presentation 2 phonetic in prosthodontic

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GOOD MORNING1

2 Guided by - Dr P. Balaji Raman Dr SashiPurna Dr Durga raju Dr Ashwin Aidasani Dr Abhay NarayanePHONETICS IN PROSTHODONTIC

Presented by ------------------------------------------- Dr PRATIK HODAR (Pg 1st yr)DR. HSRSM DENTAL COLLEGE AND HOSPITAL, HINGOLI DEPARTMENT OF PROSTHODONTICS

OBJECTIVES

Say now shibboleth; and he said sibboleth, for he could not frame to pronounce it right.. (THE BIBLE )3

ACCORDING ,to the bible, failure to pronounce this single word correctly not only cost the ephraimite(8th centre war)who mispronounced his life but also 42000 of his fellow tribes were slain in the ensuring battle gileadetsTHIS IMPLIES SPEECH IS ONE OF THE IMPORTANT FACToR AFFECTING THE HUMAN PERSONA , hence v being prosthodontic v should keep this fact in mind a plan accordingly the prosthesis so lets learn something about phonetic in prosthodontic.3

CONTENTSIntroductionDefinition Review of literature Mechanism of sound production Types/Classification of speech soundsS sounds and their prosthodontic considerations Prosthodontic implication in denture design affecting speech Speech testsSpeech analysisSpeech defectsSpeech consideration in implant Speech consideration in partial edentulousSpeech consideration in maxillofacial defectsConclusionList of references

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INTRODUCTION5

Phonetics (from the Greek (phon) "sound" or "voice") is the study of the physical sounds of human speech.Speech is very essential for human activity.....The primary concern in phonetics is with the changes in the stream of air asit passes through the oral cavity. Phonetics must be considered as cardinal factor for the success of the dental prosthesis along with esthetics and mechanical factors

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DEFINITIONSpeech:- The expression of or the ability to express thoughts and feelings, by the articulation of words.(oxforddictionary.com)

Phonetics:- The branch of linguistics that deals with the sounds of speech and their production, combination, description, and representation by written symbols. (thefreedictionary.com)

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Phenomes: It is the unit of speech by which distinguish one utterance from another and which, collectively make up the phonemics of a language.(John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics)7

Review of litreture 1989 Liddelow F. Gimson Voice is mainly produced in larynx and modified by tongue by constantly altering its shape, position and by contacting lips, teeth, alveolar processes, hard palate and soft palate1961Rothman Resonance and all other sounds are produced by of air passing the lower air stream as it strikes palate and gets altered by the oral structures(Rothman: Phonetic Considerations in Denture Prosthesis, J. PROSTHET. DENT. 11:214-223, 1961.)

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1957, Kaire reported & determined the palatal pressure of the tongue in the pronunciation of selected palatolingual speech sounds, by electronic means under predetermined vertical dimensions of occlusion. (Kaires: Palatal Pressures of the Tongue in Phonetics and Deglutition, J. PROS. DEN. 7:305-317, 1957)

1958 Allen: These structures are Covered Or replaced by the denture, and the dentist must know where the tongue contacts them so that they may he appropriately restored in the prosthesis. (Allen: Improved Phonetics in Denture Construction, J. PROS. DEN. 8:753-763, 1958.)9

In 1949 Sears recommended grooving the palate just above the median sulcus of the patient. (Sears: Principles and Techniques for Complete Denture Construction, St. Louis, 1949,The c.v mosby Company, pp. 313-322.)

In 1951 Pound was successful in improving phonetics by contouring the entire palatal aspect of the maxillary denture to simulate the normal palate(Pound E: Let /S/ be your guide. J Prosthet Dent. 38:482; 1951.)10

1953 & 1956, Silverman used speaking method to measure patients vertical dimension in natural teeth with & without dentures.(Silverman: Determination of Vertical Dimension by Phonetics, J. PROS. dent.6:465-471. 1956)

Morrison suggested the use of the word, sixty six & Mississippi to determine closest speaking space

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Landa suggested the use of s sound to determine the adequacy of free way space & M sound to establish a desirable rest position. Also suggested use of fricatives like f&v when arranging anterior teeth(Landa: Free-way Space and Its Significance in the Rehabilitation of the MasticatoryApparatus, J. PROS. DENT. 2: 756, 1952) 12

The motor( lungs, associated muscle of larynx ,and respiratory muscles which supply the air).

MECHANISM OF SPEECH PRODUCTIONNormal speech depends on proper functioning of 5 essential mechanisms(Kantner and West) The vibrator ( vocal cords that give pitch to the tone).

The resonator ( consist of the oral,nasal, pharyngeal cavity and paranasal sinuses).

The enunciators or articulators( lip, tongue, palate and teeth)

The initiator( motor area of the brain)

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COMPONENTS OF SPEECH

RESPIRATIONPHONATIONRESONATIONSARTICULATIONSNEUROLOGIC INTEGRATIONSAUDITIONCOMPONENTS OF SPEECHRef:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-3915

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This is a sigital section showing different areas which affects speech16

NEUROLOGIC INTEGRATION Factors for speech production are highly coordinated, some sequentially and some simultaneously by the central nervous system. Speech is a learned function and requires adequate hearing, vision, and normal nervous system for its full development.MacNeilage and DeClerk stated that at least 17,000 different motor patterns are required during speech

Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-3917

Motar spech area brocas areaSensory speech area wrenicke area17

RESPIRATIONThe movement of air in the inspiratory and expiratory phase is important in production of speech.


PHONATIONAir from the lungs courses through the trachea.

Sound is produced in the larynx

Vibration of vocal cord takes place


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Nerve supply:Recurrent larengeal21

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RESONANCE Sound that is produced by the vocal cord is modified by various chambers

Resonators are Pharynx Oral cavity Nasal cavityParanasal sinuses


SPEECH ARTICULATIONSound that is produced is formed into meaningful words

Tongue,lips,palate, teeth and mandible play are very important role.


Three physiologic valves serve to form a number of more specific articulatory valves, such as (1) the mandibular lip against the maxillary lip, (2) the mandibular lip against the maxillary teeth, and (3) the tip of the tongue against the alveolar ridge25ALEXANDER L. MARTONE, AN APPROACH TO PROSTHODONTICS THROUGH SPEECH SCIENCE Part V: Speech Science Research of Prosthodontic Significance J. Pros. Dent. May-June, 1962

TYPES OF SPEECH1.VOWELS: a,e,i,o,u. they are voiced sounds,

2.CONSONANTS: may be either voiced or produced without vocal cord vibration, in which case they are called breathed sounds. eg: p, b, m, s, t, r, z etc

3.COMBINATION: Is blend of a consonant and vowel, articulated in quick succession that they are identified as single phonemes. EX:- WORD

Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients26

CLASSIFICATION OF SPEECHAccording to Boucher

Vowels.Consonants.Plosives/stopsFricativesAffricativesNasalLiquidGlides


STRUDS:- Voiceless sounds Produced by the separation of vocal cords Eg:- s,h,sh,zh

ACCORDING TO SONORITY

SONANTS:-Voiced soundProduced by vibration of a portion of the vocal cords Oral resonators modify the airstreamAll vowels and vowel like sounds are representatives.

CONSONANTS:-Articulated speechAirstream has to be modified at the proper place and time for producing these soundMost important for dentistJohn. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 13228

CLASSIFICATION OF CONSONANTS:

Divided into groups depending on their characteristic production and use of different articulators and valves. They are as follows.

Plosive consonants: These sounds are produced when overpressure of the air has been built up by consonants between the soft palate and pharyngeal wall and released in an explosive way. Ex: P (pay), B (bay), T (to), D (dot)


Fricatives: are also called sibilants and are characterized by their sharp and whistling sound quality created when air is squeezed through the nearly obstructed articulators. Ex: S (so), Z (zoo)

Affricative consonants: are a mix between plosive and fricative ones. Ex: Ch (chin), J (jar)Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients30

Liquid consonants(semi vowels) : are , as the name implies , produced with out friction. Ex: R (rose), L(lily)

Glides:: that is sounds characterized by a gradually changing articulator shape Ex: W (witch), Y (you)


Nasal consonants: are produced without oral exit of air. Production involves the coupling of nasal cavity as resonators. Ex: M (man), N (name), NG (bang)


DIFFERENT PARTS OF ORAL CAVITY AND THEIR INFLUENCE ON SPEECH TONGUE:

LIPSPALATETEETH

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CLASSIFICATION OF CONSONANTS BASED ON THE PLACE OF THEIR PRODUCTION Consonant sounds are most important from the dental point of view. They may be classified according to the anatomic parts involved in their formation:

(1) Palatolingual sounds, formed by tongue and hard or soft palate, (2) Linguodental sounds, formed by the tongue and teeth, (3) Labiodental sounds, formed by the lips and teeth, and (4) Bilabial sounds, formed by the lips.Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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PALATOLINGUAL SOUNDS FORMEDTongue and hard palateTongue and rugaeTongue and soft palate35

TONGUE AND HARD PALATE

Word like S,T, D, N and L belong to this categoryS- the sound s as in sixty six- is formed by a hiss of air as it escapes form the median groove of the tongue when the tongue is behind the upper incisor- Sears If groove is decreased s is softened towards sh (Lisping)If groove is deep a whistling will be heard when s is pronouncedRobert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)36

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CLINICAL SIGNIFICANCEThus we can say that the sound S can be used to check the proper placement of the anterior teethAlso the thickness of the denture base can be adjusted in case the sound S is not produced correctly

Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)37

CLINICAL SIGNIFICANCE

Silvermans closest speaking space also used this word t o establish and check a proper vertical dimension of occlusion

Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)38

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Rugae and tongue

T, D, N and L word Rugae area is very important for the production of these sounds.Tongue must be placed firmly against the anterior part of the hard palate for the production of these words.Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)40

Therefore. Should rugae be duplicated in the denture or not is the question that arises.

Slaughter say.. The smoothness of the denture is disturbing and the tongue looses its capacity for local orientation

Landa says that rugae is useless or even detrimental because it adds more bulk to the dentureRef:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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CLINICAL SIGNIFICANCEIf teeth too lingual T will sound like D

If teeth too forward - D will sound like T42

TONGUE AND SOFT PALATE

Consonant k, ng and g are representative of the palatolingual group of sounds. Sound is formed by raising the back of the tongue to occlude with the soft palate and then suddenly depressing the middle portion of the back of the tongue realising the air in a puff 43

CLINICAL SIGNIFICANCEIf the posterior borders are over extended or if there is no tissue contact k becomes ch sound.Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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LINGUODENTAL SOUNDS

Consonant Th is representative of the linguodental group of sounds

Dental sounds are made with the tip of the tongue extending slightly between the upper and lower anterior teeth.

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LINGUODENTAL SOUNDS

Sound is actually made closer to the alveolus (the ridge) than to the tip of the teeth.

Careful observation of the amount of tongue that can be seen with the words - this, that, these and those will provide information as to the labio-lingual position of the anterior teeth.

Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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CLINICAL SIGNIFICANCEIf about 3mm of the tip of the tongue is not visible, the anterior teeth are probably too far forward,

If more than 6mm of the tongue extends out between the teeth when such sounds are made, the teeth are probably too lingual

(Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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LINGUOALVEOLAR SOUNDS

Formed with the valve formed by contact of the tip of the tongue with the most anterior part of the palate (the alveolus) or the lingual sides of the anterior teeth.

T, D, S, Z, V & 1 are representative of the linguoalveolar group of soundsRobert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)48

LINGUOALVEOLAR SOUNDS

Sibilants (sharp sounds) s, z, sh, ch & j (with ch & j being affricatives) are alveolar sounds, because the tongue and alveolus forms the controlling valve.

Important observations when these sounds are produced are the relationship of the anterior teeth to each other.

Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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Upper and lower incisors should approach end to end but not touch.

Failure indicates a possible error in the horizontal overlap of the anterior teethRef :- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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LABIODENTAL SOUNDSF and V are representatives of the labiodental group of sounds.

Formed by raising the lower lip into contact with the incisal edge of the maxilliary anterior teeth.

Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)

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Upper anterior teeth are too short (set too high up), V sound will be more like an F.

If they are too long (set too far down), F will sound more like a V.Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)52

BILABIAL SOUNDSB,p and m are representatives of the bilabial group of sounds.

Formed by the stream of air coming from the lungs which meets with no resistance along its entire path until it reaches the lip.

Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)53

CLINICAL SIGNIFICANCEUsed to asses the correct interarch spaceCorrect labiolingual positioning of the anterior teethLabial fullness of the rims can also be checked

Ref:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)54

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VOWELSClassification according to tongue position in oral cavity:HighMid Low2. Combination of 2 vowels are called as dipthongs eg you.56

John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

PHONETICS IN RECORDING JAW RELATIONAlso called as the speaking method determining sliverman closest speaking space

Sibiliant sounds like S and M is used.

S sound gives the approximate closest speaking space

M sound gives us the freeway space

Approximately 2mm of space must be there between the two occlusal rims

Meyer M Silverman :The speaking method in measuring vertical dimension; J prosthet dent 1953;3:193-19957

CLINICAL SIGNIFICANCE OF S SOUNDThickness of denture

Antero-posterior position of teeth

Vertical dimension of occlusion

Width of dental arch:

Relationship of upper teeth to the lower anterior teeth by S-POSITION

58Saryu Arora :Phonetics - Its Role In Prosthodontics, Indian Journal of Dental Sciences.June 2011 Issue:2, Vol.:3

PROSTHODONTIC IMPLICATION IN DENTURE DESIGN AFFECTING SPEECH Denture thickness and peripheral outlineVertical dimensionOcclusal planeAnteriorposterior positioning of teethPost dam areaWidth of dental archRelationship of the upper and lower teethRajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-134359

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DENTURE THICKNESS AND PERIPHERAL OUTLINE

If the denture bases are too thick.

Lisping will occur with the word like S,C and Z

Palatolingual sounds most affected. (T,D).

Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343

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VERTICAL DIMENSIONBilabials are mostly affected P,B and M

If both rims touch prematurely it indicated excessive vertical dimension.

In try in stage teeth clicking will be heard.


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OCCLUSAL PLANELabioldental sounds F and V are affected.

If occlusal plane is too high the correct positing of the lower lip is difficult

If the occlusal plane is too low there is overlap of the lower lip on the labial surface of upper teeth


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ANTERIORPOSTERIOR POSITIONING OF TEETHF and V sounds are hampered.

labiopalatal positions of the teeth is very important

Teeth if placed to palatally the lower lip will not meet the insical edge of the upper teeth.


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POST DAM AREAPalatolingual consonants are affected (K, NG and G)

Thick post dam areas will irritate the dorsum of the tongue

Patient feels nausea like effect while speaking

If inadequate the plosive sound of the word is hampered

This area is very important for singers who wear complete denture

Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern,Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343

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WITDH OF DENTAL ARCHIf teeth are set into an arch that is too narrow the tongue will be cramped

Consonants like T, D, N K and S are affected


RELATIONSHIP OF THE UPPER AND LOWER INCISORSThe chief concern is the S CH, J and Z sound.

These sounds need a near contact of the upper and lower teeth so that the air stream is allowed to pass.

Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, 67

SPEECH TESTThe speech test should be made after satisfactory esthetics, correct centric relation, proper vertical dimension and balanced occlusion have been attained and after wax up for esthetics has been completed.

John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 13268

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TEST 1:TEST OF RANDOM SPEECH

Engage the patient in a conversation and obtaining a subjective speech analysis by asking the patient say how he feels, how his speech sounds to him and what words seem most difficult to pronounce.


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TEST 2: TEST OF SPECIFIC SPEECH SOUNDS This is best accomplished by having the patient say 6-8 words containing the sound and then combining these words into a sentence. The following is the list of sounds to be tested


S, ShSix, sixty, ships, sailed Mississippi, sure ,sign, sun, shineSixty six ships sailed Mississippi. Sure sign of sun shineT,D,N,LLocator, located, tornado, near, ToledoLocator located tornado near ToledoCh,JJoe, Joyce, joined, George, Charles, churchJoe and Joyce joined George and Charles at churchKCommittee, convented, political, convention, ConnecticutThe committee convened at the political convention in Connecticut.F,VVivacious, Vivian, lived, five, fifty, five, fifth, avenueVivacious Vivian lived at five fifty-five fifth avenue

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TEST 3: TEST OF READING A PARAGRAPH Make the patient read a paragraph containing abundance of S, Sh, Ch sounds.

(John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 132)73

SPEECH ANALYSIS2 categories

1) Perceptual / acoustic

Based on broad band spectrogram, recording by Sonograph Objective opinion of performance

(Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients74

2) Kinematic movement analysis :

Ultrasonics X-ray mappingCineradiographyOptoelectronic articulatory movement trackingElectropalatography

Ref:- Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients75

PALATOGRAPHY What is palatography?

A group of techniques to record contact between the tongue and the roof the mouth to get articulatory records for the production of speech sounds.

76John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

In brief, it involves putting a marker paint on the tongue, pronouncing a word and seeing where ink rubbed off onto the roof of the mouth. This gives the place of articulation. Also, the roof of the mouth can be painted and it can be investigated where the ink rubbed off onto the tongue. These two types of records are called palatograms and linguograms respectively

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PREREQUISITE FOR MAKING PALATOGRAM The artificial palate made must be uniformly adapted, no adhesive must be used. Patient who have severe gagging must not be used for making palatograms.The patient has to be trained to open his mouth after uttering the desired word.The tracing material must not be distasteful and its consistency should permit easy application 77John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

The palate has to be thoroughly dried before the medium is applied and the medium must have a contrasting colour so that it can be easily identifiedTalc is considered the best material that can be used for palatogram, although activated charcoal, chocolate powder where also used78John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

PALATOGRAM OF VOWELS.PALATOGRAM OF CONSONANTS.79

John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

TERMINLOGIES RELATED TO SOME SPEECH DISTURBANCESAPHASIA (DYSPHASIA): Means defective speech due to damage of cortical area required for speech making. (Brocas area, Wernickes area).

DYSARTHRIA: Motor speech problems caused, not due to sensory loss or mental retardation.

SPEECH AND LANGUAGE RETARDATION: Delay in acquistion of communicating skills80

DISORDERS OF SPEECH HypernasalityHyponasalityDenasalityNASAL BALANCE

Eg: m, n & ng b d g Morning bordig 81Maxillofacial rehabilitation prosthodontic and surgical concideration: jhon beumer Speech, Velopharyngeal Function, and Restoration of Soft Palate Defects p 285- 329

82ARTICULATOR DEFETCSDistortionEg: Vowel pop for pipe Consonants cah for carSubstitution Eg: teef for teethOmission Eg: bow for boat

Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

ALTERATION OF SPEECH ARTICULATIONNatural dentitionMissing bicuspid:- lateral emission (stigmatismus lateralis)Anterior missing:-anterior emissionGross removal of gingival tissue denies the tongue its soft tissue contactArtificial dentition Poorly contoured: speech impedimentLarge restoration:-impaired speech

83John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

Lateral emission : intolerable to precise speaker or singerAnt emission : impair speakingGingival tissue : potential escape of air stream bet the interspaced of exposed rootsExpansion of arch :increase speech articulationConstriction of arch : decrease speech articulation83

RELATION TO MAXILLOFACIAL DEFECTS Acquired Accidental or surgical

Congenital Cleft palate, Short palate, Large velopharyngeal space, Limited velar mobility,Submucous cleft palate

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Nervous system speech defectCerebral palsy, Lateral sclerosis, Poliomyelitis, Myasthenia gravis,Myotonic dystrophy .

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Speech consideration related to implant prosthesisMandibular low lip line should be assessed during speech as pronouncing sibilants lower anterior can be completely exposed (Karl mish: Contemporary implant dentistry)A fully bone anchored prosthesis in maxilla can cause phonetic problems, (Richard palmer:implant in clinical dentistry,p 258)Normal pronunciation is possible after approximately 3 months,

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due to the space between the prosthesis and residual ridge.Normal pronunciation can extend upto one year also

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Removable appliances like artificial gingival extensions made of silicones or resin materials should be giAssociated with changed contours and dead space below fixed prostheses required for oral hygiene ven.(Jhon hobkirk:Introducing dental implant, p 143)

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Speech consideration in partial edentulismIn partial prosthodontics, clinical evidence often reveals that there is very little or no loss of the ability to phonate correctly.In fixed prosthodontics, in anterior restorations, the pontic and connector design is very important. Poor adaptation of the pontic to the ridge, either due to faulty design or due to residual ridge resorption, there is air escape through the tissue surface of the pontic results in faulty production of sibilants.88Carr Alan B, Brown David McCrackens Removable Partial Prosthodontics. 11th ed. Mosby; 2005. p.397-426

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Speech consideration in maxillofacial defectsTachimura T, Nohara K, Hara H, Wada T (1999) concluded that the severity of velopharyngeal incompetence might be related in part to change in levator activity in association with oral air pressureVelopharyngeal orifice size Warren, using these hydraulic principles to compute velopharyngeal orifice size, found that this opening should be less than 0.2 cm during the production of plosive and fricative sound

90Maxillofacial rehabilitation prosthodontic and surgical concideration: jhon beumer Speech, Velopharyngeal Function, and Restoration of Soft Palate Defects p 285- 329

The popularity of the palatal lift prosthesis has increasedsince it was first advocated by Gibbons and Bloomer136. Thistype of prosthesis is especially useful for patients with velopharyngealincompetence who exhibit compromised motor controlof the soft palate and related musculature. Examples can beseen following myasthenia gravis, cerebrovascular accidents,traumatic brain injuries, bulbar poliomyelitis, cerebral palsy, orinjury to the soft palate (as sequelae following adenoidectomy,tonsillectomy, or maxillary resections), or with cleft palate patientswith palatal insufficiency and submucous cleft palate

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velopharyngeal closure patternsCoronal Pattern :The majority of the valving is palatal and accomplished by the full width of the soft palate contacting the posterior wall. The lateral walls exhibit limited movement to contact the lateral margins of the velum. There is no posterior pharyngeal wall movement.Sagittal Pattern :The majority of the valving is pharyngeal. The lateral walls move extensively to the midline and approximate each other. The velum does not contact the posterior pharyngeal wall but elevates to contact the approximated lateral pharyngeal walls. The posterior pharyngeal wall does not contribute to closure.

91Maxillofacial rehabilitation prosthodontic and surgical consideration : jhon beumer Speech, Velopharyngeal Function, and Restoration of Soft Palate Defects p 285- 329

Nasal endoscopy provides a perspectivefrom above the velopharyngeal portal (Figure 7-7), whichhas led to refinement of the 4 velopharyngeal closure patternsinitially described by Skolnick38 from base-view videofluoroscopy.For example, Siegel-Sadewitz and Shprintzen describethe 4 closure patterns, as viewed with nasal endoscopy

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Circular pattern: There is essentially equal participation from the soft palate and the lateral pharyngeal walls, with the contracting muscles uvula acting as a focal point. The lateral walls contact the muscles uvula as it contracts and contacts the non-mobile posterior pharyngeal wall.Circular Pattern with Passavants ridge: The same pattern as circular closure, except that the posterior pharyngeal wall (Passavants ridge) moves forward to complete the closure pattern around the muscles uvula posteriorly.92Maxillofacial rehabilitation prosthodontic and surgical consideration: jhon beumer Speech, Velopharyngeal Function, and Restoration of Soft Palate Defects p 285- 329

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Soft palate defect

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The popularity of the palatal lift prosthesis has increasedsince it was first advocated by Gibbons and Bloomer136. Thistype of prosthesis is especially useful for patients with velopharyngealincompetence who exhibit compromised motor controlof the soft palate and related musculature. Examples can beseen following myasthenia gravis, cerebrovascular accidents,traumatic brain injuries, bulbar poliomyelitis, cerebral palsy, orinjury to the soft palate (as sequelae following adenoidectomy,tonsillectomy, or maxillary resections), or with cleft palate patientswith palatal insufficiency and submucous cleft palate

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Maxillary defects

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Cleft lip and cleft palate

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CONCLUSION

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A man is not only judged by wt he says but also the way hw says itSo phonetics must also be given utmost importance in fabrication of complete.

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REFERENCESJohn. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics. 3rd editionZarb - Bolender: Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients.13th edition Guyton and Hall: Textbook of medical physiology, 12th edition, Churchhill Livingstone:Grays anatomy 40th edition

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Carr Alan B, Brown David McCrackens Removable Partial Prosthodontics. 11th ed. p.397-426Maxillofacial rehabilitation prosthodontic and surgical consideration: jhon beumer Speech, Velopharyngeal Function, and Restoration of Soft Palate Defects p 285- 329 Thomas Taylor: Clinical maxillofacial prosthesis.Karl mish: Contemporary implant dentistryJhon hobkirk: Introducing dental implant, p 143Richard palmer: Implant in clinical dentistry,p 258

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Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39.Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223).Meyer M Silverman :The speaking method in measuring vertical dimension; J prosthet dent 1953;3:193-199.ALEXANDER L. MARTONE, AN APPROACH TO PROSTHODONTICS THROUGH SPEECH SCIENCE Part IV. Physiology of Speech*, J. Pros. Dent. May-June, 1962ALEXANDER L. MARTONE, AN APPROACH TO PROSTHODONTICS THROUGH SPEECH SCIENCE Part V: Speech Science Research of Prosthodontic Significance J. Pros. Dent. May-June, 1962

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104Allen :Improved phonetic in denture construction. J pros dent. 8 753-763. 1958Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343Abdul-Aziz Abdullah: Phonetics Related to Prosthodontics Middle-East Journal of Scientific Research 12 (1): 31-35, 2012 Saryu Arora :Phonetics - Its Role In Prosthodontics, Indian Journal of Dental Sciences.June 2011 Issue:2, Vol.:3

THANK YOU105

presentation 2 phonetic in prosthodontic

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