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Influence of Oral Morphology on Speech Production in Subjects Wearing

Maxillary Removable Partial Dentures with Major Connectors

Article  in  Folia Phoniatrica et Logopaedica · August 2018

DOI: 10.1159/000491789

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 Original Paper

Folia Phoniatr Logop 2018;70:138–148 Published online: August 23, 2018

DOI: 10.1159/000491789

Influence of Oral Morphology on Speech

Production in Subjects Wearing Maxillary
Removable Partial Dentures with Major
Connectors
Junichiro Wada a Masayuki Hideshima b Shusuke Inukai a Azusa Katsuki a
       

Hiroshi Matsuura c Noriyuki Wakabayashi a
   

a Sectionof Removable Partial Prosthodontics, Department of Masticatory Function Rehabilitation, Graduate School
of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan; b Dental Clinic for Sleep
 

Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, University Hospital of Dentistry, Tokyo Medical
and Dental University (TMDU), Tokyo, Japan; c Graduate School of Management and Information of Innovation,
 

University of Shizuoka, Shizuoka, Japan

Keywords the multiple linear regression test, a significant association

Dental consonant misarticulation · Morphology · Speech
production · Removable partial denture
Abstract
Background/Aims: Speech impairment during the initial
phase of removable partial denture (RPD) treatment can pre-
vent patient adaptation to RPDs. This study was undertaken
to investigate the influence of oral morphology on speech
production in subjects wearing RPDs with major connectors.
Methods: Two types of connectors were fabricated for 17
subjects with normal dentitions: covering the middle palate
(M-bar) and the anterior/posterior palate (AP-bar). Four tar-
get sounds ([∫i], [t∫i], [çi], and [ki]) were evaluated under 3
recording conditions: no connector, M-bar, and AP-bar. The
mean appearance ratios of correct labels (MARCs) were cal-
culated as parameters representing speech production ac-
curacy with the speech evaluation system. Subgroup analy-
sis was conducted based on palate height, dental arch width,
and front space volume of the oral cavity. Results: Based on
was found between the MARCs of [∫i] with M-bar and front
space (p = 0.036). In the subgroup analysis, the AP-bar had a
significant effect on the MARCs of [∫i] among subjects with
high palate (p = 0.026), narrow arch (p = 0.004), and small
front space (p = 0.014). Conclusion: RPDs with major connec-
tors could disturb speech production among patients with
high palates, narrow arches, and small front spaces.
© 2018 S. Karger AG, Basel
Introduction
Improving speech production is an important goal of
prosthetic dentistry in partially edentulous patients. A re-
movable partial denture (RPD) is an appropriate treat-
ment to restore missing teeth for partially edentulous pa-
tients whose remaining teeth have been weakened by se-
vere tooth wear or periodontitis [1–3]. Recently, the
combination of RPDs and implants has become a com-
mon method for restoring missing teeth with heavy re-
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© 2018 S. Karger AG, Basel Junichiro Wada

Department of Masticatory Function Rehabilitation, Graduate School of Medical
Tokyo Ikashika Daigaku

and Dental Sciences, Tokyo Medical and Dental University (TMDU)

E-Mail karger@karger.com
1-5-45 Yushima, Bunkyo-ku, 113–8549 Tokyo (Japan)
www.karger.com/fpl E-Mail wadajun.rpro @ tmd.ac.jp
sorption of partially edentulous ridges [4–6], and for re-
covery after failure of implant-supported fixed prostheses
[7], due to the adaptability of RPDs with respect to chang-
es in oral conditions [8, 9]. However, it has been reported
that RPDs can disturb speech production, in comparison
to other prostheses [10, 11]. Speech impairment signifi-
cantly affects the quality of life of RPD wearers [12]. Many
studies have investigated the influence of RPD design on
speech production [13–15]. According to these reports,
RPDs designed to cover a large area of the palate, espe-
cially the anterior palate, tend to disturb speech produc-
tion; thus, a palatal bar covering the middle area of the
palate is recommended to serve as a major connector of
RPDs.
Sound spectrography evaluates the influence of re-
movable dentures on speech production by analyzing the
energy spectrum and formant frequency of recorded
acoustic data [16, 17]. Palatography, which evaluates the
contact patterns of the tongue on the palate during pro-
nunciation, has also been used as a standard method [18–
22]. Although these methods have demonstrated effec-
tiveness in evaluating structural and physiological mech-
anisms, they are limited to the assessment of a single
aspect of speech production. More specifically, these
methods cannot directly evaluate how listeners recognize
the sound produced by the patient. Auditory evaluation
by speech pathologists can directly assess the produced
sounds. However, this involves limitations in terms of re-
liability and reproducibility [23, 24].
We previously developed an evaluation system with
incorporated speech recognition. This system could spe-
cifically and objectively evaluate the accuracy of speech
production [25] and report the influence of RPD designs
on speech production [15, 26–28]. Nevertheless, speech
impairment remains an intractable problem in clinical
practice, as RPD design is influenced by the condition of
the remaining teeth and alveolar ridge, rather than the
phonetic function of patients.
Frank et al. [29] reported that design/fabrication stan-
dards were not related to patient satisfaction, including
speech production. Clinically, RPDs with similar designs
could disturb patients’ speech production by varying de-
grees; thus, speech impairment after RPD insertion is de-
pendent on both RPD design and patient factors. Al-
though the relationship between speech production and
deformation of the oral cavity in patients after tumor ex-
cision has been evaluated with and without prostheses,
few studies have investigated the relationship between
RPDs and speech production, focusing on morphological
characteristics of the patients’ oral cavities [30–32]. Brun-
Influence of Oral Morphology on Speech
with Partial Dentures
ner et al. [33, 34] reported that the shape of the palate af-
fects acoustic variability. Tanaka [35] reported that palate
morphology affected the speech patterns of complete
denture (CD) wearers. The shapes of the palate and den-
tal arch are important factors in RPD design, especially
when choosing the major connector. Predicting the influ-
ence of the major connector on speech production, spe-
cifically on the basis of oral morphology, would substan-
tially facilitate RPD design.
With regard to long-term adaptation, Hamlet and
Stone [36] reported that successful adaptation to speech
production occurred in one-half of subjects at 2 weeks
after placement of the palatal plate. Knipfer et al. [37] re-
ported that disorders of speech production with CDs dis-
appeared 6 months after placement. Although those stud-
ies indicated that adaptation for a certain period after
placement of RPD could help patients to overcome disor-
ders of speech production, speech disorders that occur
soon after RPD insertion may prevent patients from con-
tinuing to use their new RPDs before sufficient adapta-
tion to wearing their RPDs [38]. Additionally, for clini-
cians, the ability to predict whether patients will experi-
ence speech problems, and to determine the severity of
those potential problems, will facilitate decisions regard-
ing whether particular patients must be monitored and
referred for speech therapy.
We previously evaluated the influence of placement
area and cross-sectional shape of major connectors on
speech production [15, 28]. In this study, we inserted ex-
perimental major connectors into subjects with various
palatal shapes and dental arch morphologies. The accu-
racy of phonetic output and changes in Japanese conso-
nants were evaluated by a speech evaluation system. Our
goal was to investigate the influence of oral morphology
on speech production in subjects wearing major connec-
tors in the initial phase of RPD treatment. The null hy-
pothesis was that oral morphology would not influence
speech production in subjects wearing major connectors.
Materials and Methods
Subjects
Adult subjects were recruited from a pool of patients and staff
members at Tokyo Medical and Dental University Dental Hospital
(Tokyo, Japan) in 2016–2017. Only volunteers who spoke standard
Japanese and had class I occlusion were included in this study. Ex-
clusion criteria comprised the following: (1) suspicion of speech
impairment (either reported by the participants or based on the
clinical impression of the experimenter [J.W.] at the time of in-
take), (2) acute symptoms of oral and/or craniofacial diseases, (3)
current dental treatment, and (4) missing teeth, except third mo-
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DOI: 10.1159/000491789
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 10 mm

10 mm 10 mm

0.8 mm

0.8 mm 0.8 mm
a b

Fig. 1. Experimental major connectors. Photograph depicting experimental major connectors covering the mid-
dle area of the palate (M-bar) (a) and both anterior and posterior areas of the palate (AP-bar) (b). Schematic il-
lustrations represent cross-sectional views of the connectors.

lars. Subjects received written information regarding the study
purpose and protocol before they consented to participation. A
total of 17 subjects (7 female, 10 male; mean age, 35.0 years; range,
21–58 years) were eligible to participate. All experimental proce-
dures upheld the principles of the 1975/1983 Helsinki declaration
and were approved by the Ethics Committee of the University (Au-
thorization No. 286).
Design of the Experimental Procedure
As shown in Figure 1, the experimental major connectors were
fabricated from cobalt-chromium (Cobaltan; Shofu Co., Kyoto, Ja-
pan) by using casts made from silicone impressions of the subjects’
maxillae. Two different designs were fabricated: a connector cov-
ering the middle area of the palate (M-bar) and a connector cover-
ing both the anterior and posterior areas (AP-bar). The connectors
were fabricated with a maximum thickness of 0.8 mm and a width
of 10 mm at the narrowest part. The cross-sectional shape of the
connecter in the sagittal plane was moderately curvilinear.
Recording and Evaluation of Speech Data
In speech, consonants whose production requires contact be-
tween tongue, palate, and alveolus were reported to be affected by
the placement of dentures [13–17, 20, 22, 26–28, 39, 40]. In addi-
tion, disorders of pronunciation have been reported to appear
readily on the second mora [39, 40]. Accordingly, the second mo-
rae (/shi/: [∫i], /chi/: [t∫i], /hi/: [çi], and /ki/: [ki]) of 4 test words
(/i/shi/kawa/, /i/chi/ro/, /e/hi/meken/, and /o/ki/nawa/) were cho-
sen as the target sounds (Table 1). These target sounds can be clas-
sified into 3 groups on the basis of articulation position: (1) alveo-
lar: [∫i] and [t∫i]; (2) palatal: [çi]; and (3) velar: [ki]. The sounds
can also be classified into 3 groups on the basis of the manner of
articulation: (1) fricative: [∫i] and [çi]; (2) affricate: [t∫i]; and (3)
plosive: [ki]. The target sounds included the vowel [i], which re-
quires the highest tongue position among Japanese vowels. These
test words are meaningful Japanese words, which have both target
sounds and accents on the second morae.
Speech data of the test words were recorded under the follow-
ing conditions: without a connector (control); with M-bar; and
with AP-bar. Each subject was required to pronounce a test word
5 times under the above-mentioned conditions. The order of the
recording conditions was randomly arranged. Each subject was
instructed not to vocalize the test words before recording, and the
recordings were initiated immediately after the connectors were
stably inserted. During the measurements, the subjects were asked
to maintain their pronunciation at a constant speed and volume,
as in their daily life. Speech data were recorded with a headset-type
microphone and a laptop computer (PAC9214LDEW; Toshiba
Co., Tokyo, Japan) with a speech evaluation system. Subjects were
given rests after each recording and were not allowed to speak dur-
ing the breaks.
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DOI: 10.1159/000491789 Matsuura/Wakabayashi
Tokyo Ikashika Daigaku
 23 ms Speech waveform
of test word
Analytical frames
79 ms 8 ms

Power spectrum

FFT 64 ms

8 ms

MAFP 48 ms Reference patterns

Pattern matching

GG $$ $I ##
Segment label
8 ms $I Segment label
a b

Fig. 2. Flow process of the speech evaluation system. a Acoustic
analysis was performed using a fast Fourier transform (FFT) that
transformed the speech data of 8 analytical frames (79 ms) into 64
ms of information (FFT parameters). Then, the multiple acoustic
feature plane (MAFP) pattern, emphasizing the local changes in
frequency and time frame, was extracted. Finally, 6 MAFP patterns
(48 ms) were quantized with statistical pattern-matching process-
ing and the integrated phonetic segment was labeled every 8 ms.
b The pattern is extracted from the power spectrum every 8 ms.
The extracted pattern is matched to a phonetic segment in the ref-
erence patterns and labeled as a combination of 2 letters.

Table 1. Target sounds and test words

Target sounds Test words

IPA sound articulation point articulation manner correct label(s) word meaning

[∫i] /shi/ alveolar fricative $$, SS, $I i/shi/kawa name of a Japanese golf player
[t∫i] /chi/ alveolar affricate CC, CI i/chi/ro name of a Japanese baseball player
[çi] /hi/ palatal fricative ##, HH, HI e/hi/meken one of the prefectures in Japan
[ki] /ki/ velar plosive KI o/ki/nawa one of the prefectures in Japan

The speech evaluation system (Voice Analyzer; Toshiba Digital
Media Engineering Co., Tokyo, Japan) used speech recognition
based on 213 types of integrated phonetic segments that represent
phonetic features of transitions from one phoneme to another [27].
The flow process of this system is shown in Figure 2. The acoustic
analysis, which had an analytical frame of 23 ms and a frame shift
range of 8 ms, was performed by using a fast Fourier transform)
that transformed the speech data of 8 analytical frames (79 ms) into
64 ms of information (fast Fourier transform parameters). Then,
multiple acoustic feature plane patterns, emphasizing local changes
in frequency and time frame, were extracted. Finally, the 6 multiple
acoustic feature plane patterns (48 ms) were quantized with statis-
tical pattern-matching processing and the integrated phonetic seg-
ment was labeled every 8 ms. Thus, this system performed micro-
period (8 ms) evaluations on a frame-by-frame basis and was able
to record time-scale information (Fig. 2a). Integrated phonetic seg-
ment labels which indicated the correct pronunciation of the target
part of the target sound were defined as “correct labels” (Table 1).
The number of correct labels varied with the type of test sound. This
system also performed macro-period quantitative sound evalua-
tions by using the ratio between the numbers of correct and incor-
rect integrated phonetic segment labels during the evaluation pe-
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Influence of Oral Morphology on Speech Folia Phoniatr Logop 2018;70:138–148 141

with Partial Dentures DOI: 10.1159/000491789
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 I I I I I $ C $ $ $ $ C C $ C I I I I I I I K K K K K K K A A A A A A A WW
S S S S S $ C $ I $ $ C C $ Y 4 4 Q Q Q 4 Q A A A A A A A A A A W O WW A A

I I I $ C $ $ $ $ C C $ C I I I

S S S $ C $ I $ $ C C $ Y 4 4 Q

Transition from Consonant part of [∫i] Vowel part

[i] to [∫i] (Target part) of [∫i]
MARC = 60%

Fig. 3. Method of calculating the mean appearance ratio of correct labels (MARC) (sample [∫i]). In this record-
ing, there are 10 segment labels in the target part. There are 6 correct labels of [∫i] ($$ and $I) and 4 incorrect
labels (CC and CY). Thus, the MARC of [∫i] is calculated to be 60%.

riod. Matsuura et al. [25] conducted a recall test to verify the reli-
ability of this system with sound subjects. The recall and precision
averages were 95.4 and 95.9%, respectively. The F-measure was
95.7, which indicated that the speech evaluation system was a reli-
able method [41]. The results of our studies with this system were
consistent with the results of previous studies with conventional
methods, such as sound spectrography, palatography, and auditory
evaluations by speech pathologists [15–28].
As shown in Figure 2b, the pattern was extracted from the pow-
er spectrum and matched to a phonetic segment of the reference
pattern. These results were labeled and displayed. As an example,
the method to extract the consonant part of the target sound [∫i]
from the speech data of the test word /i/shi/kawa/ is shown in Figure
3. The head border of the range of the [∫i] sound was the transition
from [i] to [∫i], and the foot was the part containing the transition
from [∫i] to [ka]. The vowel part of [∫i] was then removed, and the
remaining section was defined as the target part. Extractions of oth-
er target sounds were performed in the same manner. The ratios of
correct labels to all labels appearing in the consonant parts of the
target sounds were calculated. The mean appearance ratio of correct
labels (MARC) was regarded as a representative value reflecting the
accuracy of phonetic output of the target sounds. The mean appear-
ance ratio of incorrect labels (MARIC) was also calculated for statis-
tical analysis. For other target sounds, calculations of MARCs and
MARICs were performed in the same manner.
Morphometry of Oral Cavity and Subgrouping
Maxillary stone models of the subjects were digitized with a
three-dimensional (3D) scanner (ARCTICA Scan; KaVo, Biber-
ach, Germany). The digital data were saved in a surface tessellation
language (STL) format. Three parameters – representing the shape
of the palate and dental arch; palate heights, narrowing of dental
arches, and front spaces of the oral cavities – were then computed
for each STL datum by using 3D evaluation software (Geomagic
Studio 2014; 3D Systems, Rock Hill, SC, USA). Calculation meth-
ods for these parameters are shown in Figure 4. The palate height
was defined as the distance from the midpoint between the mesio-
palatal cusps of both first molars to the palate (Fig. 4a). The ratio
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 CR
Palate height
a b
Reference plane (RP)
PI
PR
PL
c d
Fig. 4. Calculation of the 3 morphological parameters. a Palate
height was calculated as the length of the line (perpendicular to the
reference plane [RP] from the midpoint between the mesiopalatal
cusps of the left (CL) and right first molars (CR) to the palate.
b Narrowing of the dental arch was calculated as the ratio of the
interpremolar distance (DIP) to the mesiodistal width of the dental
arch (WMD). c The RP included the incisive papilla (PI) as well as
the palatal interdental papillae between the first and second molar
of the interpremolar distance to the mesiodistal width of the dental
arch was defined as narrowing of the dental arch (Fig. 4b). The to-
tal volume of the oral cavity was divided into front volume and rear
volume. The ratio of front volume to total volume was defined as
the front space (Fig. 4c, d).
The study group was divided into 2 subgroups for each param-
eter (Table 2). The boundary between the 2 subgroups was the
median of all subjects.
Statistical Analysis
The Kolmogorov-Smirnov test was used for normality analysis.
Due to the absence of normality of some data, such as MARCs of
[∫i] and [ki], nonparametric statistical analyses were conducted.
Spearman’s rank correlation with Bonferroni correction was per-
formed to evaluate associations between morphometric parame-
ters. For each parameter, comparisons of MARCs among the 3
recording conditions (no connector, M-bar, and AP-bar) were
Influence of Oral Morphology on Speech
with Partial Dentures
DIP
CL
WMD
PI
RP
BP
DP
of the left side (PL) and right side (PR). d The front space was cal-
culated as the ratio of front volume to total volume. The total vol-
ume was defined as the space enclosed by the palate, RP, and distal
plane (DP; the perpendicular plane to RP including the distal ends
of the left and right second molars). The bounding plane (BP) be-
tween the front and rear spaces included the midpoint of the per-
pendicular line from PI to DP.
performed for each subgroup by using the Friedman test and pair-
wise comparisons. A multiple linear regression test was applied to
evaluate the association of the 3 morphometric parameters to
MARCs with each recording condition. For the comparison of
MARICs, the Mann-Whitney U test was performed among sub-
groups for the 3 parameters (SPSS version 22.0; SPSS Japan Inc.,
Tokyo, Japan); p < 0.05 after Bonferroni correction was considered
to be statistically significant.
Results
Correlations between Morphometric Parameters
Front space was significantly correlated with palate
height (ρ = –0.591; p = 0.039). Narrowing of the dental arch
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 Table 2. Morphological characteristics of subjects

Subject HP, mm HP NDA NDA FS, % FS

No. sex age, years subgroup subgroup subgroup

1 M 28 13.17 low 1.09 narrow 24.90 large

2 F 22 15.32 low 1.12 wide 20.64 small
3 F 27 16.60 low 1.11 wide 20.12 small
4 F 28 16.79 low 1.08 narrow 27.90 large
5 M 27 16.97 low 1.14 wide 23.22 large
6 M 46 17.16 low 1.08 narrow 31.37 large
7 M 54 17.28 low 1.10 wide 27.40 large
8 F 23 17.99 low 1.01 narrow 27.22 large
9 M 27 18.09 low1 1.08 narrow 25.59 large
10 M 39 19.27 high 1.04 narrow 22.26 large
11 F 58 19.48 high 1.14 wide 20.40 small
12 M 29 19.54 high 1.03 narrow 20.63 small
13 M 37 20.05 high 1.22 wide 16.57 small
14 F 29 20.35 high 1.08 narrow1 15.61 small
15 M 58 20.50 high 1.17 wide 18.88 small
16 M 21 20.66 high 0.96 narrow 21.92 small1
17 F 42 21.18 high 1.08 narrow 15.58 small

HP, height of palate; NDA, narrowing of dental arch; FS, front space. 1 Median of all subjects.

Table 3. Partial regression coefficients (β) in multiple regression analysis among morphometric parameter and
MARC with each recording condition

Recording condition: M-bar AP-bar

Target sound: [∫i] [t∫i] [çi] [ki] [∫i] [t∫i] [çi] [ki]

Height of palate 0.512* 0.422 0.244 –0.299 –0.076 0.101 0.167 –0.062
Narrowing of dental arch 0.143 –0.061 –0.124 –0.089 0.427 0.42 0.056 0.134
Front space –0.188 0.118 –0.09 –0.506 –0.343 0.108 0.001 –0.37

* p < 0.05.

was not significantly correlated with palate height (ρ =
–0.184; p = 1.00) or front space (ρ = –0.328; p = 0.594).
Correlations between MARCs and Parameters
The results of multiple linear regression tests are
shown in Table 3. A significant correlation was found
only between the change in MARCs of [∫i] with M-bar
and “front space” (β = 0.512, p = 0.036).
Subgroup Comparison of MARCs among 3 Recording
Conditions
The MARCs under the 3 recording conditions, ac-
cording to morphological subgroup, are shown in Figure
5. The placement of an M-bar had no significant effect on
the MARCs of all target sounds in all subjects; however,
placement of an AP-bar had a significant effect on the
MARCs of [t∫i] and [ki] (Fig. 5c). No significant effect
was found under any recording condition with respect to
the MARCs of [çi] (Fig. 5b).
In contrast, the placement of an AP-bar had a signifi-
cant effect on the MARCs of [∫i] among high-palate (p =
0.026), narrow dental arch (p = 0.004), and small front
space subgroups (p = 0.014) (Fig. 5a).
Comparison of MARICs
Regardless of the recording condition, type of target
sound, or subgroup, various incorrect labels appeared
among all subjects. Regarding the MARICs of [ki], incor-
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 ■ Ctrl ■M ■ AP

* ** *
**
100

80
MARC of [∫i], %

60

40

20

0
Low High Narrow Wide Small Large
a Palate Dental arch Front space

100

80
MARC of [çi], %

60

40

20

0
Low High Narrow Wide Small Large
b Palate Dental arch Front space

* ** ** ** ** ** ** ** ** * ** **
100
*
80

60
MARC, %

40

20

0
Low High Low High Narrow Wide Narrow Wide Small Large Small Large
[t∫i] [ki] [t∫i] [ki] [t∫i] [ki]

c Palate Dental arch Front space

Fig. 5. MARCs under 3 recording conditions, according to morphological subgroup. The MARCs under 3 record-
ing conditions (the white bar, grey bar, and dark bar represent control [Ctrl], with M-bar, and with AP-bar, re-
spectively) are shown by the subgroups. The MARCs of [∫i], [çi], and both of [t∫i] and [ki] are shown in a, b, and
c, respectively. The asterisks indicate a significant difference between recording conditions (* p < 0.05, ** p < 0.01).
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with Partial Dentures DOI: 10.1159/000491789
Tokyo Ikashika Daigaku

■ Low-palate ■ High-palate
* *
16
12
MARIC, %
8 Previous palatographical studies reported that vocal
4 by changes in the tongue contact, as well as disorders of
0 the placement of dentures [18–21]. The speech evaluation
M-bar AP-bar M-bar AP-bar
[gi] [çi]
Fig. 6. Appearance ratios of incorrect labels of [ki]. The mean ap-
pearance ratios of incorrect labels (MARICs) of 2 labels of [ki] ([gi]
and [çi]) are shown by the recording conditions. The white bars
represent the low-palate group, while the dark bars represent the
high-palate group. The asterisk indicates a significant difference
(* p < 0.05) between groups.
rect labels representing the [gi] sound were significantly
higher with the placement of M-bars in low-palate subjects
(p = 0.027). The number of incorrect labels representing
the [çi] sound significantly increased with the placement
of an AP-bar in a high-palate subject (p = 0.027) (Fig. 6).
Discussion
In this study, 2 alveolar ([∫i] and [t∫i]), 1 palatal ([çi]),
and 1 velar ([ki]) sounds were considered the target
sounds. During articulation, the [∫i] and [çi] sounds do
not require contact between the tongue and palate, where-
as [t∫i] and [ki] sounds do require contact. To minimize
the influence of individual variations on the speech data,
the selected test words were proper familiar nouns for
these study subjects. In contrast to the auditory evalua-
tion by speech pathologists, this selection did not affect
evaluation by the speech recognition system.
The results of this study showed that [t∫i] and [ki]
were significantly disturbed by the placement of an AP-
bar, with no significant effect on [çi] among all subjects.
This was consistent with the findings of previous studies
[13–17, 20–22, 26–28, 39, 40]. In contrast, there were dis-
tinctive trends in subgroup analysis only in the MARCs
of [∫i], which was readily disturbed by dentures (in a
146 Folia Phoniatr Logop 2018;70:138–148
DOI: 10.1159/000491789
manner similar to [t∫i] and [ki]). Thus, the findings of
this study suggested that a palatal bar covering the middle
area of the palate was not detrimental for speech produc-
tion, regardless of the shapes of the dental arch and palate.
Furthermore, the major connectors of RPDs exhibited di-
verse categories of sound that were readily disturbed
among high-palate, narrow dental arch, and small front
space patients.
tract leaks-in and closures in the oral cavity, both caused
speech production, were typically encountered following
system used in this study could assess leaks-in or closure
of the vocal tracts by comparing tongue contact areas be-
tween the target and emerging sounds, thus identifying
the incorrect labels [15, 27, 28]. In this study, the appear-
ance of the [gi] sound as an incorrect label for [ki] sig-
nificantly increased with the placement of an M-bar in
low-palate subjects, compared with high-palate subjects.
Since the voice onset time of the voiced plosive [gi] is
shorter than that of the voiceless plosive [ki], the appear-
ance of [gi] indicated that the voice onset time of [ki] was
incidentally shortened [42, 43]. This suggests that the
placement of a palatal bar covering the middle area in
low-palate patients could readily cause closures of the vo-
cal tracts. In contrast, the appearance of the [çi] sound as
the incorrect label for [ki] significantly increased with the
placement of an AP-bar in high-palate subjects, in com-
parison to low-palate subjects. The tongue does not block
airflow through the vocal tract when the fricative [çi] is
produced. However, the vocal tract is blocked when the
plosive [ki] is produced. Thus, the appearance of [çi] in-
dicated that the vocal tract for [ki] was incidentally leaked
by the placement of an AP-bar. This suggests that the
placement of a palatal bar covering both anterior and pos-
terior areas for high-palate patients could readily cause a
leak in the vocal tract.
Despite various reported methods for evaluating the
shape of the palate and dental arch, there is no consensus
standard [44, 45]. In this study, palate height, narrowing
of the dental arch, and the ratio of front area space were
regarded as “palate and dental arch parameters,” which
could be easily measured on maxillary stone models.
Tanaka [35] reported that disorders of speech production
with CDs were more severe in small front space patients
than in large front space patients. Although we identified
a significant association between MARC of [∫i] with M-
bar and front space on the basis of multiple linear regres-
sion, our findings that placement of the experimental bar
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significantly disturbed speech production in small front
space subjects, compared with large front space subjects,
suggested that speech production in small front space pa-
tients was readily disturbed by RPDs. However, the ratio
of front volume to total volume is difficult to calculate at
the chairside. Conversely, palate height and narrowing of
the dental arch can be easily calculated by dental clini-
cians. The results of correlation analysis among the 3 pa-
rameters revealed a negative correlation between the ratio
of front volume to total volume and palate height, as the
palate height of small front space subjects was high. The
results of MARC analysis in high-palate subjects were
similar to that of small front space subjects in this study.
Brunner et al. [33] reported that acoustic variability was
lower among speakers with low palates than among
speakers with high palates. Our findings suggested that
oral morphology affected the speech production of RPD
wearers, as mentioned in previous studies regarding
sound dentitions; moreover, prediction of speech disor-
ders in RPD wearers, based on their palate heights or nar-
rowing of the dental arches, was effective.
It was appropriate to recruit RPD wearers to evaluate the
influence of major connectors of RPDs. However, other fac-
tors, including history of RPD use or the condition of op-
posing dentitions, could affect speech production in RPD
wearers [10]. In this study, we recruited subjects with nor-
mal dentitions to clarify the influence of connector place-
ment, palate shape, and dental arch shape. In this study,
MARC evaluations were consistent with the findings of
previous studies that investigated speech production among
RPD wearers [13–16, 26–28]. Therefore, subjects chosen
for this study were appropriate, regardless of whether they
were RPD wearers. However, post hoc analysis yielded a
power <0.8, which suggests that the sample space may have
been inadequate and may have led to false negatives.
Previous studies revealed the presence of variability in
MARC speech evaluation among subjects without exper-
imental connectors [15, 25–28]. Thus, the MARCs with
connectors were analyzed with respect to those without
connectors; therefore, we did not conduct comparative
analyses between subgroups for the evaluation of MARCs;
instead, we performed a Friedman test. The Mann-
Whitney U test was performed for subgroup analyses of
MARICs because target-incorrect labels in this study did
not emerge without experimental connectors; therefore,
appearance ratios between subgroups could be com-
pared.
In this study, the influence of experimental connectors
on speech production was evaluated immediately after
placement. Baum and McFarland [46] reported that adap-
Influence of Oral Morphology on Speech
with Partial Dentures
tation to structural modification of the oral cavity could
occur relatively quickly by using intensive, object-specific
practice with a palatal plate. Therefore, we randomized
the order of the 3 recording conditions for each subject to
avoid the possibility of short-term adaptations. Although
several reports regarding palatal plates or CDs have fo-
cused on long-term adaptations, there have been no stud-
ies investigating adaptations to speech production in RPD
wearers with bar-type major connectors [36, 37]. Celebić
and Knezović-Zlatarić [11] reported that disorders in
speech production were more prevalent among RPD
wearers than among CD wearers. The findings of the pres-
ent study indicated that oral morphology could amplify
disorders of speech production in RPD wearers in the ini-
tial phase of RPD treatments. For clinicians, it is impor-
tant to elaborate sensational disturbances associated with
initial RPD treatment phases until sufficient patient adap-
tation occurs, and to determine which patients will re-
quire care for a speech disorder. Our findings showed that
speech impairments tended to appear immediately after
RPD placement in patients with high palates and/or nar-
row dental arches. The relationship between oral mor-
phology and adaptation to speech production in RPD
wearers would be an interesting topic for future studies.
Conclusion
We evaluated the influence of oral morphology on
speech production in subjects with experimental major
connectors. Notably, patients with high palates and/or
narrow dental arches appear more prone to speech disor-
ders during the initial phase of RPD treatment. Thus,
treating patients with such characteristics requires fur-
ther consideration regarding shapes and designs of major
connectors.
Acknowledgements
This work was partially supported by grants (No. 16K20485 to
J.W. and No. 15K20430 to A.K.) offered by the Ministry of Educa-
tion, Culture, Sports, Science, and Technology of Japan. The au-
thors would like to thank the staff of Toshiba Digital Media Engi-
neering, who were involved in the development of the Voice Ana-
lyzer used in this study. We would also like to thank Kazuyuki
Handa and Hironari Hayama for their valuable comments.
Disclosure Statement
The authors have no conflict of interest to declare.
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Folia Phoniatr Logop 2018;70:138–148 147
DOI: 10.1159/000491789
Tokyo Ikashika Daigaku
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