Page 145 - Impact of implant retained overdenture treatment and speech, oromyofunction, social participation and quality of life.

Future considerations
The current research provided some answers but also opportunities to work with in the future. Firstly the use of the extensive protocol, including consensus evaluation by two professional SLPs and the addition of spectral analysis to the protocol should be standard for research and clinical use when evaluating speech and oromyofunctional behavior. On this topic, it will be important to find a way in which this evaluation can be performed in a less intensive way, without jeopardizing the reliability. For example in cleft palate literature, Ahl et al. (2018) developed an efficient, but reliable way of evaluating speech, using SLPs perceptual evaluation 70. On the other hand the inclusion of a control group, gender and age matched, with evaluation of the same outcome measurements at similar timepoints would be an improvement of the study design. The study protocol can be enriched by adding evaluation of spontaneous speech, to be able to detect more subtle changes in the speech pattern and including a larger panel of SLP’s for perceptual ratings. The SLP’s could use a more detailed way of rating the speech samples by using relative percentage of occurrence of distortions or percentage of consonants correct. Besides the screening, how the remaining articulation errors and oromyofunctional problems can be solved is another research question. It might be needed to adjust the width of the denture to allow the tongue to move properly in the oral cavity to produce correct sounds. This was already suggested by Collaert et al.34. Further, articulation therapy could be a solution worth investigating together with the possible use of spectral properties as a biofeedback tool for patients and dentists. On the other side it is to be evaluated if this is the best option for an elderly population. Besides the care after treatment it is still a challenge to find a way to assess possible speech problems before treatment. The possibility that certain patients already had speech difficulties, not related to their dental problems, makes it hard to evaluate the course of the treatment. On the topic of OHRQoL and social participation, the possible effect of personality and the way to handle some patients needs to be more highlighted in dental education. It is a helpful way for the clinician (and the patients) to put certain problems in perspective.
Future research should focus on larger samples to generate robust statistical results. Still it is for this kind of research with a specific treatment in this population (higher age) a great challenge to organize this. Collaboration of
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General discussion and future considerations
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