Page 84 - Impact of implant retained overdenture treatment and speech, oromyofunction, social participation and quality of life.

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Chapter 3
Figure 3 shows the evolution of the main domain scores on the OHIP-14. All domains (D1-7) improved significantly when comparing the preoperative situation to the situation when the IOD is connected to the implants. There was no extra improvement on any of the domains of the impact on oral health after 3 years compared to the situation shortly after connection.
Discussion
The use of IODs in treatment of the edentulous maxilla is becoming commonly used in the dental clinic.8,9 Still some answers are needed to provide patients with sufficient information. This study examined the possible risk of causing speech problems and the impact on quality of life and satisfaction in patients treated with maxillary IODs (without palate).
Firstly the impact of the treatment on articulation of speech sounds was examined. The production of speech sounds is a complex process. It is influenced by the position of the articulators when the airflow passes through the mouth. When treating patients with dentures, changes are made in the area of important speech structures, like the teeth, alveolar ridge, and hard palate.24 Pre-treatment patients, presented in the dental clinic, wore CDs in the maxilla and were in search of a stable solution. The palatal coverage of the CD was removed in the design of the IOD. This action provides more space for the tongue to move upwards, but sharpens the angle of the alveolar ridge. Because of the delicate nature of speech production, we expected this major adjustment to the denture to cause some additional changes in the articulation pattern of the patients. We couldn’t confirm this expectation with significant results. Articulation disorders occurred in all stages of IOD treatment but no significant differences were found between the stages. In literature, problems with /s/, /z/, /ʃ/, /ξ/, /t/, /d/, /l/, /n/ and /r/ sounds are reported during and after treatment with dental rehabilitation.18,23,26,28 Except for the /ξ/ sound, these findings are similar to the results in this study. Remarkable is that 47.6% of the subjects produced a distorted /s/ sound pre-treatment and this is still present in 37.5% after a follow-up period of 3 years. This is also shown in previous studies on maxillary FID and IOD treatments.18,23,26–29 The /s/ sound in particular is sensitive to changes in the oral cavity as it is produced