A simple method of adding palatal rugae to a complete denture

Christina A. Gitto, DDS,a Salvatore J. Esposito, DMD,b and Julius M. Draperc The Cleveland Clinic Foundation, Cleveland, Ohio
Restoring patients speech is an important goal in complete denture fabrication. For those patients who have difficulty with their speech patterns accommodating to the introduction of a prosthesis, texture in the palatal region may prove helpful. This article describes methods of incorporating palatal rugae in a newly fabricated and existing complete denture. (J Prosthet Dent 1999;81:237-9.)

ne of the factors influencing denture fabrication is the restoration of the patients speech patterns. To accommodate speech properly, the dentist must have an understanding of the components that make up speech. Speech consists of respiration, phonation, resonation, articulation, neural integration, and audition.1 Of these components, articulation is most readily affected by the construction of a complete denture. By definition, articulation is the resonated sound formed into meaningful speech by the movements and interaction of the mandible, lips, tongue, soft palate, hard palate, alveolar ridge, and teeth.2,3 The tongue, lips, and soft palate are dynamic structures that control and direct air movement. Rapid and precise movements of the tongue and lips move air across the static structures. Their approximation to the teeth, the hard palate, and the alveolar processes create valves for the production of specific sounds of speech. These sounds include the lingual-dental, lingual-alveolar, and palatal consonants. The lingual-dental or the /th/ sound is made with the tip of the tongue extending through the maxillary and mandibular incisors. The lingual-alveolar or the fricatives /s/ and /z/ are made by flattening the tongue and elevating the lip to make contact with the maxillary alveolar ridge. The palatal consonants or the fricatives /sh/ and /z/ are formed with the tip of the tongue forward and elevated, contacting with the lateral surfaces of the maxillary posterior teeth.4 A complete denture alters these relationships. Normally, most patients have the ability to adapt their speech production to compensate for the presence of a denture.5-8 However, there are persons whose speech is sensitive to these changed relationships and have difficulty accommodating. These patients often require a tactile sense to orient the tongue. The palatal rugae and the incisive papilla can often serve as a cue.9,10 Because the lack of texture on the palatal portion of a complete denture can
aAssociate

Fig. 1. Tinfoil trimmed and adapted to cast with prominent rugae.

Fig. 2. Sealing of tinfoil pattern to palatal area of completed wax-up.

Staff, Department of Dentistry and Maxillofacial Pros-

thetics.
bChairman, cChief

Department of Dentistry and Maxillofacial Prosthetics. Maxillofacial Prosthetics Technologist, Department of Dentistry and Maxillofacial Prosthetics.

impede proper articulation, one solution is to add palatal rugae. The purpose of this article is to present quick and easy methods of adding palatal rugae to newly fabricated and existing complete dentures.
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GITTO, ESPOSITO, AND DRAPER

Fig. 6. Acrylic resin rugae is secured to existing prosthesis with autopolymerizing acrylic resin.

Fig. 3. Tinfoil adapted to cast.

Fig. 7. Completed addition of rugae.

Fig. 4. Hot wax is flown over surface of tinfoil to reinforce pattern.

PROCEDURES New prosthesis

1. Cut tinfoil (0.001 tinfoil, Buffalo Dental Mfg. Co., Inc., Syossett, N.Y.) to the desired shape and adapt it to the rugae area on the master cast or any available cast with prominent rugae (Fig. 1). 2. Remove the tinfoil pattern from cast and seal it to the palatal area of the completed wax-up with hot baseplate wax (Tru Wax, Dentsply International Inc., York, Pa.) (Fig. 2). 3. Flask, process, finish, and polish as usual.

Existing prosthesis
1. Adapt tinfoil on any available cast with prominent rugae; flow hot baseplate wax over the surface to reinforce the tinfoil (Figs. 3 and 4). 2. Prepare the existing prosthesis by roughing the rugae area. 3. Remove wax reinforced tinfoil from the cast and trim to desired shape; salt and pepper autopolyVOLUME 81 NUMBER 2

Fig. 5. Autopolymerizing acrylic resin is applied to pattern to fabricate rugae.

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merizing acrylic resin (Perm Reline and Repair Resin, The Hygenic Corp., Akron, Ohio) onto the underside of the tinfoil pattern (Fig. 5). 4. When cured, remove the tinfoil and secure acrylic rugae to the palatal area of the existing prosthesis with autopolymerizing acrylic resin (Fig. 6). 5. Refine, finish, and polish (Fig. 7).

the changed relationships caused by the introduction of a prosthesis into the mouth.
REFERENCES
1. Haitas GP, Wolfaardt JF, Carr L. Speech defects in prosthetic dentistry, part Ithe mechanism of speech production. J Dent Assoc S Afr 1985; July:381-6. 2. Chierici G, Lawson L. Clinical speech considerations in prosthodontics: perspectives of the prosthodontist and speech pathologist. J Prosthet Dent 1973;29:29-39. 3. Curtis TA, Beumer J. Maxillofacial rehabilitation prosthodontic and surgical considerations. St Louis: Ishiyaku EuroAmerica; 1996. p. 285-9. 4. Esposito SJ. Speech and palatopharyngeal function. In: Zlotolow I, Esposito S, Beumer J, editors. Proceedings of the first International Congress on Maxillofacial Prosthetics, Indian Wells, Calif., April 27-30, 1994. p. 43-8. 5. Petrovic A. Speech sound distortions caused by changes in complete denture morphology. J Oral Rehabil 1985;12:69-79. 6. Hamlet SL. Speech adaptation to dental appliances: theoretical considerations. J Baltimore Coll Dent Surg 1973;28:52-63. 7. Hamlet SL, Cullison BL, Stone ML. Physiological control of sibilant duration: insights afforded by speech compensation to dental prostheses. J Acoust Soc Am 1979;65:1276-85. 8. Hamlet SL. Speech compensation for prosthodontically created palatal asymmetries. J Speech Hear Res 1988;31:48-53. 9. Palmer JM. Structural changes for speech improvement in complete upper denture fabrication. J Prosthet Dent 1979;41:507-10. 10. Pound E. Esthetic dentures and their phonetic values. Dent J Aust 1953;25:150.

SUMMARY
The advantages of the described procedures are that they can easily and quickly be accomplished by the dentist or the laboratory technician. The dentist or technician can complete the addition of rugae to an existing prosthesis in approximately 30 minutes eliminating the need for the patient to go without their prosthesis. With a newly fabricated denture, the laboratory technician adds the foil pattern as part of the completed waxup in a matter of minutes. If no in-house laboratory support is available, the dentist can add the foil pattern at the time of the final try-in appointment and return it to the laboratory for processing. In the event that a patients speech is not improved, is worsened, or the patient finds the texture annoying, it can easily be eliminated with an acrylic resin bur and routine polishing. Unfortunately, the addition of rugae to a prosthesis is not a full-proof method of eliminating speech problems. Some patients may still experience difficulty with speech accommodation. A simple method of adding rugae to a newly fabricated complete denture and an existing prosthesis has been presented. It is a tool for the alleviation of the speech problems encountered by patients sensitive to

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