent 1957;7:126-34.  Back to cited text no. 7
    
8.
Rahn AO, Boucher LJ. Maxillofacial Prosthetics: Principals and Concepts. St. Louis: Elsevier; 1970. p. 95.  Back to cited text no. 8
    
9.
Chalian VA, Barnett MO. A new technique for constructing a one-piece hollow obturator after partial maxillectomy. J Prosthet Dent 1972;28:448-53.  Back to cited text no. 9
    
10.
Holt RA Jr. A hollow complete lower denture. J Prosthet Dent 1981;45:452-4.  Back to cited text no. 10
    
11.
Jhanji A, Stevens ST. Fabrication of one-piece hollow obturators. J Prosthet Dent 1991;66:136-8.  Back to cited text no. 11
    
12.
Indrakumar HS, Amarnath GS, Shavi GR, Hariprasad A, Hilal SM, Anand M. A denture with hollow to make weight shallow: A case report with a new putty method. J Int Oral Health 2014;6:92-4.  Back to cited text no. 12
    
13.
DaBreo EL. A light-cured interim obturator prosthesis. A clinical report. J Prosthet Dent 1990;63:371-3.  Back to cited text no. 13
    
14.
Elliott DJ. The hollow bulb obturator: Its fabrication using one denture flask. Quintessence Dent Technol 1983;7:13-4.  Back to cited text no. 14
    
15.
Bhushan P, Aras MA, Chitre V, Mysore AR, Mascarenhas K, Kumar S. The hollow maxillary complete denture: A simple, precise, single-flask technique using a caramel spacer. J Prosthodont 2019;28:e13-7.  Back to cited text no. 15
    
16.
Deogade SC, Patel A, Mantri SS. An alternative technique for hollowing maxillary complete denture. J Indian Prosthodont Soc 2016;16:412-5.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Larsen SJ, Carter JF, Abrahamian HA. Prosthetic support for unilateral facial paralysis. J Prosthet Dent 1976;35:192-201.  Back to cited text no. 17
    
18.
Fickling BW. Buccal sulcus supports for facial paralysis. Br Dent J 1951;90:115-7.  Back to cited text no. 18
    
19.
Riley MA, Walmsley AD, Harris IR. Magnets in prosthetic dentistry. J Prosthet Dent 2001;86:137-42.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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