Phonetics in complete dentures./ dentistry course in india

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Phonetics in complete dentures./ dentistry course in india

  1. 1. Phonetics in complete dentures. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Table of contents. • Introduction • Review of literature. • Speech production. • Phonemics www.indiandentalacademy.com
  3. 3. • Factors in denture affecting speech -position of teeth. -denture thickness. -Occlusal plane. -Vertical dimension. -width of the dental arch. www.indiandentalacademy.com
  4. 4. • Use of phonetics in denture construction. • Speech tests. • Summary • Conclusion • references. www.indiandentalacademy.com
  5. 5. Introduction. Speech is a very sophisticated, autonomous and unconscious activity. Its production involves neural, muscular, mechanical, aerodynamic, acoustic and auditory factors. www.indiandentalacademy.com
  6. 6. Because orodental morphological features also may influence an individuals speech, the dentist should recognize the possible role of prosthetic treatment on speech activity. www.indiandentalacademy.com
  7. 7. The oromotor functions, such as mastication and speech are interrelated because the mouth , lower jaw, lips, teeth and tongue are used for both the activities. Any alterations in these structures will inevitebly mediate a disturbance in the system. www.indiandentalacademy.com
  8. 8. Articulatory deficits may be generally classified into three categories: omission of a phoneme, substitutions and distortions. Distortions is most usual consequence after the prosthodontic treatment. www.indiandentalacademy.com
  9. 9. • What is Phonetics? • Phonetics is the study of the articulatory and acoustic properties of the sounds of human language. www.indiandentalacademy.com
  10. 10. Review of literature. www.indiandentalacademy.com
  11. 11. Leslie R. Allen etal., Improved phonetics in complete dentures. JPD1958;8(5)573-83. The article describes that the labio- dental sounds are recommended for arriving at the proper arrangement of the anterior teeth , and vertical dimension for s pronunciation. www.indiandentalacademy.com
  12. 12. Phonetics can be improved by contouring the entire palatal surface of the maxillary denture to simulate the natural palate. . www.indiandentalacademy.com
  13. 13. • It was found that good results can be obtained by thickening the areas necessary to produce normal tongue contact without meticulous carving and contouring www.indiandentalacademy.com
  14. 14. Edward J. Mehringer. The use of speech patterns as an aid in Prosthodontic reconstruction. JPD1963;13(5):825-35). . www.indiandentalacademy.com
  15. 15. The purpose of this article was ; To show how the speech patterns develop physiologically . To illustrate graphically the basic formats established by neuromuscular patterns in articular speech www.indiandentalacademy.com
  16. 16. To show how the speech patterns can be utilized under functional conditions fit record making purpose. www.indiandentalacademy.com
  17. 17. The author says that the integration of the artificial teeth to the functional movements take precedence over the fit of the denture base to its foundation. When teeth donot conform to these functional patterns, the fit of the base cannot endure. www.indiandentalacademy.com
  18. 18. Meyer M. Silverman The whistle and swiss sound in denture patients. JPD 1967;17(2):144-48 . www.indiandentalacademy.com
  19. 19. • The article describes the causes of certain abnormal sounds , such as whistle and swish sounds, that occur in the speech of the patients wearing fixed and removable restorations involving the anterior teeth. www.indiandentalacademy.com
  20. 20. • Ideally, the artificial teeth should be located in the same position as the natural teeth they replace for proper phonetics. www.indiandentalacademy.com
  21. 21. Joseph G. Agnello etal., A study of phonetics in edentulous patients following complete denture treatment • JPD 1972;27(2):133-39. www.indiandentalacademy.com
  22. 22. • The aim of this study was to asses the speech changes in complete denture patients 1. In the edentulous state . 2. Immediately following denture insertion 3. Two weeks following insertion of dentures 4. Twelve weeks following the insertion of dentures. www.indiandentalacademy.com
  23. 23. • They concluded that words spoken in the edentulous state were paired with words spoken in the different stages of denture wear. • Analysis revealed that the s, sh, t showed improvement . • The voiced th sound did not show any general improvement. www.indiandentalacademy.com
  24. 24. Earl Pound; Utilizing speech to simplify a personalized denture service . • JPD 1970;24(6):586-600. www.indiandentalacademy.com
  25. 25. • A fresh approach toward the solution of many of the debatable problems in complete denture construction consists of simple recording, as guided by muscle memory, the extent of the downward and forward mandibular movements made during speech. www.indiandentalacademy.com
  26. 26. • This automatically restores the patients original horizontal and vertical overlaps which can be used to control the factors of occlusion. www.indiandentalacademy.com
  27. 27. • The values derived by progressive function refinement of this information, through the controlled use of diagnostic treatment dentures incorporating tissue treatment material, and free occlusal scheme. www.indiandentalacademy.com
  28. 28. George A. Murrell. The problems of functional conflicts between anterior teeth. • JPD1972;27(6):591-99. www.indiandentalacademy.com
  29. 29. • Phonetic positioning of the anterior teeth usually produces a natural, esthetic tooth arrangement and provides occlusal clearence during the function of speech with complete dentures. www.indiandentalacademy.com
  30. 30. • Natural tooth positioning, however, frequently results in increased horizontal and vertical overlaps which magnify the possibility of functional conflicts in anterior teeth. www.indiandentalacademy.com
  31. 31. Interferences in speech can be avoided during denture construction, but those of mastication and swallowing must be corrected after the dentures are constructed. www.indiandentalacademy.com
  32. 32. Hisatoshi Tanaka. Speech patterns of edentulous patients and morphology of the palate in relation to the phonetics. • JPD1973:29(1):16-28. www.indiandentalacademy.com
  33. 33. • The purpose of this study was to investigate 1. Changes in the speech patterns of patients with new complete dentures before and various times after insertion of the new dentures. 2. The relationship between the speech and the palatal contours of the denture.www.indiandentalacademy.com
  34. 34. • On the basis of analysis of the data collected ,the following conclusions were made: 1.Most of the patients made speech improvement when the dentures were first inserted. www.indiandentalacademy.com
  35. 35. 2.With increased length of time of wearing the dentures, the speech intelligibility was improved. 3.The speech of the patients can be improved by experience with their new dentures. www.indiandentalacademy.com
  36. 36. 4.Individual sounds showed different levels of speech intelligibility, and this level improves with the length of the denture usage. 5.Acoustic distortions occurred more frequently In the s, sh, ch, zh, and j sounds than in z, t, n, d, and l sounds. www.indiandentalacademy.com
  37. 37. 6.The s sound is a poor prognostic sound for intelligibility of speech. 7.The palatal ridge formation (palatal contour) of the complete dentures will affect the acoustic distortion of the affricative and the fricative sounds. www.indiandentalacademy.com
  38. 38. Carl A. Hansen . Phonetic considerations of the chromium alloy plates in complete dentures. • JPD 1975; 34(6);620-24. www.indiandentalacademy.com
  39. 39. • The author says that there is valid indications for the use of chromium alloy plates, • The contour of the entire palatal surface must, however be considered for optimum phonetics. • Both resins and metal must be related to each other www.indiandentalacademy.com
  40. 40. in an intelligent manner to insure precise contours, minimum weight, and maximum strenght. • Two approaches to these techniques will be described. www.indiandentalacademy.com
  41. 41. Earl Pound. Let /s/ be your guide. • JPD 1977;38(5):482-89. www.indiandentalacademy.com
  42. 42. • This article reviews the new guidelines for establishing the vertical dimension of occlusion . www.indiandentalacademy.com
  43. 43. • They are based on the fact that the body of the mandible assumes an easily recordable , repetitive horizontal and vertical position when the patient is at /s/ position during speech. www.indiandentalacademy.com
  44. 44. • This controlled method of developing vertical dimension correlates the posterior speaking space with the placement of upper and lower anterior teeth when set to phonetic standard. www.indiandentalacademy.com
  45. 45. • This permits the development of a dependable vertical dimension of occlusion for most patients and also serves as a guide for the more difficult to treat classII and tongue – thrusting patients. www.indiandentalacademy.com
  46. 46. Bal k. Goyal etal.,. Functional contouring of the palatal vault for improving speech with complete dentures • JPD1982;48(5):640-46. www.indiandentalacademy.com
  47. 47. • According to the study : • The slight bulging of the denture base palatal to the anterior teeth probably helps in improved pronunciation of /s/ and /sh/ sounds . www.indiandentalacademy.com
  48. 48. • Earl Pound; Utilizing speech to simplify a personalized denture service . www.indiandentalacademy.com
  49. 49. • Also suggest that placing the non- anatomic papilla somewhat posterior to the incisive papilla location provides tactile sensation location. • The s curve in the molar area is important for proper enunciation of the sounds.www.indiandentalacademy.com
  50. 50. Emily A. Tobey. Active versus passive adaptation: an acoustic study of vowels produced with and without dentures. • JPD1983;49(3):314-20. www.indiandentalacademy.com
  51. 51. • Data from this study indicate the close examination of vowels , as well as consonants , assists in delinating active articulatory versus passive acoustic changes to orofacial reconstruction. • Data from the study reveal that consonants and vowels are influenced by the prostheses. www.indiandentalacademy.com
  52. 52. • Moreover, the data suggest that adjusting prostheses by listening for changes in the consonant sounds may change only the passive acoustic characteristics of the prostheses and may not necessarily influence active accommodation by the patient. www.indiandentalacademy.com
  53. 53. Ronald J. Hammond. Increased vertical dimension and speech articulation errors. • JPD1984;52(3):401-6. www.indiandentalacademy.com
  54. 54. • The study evaluates the effects of speech articulation of increasing the vertical dimension of occlusion. • This study indicates that gross articulatory adaptation to increased vertical dimension occurs within 4-6 days and that thereafter adaptation is a matter of refinement and fine adjustment. www.indiandentalacademy.com
  55. 55. J. FMcCord Phonetic determinants of tooth placement in complete dentures Quintessence Int 1994;25:341-45. www.indiandentalacademy.com
  56. 56. • The provision of complete dentures requires that dentist, technician and the patient adequately fulfill their respective roles in provision and adaptation to, these dentures. www.indiandentalacademy.com
  57. 57. • An increasing number of replacement of the dentures are being prescribed for older patients. www.indiandentalacademy.com
  58. 58. • Thus , the need to utilize functional factors to determine tooth placement is reviewed. • This review demonstrates demonstrate the overall relationship between speech and denture construction. www.indiandentalacademy.com
  59. 59. Christina A. Gitto. A simple method of adding palatal rugae to complete dentures. • JPD1999;81:237-9. www.indiandentalacademy.com
  60. 60. • Restoring patient’s speech is an important goal in complete denture fabrication. • For those patients who have difficulty with their speech patterns accommodating to the introduction of the a prosthesis, texture in the palatal region may prove helpful. . www.indiandentalacademy.com
  61. 61. • Article describes method of incorporating palatal rugae in newly fabricated and existing dentures. www.indiandentalacademy.com
  62. 62. Ederhard Seifert etal.,. Can dental prosthesis influence vocal parameters? • JPD1999:81:579-85. www.indiandentalacademy.com
  63. 63. • This study evaluated the effects of changes on phonation by varying the dentures of 20 subjects in line with those of the first patient. www.indiandentalacademy.com
  64. 64. • They concluded that variation of thickness and or volume of dentures and of the vertical and horizontal dimensions of occlusion may result in unpredictable audible changes to the voice. www.indiandentalacademy.com
  65. 65. Christoph runte.The influence of maxillary central incisor position in complete dentures on /s/ sound production. • JPD2001:85:485-95. www.indiandentalacademy.com
  66. 66. • The study investigated the effect of different maxillary central incisor position on phonetic patterns. www.indiandentalacademy.com
  67. 67. • They concluded that immediate phonetic adaptation of prosthetic restorations in the maxillary incisor region can be achieved only if the original position of the natural teeth is transferred to the dentures. www.indiandentalacademy.com
  68. 68. • Although these misarticulations are likely to disappear in many cases within few weeks ,they may persists and even lead to psychological problems. www.indiandentalacademy.com
  69. 69. R.C Matheus rodrigues .effect of new dentures on inter occlusal distance during speech. • Int J Prosthodont2003;16:533-37. www.indiandentalacademy.com
  70. 70. • The study investigated the changes in the interocclusal distance during pronunciation of /m/ and /s/ sounds. www.indiandentalacademy.com
  71. 71. • They concluded that insertion of new dentures , with the vertical dimension corrected ,changes interocclusal distance of speech during phonation of /m/ and /s/ sounds. www.indiandentalacademy.com
  72. 72. Speech production. Any vibrating body will make sound and the prerequisites for sound are a source of energy and a vibrator. The source of energy for the voice is air in the lungs. The vibrators for the voice are the vocal folds in the larynx.www.indiandentalacademy.com
  73. 73. Controlled airstem that is initiated in the lungs and passes through the larynx and the vocal cords produces all speech sounds. Speech sounds need more air than quite exhalation. www.indiandentalacademy.com
  74. 74. www.indiandentalacademy.com
  75. 75. www.indiandentalacademy.com
  76. 76. • The larynx contains folds of muscle called the vocal folds (sometimes called vocal cords). www.indiandentalacademy.com
  77. 77. • Sounds that are produced with relaxed vocal folds are known as voiceless sounds, and sounds that are produced with tensed vocal folds are known as voiced sounds. If the folds are only partially closed, a whispered sound is produced. www.indiandentalacademy.com
  78. 78. • The adjustments in the airflow contribute to the variations in pitch and intensity of the speech sounds. Structural controls for speech sounds are: the valves in the pharynx and the oral and nasal cavities. www.indiandentalacademy.com
  79. 79. • Nearly all sounds are emitted from the mouth. • The nasopharynx is closed off from oropharynx during speech. • This closure is done by upward closure of the soft palate. www.indiandentalacademy.com
  80. 80. • As the air passes through the mouth the tongue ,lips and mandibular oscillations modify it. • The tongue has a critical impact on the speech production. www.indiandentalacademy.com
  81. 81. www.indiandentalacademy.com
  82. 82. • Jaw and tooth relationships enable the tongue to articulate against the maxillary teeth or the alveolus ,permit the maxillary teeth and the lips to make easy contact and allow lips to contact to produce speech. www.indiandentalacademy.com
  83. 83. Neurophysiologic background • A complex and imperfectly understood mechanism governs the speech. • A large no of oral mechanosensitive receptors are involved in motor control. www.indiandentalacademy.com
  84. 84. • Therefore all prosthodontic treatment will have an influence on speech performance because a great no of these structures will be involved. www.indiandentalacademy.com
  85. 85. • It has been hypothetised that less cortex area is required processing skills once they become automatised. www.indiandentalacademy.com
  86. 86. • A prerequisite to satisfactory speech sounds and adaptation is intact general feedback system that is orosensory and auditory feedback. www.indiandentalacademy.com
  87. 87. • Gradual hearing loss could be present in older ages and the process of adaptation to the dental prosthesis could be impaired. www.indiandentalacademy.com
  88. 88. • Adaptation to the complete dentures is by feedback mechanism to speech motor programming. www.indiandentalacademy.com
  89. 89. How does dental treatment affects speech? • Since most of the articulations takes place in the oral cavity, any alterations of these structures will affect speech. www.indiandentalacademy.com
  90. 90. • For ex: • a missing bicuspid • Missing anterior teeth. • Gross removal of the gingival tissue. • Mechanical movement of the teeth in the maxillary arch. www.indiandentalacademy.com
  91. 91. • high % of sounds are produced by contact of the tongue with some portion of the palate and the teeth . Since these areas are covered or replaced by the CD speech rehabilitation becomes onerous task to the prosthodontist. www.indiandentalacademy.com
  92. 92. Phonemics. • Articulation is usually considered to be joining of the parts. • Speech articulation takes place when any approximation or movement of the articulators constricts or diverts the airstem to produce single sound. www.indiandentalacademy.com
  93. 93. • The single sounds that are produced are innumerable. • Many cccur as noise and are unclassified. • But those which are learned as speech are called phones. www.indiandentalacademy.com
  94. 94. • The closely related phones have been combined to form recognizable sounds and are called phonemes. www.indiandentalacademy.com
  95. 95. • The phoneme, then is a unit of speech by which we can distinguish one utterence from another and which collectively make up phonemics of language. • Study of these phonemics is known as phonetics. www.indiandentalacademy.com
  96. 96. Classification of speech. Since speech production can be used as a guide for the arrangement of the teeth, it is necessary to be familiar with the different types of speech sounds. www.indiandentalacademy.com
  97. 97. Speech sound can be classified as • Surds • Sonants • consonants. www.indiandentalacademy.com
  98. 98. • Surds : these are any voiceless sound produced by separation of the vocal cords with no marginal vibration. www.indiandentalacademy.com
  99. 99. • Example: • The initial h sound as in huh. • Voiceless sibiliants s, sh, zh produced initially. www.indiandentalacademy.com
  100. 100. Sonants: these are voiced sounds that include all vowels and vowel- like sounds. They require minimum articulation and are classified according to tongue position and position of the lips. www.indiandentalacademy.com
  101. 101. • consonants: are produced as a result of airstem being impeded, diverted, or interrupted before its release. • Ex: p, g, m, b, s, t, r, z. www.indiandentalacademy.com
  102. 102. • Consonants also are divided into groups, depending on their characteristic production and use of different articulators and valves. www.indiandentalacademy.com
  103. 103. • Plosive consonants: produced when an overpressure of air has been built up by contact between the soft palate and the pharyngeal wall and released in an explosive way. • Ex: p and t. www.indiandentalacademy.com
  104. 104. www.indiandentalacademy.com
  105. 105. • Fricative consonants: also called sibilants and are charecterised by their sharp and whistling sound quality created when air is squeezed through the nearly obstructed articulators. • Ex: s and z. www.indiandentalacademy.com
  106. 106. www.indiandentalacademy.com
  107. 107. • Affricate consonants: are produced by combination of stops and friction, accomplished by articulation of tongue and anterior hard palate. • Ex: j and ch. www.indiandentalacademy.com
  108. 108. www.indiandentalacademy.com
  109. 109. • Nasal consonants: produced without oral exit of air. • Ex: n and m. www.indiandentalacademy.com
  110. 110. www.indiandentalacademy.com
  111. 111. • Liquid consonants: they are produced with friction. • Ex: r www.indiandentalacademy.com
  112. 112. • Glides: sounds characterized by gradually changing articulator shape. www.indiandentalacademy.com
  113. 113. • Depending on the contacts made by the lips and tongue on the teeth and the palate the sounds are classified as : • Bilabial sounds: b, p, m. • Labiodental sounds: f, v. • Linguo dental sounds: th in this. • Linguoalveolar sounds: t, d, s, z, l. • Linguopalatal sounds: year, she, vision. www.indiandentalacademy.com
  114. 114. Phonetic changes in edentulous patients following complete denture treatment. • JPD1972;27(2):133-39. www.indiandentalacademy.com
  115. 115. The absence of teeth creates difficulties in speech sounds. Some patients donot exhibit any speech problems, because it appears that the tongue makes compensatory adjustments for the absence of the sounds. www.indiandentalacademy.com
  116. 116. • Allen (1958) says that a patient fitted with complete dentures generally adjusts to the speech pattern to the appliance and thus improves. www.indiandentalacademy.com
  117. 117. • Kaires(1957) and Sovijarvi(1962) reported that in the absence of dentures, the concentration of the higher frequencies in the overall acoustic spectrum of speech was reduced. www.indiandentalacademy.com
  118. 118. • Angello and Wictorin (1972) they made a study to asses speech changes in edentulous state and following insertion of dentures. • They concluded that /s/ /sh/ /t/ sounds showed improvement. www.indiandentalacademy.com
  119. 119. Factors in denture design affecting speech. • Keuebeker (1984) investigated speech problems that occurred after fitting the dentures and listed following causes. 1.Incorrectly positioned anterior teeth. 2.Vertical dimension. 3.Occlusal plane www.indiandentalacademy.com
  120. 120. 4.width of the dental arch. 5.Relationship of the upper and lower anterior teeth 6.Denture thickness. 7.Postdam area. www.indiandentalacademy.com
  121. 121. Tooth positions. Tooth positions are sometimes critical to the production of certain sounds and not at all for others. www.indiandentalacademy.com
  122. 122. Because the teeth are arranged for esthetics, it is not only the speech sound itself that is critical but rather the interrelationship of the tongue ,lips, teeth and denture base. www.indiandentalacademy.com
  123. 123. • Bilabial sounds: they are made by the contact of the lips. b, p,m. • Insufficient support of the by the teeth can cause these sounds defective. • Therefore anterioposterior positioning of the anterior teeth can effect production of these sounds. www.indiandentalacademy.com
  124. 124. www.indiandentalacademy.com
  125. 125. • Labiodental sounds: these are f,v sounds made between the upper incisors and the labiolingual center to the posterior third of lower lip. www.indiandentalacademy.com
  126. 126. • If the upper anterior teeth are set too short (set too high) the v sound will be more life an f. • If they are set too long (set too far long) f will sound more like v. www.indiandentalacademy.com
  127. 127. www.indiandentalacademy.com
  128. 128. • If the teeth touch labial side of the lower lip when these sounds are made the upper teeth are too forward. • If the teeth are set too far back in the mouth they will contact the lingual side of the lower lip. www.indiandentalacademy.com
  129. 129. • Linguodental sounds: these are made with the tip of the tongue extending slightly between the upper and lower teeth. • If 3mm of the tongue tip is not visible then the teeth are probably too forward. www.indiandentalacademy.com
  130. 130. • Or there may be excessive overlap that does not allow the tongue to protrude. • If more than 6mm of tongue extends out the teeth are set too lingually. www.indiandentalacademy.com
  131. 131. • Linguoalveolar sounds: are made with the tip of the tongue with most anterior part of the palate. • Ex: t, d, s, z, l www.indiandentalacademy.com
  132. 132. • The important observation is when these sounds are produced in relation to the upper and lower anterior teeth. • The upper and lower incisor should approach each other but not touch. www.indiandentalacademy.com
  133. 133. www.indiandentalacademy.com
  134. 134. The influence of maxillary central incisor position in complete dentures on /s/ sound production. • (JPD 2001;85:485-95) www.indiandentalacademy.com
  135. 135. Acc to this study the change in the inclination angle of the central incisors in a range of -30deg to +30deg caused poor execution of /s/ sounds . The labial angulation seemed to have greater effect than the palatal angulation. www.indiandentalacademy.com
  136. 136. www.indiandentalacademy.com
  137. 137. The whistle and Swiss sound in denture patients. • JPD 1967;17(2):144-48. The whistle sound is a familiar shrill musical sound which is prolonged sibilant or whistling s lisp. The Swiss is a lateral lisp is the substitution of sh and zh when trying to say s sound. www.indiandentalacademy.com
  138. 138. • These are caused by the abnormal emmision of air passing over the tongue between the upper and lower central incisors while trying to produce sibiliant sounds such as s and z. www.indiandentalacademy.com
  139. 139. www.indiandentalacademy.com
  140. 140. • When the upper teeth are set too far posteriorly , the space for the tongue is reduced. • When s sound is attempted there is lack of space to allow narrow stream of air to pass over the tip of the tongue. www.indiandentalacademy.com
  141. 141. • The air is pressed past all the anterior teeth in a wider stream causing the s to resemble sh www.indiandentalacademy.com
  142. 142. Phonetics in complete dentures By – Dr. Vijayalaxmi. www.indiandentalacademy.com
  143. 143. Denture base • One of the reasons for the loss of tone are and incorrect articulation of speech is the decrease in the air volume and loss of tongue space in the oral cavity resulting from unduly thick denture base. www.indiandentalacademy.com
  144. 144. Most important is the denture base covering the center of the palate. Because for here no loss of the tissue of the natural tissue has occurred, and the base reduces the tongue space and oral air volume. www.indiandentalacademy.com
  145. 145. • Any thickening of the denture base in the anterior region of the hard palate cause incorrect formation of palatolingual sounds such as t, d. www.indiandentalacademy.com
  146. 146. • In case of s,c,z sounds, a slit like channel is formed between the tongue and the palate through which the air hisses. • If the artificial rugae are too pronounced or the denture base is too thick in this area the air channel is blocked and noticeable lisp may occur. www.indiandentalacademy.com
  147. 147. • The linguoalveolar components such as Ch and j are also affected if the denture base is too thick in the region of rugae. www.indiandentalacademy.com
  148. 148. • Allen (1958) said that the thickness in the palatal vault is critical to speech in the anterior section from canine to canine. • He advised that the thickening the area of the incisive papilla facilitates proper enouciation . www.indiandentalacademy.com
  149. 149. • Palmer(1979) indicated that some patients develop problem after insertion of the CD because they experience a loss of tactile location skills. • He recommended that non anatomic papilla to be placed an the denture posterior to the incisive papilla to foster normal speech. www.indiandentalacademy.com
  150. 150. Occlusal plane • The labiodentals f and v are produced through the narrow gap between the lower lip and inicisal edges of the upper anterior teeth. www.indiandentalacademy.com
  151. 151. • If the occlusal plane is too high the correct positioning of the lower lip may be difficult. • If the plane is low the lip will overlap the labial surface of the upper teeth to a greater extent and the sound might be affected. www.indiandentalacademy.com
  152. 152. www.indiandentalacademy.com
  153. 153. Vertical dimension • Ribner (1965) • With a correctly trimmed maxillary rim in place ,the mandibular rim is trimmed so that 1mm of space exists between the two when the patient says /s/. If there is insufficient vertical height, the bilabials /p/, /b/ are affected.www.indiandentalacademy.com
  154. 154. • This is because these require the lips to contact to check the air stream. www.indiandentalacademy.com
  155. 155. Increased vertial dimension and speech articulation errors. Ronald J. Hammond (JPD1984;52(2)). In his study he found that : Most frequently misarticulated were fricatives ie., /s/ and /sh/. www.indiandentalacademy.com
  156. 156. • The second most consistently made error after increased VD were affricatives /th/. • Thirdly it was the plosives /t/. www.indiandentalacademy.com
  157. 157. Width of the dental arch. • If the teeth are set in an arch which is too narrow the tongue will be cramped , thus affecting the size of the air channel. www.indiandentalacademy.com
  158. 158. • This results in faulty articulation of consonants t, d, s, n, k, c, where the lateral margins of the tongue make contact with the palatal surface of the upper posterior teeth. www.indiandentalacademy.com
  159. 159. www.indiandentalacademy.com
  160. 160. • Hence the artificial teeth should be placed in place previously occupied by the natural teeth. www.indiandentalacademy.com
  161. 161. Postdam area. • Errors in construction in this region involve the vowels u, o and the palatolingual consonants g and k www.indiandentalacademy.com
  162. 162. • In this group the air stream is checked by the base of the tongue being raised upwards & backwards to make contact with soft palate. www.indiandentalacademy.com
  163. 163. • If the denture is thick in this area or the posterior edge is not sloppy it irritates the tongue thus impending speech. www.indiandentalacademy.com
  164. 164. Use of phonetics in denture construction. www.indiandentalacademy.com
  165. 165. Contouring the palatal vault • This is done after processing of the dentures. • This was done according to the tongue contact made by the patient while speaking different vowels and consonants. www.indiandentalacademy.com
  166. 166. • Contouring the palate: 1. The external surface of the palatal section of the denture was roughened and painted with physiologic wax lingual to the premolars and molars, in the midline, and palatal to the anterior teeth. www.indiandentalacademy.com
  167. 167. 2.The waxed up denture is placed in the mouth along with the mandibular denture and patient was asked to read 10 stimulus sentence having /ch/, /j/, sh/, /zh/, /t/, /n/, /d/, /s/ ,/t/, /n/, /d/, /z/. www.indiandentalacademy.com
  168. 168. 3. After completion of 10 sentences ,the maxillary denture was removed from the mouth and chilled in the cold water. Freshly developed wax contour was examined. www.indiandentalacademy.com
  169. 169. • A positive contact with wax was smooth and shiny, while lack of contact appeared dull and irregular. www.indiandentalacademy.com
  170. 170. • Converting the wax contour into acrylic resin. www.indiandentalacademy.com
  171. 171. www.indiandentalacademy.com
  172. 172. www.indiandentalacademy.com
  173. 173. www.indiandentalacademy.com
  174. 174. www.indiandentalacademy.com
  175. 175. The use of speech patterns as an aid in prosthodontic reconstruction • Edward J. Mehringer. JPD196313(5). • He described denture construction to conform with the neuromuscular patterns for speech. www.indiandentalacademy.com
  176. 176. • The wax rims are fabricated to provide esthetically accepted lip fullness and lip line. • Then a tentative centric relation record is made. www.indiandentalacademy.com
  177. 177. • The occlusal rims are contoured to simulate the shape of the natural teeth. • The phonetic formats are evaluated as to their conformity with patients own neuromuscular speech pattern. www.indiandentalacademy.com
  178. 178. • This is accomplished by having patient count slowly and distinctly from 3-10 three times. www.indiandentalacademy.com
  179. 179. 1-1.5mm space for sibilants. www.indiandentalacademy.com
  180. 180. 2-4mm space for nasal consonants. www.indiandentalacademy.com
  181. 181. 5-10mm space for diphthongs. www.indiandentalacademy.com
  182. 182. • If the patient phonetic spaces during counting procedures, the centric occlusion is recorded and transferred to the articulator. www.indiandentalacademy.com
  183. 183. Vertical dimension. • Determination of vertical dimensions by phonetics. • Meyer M. Silverman. www.indiandentalacademy.com
  184. 184. • The occlusal rims are fabricated . • They are trimmed to allow normal space for the tongue . • The palatal and lingual surfaces of the teeth are trimmed to simulate the width and shape of the teeth. www.indiandentalacademy.com
  185. 185. • The patient is instructed to pronounce the s sound and then to speak or read a magazine. • By sight or measuring the approximate closest speaking space is noted. • A closest speaking space of 2mm is decided arbitrarily. www.indiandentalacademy.com
  186. 186. www.indiandentalacademy.com
  187. 187. • Why /s/ sound is used? 1.Most forward and most closed position of the mandible during speech is assumed when /s/ sounds are enounciated. 2./s/ sound is created when air is forced through a 1-1.5mm gap between the incisal edges of the lower CI and coronal surfaces of the upper CI.www.indiandentalacademy.com
  188. 188. www.indiandentalacademy.com
  189. 189. Determining the class of occlusion. www.indiandentalacademy.com
  190. 190. www.indiandentalacademy.com
  191. 191. www.indiandentalacademy.com
  192. 192. Ribner (1965) • Summarized the benefits of utilizing phonetics exercises in denture prescription by listing following examples. www.indiandentalacademy.com
  193. 193. 1.Posterior border of the denture /ah/ 2.Vertical dimension 1mm space exists between the upper and lower rim when patient says /s/. 3.Height of the anterior teeth and thus occlusal plane /f/, /v/. www.indiandentalacademy.com
  194. 194. • Thickness in the anterior region of the palate a lisp in /t/ indicates excessive thickness. • Thickness of postdam difficulty in saying /g/ indicates excessive thickness. www.indiandentalacademy.com
  195. 195. Summary. www.indiandentalacademy.com
  196. 196. Conclusion. www.indiandentalacademy.com
  197. 197. References. • Prosthodontic treatment for edentulous patients.12 ed. • Clinical dental prosthetics 3 Edn • Speech patterns of edentulous patients JPD1973;29(1). • A study of phonetic changes in edentulous patients following complete denture treatment. JPD 1972;27(2). www.indiandentalacademy.com
  198. 198. • Phonetic determinants of tooth placement in complete dentures. Quint Int 1994;25:341-45. • The speaking method of determining vertical relation. JPD 1953;3(2). • Palatal pressures of the tongue in phonetics and deglutation. JPD1957;7(3). www.indiandentalacademy.com
  199. 199. • Controlling anamolies of vertical dimension. JPD 1976;36(2). • A simple method of adding palatal rugae to complete dentures. JPD1999;81:237-9. • The whistle and swiss sound in denture patients. JPD 1967;17(2). www.indiandentalacademy.com
  200. 200. • Can dental prostheses influence vocal parameters. JPD 1999.81:57-85. • The influence of maxillary central incisors in complete dentures in /s/ sound production. JPD2001;85:485-95. www.indiandentalacademy.com
  201. 201. • Phonetic considerations of chromium cobalt alloy plates for complete dentures. JPD 1975;34(6). Analysis of speech in prosthodontics. JPD 1974;31(6). The whistle and swiss sound in denture patients. JPD 1967;17(2). www.indiandentalacademy.com
  202. 202. • Effect of new dentures on interocclusal distance during speech. JPD 2003; 16:533-37. www.indiandentalacademy.com
  203. 203. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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