Speech with Maxillary Implant Prostheses: Ratings of Articulation

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Speech with Maxillary Implant Prostheses: Ratings of Articulation
2004
G. Heydecke1,2, D.H. McFarland3,6, J.S. Feine1,4,5, and J.P. Lund1,6,*
Journal of Dental Research
1 Faculty of Dentistry, McGill University, 3640 University Street, Montreal, Quebec H3A 2B2, Canada;
2 Department of Prosthodontics, School of Dentistry, Albert-Ludwigs University, Freiburg, Germany;
3 ?‚cole dǃÙorthophonie et dǃÙaudiologie, Universit?© de Montr?©al, PQ, Canada;
4 Department of Epidemiology & Biostatistics and Occupational Health, Faculty of Medicine, McGill University;
5 Department of Oncology, Faculty of Medicine, McGill University; and
6 Centre de recherche en sciences neurologiques, Universit?© de Montr?©al, Canada;
* corresponding author, james.lund@mcgill.ca
ABSTRACT
Speech is often perturbed after placement of maxillary implant-retained prostheses. We tested the hypothesis that the rate of speech errors varies with prosthetic design. Thirty edentulous subjects with mandibular implant prostheses entered two within-subject crossover trials. Subjects wore maxillary fixed prostheses and removable long-bar overdentures (Trial 1), or overdentures with and without palates (Trial 2). Test words from a French language speech battery were recorded after each prosthesis had been worn for two months. The percentages of stops, fricatives, and vowels correctly perceived by lay judges were calculated. Subjects produced a significantly higher percentage of sounds correctly with overdentures than with fixed prostheses. Between-treatment differences were significant for stops and fricatives (p < 0.01), but not for vowels. There were no significant differences in error rates between the two overdentures. In conclusion, maxillary implant overdentures with and without palates enable patients to produce more intelligible speech than fixed prostheses.
KEY WORDS: dental implants ǃ¢ overdentures ǃ¢ clinical trial ǃ¢ maxillary prostheses ǃ¢ speech
INTRODUCTION
Dentists know that dental prostheses sometimes alter speech, and patients identify speaking ability as an important factor in their satisfaction with implant prostheses (Awad and Feine, 1998; Zitzmann and Marinello, 2000).
Speech problems with maxillary fixed prostheses are frequently reported, mostly during the first weeks after delivery (Haraldson and Carlsson, 1977; Lundqvist et al., 1992a). Lundqvist et al.(1992a) reported that 60% of the patients in a clinical trial had distorted speech soon after treatment, and 3 yrs later the rate was still 30%. However, it is hard to extrapolate these findings to the general population, because 67% of the subjects had hearing deficits, which themselves have a negative impact on speech (Lundqvist et al., 1992a,b). Another study showed that approximately 9 yrs after the placement of implant prostheses in the mandible and/or maxilla, 82% of patients still made articulatory errors, compared with only 52% of subjects with natural teeth (Jacobs et al., 2001).
The gap between mucosa and fixed prostheses is thought to be a major cause of speech errors (Lundqvist et al., 1992a). It can be closed if removable appliances are used, but these usually cover the palate, which may also interfere with speech (Petrovic, 1985). Indeed, when the palate of a dentate subject is covered experimentally, the articulation of consonants is often abnormal, even after prolonged periods of adaptation (McFarland et al., 1996; Baum and McFarland, 1997).
We have carried out a series of within-subject crossover comparisons of maxillary implant-supported prostheses, and have reported on patientsǃ٠satisfaction with and ability to chew with fixed prostheses, removable overdentures without palates, and removable overdentures with palatal coverage (de Albuquerque et al., 2000; Heydecke et al., 2003).
In this paper, we report on the quality of speech produced by the study subjects. Sounds were selected to cover the major categories used in spoken French and English: vowels, stops, and fricatives. Speech sounds are classified as voiced or unvoiced, depending on the presence or absence of vocal fold vibration. All vowels are voiced; consonants are either voiced or voiceless. Fricative consonants are produced when oral airflow is restricted, creating turbulence, while stops are produced when air flow is blocked, and there is a rapid release of air (Shriberg and Kent, 1982; McFarland and Lund, 1995).
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