Palatogram revisited
Identifieur interne : 000146 ( Pmc/Corpus ); précédent : 000145; suivant : 000147Palatogram revisited
Auteurs : Ashish R. Jain ; M. K. Venkat Prasad ; Padma ArigaSource :
- Contemporary Clinical Dentistry [ 0976-237X ] ; 2014.
Abstract
It is the responsibility of the dentist to fabricate a denture that is fully functional and perfectly esthetic. One prime oral function that has always been overlooked in this regard is speech. It has been thought that speech will follow mere replacement of teeth and that it is the patient's duty to fine tune this function with practice. Phonetics, esthetics, function and comfort form the foundation of a successful prosthodontic treatment. Accurate approximation of palatal contours of a maxillary complete denture to a patient's tongue can improve speech intelligibility, if other factors such as tooth position, occlusal plane and occlusal vertical dimension are satisfactory. Customizing palatal contours of a maxillary complete denture can be accomplished by using tissue-conditioning material, which provides sufficient working time for a patient to pronounce a series of sibilant sounds while recording dynamic impression of the tongue. This article describes a technique of obtaining palatogram and customizing palatal contours of a maxillary complete denture with autopolymerizing acrylic resin to improve the intelligibility of speech.
Url:
DOI: 10.4103/0976-237X.128696
PubMed: 24808716
PubMed Central: 4012109
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Palatogram revisited</title><author><name sortKey="Jain, Ashish R" sort="Jain, Ashish R" uniqKey="Jain A" first="Ashish R." last="Jain">Ashish R. Jain</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Venkat Prasad, M K" sort="Venkat Prasad, M K" uniqKey="Venkat Prasad M" first="M. K." last="Venkat Prasad">M. K. Venkat Prasad</name><affiliation><nlm:aff id="aff2"><italic>Department of Prosthodontics, Saveetha University, Chennai, Tamil Nadu, India</italic></nlm:aff></affiliation></author><author><name sortKey="Ariga, Padma" sort="Ariga, Padma" uniqKey="Ariga P" first="Padma" last="Ariga">Padma Ariga</name><affiliation><nlm:aff id="aff2"><italic>Department of Prosthodontics, Saveetha University, Chennai, Tamil Nadu, India</italic></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24808716</idno><idno type="pmc">4012109</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012109</idno><idno type="RBID">PMC:4012109</idno><idno type="doi">10.4103/0976-237X.128696</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000146</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000146</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Palatogram revisited</title><author><name sortKey="Jain, Ashish R" sort="Jain, Ashish R" uniqKey="Jain A" first="Ashish R." last="Jain">Ashish R. Jain</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Venkat Prasad, M K" sort="Venkat Prasad, M K" uniqKey="Venkat Prasad M" first="M. K." last="Venkat Prasad">M. K. Venkat Prasad</name><affiliation><nlm:aff id="aff2"><italic>Department of Prosthodontics, Saveetha University, Chennai, Tamil Nadu, India</italic></nlm:aff></affiliation></author><author><name sortKey="Ariga, Padma" sort="Ariga, Padma" uniqKey="Ariga P" first="Padma" last="Ariga">Padma Ariga</name><affiliation><nlm:aff id="aff2"><italic>Department of Prosthodontics, Saveetha University, Chennai, Tamil Nadu, India</italic></nlm:aff></affiliation></author></analytic><series><title level="j">Contemporary Clinical Dentistry</title><idno type="ISSN">0976-237X</idno><idno type="eISSN">0976-2361</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>It is the responsibility of the dentist to fabricate a denture that is fully functional and perfectly esthetic. One prime oral function that has always been overlooked in this regard is speech. It has been thought that speech will follow mere replacement of teeth and that it is the patient's duty to fine tune this function with practice. Phonetics, esthetics, function and comfort form the foundation of a successful prosthodontic treatment. Accurate approximation of palatal contours of a maxillary complete denture to a patient's tongue can improve speech intelligibility, if other factors such as tooth position, occlusal plane and occlusal vertical dimension are satisfactory. Customizing palatal contours of a maxillary complete denture can be accomplished by using tissue-conditioning material, which provides sufficient working time for a patient to pronounce a series of sibilant sounds while recording dynamic impression of the tongue. This article describes a technique of obtaining palatogram and customizing palatal contours of a maxillary complete denture with autopolymerizing acrylic resin to improve the intelligibility of speech.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Jain, Ar" uniqKey="Jain A">AR Jain</name></author><author><name sortKey="Jain, Sa" uniqKey="Jain S">SA Jain</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Allen, Lr" uniqKey="Allen L">LR Allen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Runte, C" uniqKey="Runte C">C Runte</name></author><author><name sortKey="Lawerino, M" uniqKey="Lawerino M">M Lawerino</name></author><author><name sortKey="Dirksen, D" uniqKey="Dirksen D">D Dirksen</name></author><author><name sortKey="Bollmann, F" uniqKey="Bollmann F">F Bollmann</name></author><author><name sortKey="Lamprecht Dinnesen, A" uniqKey="Lamprecht Dinnesen A">A Lamprecht-Dinnesen</name></author><author><name sortKey="Seifert, E" uniqKey="Seifert E">E Seifert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Farley, Dw" uniqKey="Farley D">DW Farley</name></author><author><name sortKey="Jones, Jd" uniqKey="Jones J">JD Jones</name></author><author><name sortKey="Cronin, Rj" uniqKey="Cronin R">RJ Cronin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rieger, J" uniqKey="Rieger J">J Rieger</name></author><author><name sortKey="Wolfaardt, J" uniqKey="Wolfaardt J">J Wolfaardt</name></author><author><name sortKey="Seikaly, H" uniqKey="Seikaly H">H Seikaly</name></author><author><name sortKey="Jha, N" uniqKey="Jha N">N Jha</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rothman, R" uniqKey="Rothman R">R Rothman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kong, Hj" uniqKey="Kong H">HJ Kong</name></author><author><name sortKey="Hansen, Ca" uniqKey="Hansen C">CA Hansen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tanaka, H" uniqKey="Tanaka H">H Tanaka</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Contemp Clin Dent</journal-id><journal-id journal-id-type="iso-abbrev">Contemp Clin Dent</journal-id><journal-id journal-id-type="publisher-id">CCD</journal-id><journal-title-group><journal-title>Contemporary Clinical Dentistry</journal-title></journal-title-group><issn pub-type="ppub">0976-237X</issn><issn pub-type="epub">0976-2361</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24808716</article-id><article-id pub-id-type="pmc">4012109</article-id><article-id pub-id-type="publisher-id">CCD-5-138</article-id><article-id pub-id-type="doi">10.4103/0976-237X.128696</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Palatogram revisited</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Jain</surname><given-names>Ashish R.</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Venkat Prasad</surname><given-names>M. K.</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Ariga</surname><given-names>Padma</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib></contrib-group><aff id="aff1"><italic>Department of Prosthodontics, Tagore Dental College and Hospital, Chennai, Tamil Nadu, India</italic></aff><aff id="aff2"><label>1</label><italic>Department of Prosthodontics, Saveetha University, Chennai, Tamil Nadu, India</italic></aff><author-notes><corresp id="cor1"><bold>Correspondence:</bold> Dr. Ashish R. Jain, R House C1, No. 3, Manonmani Ammal Road, Pavapuri, Kilpauk, Chennai - 600 010, Tamil Nadu, India. E-mail: <email xlink:href="dr.ashishjain_r@yahoo.com">dr.ashishjain_r@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jan-Mar</season><year>2014</year></pub-date><volume>5</volume><issue>1</issue><fpage>138</fpage><lpage>141</lpage><permissions><copyright-statement>Copyright: © Contemporary Clinical Dentistry</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>It is the responsibility of the dentist to fabricate a denture that is fully functional and perfectly esthetic. One prime oral function that has always been overlooked in this regard is speech. It has been thought that speech will follow mere replacement of teeth and that it is the patient's duty to fine tune this function with practice. Phonetics, esthetics, function and comfort form the foundation of a successful prosthodontic treatment. Accurate approximation of palatal contours of a maxillary complete denture to a patient's tongue can improve speech intelligibility, if other factors such as tooth position, occlusal plane and occlusal vertical dimension are satisfactory. Customizing palatal contours of a maxillary complete denture can be accomplished by using tissue-conditioning material, which provides sufficient working time for a patient to pronounce a series of sibilant sounds while recording dynamic impression of the tongue. This article describes a technique of obtaining palatogram and customizing palatal contours of a maxillary complete denture with autopolymerizing acrylic resin to improve the intelligibility of speech.</p></abstract><kwd-group><kwd>Complete denture</kwd><kwd>palate</kwd><kwd>palatogram</kwd><kwd>phonetics</kwd><kwd>sounds</kwd><kwd>speech</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>“Speech is the use of systematized vocalization to express verbal symbols or words.” (Sheridan: 1964). Speech is a very sophisticated autonomous and unconscious activity. Speech in matured man is a learned habitual neuromuscular pattern which makes use of anatomical structures designed primarily for respiration and deglutition. Because oro-dental morphological features also may influence an individual speech, the dentist should therefore recognize the possible role of prosthetic treatment on speech activity.[<xref rid="ref1" ref-type="bibr">1</xref><xref rid="ref2" ref-type="bibr">2</xref>]</p><sec id="sec2-1"><title>Aim</title><p>This article describes a technique of obtaining palatogram and customizing palatal contours of a maxillary complete denture with autopolymerizing acrylic resin to improve the intelligibility of speech.</p></sec></sec><sec id="sec1-2"><title>What is Palatogram?</title><p>A palatogram is a graphic representation of the area of the palate contacted by tongue during a specified activity, usually speech-GPT 8.</p><p>J. Oakley Coles, in 1871, was the first to use palatograms.[<xref rid="ref3" ref-type="bibr">3</xref>]</p><sec id="sec2-2"><title>Indications of palatogram</title><p><list list-type="bullet"><list-item><p>Used with implant - supported maxillary dentures. Deviation from ideal palatal contours is often encountered with maxillary implant-supported dentures. This can be caused by implant anplation problems, diminished restor-ative space and bulky attachment mechanisms</p></list-item><list-item><p>The evaluation of maxillary denture placement in the sensory - or muscularly impaired patient. An analysis of the space of donder in patients suffering from a loss of motor function can be simplified by the use of a palatogram</p></list-item><list-item><p>Evaluation of speech patterns and food bolus management in the orally disabled or geriatric patient may include palatal contour assessment.</p></list-item></list></p></sec></sec><sec id="sec1-3"><title>A Technique of Obtaining Palatogram to Shape the Palatal Surface of Denture</title><p>In this technique the only additional equipment necessary for palatogram is non-scented talc, in inexpensive soft bristle brush for dusting the talc on the palate and a glass marking pencil to outline the contact area.[<xref rid="ref1" ref-type="bibr">1</xref>] Palatograms can be easily and quickly made on the trial or processed denture if the following steps are recalled.</p><p>Various other recording medium can be used are:</p><p><list list-type="bullet"><list-item><p>Gothic arch tracing ink</p></list-item><list-item><p>Pressure indicating media</p></list-item><list-item><p>Powders-gypsum products, talc, alginate</p></list-item><list-item><p>Occlude aerosol</p></list-item><list-item><p>Impression waxes.</p></list-item></list></p><p>Step 1: Verification of recorded dimensions</p><p><list list-type="bullet"><list-item><p>Verify the correct vertical dimension in your patient</p></list-item><list-item><p>Verify the arrangement of teeth</p></list-item><list-item><p>Verify the occlusal plane of a trial or processed denture.</p></list-item></list></p><p>Step 2: Application of recording medium</p><p><list list-type="bullet"><list-item><p>Dry the palatal surface of maxillary denture thoroughly before dusting non-scented talc (do not use regular or surgical talc) and shake off the excess powder.</p></list-item></list></p><p>Step 3: Insertion of coated maxillary denture</p><p><list list-type="bullet"><list-item><p>Train the patient to pronounce the sound and open the mouth without again contacting the palate</p></list-item><list-item><p>Avoid touching dusted palate with the fingers during insertion, but ensure that the denture is well seated before the sound is pronounced.</p></list-item></list></p><p>Step 4: Pronunciation of palatolingual consonant sounds and recording the palatogram</p><p><list list-type="bullet"><list-item><p>Instruct the patient to articulate various palatolingual consonants sounds for example s, sh, ch, n, k etc</p></list-item><list-item><p>Use vowel “O” with the consonant to be studied, even though the combination is not a word; i.e. to study k, use ko; to study ch; use cho. This is according to Allen's protocol where o is the only vowel was tongue does not make any contact with palate. This is combined with other consonants to avoid multiple recordings of tongue to palate[<xref rid="ref2" ref-type="bibr">2</xref>]</p></list-item><list-item><p>The patient should be asked to repeat the desired sound only two consecutive times. Then the denture should be carefully removed</p></list-item><list-item><p>Be sure the patient makes definite palatal contact in pronouncing the sound, but avoids palatal contact after opening the mouth</p></list-item><list-item><p>Avoid contacting the palate with the fingers when removing the denture.</p></list-item></list></p><p>Step 5: Evaluation of recordings</p><p><list list-type="bullet"><list-item><p>Outline the contact area with a wax carver where wax is present,(in wax trial denture) and with a glass-marking pencil (in processed denture)</p></list-item><list-item><p>Note: Each individual will produce a similar palatogram for a given sound; however there will be certain unique characteristics for that particular person because variations in shape and size of tongue and palatal vault arch form.</p></list-item></list></p></sec><sec id="sec1-4"><title>Case Report of an UnderContoured Palate of a Maxillary Complete Denture</title><p>A 45-year-old man patient reported to our hospital (Saveetha Dental College and Hospital, Saveetha University, Chennai, India) with a chief complaint that he could not speak fluently. The patient had no relevant medical history. On intraoral examination maxillary denture revealed undercontoured palate. The following steps were followed for recording a palatogram as mentioned above.</p><p>Palatogram recordings using English as well as Tamil consonants:[<xref rid="ref4" ref-type="bibr">4</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref><xref rid="ref7" ref-type="bibr">7</xref>]</p><p><list list-type="bullet"><list-item><p>“S” sound palatogram using word “SO” [<xref ref-type="fig" rid="F1">Figure 1</xref>]</p></list-item><list-item><p>“Sh” sound palatogram using word “SHOW”/Nashtam [<xref ref-type="fig" rid="F2">Figure 2</xref>]</p></list-item><list-item><p>“Ch” sound palatogram using word “CHOKE”/Pachai [<xref ref-type="fig" rid="F3">Figure 3</xref>]</p></list-item><list-item><p>“N” sound palatogram using word “NO”/Mannan [<xref ref-type="fig" rid="F4">Figure 4</xref>]</p></list-item><list-item><p>“G and K” sound palatogram using word “GIVE KING”/Jeevan/kaakka [<xref ref-type="fig" rid="F5">Figure 5</xref>].</p></list-item></list></p><fig id="F1" position="float"><label>Figure 1</label><caption><p>“S” sound palatogram using word “So”</p></caption><graphic xlink:href="CCD-5-138-g001"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p>“Sh” sound palatogram using “Show”/Nashtam</p></caption><graphic xlink:href="CCD-5-138-g002"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p>“N” sound palatogram using No/Mannan</p></caption><graphic xlink:href="CCD-5-138-g003"></graphic></fig><fig id="F4" position="float"><label>Figure 4</label><caption><p>“Ch” sound palatogram using Choke/Pachai</p></caption><graphic xlink:href="CCD-5-138-g004"></graphic></fig><fig id="F5" position="float"><label>Figure 5</label><caption><p>“G and K” sound palatogram using Give King/Jeevan/ kaakka</p></caption><graphic xlink:href="CCD-5-138-g005"></graphic></fig><p>After recording the palatogram using the above mentioned various palatolingual consonants, the form of palatal surface was contoured using acrylic burs in order to create the desired shape of contact areas.</p></sec><sec id="sec1-5"><title>Case Report of an OverContoured Palate of A Maxillary Complete Denture</title><p>A 53-year-old man patient reported to our hospital (Saveetha Dental College and Hospital, Saveetha University, Chennai, India) with a chief complaint that he could not speak fluently. The patient had no relevant medical history. On intraoral examination maxillary denture revealed overcontoured palate. The following steps were followed for proper contouring of an overcontoured palate.</p><p>Stepwise solution of an overcontoured maxillary denture:[<xref rid="ref8" ref-type="bibr">8</xref>]</p><p><list list-type="bullet"><list-item><p>Draw an outline of the surface that requires correction with a pencil</p></list-item><list-item><p>Prepare a thick mixture of tissue-conditioning material (coe-comfort; gc America, inc, alsip, ill) by adding 25% more of the powder than recommended by the manufacturer and spread an adequate amount of the mixture only on the outlined surface</p></list-item><list-item><p>Insert the maxillary denture with the tissue conditioner in place and have the patient completely read each of the 10 stimulus sentences [Tables <xref ref-type="table" rid="T1">1</xref>, <xref ref-type="table" rid="T2">2</xref> and <xref ref-type="table" rid="T3">3</xref>], without repeating the same sentence twice and continue doing so for about 5 min at a rate faster than a normal speaking rate</p></list-item><list-item><p>Evaluate the patient's speech for clarity</p></list-item><list-item><p>Remove the denture from the mouth, once initial polymerization occurs. If the prosthesis is a waxed trial denture, stop at this step for processing</p></list-item><list-item><p>Fill the intaglio surface of the denture and the base of a denture processing flask with a mixture of laboratory plaster and pumice to make it easier to retrieve the denture</p></list-item><list-item><p>Lightly lubricate the set mixture of laboratory plaster and pumice with petrolatum, put the upper half of the flask in place, leaving the area of tissue conditioner uncovered</p></list-item><list-item><p>Fill the upper half of the flask with the appropriate amount of plaster and completely close the lid</p></list-item><list-item><p>After the plaster has set, open the lid. Remove the tissue conditioner from the denture</p></list-item><list-item><p>Mix autopolymerizing repair resin according to the manufacturer's instructions and place the appropriate amount of the mixture on the denture to replace the tissue conditioner. Use autopolymerizing acrylic resin because it is relatively easy to work with, inexpensive, less time consuming and dimensionally stable. Note that both the adhesive strength and color stability of an autopolymerizing acrylic resin are adequate for use in a low stress and non-visible area such as the palate of a maxillary complete denture</p></list-item><list-item><p>Coat the plaster with a separating medium and completely close the plaster and the lid. Place the assembled flask in the pneumatic or a hand bench press and slowly squeeze out the excess resin</p></list-item><list-item><p>Once the repair resin has polymerized, retrieve the denture from the flask</p></list-item><list-item><p>Carefully finish with laboratory carbide burs and polish the corrected palatal contour with a wet buffing wheel and pumice [<xref ref-type="fig" rid="F6">Figure 6</xref>]</p></list-item><list-item><p>Evaluate the intelligibility of/s/and/sh/sounds with the denture.</p></list-item></list></p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Specific speech sounds</p></caption><graphic xlink:href="CCD-5-138-g006"></graphic></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Manner of production - Hindi consonants</p></caption><graphic xlink:href="CCD-5-138-g007"></graphic></table-wrap><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Manner of production-English consonants</p></caption><graphic xlink:href="CCD-5-138-g008"></graphic></table-wrap><fig id="F6" position="float"><label>Figure 6</label><caption><p>Palatally countoured finished and polished denture</p></caption><graphic xlink:href="CCD-5-138-g009"></graphic></fig></sec><sec sec-type="conclusion" id="sec1-6"><title>Conclusion</title><p>Speech difficulties as sequelae of oral rehabilitation with complete dentures are generally a transient problem. When encountered the difficulties may not be easily solved. Therefore efforts should be made to avoid them by pretreatment records or assessment of speech and provision of information to patients about likely initial deviation from normal speech, immediately following oral rehabilitation. Hence a prosthodontist play a pivotal role in understanding the basic mechanisms involved in the various speech pathology and provide prudent treatment for the same to enhance an individual's personality. 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