Page 156 - Impact of implant retained overdenture treatment and speech, oromyofunction, social participation and quality of life.

Chapter 7
The main aim of this PhD project was to describe prospectively the influence of changes made to the oral environment during mandibulary and maxillary overdenture treatment on:
1. Speech (Papers 1- 3)
2. Oromyofunctional behavior (Papers 1& 3)
3. OHRQoL and Satisfaction (Papers 1-4)
Besides this we evaluated the impact of personality on social participation after implant treatment and the use of multi-observer ratings. (Paper 4)
Paper 1 determined alterations of articulation, oromyofunctional behavior and Oral Health Related Quality of Life (OHRQoL) in patients replacing complete removable dentures by implant retained overdentures in the mandible. Twenty- one fully edentulous patients received mandibular overdenture retained on a bar connecting 2 titanium dental implants. Patients were evaluated after receiving a new set of fully removable dentures (stage 1), after surgery during provisionalisation on healing abutments (stage 2) and after final connection to the bar (stage 3). Assessments were taken by speech therapists and included evaluation of: articulation (picture naming and reading); oromyofunctional behavior; OHRQoL (OHIP-14 questionnaire) and overall satisfaction and speech (VAS). To measure changes over time, Wilcoxon matched-pairs signed-rank-test and McNemar test was used. There was no significant impact of the treatment on speech nor on the results of oromyofunction. In stage 1 patients had different kinds of articulation errors (mean: 1.21) which evolved to 0.71 and 0.67. In stage 3 especially problems with the /s/ sound are seen in 37% (7/19) of the participants. Results of OHRQoL and satisfaction reveal that the average of satisfaction with oral health evolved from 67%, to 63% and finally 78%. OHIP-14 total score was 17.2/56 in stage 1, 17.67 in stage 2 and evolved in stage 3 to 9.16/56 (p:0.010). This indicates improvement. Satisfaction with speech evolved significantly from 72% pretreatment to 82% in stage 3 (p:0.013).
Conclusion: Despite existing articulation and oromyofunctional disorders after treatment, people are very satisfied with their OHRQoL and their speech. Impact of mandibular denture wearing on OHRQoL declines once connected. It’s important to inform patients that speech and oromyofunctional disorders may occur during treatment where especially the /s/ sound is vulnerable.
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