RESUMEN
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.
RESUMEN
STATEMENT OF PROBLEM: Clinical studies on the wear properties of different zirconia surfaces are lacking. Selecting a surface that causes and undergoes minimal wear will help improve clinical outcomes. PURPOSE: The purpose of this clinical study was to evaluate and compare the wear over 1 year use of glazed zirconia (GZ) and polished zirconia (PZ) crowns opposing natural enamel and the wear of natural enamel opposing PZ and GZ crowns. MATERIAL AND METHODS: This prospective, split mouth, randomized clinical trial included 14 participants requiring complete coverage crowns on first molars, bilaterally, in a completely dentate mandibular arch. GZ and PZ crowns were cemented according to a randomization chart. Polyvinyl siloxane impressions were made immediately and 1 year after the cementation of the crowns. The respective casts were scanned by using a 3D scanner and a software program to measure the amount of linear wear of zirconia crowns and opposing natural teeth. Wear was observed in 8 groups: PZ crowns, GZ crowns, natural enamel opposing natural enamel in the molar and premolar regions (NE-M and NE-PM), natural enamel opposing PZ crowns in the molar region (NE-PZ-M), natural enamel opposing GZ crowns in the molar region (NE-GZ-M), natural enamel opposing PZ crowns in the premolar region (NE-PZ-PM), and natural enamel opposing GZ crowns in the premolar region (NE-GZ-PM). A descriptive analysis was followed by comparison between groups by using a repeated-measure ANOVA with post hoc adjustments (α=.05). RESULTS: The mean wear (µm) observed was as follows (in ascending order): PZ crowns (13 ±3), NE-PM (13 ±1), GZ crowns (27 ±9), NE-M (34 ±3), NE-PZ-PM (44 ±18), NE-PZ-M (63 ±22), NE-GZ-PM (69 ±21), NE-GZ-M (113 ±33). Wear of GZ and PZ crowns was less than wear of NE-M. The difference was statistically significant when comparing PZ with NE-M (P<.001, CI=-17 to -24). Wear of NE-GZ-M and NE-PZ-M was higher than wear of NE-M, with a statistically significant difference (P<.001, CI=-49 to -107 and P =.004, CI=-8 to -49, respectively). Wear of NE-GZ-M was more than that of NE-PZ-M, and the difference was statistically significant (P<.001, CI=-68 to -32). Wear of NE-PZ-PM and NE-GZ-PM was also more than the wear of NE-PM, and the difference was statistically significant (P<.001, CI=-17 to -43 and P<.001, CI=-39 to -70). CONCLUSIONS: PZ and GZ crowns wear substantially with time, with lesser wear observed in PZ crowns. PZ and GZ crowns also cause more wear in opposing natural enamel than natural enamel antagonists, with the highest wear caused by GZ crowns.