Page 111 - Impact of implant retained overdenture treatment and speech, oromyofunction, social participation and quality of life.

Speech, OMF and OHRQoL in OD on MDI in the maxilla
The oromyofunctional behavior of the participants during treatment showed some striking findings. In comparison to primary studies there are more problems to report.11,13,14 It is possible that this disagreement is due to the difference in dental rehabilitation, age of the participants and way of examination. In our study whistling seems very fragile in all stages of the treatment. Preoperatively participants present with the most deviant behaviors. This can be explained by the bad fit and retention of the denture. It is possible that people put a lot of effort in keeping their denture in place and therefore can’t use their oral muscles properly. After relining of the provisional denture, more retention of the denture is accomplished and some of the pretreatment oromyofunctional problems disappeared. But more people present with whistling problems. There is no other report of this kind of problem in previous research mainly because this function was not assessed before. The anatomical changes during whistling are not yet fully understood. We know that the air flow is directed through the pursed lips by the tongue in combination with the hard palate.32 Due to the denture it is possible that the formation of the right position of the anatomical structures to produce the whistling sound is distorted. In the last phase of the treatment surprisingly tongue lift problems occur in 2 patients. This phenomenon has never been reported. To lift the tongue to the upper lip, the tongue muscles extend in ventral direction, pushing the tongue base up and forward. It is possible that because of the specific shape of the overdenture the movement of the tongue base is obstructed and lifting of the tongue to the upper lip is more difficult in some participants. This is a matter for further research.
Besides the opinion of professionals about function it is equally important to evaluate participants’ opinion about their situation. The results obtained by the VAS scales showed both low ratings for total satisfaction and satisfaction with speech pretreatment. This can be explained by the fact that participants apply for this treatment because they are in some way dissatisfied with their situation. Literature states that eating comfort, speech comfort and esthetics are the main causes of dissatisfaction in denture wearers.26 Surprisingly after relining of the provisional denture, the rates on the VAS slightly drop. It is possible that people expected more of this phase of the treatment or they still suffer from small complications due to the surgery.33 In the final stage, after loading with the actively retained horse-shoe overdenture the satisfaction rises tremendously
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