Influence of speech aid prosthesis with speech therapy on speech outcomes in adult patients with persisting velopharyngeal insufficiency: A retrospective analysis.

STATEMENT OF PROBLEM: Prosthetic intervention with a speech aid prosthesis (SAP) along with speech therapy has been reported to improve speech outcomes in patients with persisting velopharyngeal insufficiency (VPI). However, little is known regarding the impact of this treatment on different speech parameters over time in adult patients with VPI. PURPOSE: The purpose of this retrospective study was to evaluate the change in speech parameters after rehabilitation with an SAP and speech therapy in adult patients with VPI using subjective and objective tests. MATERIAL AND METHODS: Patients above 16 years of age who had received prosthetic treatment for VPI and had complete speech assessment records between 2017 and 2020 were included in the analysis. After completion of the prosthetic treatment, speech therapy comprising 2 sessions per week of 45 minutes was provided by a speech pathologist. Speech evaluation was performed using tests that included speech intelligibility calculation, nasal pinch test, audible nasal air emissions, acoustic analysis, and the nasalance check. Assessments were done at 4 time intervals: T0: without an SAP; T1: 1 week with an SAP; T2: 1 month with an SAP; and T3: 3 months with an SAP. A descriptive analysis was followed by a comparison between groups using the Friedman test for subjective assessments and repeated measures ANOVA for objective tests (α=.05). RESULTS: Of 10 individuals who had received an SAP, 5 participants, 2 men and 3 women with a mean age of 38 years were included in the analysis. Statistically significant improvement in mean scores was observed from T0 to T3 concerning speech intelligibility (P<.001), hypernasality (P<.001), audible nasal air emission (P<.001), mean fundamental frequency (P=.034), shimmer percentage (P=.004), and nasalance (P=.004). Improvement in jitter percentage was not statistically significant (P=.218). CONCLUSIONS: An SAP along with speech therapy should be considered as a conservative and effective treatment option for addressing speech issues in adult patients with VPI.

Flapless versus open flap techniques of implant placement: A 15-month follow-up study.

AIM: To evaluate and compare the effect of flapless and "open flap" techniques of implant placement on crestal bone height (CBH) around implants. MATERIALS AND METHODS: This prospective study comprised of 32 implants placed in 16 subjects with a bilateral missing mandibular first molar. In each subject, one implant was placed with "flapless" and other using "open flap" technique. Radiographic assessment of CBH was carried out using standardized intraoral periapical radiograph of the site at baseline, 3 months, 9 months and 15 months after implant placement. STATISTICAL ANALYSIS: Data were analyzed using STATA 11.0 statistical software. To determine the changes in CBH from baseline, at 3-, 9-, and 15-month, repeated measures analysis of variance followed by post-hoc Bonferroni was used for each of the two techniques for mesial and distal aspects separately. For both techniques, changes in CBH from baseline to 15 months were compared using an independent t-test with a confidence interval of 95%. RESULTS: For "flapless" technique, there was no statistically significant (P > 0.05) reduction of CBH in initial 9 months but was significant for the 9-15 months period while for "open flap" technique, statistically significant (P < 0.05) reduction was observed up to 15 months. Comparison of both techniques showed significantly lesser reduction with "flapless" than "open flap" technique. The overall average crestal bone loss was 0.046 ± 0.008 mm on mesial aspect, 0.043 ± 0.012 mm on distal aspect with "flapless" technique and 1.48 ± 0.085 mm on mesial aspect, 1.42 ± 0.077 on distal aspect "open flap" technique. CONCLUSIONS: Both techniques showed a reduction in CBH with time but the flapless technique showed a lesser reduction. Therefore, the flapless technique can be considered as a better treatment approach for placement of implants, especially where adequate width and height of available bone are present.

Strategic Use of Telescopic Retainers and Semi-rigid Precision Attachments in a Geriatric Patient: A Case Report.

The rehabilitation of medically compromised elderly patients with long span partially edentulous arches has been a tremendous challenge for dentists. Proper dental management requires a commitment to provide the best treatment despite the compromised oral conditions. The aim of this paper is to describe the prosthetic rehabilitation of an elderly patient who presented with chief complaints of gagging sensation while using upper denture, loose upper and lower dentures and difficulty in eating food. Patient was rehabilitated using removable partial denture with semi-rigid attachments in the maxillary arch and telescopic prosthesis in the mandibular arch. Use of semi precision attachments helped in increasing the retentive ability of the maxillary prosthesis, even in the presence of only few abutments. Fabrication of a telescopic denture is a technique sensitive procedure but it offers advantages like bilateral splinting effect in long span partially edentulous arches, reduced effective crown-root ratio, maintenance of proprioception and transfer of forces along the long axis of the abutments. Although the management was complex but it improved patient's esthetics, oral function and social confidence.