SYNOPSIS

DR. RAVI RAJ

POST GRADUATE STUDENT

DEPARTMENT OF PROSTHODONTICS INCLUDING CROWN &

BRIDGE AND IMPLANTOLOGY

K.V.G. DENTAL COLLEGE & HOSPITAL,

KURUNJIBHAG, SULLIA, DK, KARNATAKA -574327

Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE AND

ADDRESS

DR. RAVI RAJ

POST GRADUATE STUDENT,

DEPARTMENT OF PROSTHODONTICS INCLUDING

CROWN & BRIDGE AND IMPLANTOLOGY,

K.V.G. DENTAL COLLEGE & HOSPITAL,

KURUNJIBHAG, SULLIA, D.K.

KARNATAKA -574 327

2. NAME OF THE INSTITUTION K.V.G. DENTAL COLLEGE & HOSPITAL,

KURUNJIBHAG, SULLIA, D.K.

KARNATAKA -574 327

3. COURSE OF STUDY AND SUBJECT MASTER OF DENTAL SURGERY

PROSTHODONTICS INCLUDING CROWN & BRIDGE

AND IMPLANTOLOGY.

4.

5.

DATE OF ADMISSION TO COURSE

TITLE OF THE THESIS

AUGUST 19TH 2013

A STUDY TO EVALUATE THE EFFECT OF

INCORPORATION OF POSTERIOR PALATAL SEAL

AND RUGAE IN COMPLETE DENTURE ON

PERCEPTUAL AND ACOUSTIC DIMENSIONS OF

DENTURE WEARER’S SPEECH.

6. BRIEF RESUME OF THE INTENDED WORK :

6.1 Need for the study :

Speech is a unique, complex, dynamic motor activity through which we express our thoughts and

respond to control our envoirnment.1 It is most powerful tool possessed by human species, and degree to

which we employ it effectively contributes to character and quality of our live.1 The unique complexity of

the oral cavity and adjacent tissues present continual challenges to the Prosthodontist, among which

speech problem is a major concern.1

Changes in the oral cavity resulting from loss of teeth and alterations caused by dental prostheses

could effect speech articulation.2 When the oral environmental conditions suddenly change, disturbance in

speech prevails.2 Thus speech rehabilitation for these edentulous patients becomes an onerous task for the

Prosthodontist.2

The speaking sounds are produced by the contact of tongue with some portion of the palate and

teeth.1 These contact areas are either replaced or covered by complete denture.1 Failure to contour the

palate to accommodate normal tongue contact usually results in poor speech.1

Patients usually maintain acceptable speech if the denture satisfy the requirement of function

and esthetics.2 However, some patients wearing complete dentures encounter difficulty.3 If posterior

palatal seal area is not recorded well in the denture, there exists a gap between the posterior most part of

the denture and the soft palate as there is no contact between the two during the functional movment of

the soft palate. 4 Also, the masking of palatal rugae when it is covered with denure base have been related

to articulatory insufficiency because they act as tactile guide posts3 and hence these oral landmarks are

important as far as phonetics in denure construction is involved.3

This study emphasizes on the prosthodontist’s contribution as a team member working with

speech language pathologist in the appropriate fabrication of denture by evaluating the patient speech.5

Various studies were carried out to note the effect on speech with the use of different palatal forms3, labial

and buccal inclination of teeth, increase in vertical dimension4 in complete denture patients but minimal

evidence has been found in literature till date on individual and combined effect of posterior palatal seal

and rugae area on speech.6 Hence, in the present study the palate is customized with respect to posterior

platal seal5 and rugae6 and aims to assess the following two phonetic changes with respect to posterior

palatal5 seal and rugae area in complete denture wearers, using two methods, namely, audition

[perceptual] and acoustic7 [ voice onset time, formant frequency and burst duration].

6.2 Review of literature

A study was done on the analysis of tongue factor and its functioning areas in dental prosthesis

and was noted that hearing loss seems to have a lot to do with the degreee of adaptive ability to learn to

speak well with dentures. Persons who have impaired hearing sometimes never get rid of their newly

acquired speech defect by compensating for their phonetically incorrect dentures.3

An article discusses the highlights of making personalized dentures. It shows how the design and

position of both anterior and posterior teeth are influenced and greatly simplified by correlating these

factors with articulation of speech. It also explains why occlusion is correlated to speech, these two

subjects are often considered unrelated because occlusion is a contacting position of teeth whereas, during

speech, the lower teeth function in space and there must be no contact with the upper teeth at any time.

This approach is a very simple one and can be applied to any denture technique except those using linear

concepts of occlusion that do not restore the natural horizontal and vertical overlaps.7

Another article on "clinical speech consideration in prosthodontics; perspective of the

prosthodontist and speech pathologist" states that the totality of the speech process should be emphasized,

for purposes of differentiation, the various dimension basis to speech production to be considered

seperately. To clarify areas of mutual concern for prosthodontist and speech pathologist, the following

seven were assumed: 1) respiration 2) phonation 3) resonance 4) speech articulation 5) audition 6)

neurological function 7) emotional behaviour.5

An investigation was done to check the relationship between speech production and the palatal

contour of the denture. Ten stimulus sentences were used and recording was made at four different points

by qualified speech pathologist. Total of forty casts were made for recording palatal contours. Casts were

cut in to saggital and frontal sections. Mathematical formula was used to analyze the measurement and it

was inferred that by altering the thickness of the palate alters the speech of an individual.9

A study concluded that customizing palatal contours of a maxillary complete denture with tissue-

conditioning material, which provides sufficient working time for a patient to pronounce a series of

sibilant sounds while recording dynamic impression of the tongue and it would improve speech

intelligibility. A technique had also been described for customizing palatal contours of a maxillary

complete denture with autopolymerizing acrylic resin to improve speech intelligibility. This technique

could be used to replace either tissue-conditioner or waxed up palatal contour with autopolymerising

resin.6

A study was conducted to introduce and validate a computer-based speech recognition system

(ASR) for automatic speech assessment in edentulous patients after dental rehabilitation with

complete dentures. The objectives of the study were to examine the impact of dentures on speech

production, to compare the speech outcome of edentulous patients with and without complete dentures. It

concluded that word accuracy was significantly reduced in edentulous speakers compared to healthy

subjects with natural dentition. It also concluded that wearing complete dentures significantly increased

the word accuracy of the edentulous patients. Speech production quality had significantly reduced after

complete loss of teeth. Reconstitution of speech production quality would be an important part of dental

rehabilitation and could be improved for edentulous patients by means of complete dentures. It also

proved that automatic computer-based speech recognition system is a useful and easily applicable tool for

speech assessment in a standardized way.8

A prospective study was conducted on the speech intelligibility enhancement through maxillary

dental rehabilitation with telescopic prostheses and complete dentures using automatic, computer based

speech analysis and concluded that patients benefited from the fabrication of new dentures in terms of

speech intelligibility, regardless of the type of prosthesis. However, telescopic crown prosthesis yielded

7.

significantly better speech quality compared to complete deture.4

6.3 Objectives of the study:

1. To evaluate the audition (perceptual parameter) “burst duration” (acoustic parameter), voice

onset time (acoustic parameter) and formant frequencies (acoustic parameter) in complete denture wearers

without incorporation of posterior palatal seal and rugae.

2. To evaluate audition (perceptual parameter) “burst duration” (acoustic parameter), voice onset

time (acoustic parameter) and formant frequencies (acoustic parameter) in complete denture wearers with

incorporation of posterior palatal seal and rugae.

3. To compare the variations in audition (perceptual parameter) “burst duration” (acoustic

parameter), voice onset time (acoustic parameter) and formant frequencies (acoustic parameter) in

complete denture wearers with and without incorporation of posterior palatal seal and rugae.

MATERIALS AND METHODS

7.1 Source of Data:

This study will be conducted in the department of prosthodontics of K.V.G. Dental College and

Hospital, Sullia and the department of ENT, K.V.G. Medical College and Hospital, Sullia.

Study population-

The subjects in this study are the patients visiting the department of Prosthodontics, KVG Dental

Collage and Hospital, Sullia and for the purpose of the study, 30 completely edentulous patients in the age

group of 45 to 55 years will be taken randomly.

Inclusion criteria of the subject:

1. Completely edentulous.

2. First time denture wearers.

3. Accptable articulation of speech.

4. Those who will be native speakers of Kannada or Malyalam language and can read their

languages.

Exclusion Criteria:

1. Pathological changes in the oral form and structure, if any.

2. Patients having speech defects which are associated with changes in oral form and structure (cleft

lip and palate, glossectomy case, neuromuscular problems, oral pathological lesions.

3. Patients already having some discrepancy in speech which might hinder in comparison.

7.2 Methods of Collecting Data

1. Instruments and materials that will be used during course of study.

Instruments

The following instruments will be used for the study:

i. Logitech microphone

ii. Acer desktop computer.

iii. Praat software (Paul and David, 2009; version 5.0.37)

iv. Speaker/ headphone

v. Protractor

vi. Metallic scale

vii. Paint brush

Materials

i. Alginate impression material (Velplast ISO 1563:1990/ADA 18/BS 426)

ii. ADA type III dental stone (Kalstone, Kalabhai Karsons Pvt Ltd, India)

iii. Modelling wax[Surana, India]

iv. Teeth set[Premadent, India]

v. Heat cure polymethylmethacrylate acrylic resin(DPI Heat Cure, India)

vi. Digital wax melter and temperature indicator[Confident, Bangalore, India]

vii. Addition silicon impression material (Aquasil, Densply,Germany)

viii. Mouth temperature wax.[M P Sai, Mumbai]

2. Methodology :

Thirty completely edentulous patients will be selected for the study. Subjects will be informed

about instruments and procedures to be performed and consent will be taken. Complete dentures will be

fabricated without the incorporation of posterior palatal seal and palatal rugae.

After wearing the denture, the patient will be taken to the speech language pathologist and the

pathologist will record and analyze speech samples both perceptually and acoustically .

The study group will be then devided into two and the first fifteen patients’ dentures only the

posterior palatal seal will be incorporated using mouth temperature wax. The speech language

pathologist again will record and analyse speech samples both perceptually and acoustically. Then

the rugae will be incorporated into their dentures and again the speech analysis will be carried out.

For the remaining fifteen patients’ dentures, only the rugae will be incorporated using

modelling wax. The speech language pathologist will record and analyse speech samples both

perceptually and acoustically for these patients. Then the posterior palatal seal will be incorporated into

their dentures and again the speech analysis will be carried out.

In all the appointments patient will be evaluated for the same speech and velar stop consonant

monosyllable /ka/ and /ga/ mainly, along with letters like t, d. Hence, the variables used in this study will

be: denture without posterior palatal seal and rugae, denture with only posterior palatal seal incorporated,

denture with only rugae incorporated and denture with both post-dam area and rugae incorporated. If the

incorporation of ruge and posterior palatal seal improves the speech as well as the patient satisfaction,

then the wax rugae and posterior palatal seal will be acrylised onto their dentures and otherwise not.

For standardization

i. All the patients will be made to repeat the same set of words.

ii. Sound recording will be done using a microphone.

iii. Same speech language pathologist will be analysing the speech.

iv. Thickness of all the dentures in the palatal area will be kept 2mm.

v. For recording rugae area in denture; addition silicon impression of rugae will be made and then

modeling wax will be flown on to the imprint of rugae. After it hardens, it will be taken out and

positioned on to the anterior palatal portion of their respective maxillary dentures and sealed

properly.

vi. Posterior palatal seal area will be recorded by fluid wax technique on to the posterior most part of

the processed and polished denture (at the time of fit in). Fluid wax technique utilizes a special

mouth temperature wax (m p sai, mumbai) which is painted on to the posterior most intaglio

surface of the denture, between the two vibrating lines transferred to the denture by indelible

pencil.

Articulation Test:

For perceptual analysis the articulation test will be done and the material contained in word list

from Kannada Articulation Test (Babu & Rathna, 1985) and Malayalam Articulation Test ( Maya, 1990).

The samples will be collected by qualified speech language pathologists and these samples were subjected

to perceptual analysis for speech intelligibility rating. Linguovelar (velar) sounds like /ka/ and I gal which

is affected by the extent and seal of the posterior palatal area on the soft palate, will be considered. Patient

was also asked to speak stop consonants like /pa/, /ta/,da /ka/ , /ba/, /da/,and Igal .

3. Data Collection for Acoustic Analysis:

One subject at a time will be examined and the reading samples of that subject will be recorded

in four conditions.

Condition 1, The patient will be asked to speak the stop consonants like /pa/, /ta/,da/ka/, /ba/, /da/,

Igal and mainly sounds like ka and ga will be taken into considerations for acoustic analysis in terms of

burst duration, voice onset time and formant frequencies, when the patient will be wearing the denture

without incorporation of posterior palatal seal and rugae area recorded in the denture and the recording

will be carried out.

Condition 2, The patient will be asked to speak the stop consonants again, when the patient is

wearing the denture with the incorporation of only posterior palatal seal area in denture and recording is

carried out.

Condition 3, The patient will be asked to speak the stop consonants again, when the patient is

wearing the denture with incorporation of only rugae area in denture and recording is carried out.

Condition 4, The patient will be asked to speak the stop consonants again, when the patient is

wearing the denture with incorporation of both posterior palatal seal and rugae area in denture and

recording is carried out.

Data Collection for Perceptual Analysis:

One subject at a time will be examined and the reading samples of that subject will be recorded

in four conditions.

Condition 1, The patient will be asked to read the words from the articulation test list for speech

intelligibility when he/she is wearing complete denture without the incorporation of posterior palatal seal

and rugae and the recording is carried out.

Condition 2, The patient will be asked to read the words from the articulation test list for speech

intelligibility when he/ she is wearing the complete denture incorporated with only posterior palatal seal

and recording is carried out.

Condition 3, The patient will be asked to read the words from the articulation test list for speech

intelligibility” when he/ she is wearing the denture incorporated with only rugae and recording is carried

out.

Condition 4, The patient will be asked to read the words from the articulation test list for speech

intelligibility” when he/ she is wearing the denture with incorporation of posterior palatal seal as well as

rugae and recording is carried

Instructions

"Please read this word list aloud as you would normally read. Are you ready? Now start".

"........................in Kannada or Malyalam..........................."

The Kannada Articulation Test or Malyalam Articulation Test will be given to the subjects depending on

their native language for reading. The instructions will be given in Kannada or Malyalam verbally. The

speech pathologist clarifies the doubts if any from the subjects.

Recording for perceptual and acoustic analysis:

As the subject reads the word list, speech output will be recorded using PRAAT software,

through the microphone kept at a distance of 10 cm away from the mouth of the subject at a sampling rate

of 16 kHz and stored for further analysis. The total time taken to record the samples for each subject will

varying from 15 to 20 minutes approximately. The perceptual analysis will be done by the trained speech

pathologist, and speech intelligibility will be rated in terms of good, satisfactory and poor. The acoustic

recordings will be digital and difference between the variables will be assessed on objective parameters by

speech pathologist for the following parameters: Burst duration, Voice onset time and Formant

frequencies. As the data will be interpreted by PRAAT software, there will be no chance for examiner

bias.

4.Statistical analysis:

The study result will be analyzed using,

8.

a. Wilcoxon Sign Rank test

b. Kruskal Wallis test

c. Chi Square test

REFERENCES

1. Eberhard Seifert, Christoph Runte, Michael Riebadt. Can Dental prostheses influence vocal

parameters J Prosth Dent 1999; 81:579-85.

2. John.PM. Structural changes for speech improvement in complete upper denture fabrication.

J.Prosthet.Dent 1979 41(5):507-510.

3. 3 Kessler.B. An analysis of the tongue factor and its functioning areas George Chierici, Lucie

Lawson.The clinical speech considerations in prosthodontics: J. Prosthet Dent ,1955, 5(5),629-635.

4. Knipfer.C. Speech Intelligibility Enhancement Through Maxillary Dental Rehabilitation With

Telescopic Prostheses and Complete Dentures: A Prospective Study Using Autoatic, Computer-

Based Speech Analysis. The International Journal of Prosthodontics. 2012 Feb; 25(1):24-32.

5. Chierici.G, and Lawson.L. Clinical speech considerations in prosthodontics: Perspective of the

prosthodontist and speech pathologist. J Prostuary 1973:29-39.

6. Hyung-Jun Kong, Carl A. Hansen. Customizing palatal contours of a denture to improve speech

intelligibility. J Prosthet Dent 2008;99:3:243-248.

7. Pound E. Utilizing speech to simplify a personalized denture service. J ProsthetDent.1970;24(6):586-

600.

8. Steizle F.Automatic, computer-based speech assessment on edentulous patients with and without

complete dentures - preliminary results. J Oral Rehabil. 2010 Mar;37(3):209-16.

9. Tanaka.H.Speech patterns of edentulous patients and morphology of the palate in relation to

phonetics.J. Prosthet Dent,January.1973(29)1:16-6.

10. Christina.GA, Salvatore Draper.EJ, Julius.M, Simple method of adding palatal rugae to complete

denture J.Prosthet.Dent 1999, 81(2):237-239.

9 Signature of the candidate

10 Remarks of the guide

11 Name and designation( in block letters) of

11.1 Guide

DR.DEVI PRASAD NOOJI

READER

11.2 Signature

11.3 Co-Guide

11.4 Signature

11.5 Head of the department PROF. DR. PRANAV V. MODY

PROFESSOR AND HEAD OF THE DEPARTMENT

11.6 Signature

12.1 Remarks of the chairman and

principal

12.2 Name And Signature of Principal PROF. DR. MOKSHA NAYAK