Palatal lift prosthesis/ orthodontic straight wire technique

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INDIAN DENTAL ACADEMY

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Contents

• Introduction

• Anatomy of soft palate

• Function of soft palate

• Defect of soft palate

• Classification of Palatopharyngeal deficiencies

• Speech

• Physiology and anatomy of Palatopharyngeal closure

• Speech problem

• Diagnostic assessment

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• Clinical evaluation• Achieving acceptable speech • Prosthodontic procedure • Palatal lift prosthesis • Palatal lift prosthesis in complete denture • Speech bulb prosthesis• Results of palatal lift prosthesis and combination

prosthesis • Speech therapy • Conclusion

INTRODUCTION

• The palatal lift prosthesis is used to improve soft

palate dysfunction.

• It places the soft palate in contact with the lateral

and posterior pharyngeal walls to prevent nasal

air escape during speech

• Prevents regurgitation of food and liquid during

swallowing.www.indiandentalacademy.co

ANATOMY OF SOFT PALATE

MUSCLE OF SOFT PALATE

NERVE SUPPLY OF SOFT PALATE

FUNCTION OF SOFT PALATE

CLASSIFICATION OF SOFT PALATE DEFECT

JPD 1978.vol 39 page 539 www.indiandentalacademy.com

Surgically unrepaired

JPD 1978 vol 39 .539www.indiandentalacademy.com

• Surgically repaired soft palate

• Soft palate paralysis

• Palatopharyngeal deficiencies may be classified on the basis of physiology and structural integrity

Palatal insufficiency

Inadequate length of the soft palate to affect palatopharyngeal closure

Palatal incompetence

adequate length of soft palate

Speech

Speech is a learned process that makes use of

anatomic structures designed primarily for respiration

and deglutition.

(Huntington1968)www.indiandentalacademy.co

Components of speech

(Kantner and West 1941)www.indiandentalacademy.com

CHIERICI AND LAWSON

Audition

Speech begins with respiration

Vibrate the vocal cords ,called phonation

tone modified by the resonators the pharynx, oral and nasal cavity

shaped by the movement of the tongue, soft palate, teeth and lips during articulation

JPD 2000 VOL 83 PAGE 90 www.indiandentalacademy.com

SPEECH AND MAXILLOFACIAL PROSTHETICS

PALATOPHARYNGEAL / VELOPHARYNGEAL

FUNCTION

This term relates to the coordinated movement of the soft palate and

the lateral and posterior nasopharyngeal wall which is so important

for speech and swallowing .

DENTAL UPDATE 2005.32.217

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Physiology and anatomy

Palatopharyngeal mechanism is a precisely

coordinated valve formed by several muscle groups.

JPD 1991,66.63

• When Palatopharyngeal closure is required

The speech problem

Hypernasality

Nasal air loss on the plosives and affricate and

the fricative sounds

JPD AUG 1968 PAGE 182www.indiandentalacademy.co

Diagnostic assessment

JPD 1991.66.63-71

ACHIEVING ACCEPTABLE SPEECH

Speech and myofunctional therapy

Surgical procedures to reduce the

Palatopharyngeal gap

Faradization and electrical vibration massage

Prosthetic elevation and stimulation

Combination of surgery and a prosthesis

JPD 1976,MARCH ,PAGE 319www.indiandentalacademy.co

PROSTHODONTIC PROCEDURE

Palatal incompetency Palatal insufficiency

Palatal lift prosthesis was first advocated by

GIBBONS and BLOOMER (1958)

Indication

• Myasthenia gravis

• Cerebrovascular accidents

• Traumatic brain injuries

• Bulbar poliomyelitis

• Cerebral palsies

• Injury to the soft palate

Contraindication

• If adequate retention is not available for the

prosthesis

• If the soft palate is not displaceable

• Uncooperative patients

Objectives

hypernalality

palatal disuse tissue

Palatopharyngeal function

neuromuscular response

Repositioning of tongue

JPD MARCH 1976

Advantages

• Gag response is minimized

• Physiology of the tongue is not compromised

• Access to the nasopharynx for the obturator is

facilitated

• The lift portion may be developed sequentially

to aid patient adaptation to the prosthesis

• The lift principle has application to a diverse

patient population that cannot be treated as

effectively with palatal surgery.

FABRICATION

JP 2010.19.397-402

Before PLP After PLP

Clinical evaluation

JPD 1987.VOL 58 PAGE 206

Palatal lift prosthesis in edentulous patients

JPD 1987 VOL 58. NO 2.206www.indiandentalacademy.com

Removable palatal lift prosthesis

QUINTESSENCE INT 2002;33;675www.indiandentalacademy.co

Speech bulb or combination prosthesis

A conventional speech prosthesis may be divided

into three specific components or stages

The maxillary section

The palatal extension

Nasopharyngeal section

JPD MAY 1978 VOL 39 PAGE 539www.indiandentalacademy.co

Moulding procedures for speech bulb

The end of the loop should be at least 4mm short

of posterior pharyngeal wall

The head should be turned from left to right and

the chin dropped to the chest

The bulb should not interfere with the

musculature or pharyngeal narrowing

• Speech bulb should be placed in the location of

the greatest posterior and lateral pharyngeal wall

activity

• voice quality is best judged when speech bulb is

at this position.

Palatal training aid

Adisman has described an isometric palatal training prosthesis

• it is similar to the conventional speech prosthesis

• include a cast metal rings circumscribing the

uvula to permit free, unimpeded activity

• an acrylic extension retained by a cast metal loop

in the nasal cavity

• provides the antagonistic resistance to dorsal

movement of the soft palate

• it is attached superiorly to the uvula ring

Prerequisites of the palatal lift/pharyngeal section

combination prosthesis

Maxillary portion designed to achieve optimal

retention and stability

The lift portion should be placed so that palatal

elevation occur

Elevation of soft palate should be gradual

Pharyngeal section should be placed in the region

where constriction of the posterolateral

pharyngeal wall takes place

The reduction of the pharyngeal section

Speech therapy including lip, tongue, and palatal

exercise

JPD march 1976 www.indiandentalacademy.co

Results of palatal lift and combination prosthesis

Speech therapy

JP 2010 ;19:397-402

Bloomer mini test

Palatal incompetence Palatal insufficiency

Conclusion

The prosthodontist play a vital role in the

management of Palatopharyngeal disorders .

Palatal lift prosthesis serves to reduce

hypernalality and thus improves the intelligibility of

speech

Above all it contributes to improving the patient self

esteem.

The advantages of prosthodontic treatment is

relatively simple, noninvasive and versatile .

The speech prosthesis can eliminate hypernasality

and produce stimulation of the soft palate and does

not hinder growth and development.

• References

• Maxillofacial rehabilitation, Beumer,Curtis and

Fritell

• Maxillofacial prosthetics. Chalian

• BD Chaurasia – human anatomy 3rd edition

• Australian dental journal 1988;33;6:491-495

• Brit Dent J.1981;151:338

• JPD June 1967;page 620-626

• JPD May 1996;479-482

• JPD Aug 1987 vol 58 page 206

• JPD march 1976

• JPD 1978 vol 39 page 539-545

• JPD 1991;66:63-71

• JPD Aug 1968;page 182-188

• JPD 2000;83:99-106

• JPD 2000;83: 90-98

• Quintessence Int 2002;33:675-678

• Dental update 2005;32:217-223

• JP 2010 ;19:397-402

Palatal lift prosthesis/ orthodontic straight wire technique

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