The European Journal of Orthodontics Advance Access published August 9, 2016

European Journal of Orthodontics, 2016, 1–6

doi:10.1093/ejo/cjw050

Original Article

Comparing the effects of Essix and Hawley

retainers on the acoustics of speech
Ezgi Atik1, Fatma Esen Aydınlı2, Maviş Emel Kulak Kayıkçı2 and
Semra Ciğer1
1
Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey and 2Department of Speech
Language Pathology, Faculty of Health Science, Hacettepe University, Ankara, Turkey

Correspondence to: Ezgi Atik, Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100
Ankara, Turkey. E-mail:ezgibaytorun@hotmail.com

Summary
Objective:  The aim of this study was to compare the effects of two retainer types (Essix and
Hawley) on speech performance.

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Subjects and methods:  The speech articulation of 30 patients was evaluated prospectively. Five
patients did not appear during the follow-up periods. The patients were randomly divided into
retention groups by treatment allocation cards as Essix and Hawley. The Essix group included
13 participants with a mean age of 15.3 ± 2.4  years; the Hawley group included 12 participants
with a mean age of 16.3 ± 2.56  years. Speech sound assessments were performed on the first
day and 1 week, 4 weeks, and 3 months later. On the first day, the assessments were conducted
prior to inserting the retainers, immediately after maxillary and mandibular retainer application,
individually, and with both retainers applied. The acoustic analyses were obtained using spectral
and temporal parameters.
Results:  Statistical analyses were performed with IBM SPSS for Windows, version 20. A P value
less than 0.05 was considered statistically significant. The most apparent changes were found in
the [a] vowel in the Hawley group, the [e] vowel in the Essix group, and the [u] vowel in both
groups (P < 0.05). While the number of affected consonant–vowel couples in the Essix group was
low, alterations were common in the Hawley group. There was a statistically significant difference
(P < 0.05) in voice onset time of the [d] sound between the groups.
Limitations:  The trial had a small sample size and a short follow-up period.
Conclusions:  The Hawley retainer affected articulatory movements in consonant–vowel
combinations more prominently than the Essix retainer did. Voice onset time of the consonant
[d] in the Hawley group was shorter than normal, indicating rapid articulatory movement in the
alveolar region.

Introduction retainers are acrylic, whereas Essix retainers are vacuum formed.
Both appliances fit against the lingual surfaces of the teeth, palate,
Retainers are routinely used by patients for 6–12 months after ortho-
and lingual mucosa in the maxillary and mandibular arches. Essix
dontic treatment has been completed because remodelling of the soft
retainers were introduced in 1996; since then, their rate of use has
and hard tissues occurs during this period (1). However, in the long
increased more than that of Hawley retainers. This is probably due
term, it might be necessary to sustain the retention protocol until
to their improved aesthetics, ease of fabrication, and lower costs (2).
the growth is complete. Hawley and Essix are the two most com-
Many studies have reported that removable retainers affect
monly used removable retainers in orthodontic treatment. Hawley
speech production (3–7). Erb (3) found distortions of lingualveolar,

© The Author 2016. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved.
1
For permissions, please email: journals.permissions@oup.com
2 European Journal of Orthodontics, 2016
linguopalatal, and linguodental sounds immediately after a maxil-
lary retainer was worn. Haydar et al. (4) noted significant articula-
tory distortions on the first day with upper retainer wear only and
with both retainers worn together. However, they reported that these
distortions disappeared completely by the seventh day, indicating
tongue adaptation in a very short period. Kulak Kayikci et  al. (6)
assessed the effects of Hawley retainers on speech disturbance and
the duration of speech adaptation to Hawley retainers. They con-
cluded that the retainer caused temporary changes (1 week to as long
as 3 months) in speech as the patients adapted their speech patterns.
Speech articulation is one of the most complex motor activities
in humans, and articulatory organs alter the resonance of the vocal
tract in various ways (8). Because speech articulation needs rapid,
complex, and delicate movements of the articulator organs, it can
be affected by dental appliances. Articulatory–acoustic features of
speech sounds may be a useful instrument for assessing articulation
proficiency (9). One of the most important analysed acoustic char-
acteristic of vowels is called formant frequency. Formant frequencies
can be used as indexes of front–back or low–high dimensions of
lingual function (10). As a general rule, First Formant Frequency
(F1) is related to tongue height, Second Formant Frequency (F2) is
related to tongue advancement and lip rounding, and Third Formant
Frequency (F3) is related more to the back oral cavity (10). The
articulatory–acoustic relationship is also important in consonant
production. When producing stop consonants, articulators create a
brief constriction. Air pressure builds up behind this constriction,
and it is released from the mouth by sudden movement of the articu-
lators. The shape, timing, and degree of this constriction lead to the
occurrence of some acoustic events. One of those events is called
‘voice onset time’ (VOT) (11). VOT measurements provide infor-
mation regarding the temporal relationship between the onset of
glottal pulsing and the release of the initial stop consonant (11–13).
VOT also helps to differentiate between voiced and voiceless stops
(11,14).
Many studies have conducted acoustic analyses of speech with
regard to orthodontic appliances (15–18). However, only in one
study (6), the formant frequencies of sustained vowels were meas-
ured as they relate to wearing retainers. The main purpose of the
present prospective study was to compare the effects of two retainer
types (Essix and Hawley) on the acoustics of speech. From a tempo-
ral acoustics standpoint, alveolar stop consonants [d] and [t] were
also selected for VOT analysis. They may tend to have articulatory
distortion depending on the manner and place of their production.
To investigate spectral acoustics, the formant frequencies of the vow-
els [a], [e], [u], and [i] and consonants combined with the vowel [a]
were examined. The hypothesis to be tested was whether there was a
difference in speech production between the use of Hawley and Essix
retainer. The null hypothesis was that there were no significant dif-
ferences in the speech production changes caused by the Hawley and
Essix retainers. The alternative hypothesis would be that Hawley
retainer effected speech performance more than the Essix retainer.
Subjects and methods
At the end of the orthodontic treatment, the speech articulation
of 30 patients was evaluated with the initiation of retainer wear.
This study was carried out in accordance with the ethics board of
Hacettepe University (GO 15/124–32).
Thirty patients were selected at the beginning of the study to
provide a power of 80 per cent with a 5 per cent significance level
to detect a true difference. For the most important five variables (ç,
g, m, u, a), the sample sizes were calculated separately based on the
difference in the groups between the different time points; maximum
sample size was taken into account. The power analysis was done via
the two-way repeated measures.
These patients were randomly divided into two equal retention
groups as Essix and Hawley. Five patients did not appear during the
follow-up periods. Thus, the Essix group ultimately included 13 par-
ticipants (3 male and 10 female), with a mean age of 15.3 ± 2.4 years,
and the Hawley group included 12 participants (5 male and 7
female), with a mean age of 16.3 ± 2.56  years. All of the patients
were native speakers raised in a monolingual environment. At the
beginning of the observation period, none of the patients had known
cognitive deficits, definite dysmorphology such as cleft lip and/
or palate, neurological disorders, phonological problems, articula-
tion problems, or hearing loss. Patients who were due to debond-
ing process were assessed by the orthodontist (EA) for inclusion in
the trial according to the inclusion and exclusion criteria and were
recruited by consecutive debonds. The patients were treated with
non-extraction treatment protocol and had Class I and II malocclu-
sion. Potential contributors were identified at the last appointment,
and the orthodontist explained the purpose and process of the study
to both parents and patients.
Numbered and closed envelopes were prepared before the trial
including the treatment allocation card. And a secretary out of the
study was responsible for opening the envelope in sequence. Patients
completing full orthodontic treatment were randomly assigned
to the Essix or Hawley retention groups. Fixed lingual retain-
ers were not applied to any of patient in order to reveal only the
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effects of removable appliances on speech performance. During the
fixed labial orthodontic treatment of these patients, lingual/palatal
anchorage devices or acrylic appliances such as bite plates were not
used, as they would have allowed better or faster speech adaptation
to the retainers. The Essix retainers were constructed from plastic,
copolyester .030″ Essix sheet materials according to the manufac-
turer’s instructions, and the maxillary retainers were trimmed into
a horseshoe shape. The Hawley retainers were made with Adams
clasps, labial wire with vertical loops, and lingual acrylic. The acrylic
part of the Hawley retainer had a uniform thickness of 2–3 mm, and
it was trimmed into a horseshoe shape. The patients were instructed
to wear the retainers 24 hours a day for 6 months, including while
eating, but to remove them when brushing their teeth. It was recom-
mended that the patients not read paragraphs out loud to expedite
speech adaptation, in order to allow spontaneous flow during speech
adaptation. The speech sound assessments were performed by a
speech–language pathologist (FE) who was blinded to the nature of
the study and did not have a thorough knowledge of the potential
effects of the retainers.
The recording procedure was repeated for each participant at
four different time points: 1. on the first day, 2. 1 week later, 3. 4
weeks later, and 4. 3 months later. On the first day, the assessments
were conducted prior to inserting the retainers, immediately after
maxillary and mandibular retainer application, individually, and
with both retainers applied. The later assessments were conducted
while both retainers were worn. The recording order was the same
for every patient.
Recordings and acoustic analysis
Prior to recording, all speech tasks were read by the speech–language
pathologist to instruct the participant. During the recording, the
participants were seated in an upright position, and the microphone
was placed 15 cm away from the participants’ lips. Computerized
Speech Lab Model 4300B (Kay Elemetrics Corp, Lincoln Park,
E. Atik et al. 3

New Jersey, USA) equipment was used for acoustic analysis to meas-
ure formant frequencies F1, F2, and F3. In the course of recording
consonants [b, d, g, t, ş, ç, l, z, c, m, n] combined with vowel [a]
and isolated vowels [a, e, u, i], there was a pause between every
utterance. When recording isolated vowels, the subjects were asked
to sustain the vowel for 4–5 seconds at a conversational pitch and
loudness. F1, F2, and F3 formant frequencies for each vowel were
determined using linear predictive analysis on a spectrogram.
VOT values were measured using waveforms and spectrograms
generated from the speech samples. Speech samples consisted of voice-
less [t] and voiced [d] stop consonants in combination with vowel [a].
The measurements were made on a wideband spectrogram (215 Hz) in
accordance with the procedure advised by Lisker and Abramson (12).
Release of the stop was represented as a vertical line of energy on the
spectrograms and as a change in pressure on the waveform. The dura-
tion between two cursors was recorded in milliseconds and documented.
These locations on the display were marked by hand-controlled cursers
that were time locked across the two displays; 50 per cent of the analy-
ses were repeated for reliability. The spectrographic representations were
associated with the waveform to determine the exact VOT (19).
Statistical analysis
Descriptive and analytical statistical analyses were performed with
IBM–SPSS for Windows software, version 20 (SPSS Inc., Chicago,
Illinois, USA). A generalized estimating equation was used to reveal
the differences between different observation periods in both groups.
the results. It was noticed that the most apparent changes were for
vowels [a] and [e] in the Hawley and Essix groups, respectively, and
for [u] in both groups (P < 0.05).
The F2 value of vowel [a] decreased significantly when both
retainers were worn in the Hawley group, and it was still noticeable
at the third month (Table  1). The F2 value of vowel [e] increased
significantly in the Essix group under two conditions: when only
the upper retainer was worn and when both retainers were worn
at the first evaluation (Table 1). The effect of the retainer was still
evident at the first and third months (2472.23 Hz and 2497.97 Hz,
respectively; Supplementary Table 2). In the Hawley group, the F1
value of vowel [u] decreased significantly, from 397.22 Hz to 382.94
Hz, when only the upper retainer was worn at the first evaluation.
Similarly, the F2 value decreased from 995.79 Hz to 943.36 Hz
when both retainers were worn in the Essix group (Supplementary
Tables 1 and 2). The F3 value also changed in the Hawley group,
increasing from 3014.42 Hz to 3253.49 Hz when only the lower
retainer was worn (Supplementary Table 1).
Formant frequencies of vowel [a] in combination
with consonants
In both groups, there were differences in the consonant [ç, g, m, n]
and vowel [a] combinations among the different evaluation periods. In
addition, consonants [b], [d], [c], [t], [ş], [ç], and [z] were affected in the
Hawley group (Supplementary Tables 3 and 4). Differences in altera-
tions during different evaluation times for both groups are summa-

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Median values and interquartile ranges are provided in the tables.
A P value less than 0.05 was considered statistically significant.
Results
Formant frequencies of sustained vowels
For all sustained vowels, statistically important differences in the dif-
ferent evaluation periods were detected (Table 1). The F1, F2, and F3
values of four sustained vowels [a, e, i, u] are shown separately for
each group in Supplementary Tables 1 and 2. Compatible with our
study’s purpose, the consistent findings were interpreted to discuss
rized in Table 2. In the Essix group, a low number of consonant–vowel
couples were affected. On the other hand, alterations were common in
the Hawley group (P < 0.05; Table 2). Especially in combination with
alveolar sounds [d, t, n, z], vowel [a] had higher F1 values in the first
week, indicating a higher tongue position. Another interesting finding
was that lower F1 values of [a] in combination with consonants [d],
[c], and [b] were associated with the lower retainer on the first day
(Supplementary Tables 3 and 4). It is apparent that F2 and F3 values
were generally lower in the Hawley group (Table 2). The general trend
of formant frequency change was similar for the isolated [a] vowel
and consonant–[a] vowel combinations in the Hawley group.

Table 1.  Statistical evaluation of F1, F2, and F3 frequencies of the [e,a,i,u] vowels in different observation periods.

Only lower retainer Only upper retainer Both retainers 1 Week later 4 Weeks later 3 Months later

Hawley Essix Hawley Essix Hawley Essix Hawley Essix Hawley Essix Hawley Essix

[e]
 F1 .100 .463 .327 .751 .286 .579 .201 .577 .689 .228 .315 .581
 F2 .160 .051 .754 .036* .673 .050* .353 .091 .541 .037* .944 .029*
 F3 .285 .431 .796 .623 .733 .251 .899 .363 .963 .70 .503 .998
[a]
 F1 .406 .733 .301 .596 .461 .806 .953 .491 .441 .125 .007* .014*
 F2 .121 .360 .240 .536 .001* .211 .385 .985 .669 .418 .020* .668
 F3 .750 .540 .575 .321 .118 .346 .770 .095 .672 .040* .112 .359
[i]
 F1 .082 .584 .795 .220 .552 .190 .529 .148 .763 .747 .170 .477
 F2 .160 .054 .845 .167 .792 .327 .405 .094 .691 .058 .504 .556
 F3 .031* .194 .431 .914 .178 .206 .841 .000* .278 .008* .171 .103
[u]
 F1 .194 .561 .031* .529 .090 .671 .681 .385 .790 .415 .505 .664
 F2 .988 .021* .111 .321 .015 .035* .985 .441 .916 .785 .180 .322
 F3 .001* .654 .106 .221 .748 .366 .013* .323 .051 .065 .877 .155

F1, first formant frequency; F2, second formant frequency; and F3, third formant frequency.
*P ≤ 0.05 is statistically significant.
4 European Journal of Orthodontics, 2016

Table 2.  Statistical evaluation of F1, F2, and F3 frequencies of the [a] vowel with different consonants in different observation periods.

Only lower retainer Only upper retainer Both retainers 1 Week later 4 Weeks later 3 Months later

Hawley Essix Hawley Essix Hawley Essix Hawley Essix Hawley Essix Hawley Essix

[ba]
 F1 .031* .518 .027* .505 .226 .298 .047* .294 .286 .533 .169 .513
 F2 .051 .228 .228 .377 .268 .069 .579 .345 .397 .706 .864 .764
 F3 .106 .950 .072 .154 .862 .643 .103 .245 .620 .778 .613 .453
[da]
 F1 .000* .701 .252 .899 .254 .577 .314 .803 .171 .760 .916 .361
 F2 .561 .386 .962 .362 .348 .962 .469 .258 .794 .096 .161 .768
 F3 .493 .333 .815 .758 .103 .070 .016* .969 .431 .465 .910 .406
[ga]
 F1 .454 .409 .131 .817 .980 .583 .028* .942 .895 .889 .655 .819
 F2 .730 .287 .265 .700 .312 .528 .027* .745 .813 .232 .271 .025*
 F3 .888 .431 .304 .623 .922 .251 .008* .704 .999 .265 .306 .020*
[la]
 F1 .939 .770 .787 .836 .510 .998 .720 .405 .415 .889 .318 .712
 F2 .866 .771 .193 .355 .909 .510 .638 .361 .926 .921 .537 .946
 F3 .813 .873 .303 .782 .823 .733 .418 .423 .483 .789 .294 .910
[za]
 F1 .788 .452 .661 .522 .307 .962 .478 .713 .269 .897 .065* .644
 F2 .737 .714 .887 .941 .561 .682 .153 .785 .066 .941 .473 .137
 F3 .896 .321 .952 .271 .853 .847 .656 .267 .371 .775 .535 .143
[ca]
 F1 .010* .776 .913 .827 .975 .309 .231 .405 .0872 .485 .907 .862
 F2 .002* .775 .470 .421 .226 .964 .003* .618 .266 .244 .708 .574
 F3 .110 .281 .460 .236 .643 .878 .242 .527 .252 .546 .000* .427

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[ma]
 F1 .177 .941 .815 .602 .361 .526 .282 .013* .031* .265 .000* .305
 F2 .537 .654 .888 .304 .725 .208 .984 .185 .553 .688 .154 .932
 F3 .049* .152 .099 .099 .933 .933 .090 .192 .683 .438 .872 .650
[na]
 F1 .769 .299 .834 .884 .430 .127 .927 .034* .632 .019* .035* .862
 F2 .674 .166 .974 .836 .734 .057 .807 .379 .512 .296 .174 .901
 F3 .886 .728 .312 .901 .932 .969 .751 .657 .452 .471 .923 .369
[ta]
 F1 .234 .923 .575 .907 .029* .852 .573 .618 .129 .417 .193 .105
 F2 .875 .387 .746 .178 .809 .470 .343 .666 .038* .924 .896 .833
 F3 .315 .865 .693 .622 .720 .958 .716 .278 .180 .694 .368 .545
[şa]
 F1 .265 .956 .692 .582 .276 .263 .054 .595 .147 .400 .040* .555
 F2 .420 .229 .007* .663 .184 .278 .177 .856 .964 .960 .504 .503
 F3 .032* .100 .031* .359 .152 .111 .051 .491 .350 .910 .017* .884
[ça]
 F1 .377 .119 .618 .588 .221 .053* .250 .250 .931 .284 .681 .130
 F2 .309 .067 .333 .467 .059 .309 .896 .357 .231 .871 .408 .486
 F3 .285 .026* .176 .057 .007* .013* .153 .370 .045* .717 .275 .196

F1, first formant frequency; F2, second formant frequency; and F3, third formant frequency.
*P ≤ 0.05 is statistically significant.

VOT values values are related to tongue placement in the anteroposterior direc-

The VOT results are shown in Table 3. There was a statistically sig-
nificant difference in the VOT of the [d] sound between the groups.
Differences were seen when only the maxillary retainer was worn
(P = 0.036). Significant shortening of the VOT was apparent in the
Hawley group. The VOT of 8.19 millisecond (msec) at the beginning
decreased to −31.81 msec when wearing only the maxillary retainer.
Discussion
Vowels are characterized by their height, backness, and lip round-
ing. Generally, F1 values are directly related to tongue height, and F2
tion and lip rounding (20). F3 value is associated more with a shorter
back cavity (21). Because every vowel has different articulatory char-
acteristics, vowels can be affected differently when a retainer is worn.
Therefore, it was decided that main vowels with different articulatory
characteristics would be examined in the present study: [i] is a high-
front vowel, [e] is a mid-front vowel, [u] is a high-back vowel, and [a]
is a low-central vowel. To the best of our knowledge, no direct com-
parisons of speech performance with two different retainer appliances
have been published yet in the literature. Thus, the aim of this pro-
spective study was to compare the speech effects of two main retainer
types (Essix and Hawley) used after active orthodontic treatment.
E. Atik et al. 5

Examining the effects of retainers on speech by instrumental

19.90
25.00

61.56
88.84
IQR
analysis might help to detect changes more precisely compared with

3 Months later
perceptual articulatory tests. In the present study, not only were the
formant frequencies of vowels included but also the VOT evalua-

Median
tions of consonants [t] and [d] by acoustic analysis.

54.60
50.31

3.27
7.87
Sustained vowel results
In the present study, significant differences were found between the

22.59
20.83

17.06
18.81
IQR
groups not only in terms of tongue position but also in the adapta-
tion manner of vowel articulation. It was found that [e] was the
4 Weeks later

most affected vowel in the Essix group and [a] was the most affected
Median

vowel in the Hawley group. The F2 value change in vowel [a] in the
59.62
55.89

6.44
5.07
Hawley group indicated more of a back and lower position of the
tongue. On the other hand, the second formant frequency change of
vowel [e] in the Essix group indicated more of a front position of the
30.50
13.18

14.18
84.27

tongue in the oral cavity. In a similar study, Kulak Kayikci et al. (6)
IQR

found that the F1, F2, and F3 values of vowel [i] changed among
1 Week later

different observation periods. However, they did not find any differ-
ences in vowels [a], [e] or [u] in children wearing Hawley retainers.
Median

58.26
47.34

3.27

A possible explanation is that subjects might lower the mandibula

0

to obtain a larger vocal tract space, thus resulting in unchanged for-

mant values. Researchers have discussed that this compensation can
be changeable across participants (16,22). The results of the present
22.65
13.70

101.10
95.02

study also indicated that speech may still have been affected in the
IQR

third month for both vowels. Although previous studies investigat-

Both retainers

ing speech articulation subjectively showed that adaptation occurred

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in 2 weeks (3,4), the results of the present study indicate that more
Median

57.21
50.76

5.24

time was needed to adapt, similar to the results of the study by Kulak
0

Kayikci et  al. (6). This finding can support the idea that acoustic
evaluations may be more delicate than perceptual evaluations.
18.97
16.70

110.79
89.18
Only upper retainer

IQR

Vowel [a] in combination with consonant results

Because coarticulation may involve a higher degree of complexity
than an isolated vowel (23), the acoustics of vowels in consonant–
−31.81*
Median

vowel syllables were also investigated. In both groups, there were

54.66
49.84

−10.56

differences among the different observation periods for combina-

tions of consonants [ç], [g], and [m] with vowel [a]. In addition, the
[b, d, c, t, ş, z] consonant sounds were also affected in the Hawley
group. When producing consonants, the vocal tract is changed and
Only lower retainer

25.01
33.65

64.47
44.29
IQR

constricted in different ways. These results might be due to the

fact that the Hawley retainer affects the articulatory movements in
consonant–vowel combinations more than the Essix retainer does.
Table 3.  Voice onset time (VOT) values of [t] and [d] sounds.

Median

However, they can also be the result of the vowel type [a] used in this
55.01
59.90

10.12
2.95

study. In addition, the detection of changes when the lower retainer

was worn might be related with the low vowel [a]. In future studies,
other vowel–consonant combinations might reveal the real cause of
8.68
14.26

60.73
7.88

this finding.
IQR
With no retainer

VOT value results

Median

In order to study articulatory–phonatory timing co-ordination, we

50.62
48.14

8.19
6.96

chose the [d-t] couple, as they are alveolar and would be more vul-
nerable to change with a retainer. It can be clearly stated that only
the Hawley retainer affected the [d] sound. The VOT of [d] was
IQR, interquartile range.
[d] Phoneme VOT (msec)
[t] Phoneme VOT (msec)

shorter when the maxillary Hawley retainer was worn, indicating

that the Hawley retainer might affect rapid articulatory movement
  Hawley group

  Hawley group

in the alveolar region. However, when both retainers were worn

  Essix group

  Essix group

together at the start of the study, there were no significant changes in

*P ≤ 0.05.

VOT. When both retainers were worn together, tongue may be more
stable with a totally smaller oral cavity compared with the situa-
tion when only upper retainer was worn. In a similar study using
6 European Journal of Orthodontics, 2016
electropalatography, which is a custom-made acrylic artificial pal-
ate, VOT for [t] decreased (16). The researchers argued that it could
have been a result of rapid speaking to adapt or an indicator of a
specific temporal adjustment to maintain perceptual integrity of the
articulation. Different from the present study, the [d] consonant was
not included in that study. Similarly, the subjects in our study might
have used a faster speaking rate to adapt at the beginning (when the
maxillary retainer was worn for the first time), which then slowed
to a normal rate. In another study, with soft palate implants (17),
the reduced the time for [k] indicated that velar [k] articulation had
changed.
Clinical implications
In terms of a clinical perspective, the results of this study would
be useful for pre-treatment counselling of patients and their fami-
lies regarding disruption of speech production after the retainer is
placed. In addition, the differences in articulatory movements in
consonant–vowel combinations, which were common in the Hawley
group, might affect the choice of the Essix retainer for patients who
have or need ongoing speech therapy.
Study limitations
The trial had a small sample size and a short follow-up period. Based
on this limitation, we suggest that it might be useful for future pro-
spective clinical trials to include a higher number of participants fol-
lowed, until no distortions are present, in order to reveal the exact
differences between different retainers used in orthodontics regard-
ing their effects on speech.
Conclusion
• The null hypothesis tested in the present study was rejected.
• Both retainer types affected the speech acoustics of isolated vow-
els. The most prominent changes were for vowel [a] in the Haw-
ley group and for vowel [e] in the Essix group.
• The Hawley retainer affected the articulatory movements in con-
sonant–vowel combinations more prominently than the Essix
retainer did.
• The VOT of consonant [d] in the Hawley group was shorter than
normal, indicating rapid articulatory movement in the alveolar
region.
Supplementary material
Supplementary material is available at European Journal of
Orthodontics online.
Conflict of interest
None to declare.
References
1. Reitan, K. 1967 Clinical and histologic observations on tooth movement
during and after orthodontic treatment. American Journal of Orthodon-
tics, 53, 721–745.
2. Rowland, H., Hichens, L., Williams, A., Hills, D., Killingback, N., Ewings,
P., Clark, S., Ireland, A.J. and Sandy, J.R. (2007) The effectiveness of Haw-
ley and vacuum-formed retainers: a single-center randomized controlled
trial. American Journal of Orthodontics and Dentofacial Orthopedics,
132, 730–737.
3. Erb, D P. (1967) Speech effects of the maxillary retainer. The Angle Ortho-
dontist, 37, 298–303.
4. Haydar, B., Karabulut, G., Ozkan, S., Aksoy, A.U. and Ciger, S. (1996)
Effects of retainers on the articulation of speech. American Journal of
Orthodontics and Dentofacial Orthopedics, 110, 535–540.
5. De Felippe, N.L., Da Silveira, A.C., Viana, G. and Smith, B. (2010) Influ-
ence of palatal expanders on oral comfort, speech, and mastication. Amer-
ican Journal of Orthodontics and Dentofacial Orthopedics, 137, 48–53.
6. Kulak Kayikci, M.E., Akan, S., Ciger S., Ozkan, S. (2012) Effects of Haw-
ley retainers on consonants and formant frequencies of vowels. The Angle
Orthodontist, 82, 14–21.
7. Stratton, C.S. and Burkland, G.A. (1993) The effect of maxillary retainers
on the clarity of speech. Journal of Clinical Orthodontics, 27, 338–340.
8. Honda, K. (2008) Physiological processes of speech production. In: Ben-
estry, J., Huang, Y.A., eds. Springer Handbook of Speech Processing.
Springer, Berlin, Germany, pp. 7–26.
9. Kent, R.D., Weismer, G., Kent, J.F., Vorperian, H.K. and Duffy J.R. (1999)
Acoustic studies of dysarthric speech: methods, progress, and potential.
Journal of Communication Disorders, 32, 141–186.
10. Kent, R.D. and Kim, Y. (2008) Acoustic analysis of speech. In: Ball, M.J.,
Perkins, M.R., Müller, N., Howard, S., eds. The Handbook of Clinical
Linguistics. Blackwell Publishing Ltd, Oxford, UK, pp. 360–381.
11. Kent, R.D. and Read, C. (2002) The Acoustic Analysis of Speech. Nelson
Education Ltd, Clifton Park, NY, pp. 139–189.
Downloaded from by guest on August 22, 2016
12. Abramson, A. S. and Liske,r L. (1973) Voice timing in Spanish word-initial
stops. Phonetica, 1, 1-8.
13. Cole, R.A. and Scott, B. (1974) The phantom in the phoneme: invariant
cues for stop consonants. Perception & Psychophysics, 15, 101–107.
14. Story, B.H. and Bunton, K. (2010) Relation of vocal tract shape, formant
transitions, and stop consonant identification. Journal of Speech Language
and Hearing Research, 53, 1514–1528.
15. Sumita, Y.I., Ozawa, S., Mukohyama, H., Ueno, T., Ohyama, T. and Tani-
guchi, H. (2002) Digital acoustic analysis of five vowels in maxillectomy
patients. Journal of Oral Rehabilitation, 29, 649–656.
16. McAuliffe, M.J., Robb, M.P. and Murdoch, B.E. (2007) Acoustic and per-
ceptual analysis of speech adaptation to an artificial palate. Clinical Lin-
guistics & Phonetics, 21, 885–894.
17. Akpinar, M.E., Kocak, I., Gurpinar, B. and Esen, H.E. (2011) Effects of
soft palate implants on acoustic characteristics of voice and articulation.
Jounal of Voice, 25, 381–386.
18. Sari, E. and Kilic, M.A. (2009) The effects of surgical rapid maxillary
expansion (SRME) on vowel formants. Clinical Linguistics and Phonetics,
23, 393–403.
19. Kopkalli-Yavuz, H., Mavis, I. and Akyildiz, D. (2011) Analysis of VOT
in Turkish speakers with aphasia. Clinical Linguistics and Phonetics, 25,
287–301.
20. Ladefoged, P. (2003) Phonetic Data Analysis: An Introduction to Field-
work and Instrumental Techniques. Wiley-Blackwell, Malden, MA.
21. Fant, G. (2004) The Relations Between Area Functions and the Acoustic
Signal in Speech Acoustics and Phonetics. Kulser Academic Publishers,
Dordrecht, The Netherlands.
22. Ladefoged, P. (2005) Vowels and Consonants. Blackwell, Oxford, UK, 2nd
ed.
23. Cervera, T., Miralles, J.L. and Gonzalez-Alvarez, J. (2001) Acoustical anal-
ysis of Spanish vowels produced by laryngectomized subjects. Journal of
Speech Language and Hearing Research, 44, 988–996.