Page 77 - Impact of implant retained overdenture treatment and speech, oromyofunction, social participation and quality of life.

Speech and OHRQoL in OD treatment in the maxilla
Surgical and prosthetic procedure
When subjects met all the criteria mentioned above, the original denture was relined or a new CD was manufactured. The purpose was to establish a correct vertical dimension, correct occlusion and aesthetics, more precisely position and length of the teeth and smile line. In the mandible the patients had their natural teeth, fixed restorative prosthetics or existing removable prosthetics on implants. If the existing maxillary complete denture fulfilled the above mentioned criteria it was relined (n=6). In the other case a new maxillary complete denture was fabricated (n=15). Patients received this new CD or the relining of their existing denture before implant placement.
After a muco-periosteal flap was raised, four Deep Conical Cylindric implants (DCC; Southern implants, Irene, South Africa), were placed in a one-stage surgery, preferably at the position of the canine and first molar, or alternatively at the second premolar site. Healing caps were placed on the abutments, torqued to 20 Ncm, with a standardized height of 4 mm, to respect the biological width. After implant placement, the maxillary denture was adjusted and relined with a soft liner (Coe Soft, GC Europe, Leuven, Belgium). The healing caps perforating the soft tissue improved denture stability and the denture was regularly checked and relined with the soft liner to prevent implant overload. A healing period of minimum four months was respected before the abutments were torqued to 30 Ncm and the final IOD was installed on a titanium milled bar connecting the four implants (figure 2). The surgical and prosthetic procedures as well as implant-related outcome have been described previously.35
Articulation
The logopaedic examination took place in a testing room, separated from other clinical activities, ensuring as little disturbing noise as possible. The subjects were tested during the different stages of maxillary IOD treatment. The speech was evaluated pre-operatively with the CD with full palatal coverage, and after connection of the denture to the bar (the palatal coverage was removed at this moment). Speech after connection was evaluated after an adaptation period of minimum four weeks. One examination took place after 9 days of adaptation because the patient went abroad and could not attend the planned research session. Besides these two assessments, a follow-up evaluation of articulation characteristics was performed three years after connection. The position of the
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