A metal framework was fabricated of Chrome�C Cobalt alloy (Biosil-l) by use of cast model which obtained utilizing light polymerized acrylic impression tray selleck kinase inhibitor and irreversible hydrocolloid impression material. The buccal extension type of obturator, which had a wall thickness of approximately 2 mm, was processed in the standard manner, using heat-polymerizing acrylic resin (Meliodent, Heraeus Kulzer, Germany). The buccal extension of the obturator was about 15 mm above the lateral scar band and referred as high (H) (Figure 1). Four weeks later, the extension of the obturator was reduced to 10 mm to produce medium (M) (Figure 2) obturator type. Final reduction of the obturator was carried out after another four week interval to have a prosthesis with a 5 mm buccal extension referred as low (L) (Figure 3).
Figure 1 Obturator with high buccal extension design. Figure 2 Obturator with middle buccal extension design. Figure 3 Obturator with low buccal extension design. During the follow up special efforts were made to attain a close fit between the prosthesis and surrounding tissue to preclude leakage of air into the nasal cavity during speech. The permanent obturator was designed to achieve the best possible result for each patient in terms of oral-facial cosmetics and function. Articulation test Just prior to the application of H permanent obturator the articulation was evaluated without prosthesis by using a speech intelligibility test. The test was repeated at four week intervals and then the buccal extension was reduced.
The SI tests of obturator H, M were applied just prior to the wearing of obturators M and L, respectively. The SI test of obturator L was applied following a four week interval of obturator L wearing. So four SI tests (no obturation, H, M, L) were obtained for each patient. By using a standard tool in Turkish that was demonstrated to be valid for measuring SI was utilized.21,22 The test tool was comprised of ten groups of words. Each group contained 17 words that came one after the other without any relations in meaning. The performance of the patients were recorded in a quiet room where the patients were seated comfortably facing a microphone placed 15 cm from the mouth. The assessments of the recordings were done by two investigators (S.T, M.M.O).
The speech samples from each patient with varying buccal extensions were presented in random order so that the listener was unaware of the patients�� obturator design. Intelligibility of each word was evaluated separately and was assessed as negative or positive with the consensus of both investigators. The percentage of words assessed as positive for intelligibility was calculated to give SI score. Data analyses The SI scores with three different types of obturators were compared by using Friedman test which is the non parametric analogue of repeated measures by using SPSS (SPSS Inc., Chicago, GSK-3 Illinois, USA) statistical package.