On Speech Problems with Fixed Restorations on Implants in the Edentulous Maxilla: Introduction of a Novel Management Concept

BackgroundLittle attention has been paid to the effect of implant restorations on speech. PurposeThe aim of this study was threefold: (1) to find out if speech problems occur after inserting a fixed provisional restoration in the edentulous maxilla; (2) to explore speech adaptation in case articulation problems arise after rehabilitation; and (3) to describe the effect of changing the shape of the restoration on improving speech. Materials and MethodsTen patients with an edentulous maxilla were treated with fixed rehabilitation on implants. Speech evaluation was performed at four occasions: before implant surgery, immediately after restoration, and 3 weeks later before and after managing the speech problem by changing the shape of the restoration if speech problems occurred. Comparative three-dimensional-analysis of casts of the restoration before and after changing the shape of the restoration was carried out. ResultsThe majority of patients (n=7) experienced speech problems immediately after rehabilitation. Three weeks later, none of the seven patients with deteriorated speech returned to baseline speech. Then, volumetric reduction of the palatal aspects of the (pre)molars was performed, which allowed speech to return to baseline levels in five out of seven patients. In the two remaining patients, the intervention resulted in an improvement of speech without reaching their baseline levels. Three-dimensional-analysis showed that reducing the palatal volume of the premolars was effective in correcting speech. ConclusionsSpeech problems may frequently occur after fixed rehabilitation of the completely edentulous maxilla. A novel speech management concept, consisting of reducing the palatal volume of the (pre)molars, is introduced, demonstrating to solve speech problems in most cases.