complete implication of phonetic in prostho

2. 2
Guided by -
Dr P. Balaji Raman
Dr SashiPurna
Dr Durga raju
Dr Ashwin Aidasani
Dr Abhay Narayane

3. OBJECTIVES
• Say now shibboleth; and he said
sibboleth, for he could not frame to
pronounce it right…..”
(THE BIBLE )
3

4. CONTENTS
1. Introduction
2. Definition
3. Review of literature
4. Mechanism of sound production
5. Types/Classification of speech sounds
6. S sounds and their prosthodontic considerations
7. Prosthodontic implication in denture design affecting speech
8. Speech tests
9. Speech analysis
10. Speech defects
11. Speech consideration in implant
12. Speech consideration in partial edentulous
13. Speech consideration in maxillofacial defects
14. Conclusion
15. List of references

5. INTRODUCTION
5

6. DEFINITION
• Speech:- The expression of or the ability to
express thoughts and feelings, by the
articulation of words.(oxforddictionary.com)
• Phonetics:- The branch of linguistics that deals
with the sounds of speech and their production,
combination, description, and representation
by written symbols. (thefreedictionary.com)
6

7. 1. Phenomes: It is the unit of speech by which
distinguish one utterance from another and
which, collectively make up the phonemics of a
language.(John. Sharry. Complete denture Prosthodontics
3rd edition; Phonetics)
7

8. Review of litreture
• 1989 ‘Liddelow F. Gimson’ Voice is mainly
produced in larynx and modified by tongue
by constantly altering its shape, position and
by contacting lips, teeth, alveolar processes,
hard palate and soft palate
• 1961‘Rothman’ Resonance and all other
sounds are produced by of air passing
the lower air stream as it strikes palate
and gets altered by the oral structures
(Rothman: Phonetic Considerations in Denture Prosthesis, J. PROSTHET. DENT. 11:214-223, 1961.)
8

9. 1957, ‘Kaire’ reported & determined the palatal
pressure of the tongue in the pronunciation of
selected palatolingual speech sounds, by electronic
means under predetermined vertical dimensions of
occlusion. (Kaires: Palatal Pressures of the Tongue in Phonetics and Deglutition, J. PROS. DEN.
7:305-317, 1957)
•1958 ‘Allen’: These structures are Covered Or
replaced by the denture, and the dentist must
know where the tongue contacts them so that they
may he appropriately restored in the prosthesis. (Allen:
Improved Phonetics in Denture Construction, J. PROS. DEN. 8:753-763, 1958.)
9

10. • In 1949 ‘Sears’ recommended grooving
the palate just above the median sulcus
of the patient. (Sears: Principles and Techniques for Complete
Denture Construction, St. Louis, 1949,The c.v mosby Company, pp. 313-322.)
• In 1951 ‘Pound’ was successful in
improving phonetics by contouring the
entire palatal aspect of the maxillary
denture to simulate the normal palate
(Pound E: Let /S/ be your guide. J Prosthet Dent. 38:482; 1951.)
10

11. • 1953 & 1956, ‘Silverman’ used ‘speaking
method’ to measure patient’s vertical
dimension in natural teeth with & without
dentures.
(Silverman: Determination of Vertical Dimension by Phonetics, J. PROS. dent.6:465-
471. 1956)
• ‘Morrison’ suggested the use of the word,
‘sixty six’ & ‘Mississippi’ to determine
closest speaking space
11

12. • ‘Landa’ suggested the use of ‘s’ sound
to determine the adequacy of ‘free
way space’ & ‘M’ sound to establish a
desirable ‘rest position’.
Also suggested “use of fricatives like
f&v when arranging anterior teeth”
(Landa: Free-way Space and Its Significance in the Rehabilitation of the MasticatoryApparatus, J. PROS. DENT.
2: 756, 1952)
12

13. 1. The motor( lungs, associated muscle
of larynx ,and respiratory muscles
which supply the air).
MECHANISM OF SPEECH PRODUCTION
Normal speech depends on proper functioning of 5 essential
mechanisms(Kantner and West)
2. The vibrator ( vocal cords that give
pitch to the tone).
3. The resonator ( consist of the oral,nasal,
pharyngeal cavity and paranasal
sinuses).
4. The enunciators or articulators( lip,
tongue, palate and teeth)
5. The initiator( motor area of the brain)
13

14. 14

15. COMPONENTS
OF SPEECH
RESPIRATION
PHONATION
RESONATIONS
ARTICULATIONS
NEUROLOGIC
INTEGRATIONS
AUDITION
COMPONENTS OF SPEECH
Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39 15

16. 16

17. NEUROLOGIC INTEGRATION
Factors for speech production
are highly coordinated, some
sequentially and some
simultaneously by the central
nervous system.
• Speech is a learned function
and requires adequate hearing,
vision, and normal nervous
system for its full
development.
• MacNeilage and DeClerk
stated that at least 17,000
different motor patterns are
required during speech
Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39
17

18. RESPIRATION
• The movement of air in
the inspiratory and
expiratory phase is
important in production
of speech.
Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39
18

19. PHONATION
• Air from the lungs
courses through the
trachea.
• Sound is produced in
the larynx
• Vibration of vocal cord
takes place
Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39 19

20. 20

21. • Nerve supply:
1. Recurrent larengeal
21

22. 22

23. RESONANCE
Sound that is produced by
the vocal cord is
modified by various
chambers
• Resonators are
– Pharynx
– Oral cavity
– Nasal cavity
– Paranasal sinuses
Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39 23

24. SPEECH ARTICULATION
• Sound that is produced
is formed into
meaningful words
• Tongue,lips,palate,
teeth and mandible
play are very important
role.
Ref:- Chierici, Lawson; Clinical speech consideration in prosthodontics. J Prosthet dent;1973;29;1:29-39 24

25. Three physiologic valves serve to form a number
of more specific articulatory valves, such as
• (1) the mandibular lip against the maxillary
lip,
• (2) the mandibular lip against the maxillary
teeth, and
• (3) the tip of the tongue against the alveolar
ridge
25ALEXANDER L. MARTONE, AN APPROACH TO PROSTHODONTICS THROUGH SPEECH SCIENCE Part V: Speech Science Research of
Prosthodontic Significance J. Pros. Dent. May-June, 1962

26. TYPES OF SPEECH
• 1.VOWELS: a,e,i,o,u. they are voiced sounds,
• 2.CONSONANTS: may be either voiced or produced
without vocal cord vibration, in which case they are
called breathed sounds. eg: p, b, m, s, t, r, z etc…
• 3.COMBINATION: Is blend of a consonant and
vowel, articulated in quick succession that they are
identified as single phonemes.
EX:- WORD
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients 26

27. CLASSIFICATION OF SPEECH
• According to Boucher
• Vowels.
• Consonants.
– Plosives/stops
– Fricatives
– Affricatives
– Nasal
– Liquid
– Glides
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

28. STRUDS:-
1. Voiceless sounds
2. Produced by the separation of
vocal cords
Eg:- s,h,sh,zh
ACCORDING TO SONORITY
SONANTS:-
1. Voiced sound
2. Produced by vibration of a portion of t
vocal cords
3. Oral resonators modify the airstream
4. All vowels and vowel like sounds are
representatives.
CONSONANTS:-
1. Articulated speech
2. Airstream has to be modified at the
proper place and time for producing
these sound
3. Most important for dentist
John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 132 28

29. CLASSIFICATION OF
CONSONANTS:
Divided into groups depending on their
characteristic production and use of different
articulators and valves. They are as follows.
• Plosive consonants: These sounds are
produced when overpressure of the air has been
built up by consonants between the soft palate and
pharyngeal wall and released in an explosive way.
Ex: P (pay), B (bay), T (to), D (dot)
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients 29

30. • Fricatives: are also called sibilants and are
characterized by their sharp and whistling sound
quality created when air is squeezed through the nearly
obstructed articulators.
Ex: S (so), Z (zoo)
• Affricative consonants: are a mix between plosive
and fricative ones.
Ex: Ch (chin), J (jar)
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

31. • Liquid consonants(semi vowels) : are , as the name
implies , produced with out friction.
Ex: R (rose), L(lily)
• Glides:: that is sounds characterized by a gradually
changing articulator shape
Ex: W (witch), Y (you)
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients 31

32. • Nasal consonants: are produced without oral exit of
air. Production involves the coupling of nasal cavity as
resonators.
Ex: M (man), N (name), NG (bang)
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients 32

33. DIFFERENT PARTS OF ORAL CAVITY AND
THEIR INFLUENCE ON SPEECH
TONGUE: LIPS
PALATE TEETH
33

34. CLASSIFICATION OF CONSONANTS BASED
ON THE PLACE OF THEIR PRODUCTION
• Consonant sounds are most important from the dental
point of view. They may be classified according to the
anatomic parts involved in their formation:
(1) Palatolingual sounds, formed by tongue and hard or soft
palate,
(2) Linguodental sounds, formed by the tongue and teeth,
(3) Labiodental sounds, formed by the lips and teeth, and
(4) Bilabial sounds, formed by the lips.
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 34

35. • PALATOLINGUAL SOUNDS FORMED
1. Tongue and hard palate
2. Tongue and rugae
3. Tongue and soft palate
35

36. TONGUE AND HARD PALATE
Word like S,T, D, N and L belong
to this category
S- the sound ‘s’ as in sixty six- is
formed by a hiss of air as it escapes
form the median groove of the
tongue when the tongue is behind
the upper incisor- Sears
If groove is decreased s is softened towards sh
(Lisping)
If groove is deep a whistling will be
heard when s is pronounced
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 36

37. CLINICAL SIGNIFICANCE
1. Thus we can say that the sound S
can be used to check the
proper placement of the
anterior teeth
2. Also the thickness of the
denture base can be adjusted in
case the sound S is not
produced correctly
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 37

38. CLINICAL SIGNIFICANCE
3. Silverman’s closest
speaking space also
used this word t o
establish and check a
proper vertical
dimension of
occlusion
Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 38

39. 39

40. Rugae and tongue
T, D, N and L word
Rugae area is very important
for the production of these
sounds.
Tongue must be placed firmly
against the anterior part of the
hard palate for the production
of these words.
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 40

41. • Therefore…. Should rugae be duplicated in the
denture or not is the question that arises….
Slaughter say.. The smoothness of the denture is
disturbing and the tongue looses its capacity for local
orientation
Landa says that rugae is useless or even detrimental
because it adds more bulk to the denture…
Ref:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 41

42. CLINICAL SIGNIFICANCE
• If teeth too lingual – T will sound like D
• If teeth too forward - D will sound like T
42

43. TONGUE AND SOFT PALATE
Consonant k, ng and g are
representative of the palatolingual
group of sounds.
Sound is formed by raising the
back of the tongue to occlude with
the soft palate and then suddenly
depressing the middle portion of the
back of the tongue realising the air
in a puff
43

44. CLINICAL SIGNIFICANCE
• If the posterior borders are over extended or if there is
no tissue contact k becomes ch sound.
Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)
44

45. LINGUODENTAL SOUNDS
Consonant Th is representative of the
linguodental group of sounds
Dental sounds are made with the tip of
the tongue extending slightly between
the upper and lower anterior teeth.
45

46. LINGUODENTAL SOUNDS
• Sound is actually made closer to the alveolus
(the ridge) than to the tip of the teeth.
• Careful observation of the amount of tongue
that can be seen with the words - this, that,
these and those will provide information as to
the labio-lingual position of the anterior
teeth.
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 46

47. CLINICAL SIGNIFICANCE
• If about 3mm of the tip of the tongue is not visible, the
anterior teeth are probably too far forward,
• If more than 6mm of the tongue extends out between
the teeth when such sounds are made, the teeth are
probably too lingual
(Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)
47

48. LINGUOALVEOLAR SOUNDS
Formed with the valve
formed by contact of the tip
of the tongue with the most
anterior part of the palate (the
alveolus) or the lingual sides
of the anterior teeth.
T, D, S, Z, V & 1 are
representative of the
linguoalveolar group of sounds
Robert Rothman; Phonetic consideration in denture
prosthesis, J Prosthet Dent;1961;11:214-223) 48

49. LINGUOALVEOLAR SOUNDS
• Sibilants (sharp sounds) s, z, sh, ch & j
(with ch & j being affricatives) are alveolar
sounds, because the tongue and alveolus forms
the controlling valve.
• Important observations when these sounds are
produced are the relationship of the anterior
teeth to each other.
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)
49

50. CLINICAL SIGNIFICANCE
Upper and lower incisors should approach end to
end but not touch.
Failure indicates a possible error in the horizontal
overlap of the anterior teeth
Ref :- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 50

51. LABIODENTAL SOUNDS
• F and V are
representatives of the
labiodental group of
sounds.
• Formed by raising the
lower lip into contact
with the incisal edge
of the maxilliary
anterior teeth.
Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 51

52. CLINICAL SIGNIFICANCE
Upper anterior teeth are too
short (set too high up), V
sound will be more like an F.
• If they are too long (set too
far down), F will sound
more like a V.
Ref:- Robert Rothman; Phonetic consideration in denture prosthesis, J
Prosthet Dent;1961;11:214-223) 52

53. BILABIAL SOUNDS
• B,p and m are
representatives of the
bilabial group of
sounds.
• Formed by the stream
of air coming from the
lungs which meets
with no resistance
along its entire path
until it reaches the lip.
Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223) 53

54. CLINICAL SIGNIFICANCE
1. Used to asses the correct
interarch space
2. Correct labiolingual
positioning of the anterior
teeth
3. Labial fullness of the rims
can also be checked
Ref:-Robert Rothman; Phonetic consideration in denture prosthesis, J Prosthet Dent;1961;11:214-223)
54

55. 55

56. VOWELS
1. Classification according to tongue position in oral cavity:
• High
• Mid
• Low
2. Combination of 2 vowels are called as dipthongs eg you.
56John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

57. PHONETICS IN RECORDING JAW
RELATION
• Also called as the speaking
method determining sliverman
closest speaking space
• Sibiliant sounds like S and M is
used.
• S sound gives the approximate
closest speaking space
• M sound gives us the freeway
space
• Approximately 2mm of space
must be there between the two
occlusal rims
Meyer M Silverman :The speaking method in measuring vertical dimension; J prosthet dent 1953;3:193-199 57

58. CLINICAL SIGNIFICANCE OF ‘S’
SOUND
1. Thickness of denture
2. Antero-posterior position of teeth
3. Vertical dimension of occlusion
4. Width of dental arch:
5. Relationship of upper teeth to the lower anterior teeth
by “S-POSITION
58Saryu Arora :Phonetics - Its Role In Prosthodontics, Indian Journal of Dental Sciences.June 2011 Issue:2, Vol.:3

59. PROSTHODONTIC IMPLICATION IN
DENTURE DESIGN AFFECTING
SPEECH
1. Denture thickness and peripheral outline
2. Vertical dimension
3. Occlusal plane
6. Anteriorposterior positioning of teeth
5. Post dam area
7. Width of dental arch
4. Relationship of the upper and lower teeth
Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343 59

60. DENTURE THICKNESS AND
PERIPHERAL OUTLINE
• If the denture bases are
too thick.
• Lisping will occur with
the word like S,C and Z
• Palatolingual sounds
most affected. (T,D).
Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343 60

61. VERTICAL DIMENSION
• Bilabials are mostly
affected P,B and M
• If both rims touch
prematurely it
indicated excessive
vertical dimension.
• In try in stage teeth
clicking will be heard.
Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343
61

62. OCCLUSAL PLANE
• Labioldental sounds F and
V are affected.
• If occlusal plane is too
high the correct positing of
the lower lip is difficult
• If the occlusal plane is too
low there is overlap of the
lower lip on the labial
surface of upper teeth
Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343 62

63. ANTERIORPOSTERIOR
POSITIONING OF TEETH
• F and V sounds are
hampered.
• labiopalatal positions of
the teeth is very
important
• Teeth if placed to
palatally the lower lip
will not meet the insical
edge of the upper teeth.
Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343 63

64. 64

65. POST DAM AREA
• Palatolingual consonants are affected (K,
NG and G)
• Thick post dam areas will irritate the
dorsum of the tongue
• Patient feels nausea like effect while
speaking
• If inadequate the plosive sound of the
word is hampered
• This area is very important for singers
who wear complete denture
Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern,Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343
65

66. WITDH OF DENTAL ARCH
• If teeth are set into an
arch that is too narrow
the tongue will be
cramped
• Consonants like T, D, N
K and S are affected
Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern, Indian J Dent Adv 2013; 5(3) Suppl 1: 1341-1343 66

67. RELATIONSHIP OF THE UPPER
AND LOWER INCISORS
• The chief concern is the
S CH, J and Z sound.
• These sounds need a
near contact of the
upper and lower teeth so
that the air stream is
allowed to pass.
Ref:-Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime Concern,
67

68. SPEECH TEST
• The speech test should be made after satisfactory
esthetics, correct centric relation, proper vertical
dimension and balanced occlusion have been attained
and after wax up for esthetics has been completed.
John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 132 68

69. TEST 1:TEST OF RANDOM SPEECH
• Engage the patient in a conversation and obtaining a
subjective speech analysis by asking the patient say
how he feels, how his speech sounds to him and what
words seem most difficult to pronounce.
John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 132 69

70. 70

71. TEST 2: TEST OF SPECIFIC SPEECH SOUNDS
• This is best accomplished by having the patient say 6-8
words containing the sound and then combining these
words into a sentence. The following is the list of
sounds to be tested
John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 132 71

72. S, Sh Six, sixty, ships, sailed
Mississippi, sure ,sign, sun,
shine
Sixty six ships sailed
Mississippi. Sure sign of sun
shine
T,D,N,L Locator, located, tornado, near,
Toledo
Locator located tornado near
Toledo
Ch,J Joe, Joyce, joined, George,
Charles, church
Joe and Joyce joined
George and Charles at
church
K Committee, convented, political,
convention, Connecticut
The committee convened at
the political convention in
Connecticut.
F,V Vivacious, Vivian, lived, five,
fifty, five, fifth, avenue
Vivacious Vivian lived at five
fifty-five fifth avenue
72

73. TEST 3: TEST OF READING A PARAGRAPH
Make the patient read a paragraph containing abundance
of S, Sh, Ch sounds.
(John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics pg 132) 73

74. SPEECH ANALYSIS
• 2 categories
• 1) Perceptual / acoustic
• Based on broad band spectrogram, recording by
Sonograph
• Objective opinion of performance
(Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients
74

75. 2) Kinematic movement analysis :
– Ultrasonics
– X-ray mapping
– Cineradiography
– Optoelectronic articulatory movement tracking
– Electropalatography
Ref:- Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients 75

76. PALATOGRAPHY
• What is palatography?
• A group of techniques to record contact between the
tongue and the roof the mouth to get articulatory
records for the production of speech sounds.
76John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

77. PREREQUISITE FOR MAKING
PALATOGRAM
1. The artificial palate made must be uniformly adapted,
no adhesive must be used.
2. Patient who have severe gagging must not be used for
making palatograms.
3. The patient has to be trained to open his mouth
after uttering the desired word.
4. The tracing material must not be distasteful and
its consistency should permit easy application
77
John. Sharry. Complete denture
Prosthodontics 3rd edition; Phonetics

78. 5. The palate has to be thoroughly dried before the
medium is applied and the medium must have a
contrasting colour so that it can be easily identified
6. Talc is considered the best material that can
be used for palatogram, although activated
charcoal, chocolate powder where also used
78
John. Sharry. Complete denture
Prosthodontics 3rd edition; Phonetics

79. PALATOGRAM OF
VOWELS.
PALATOGRAM OF
CONSONANTS.
79
John. Sharry. Complete denture
Prosthodontics 3rd edition; Phonetics

80. TERMINLOGIES RELATED TO
SOME SPEECH DISTURBANCES
1. APHASIA (DYSPHASIA): Means defective speech due
to damage of cortical area required for speech making.
(Broca’s area, Wernicke’s area).
2. DYSARTHRIA: Motor speech problems caused, not due
to sensory loss or mental retardation.
3. SPEECH AND LANGUAGE RETARDATION: Delay
in acquistion of communicating skills
80

81. DISORDERS OF SPEECH
Hypernasality Hyponasality
Denasality
NASAL BALANCE
Eg: m, n & ng
  
b d g
Morning  bordig
81
Maxillofacial rehabilitation prosthodontic and surgical concideration: jhon beumer Speech, Velopharyngeal
Function, and Restoration of Soft Palate Defects p 285- 329

82. 82
ARTICULATOR DEFETCS
Distortion
Eg: Vowel  pop for pipe
Consonants  cah for car
Substitution
Eg: teef for teeth
Omission
Eg: bow for boat
Zarb- Bolender:Speech consideration with complete dentures ;Prosthodontic treatment For Edentulous Patients

83. ALTERATION OF SPEECH
ARTICULATION
Natural dentition
• Missing bicuspid:- lateral
emission (stigmatismus
lateralis)
• Anterior missing:-anterior
emission
• Gross removal of gingival
tissue denies the tongue its
soft tissue contact
Artificial dentition
• Poorly contoured: speech
impediment
• Large restoration:-impaired
speech
83John. Sharry. Complete denture Prosthodontics 3rd edition; Phonetics

84. RELATION TO MAXILLOFACIAL DEFECTS
Acquired
Accidental or surgical
Congenital
Cleft palate,
Short palate,
Large velopharyngeal
space,
Limited velar mobility,
Submucous cleft palate
84

85. Nervous system speech defect
– Cerebral palsy,
– Lateral sclerosis,
– Poliomyelitis,
– Myasthenia gravis,
– Myotonic dystrophy .
85

86. Speech consideration related to implant
prosthesis
• Mandibular low lip line should be assessed
during speech as pronouncing sibilants lower
anterior can be completely exposed (Karl mish:
Contemporary implant dentistry)
• A fully bone anchored prosthesis in maxilla
can cause phonetic problems, (Richard
palmer:implant in clinical dentistry,p 258)
• Normal pronunciation is possible after
approximately 3 months,
86

87. • Removable appliances like artificial gingival
extensions made of silicones or resin materials should
be giAssociated with changed contours and dead
space below fixed prostheses required for oral
hygiene ven.
(Jhon hobkirk:Introducing dental implant, p 143)
87

88. Speech consideration in partial
edentulism
• In partial prosthodontics, clinical evidence often
reveals that there is very little or no loss of the ability
to phonate correctly.
• In fixed prosthodontics, in anterior restorations, the
pontic and connector design is very important.
• Poor adaptation of the pontic to the ridge, either due
to faulty design or due to residual ridge resorption,
there is air escape through the tissue surface of the
pontic results in faulty production of sibilants.
88
Carr Alan B, Brown David McCracken’s
Removable Partial Prosthodontics. 11th ed.
Mosby; 2005. p.397-426

89. 89

90. Speech consideration in maxillofacial
defects
• Tachimura T, Nohara K, Hara H, Wada T (1999) concluded
that the severity of velopharyngeal incompetence might be
related in part to change in levator activity in association with
oral air pressure
• Velopharyngeal orifice size Warren, using these hydraulic
principles to compute velopharyngeal orifice size, found that
this opening should be less than 0.2 cm during the production
of plosive and fricative sound
90
Maxillofacial rehabilitation prosthodontic and surgical concideration: jhon beumer Speech, Velopharyngeal
Function, and Restoration of Soft Palate Defects p 285- 329

91. velopharyngeal closure patterns
• Coronal Pattern :The majority of the valving is palatal
and accomplished by the full width of the soft palate
contacting the posterior wall. The lateral walls exhibit
limited movement to contact the lateral margins of the
velum. There is no posterior pharyngeal wall
movement.
• Sagittal Pattern :The majority of the valving is
pharyngeal. The lateral walls move extensively to the
midline and approximate each other. The velum does
not contact the posterior pharyngeal wall but elevates
to contact the approximated lateral pharyngeal walls.
The posterior pharyngeal wall does not contribute to
closure.
91
Maxillofacial rehabilitation prosthodontic and surgical consideration : jhon beumer Speech, Velopharyngeal
Function, and Restoration of Soft Palate Defects p 285- 329

92. • Circular pattern: There is essentially equal participation
from the soft palate and the lateral pharyngeal walls,
with the contracting muscles uvula acting as a focal
point. The lateral walls contact the muscles uvula as it
contracts and contacts the non-mobile posterior
pharyngeal wall.
• Circular Pattern with Passavant’s ridge: The same
pattern as circular closure, except that the posterior
pharyngeal wall (Passavant’s ridge) moves forward to
complete the closure pattern around the muscles uvula
posteriorly.
92
Maxillofacial rehabilitation prosthodontic and surgical consideration: jhon beumer Speech, Velopharyngeal Function,
and Restoration of Soft Palate Defects p 285- 329

93. 93

94. 94

95. Soft palate defect
95

96. Maxillary defects
96

97. 97

98. Cleft lip and cleft palate
98

99. 99

100. CONCLUSION
100

101. REFERENCES
1. John. Sharry. Complete denture
Prosthodontics 3rd edition; Phonetics. 3rd
edition
2. Zarb - Bolender: Speech consideration
with complete dentures ;Prosthodontic
treatment For Edentulous Patients.13th
edition
3. Guyton and Hall: Textbook of medical
physiology, 12th edition,
4. Churchhill Livingstone:Gray’s anatomy 40th
edition 101

102. 1. Carr Alan B, Brown David McCracken’s
Removable Partial Prosthodontics. 11th ed. p.397-
426
2. Maxillofacial rehabilitation prosthodontic and surgical
consideration: jhon beumer Speech, Velopharyngeal
Function, and Restoration of Soft Palate Defects p
285- 329
3. Thomas Taylor: Clinical maxillofacial prosthesis.
4. Karl mish: Contemporary implant dentistry
5. Jhon hobkirk: Introducing dental implant, p 143
6. Richard palmer: Implant in clinical dentistry,p
258 102

103. • Chierici, Lawson; Clinical speech consideration in
prosthodontics. J Prosthet dent;1973;29;1:29-39.
• Robert Rothman; Phonetic consideration in
denture prosthesis, J Prosthet Dent;1961;11:214-223).
• Meyer M Silverman :The speaking method in
measuring vertical dimension; J prosthet dent
1953;3:193-199.
• ALEXANDER L. MARTONE, AN APPROACH TO
PROSTHODONTICS THROUGH SPEECH SCIENCE
Part IV. Physiology of Speech*, J. Pros. Dent. May-June,
1962
• ALEXANDER L. MARTONE, AN APPROACH TO
PROSTHODONTICS THROUGH SPEECH SCIENCE Part V:
Speech Science Research of Prosthodontic Significance J.
Pros. Dent. May-June, 1962
103

104. 104
• Allen :Improved phonetic in denture
construction. J pros dent. 8 753-763. 1958
• Rajya Lakshmi Ravuri , Phonetics in Complete Denture-A Prime
Concern, Indian J Dent Adv 2013; 5(3) Suppl 1:
1341-1343
• Abdul-Aziz Abdullah: Phonetics Related to
Prosthodontics Middle-East Journal of
Scientific Research 12 (1): 31-35, 2012
• Saryu Arora :Phonetics - Its Role In
Prosthodontics, Indian Journal of Dental
Sciences.June 2011 Issue:2, Vol.:3

105. 105