Speech and Facial Aesthetic Considerations for the Contour of Fixed Prostheses

  • Glen LiddelowEmail author
  • Graham Carmichael
Part of the BDJ Clinician’s Guides book series (BDJCG)


The treatment of edentulous or soon-to-be-edentulous jaws requires surgical and prosthetic skill to achieve a functional outcome. These interventions have a profound impact on facial aesthetics with respect to support for the peri-oral tissues and lower face. Patients may present with significant loss of supporting tissue necessitating prosthetic replacement. Ideally, this intervention should be determined in the diagnostic phases to more predictably achieve the desired result and patient approval. Change in position of teeth and prosthetic contour can detrimentally affect speech. This chapter aims to provide a background to the effects of prosthesis contour and techniques to enhance aesthetics and maximise phonetic adaptation.


  1. 1.
    Karlan M. Contour analysis in plastic and reconstructive surgery. Arch Otolaryngol. 1979;105:670–9.CrossRefGoogle Scholar
  2. 2.
    Oxford online dictionary. Online information. [accessed April 2017].
  3. 3.
    Katina S, Mcneil K, Ayoub A, Guilfoyle B, Khambay B, Siebert P, Sukno F, Rogas M, Vittert L, Waddington J, Whelan P, Bowman A. The definitions of three-dimensional landmarks on the human face: an interdisciplinary view. J Anat. 2016;228:355–65.CrossRefGoogle Scholar
  4. 4.
    Weinberg S, Scott N, Neiswanger K, Brandon C, Marazita M. Digital three-dimensional photogrammetry: evaluation of anthropometric precision and accuracy using a Genex 3D camera system. Cleft Palate Craniofac J. 2004;41:507–18.CrossRefGoogle Scholar
  5. 5.
    Fourie Z, Damstra J, Gerrits P, Ren Y. Accuracy and repeatability of anthropometric facial measurements using cone beam computed tomography. Cleft Palate Craniofac J. 2011;48:623–30.CrossRefGoogle Scholar
  6. 6.
    Nanda V, Gutman B, Bar E, Alghamdi S, Tetrads S, Lusis A, Eskin E, Moon W. Quantitative analysis of 3-dimensional facial soft tissue photographic images: technical methods and clinical application. Prog Orthod. 2015;16:21–30.CrossRefGoogle Scholar
  7. 7.
    Kim Y, Lee N, Moon S, Jang M, Kim H, Yun P. Evaluation of soft tissue changes around the lips after bracket debonding using three-dimensional stereophotogrammetry. Angle Orthod. 2015;85:833–40.CrossRefGoogle Scholar
  8. 8.
    Monsour P, Dudhia R. Implant radiography and radiology. Aust Dent J. 2008;53(1 Suppl):S11–25.CrossRefGoogle Scholar
  9. 9.
    Tyndall D, Price J, Tetradis S, Ganz S, Hildebolt C, Scarfe W. Position statement of the American Academy of oral and maxillofacial radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:817–26.CrossRefGoogle Scholar
  10. 10.
    Dreiseidler T, Mischkowski R, Neugebauer J, Ritter L, Zoller J. Comparison of cone- beam imaging with orthopantomography and computerized tomography for assessment in presurgical implant dentistry. Int J Oral Maxillofac Implants. 2009;24:216–25.PubMedGoogle Scholar
  11. 11.
    Katsoulis J, Pazera P, Mericske-Stern R. Prosthetically driven, computer-guided implant planning for the edentulous maxilla: a model study. Clin Implant Dent Relat Res. 2009;11:238–45.CrossRefGoogle Scholar
  12. 12.
    Cawood J, Howell R. Reconstructive preprosthetic surgery. I. Anatomical considerations. Int J Oral Maxillofac Surg. 1991;20:75–82.CrossRefGoogle Scholar
  13. 13.
    Spear F, Kokich V, Mathews D. Interdisciplinary management of anterior dental esthetics. J Am Dent Assoc. 2006;137:160–9.CrossRefGoogle Scholar
  14. 14.
    Fradeani M. Evaluation of dentolabial parameters as part of a comprehensive esthetic analysis. Eur J Esthet Dent. 2006;1:62–9.PubMedGoogle Scholar
  15. 15.
    Coachman C, Calamita M. Digital smile design: a tool for treatment planning and communication in aesthetic dentistry. QDT. 2012:1–9.Google Scholar
  16. 16.
    Pound E. Utilizing speech to simplify a personalized denture service. J Prosthet Dent. 2006;95:1–9. Reprint of J Prosthet Dent 1970;24:586-600.CrossRefGoogle Scholar
  17. 17.
    Schropp L, Wendel A, Kostopoulos L, Karina T. Bone healing and soft tissue contour change following single-tooth extraction. Int J Periodontics Restorative Dent. 2003;23:313–23.PubMedGoogle Scholar
  18. 18.
    Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2014;29(Suppl):25–42.CrossRefGoogle Scholar
  19. 19.
    Abboud M, Wahl G, Guirado JL, Orentlicher G. Application and success of two stereolithographic surgical guide systems for implant placement with immediate loading. Int J Oral Maxillofac Implants. 2012;27:634–43.PubMedGoogle Scholar
  20. 20.
    Vasak C, Watzak G, Gahleitner A, Strbac G, Schemper M, Zechner W. Computed tomography-based evaluation of template (NobelGuide™)-guided implant positions: a prospective radiological study. Clin Oral Impl Res. 2011;22:1157–63.CrossRefGoogle Scholar
  21. 21.
    Jung R, Schneider D, Ganeles J, Wismeijer D, Zwahlen M, Hammerle C, Tahmaseb A. Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants. 2009;24(Suppl):92–109.PubMedGoogle Scholar
  22. 22.
    Joda T, Bragger U, Gallucci G. Systematic literature review of digital three dimensional superimposition techniques to create virtual dental patients. Int J Oral Maxillofac Implants. 2015;30:330–7.CrossRefGoogle Scholar
  23. 23.
    Carlsson G. Fact and fallacies. An evidence base for complete dentures. Dent Update. 2006;33:134–42.CrossRefGoogle Scholar
  24. 24.
    Sessle B, Adachi K, Avivi-Arber L, Lee J, Nishiura H, Yao D, Yoshiko K. Neuroplasticity of face primary motor cortex control of orofacial movements. Arch Oral Biol. 2007;52:334–7.CrossRefGoogle Scholar
  25. 25.
    Molly L, Nackaerts O, Vandewiele K, Manders E, van Steenberghe D, Jacobs R. Speech adaptation after treatment of full edentulism through immediate-loaded implant protocols. Clin Oral Implants Res. 2008;19:86–90.PubMedGoogle Scholar
  26. 26.
    Collaert B, Van Dessel J, Konings M, Nackaerts O, Zink I, Slagmolen P, Jacobs R. On speech problems with fixed restorations on implants in the edentulous maxilla: introduction of a novel management concept. Clin Implant Dent Relat Res. 2015;17(Suppl 2):745–50.CrossRefGoogle Scholar
  27. 27.
    Van Lierde K, Browaeys H, Corthals P, Matthys C, Mussche P, Van Kerckhove E, De Bruyn H. Impact of fixed implant prosthetics using the 'all-on-four' treatment concept on speech intelligibility, articulation and oromyofunctional behaviour. Int J Oral Maxillofac Surg. 2012;41:1550–7.CrossRefGoogle Scholar
  28. 28.
    Van Lierde K, Browaeys H, Corthals P, Mussche P, VAN Kerkhoven E, DE Bruyn H. Comparison of speech intelligibility, articulation and oromyofunctional behaviour in subjects with single-tooth implants, fixed implant prosthetics or conventional removable prostheses. J Oral Rehabil. 2012;39:285–93.CrossRefGoogle Scholar
  29. 29.
    Jacobs R, Manders E, Van Looy C, Lembrechts D, Naert I, van Steenberghe D. Evaluation of speech in patients rehabilitated with various oral implant-supported prostheses. Clin Oral Implants Res. 2001;12:167–73.CrossRefGoogle Scholar
  30. 30.
    Heydecke G, McFarland D, Feine J, Lund J. Speech with maxillary implant prostheses: ratings of articulation. J Dent Res. 2004;83:236–40.CrossRefGoogle Scholar
  31. 31.
    Lundqvist S, Haraldson T, Lindblad P. Speech in connection with maxillary fixed prostheses on osseointegrated implants: a three-year follow-up study. Clin Oral Implants Res. 1992;3:176–80.CrossRefGoogle Scholar
  32. 32.
    Bothur S, Garsten M. Initial speech problems in patients treated with multiple zygomatic implants. Int J Oral Maxillofac Implants. 2010;25:379–84.PubMedGoogle Scholar
  33. 33.
    Lundqvist S, Lohmander-Agerskov A, Haraldson T. Speech before and after treatment with bridges on osseointegrated implants in the edentulous upper jaw. Clin Oral Implants Res. 1992;3:57–62.CrossRefGoogle Scholar
  34. 34.
    Calford M. Degree of adaptability of the somatosensory cortex to change: prospects for integration of bone-mounted dental prostheses. Clin Exp Pharmacol Physiol. 2005;32:115–8.CrossRefGoogle Scholar
  35. 35.
    Yan C, Ye L, Zhen J, Ke L, Gang L. Neuroplasticity of edentulous patients with implant-supported full dentures. Eur J Oral Sci. 2008;116:387–93.CrossRefGoogle Scholar
  36. 36.
    Sessle B. Mechanisms of oral somatosensory and motor functions and their clinical correlates. J Oral Rehab. 2006;33:243–61.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Clinical Associate ProfessorSchool of Dentistry, University of Western AustraliaPerthAustralia
  2. 2.Consultant Prosthodontist Craniofacial UnitPrincess Margaret HospitalWAAustralia
  3. 3.Private practiceThe Branemark Center Level 3West PerthAustralia
  4. 4.Consultant Prosthodontist, Craniofacial UnitPrincess Margaret HospitalWestern AustraliaAustralia
  5. 5.Consultant Prosthodontist, Maxillofacial DepartmentRoyal Perth HospitalPerthAustralia
  6. 6.Senior Clinical LecturerSchool of Dentistry, University of Western AustraliaWAAustralia
  7. 7.Private practiceThe Branemark Center Level 3West PerthAustralia

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