Palatal lift prosthesis/ orthodontic straight wire technique
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Transcript of 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
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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
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ANATOMY OF SOFT PALATE
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MUSCLE OF SOFT PALATE
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NERVE SUPPLY OF SOFT PALATE
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FUNCTION OF SOFT PALATE
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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
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• Soft palate paralysis
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• Palatopharyngeal deficiencies may be classified on the basis of physiology and structural integrity
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Palatal insufficiency
Inadequate length of the soft palate to affect palatopharyngeal closure
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Palatal incompetence
adequate length of soft palate
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Speech
Speech is a learned process that makes use of
anatomic structures designed primarily for respiration
and deglutition.
(Huntington1968)www.indiandentalacademy.co
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Components of speech
(Kantner and West 1941)www.indiandentalacademy.com
CHIERICI AND LAWSON
Audition
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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
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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.
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JPD 1991,66.63
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• When Palatopharyngeal closure is required
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The speech problem
Hypernasality
Nasal air loss on the plosives and affricate and
the fricative sounds
JPD AUG 1968 PAGE 182www.indiandentalacademy.co
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Diagnostic assessment
JPD 1991.66.63-71
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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
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PROSTHODONTIC PROCEDURE
Palatal incompetency Palatal insufficiency
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Palatal lift prosthesis was first advocated by
GIBBONS and BLOOMER (1958)
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Indication
• Myasthenia gravis
• Cerebrovascular accidents
• Traumatic brain injuries
• Bulbar poliomyelitis
• Cerebral palsies
• Injury to the soft palate
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Contraindication
• If adequate retention is not available for the
prosthesis
• If the soft palate is not displaceable
• Uncooperative patients
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Objectives
hypernalality
palatal disuse tissue
Palatopharyngeal function
neuromuscular response
Repositioning of tongue
JPD MARCH 1976
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Advantages
• Gag response is minimized
• Physiology of the tongue is not compromised
• Access to the nasopharynx for the obturator is
facilitated
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• 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.
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FABRICATION
JP 2010.19.397-402
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Before PLP After PLP
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Clinical evaluation
JPD 1987.VOL 58 PAGE 206
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Palatal lift prosthesis in edentulous patients
JPD 1987 VOL 58. NO 2.206www.indiandentalacademy.com
JPD 1987 VOL 58. NO 2.206www.indiandentalacademy.com
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Removable palatal lift prosthesis
QUINTESSENCE INT 2002;33;675www.indiandentalacademy.co
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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
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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
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• 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.
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Palatal training aid
Adisman has described an isometric palatal training prosthesis
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• it is similar to the conventional speech prosthesis
• include a cast metal rings circumscribing the
uvula to permit free, unimpeded activity
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• 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
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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
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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
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Results of palatal lift and combination prosthesis
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Speech therapy
JP 2010 ;19:397-402
Bloomer mini test
Palatal incompetence Palatal insufficiency
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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.
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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.
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• 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
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• 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
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• 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
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