Comparison of the guarding capacities of mouth protectors

Abstract The guarding capacity of seven mouth protectors (Erkoflex 3.0 and 4.0, Erkoloc 3.0, 4.5 and 5.5, TranSheet/Perform and TranSheet/LiteLine) was tested mechanically on 20 plaster models, two or three tests on each mouth protector. Two tests on a plaster model without the protector screed as control. An appliance was constructed to simulate the impact of an ice-hockey puck on the teeth, the plaster model was fixed onto the device and the minimum force needed to break the plaster teeth under the protector was recorded. The average total thickness and that of the soft and hard layers of the labial plates of each mouth protector were recorded along with the average thickness of the cervical and incisal hard and soft layers. The results showed that the best protection was achieved with the TranSheet/LiteLine model, followed by TranSheet/Perform and Erkoloc 5.5 and 4.5 mouthgards. All these had a resilient layer against the teeth, and it was shown in stepwise regression analysis that the only property having a statistically significant effect on the guarding capacity was the thickness of this cervical soft layer.     

Introduction to four custom-made mouth protectors constructed of single and double layers for activists in contact sports

Abstract Four mouth protectors are introduced, all manufactured by dentists familiar with small-scale technical work. Mouth protectors made of Erkoflex or Erkoloc sheets are moulded in an Erkopress device under a vacuum, while the Tran Sheet/Perform and Tran Sheet/LiteLine mouth protectors are constructed of a hard outer shell (Triad TranSheet, light-cured polyurethane dimethacrylate) and a soft inner part against the labial surface of the front teeth (Perform or LiteLine, both light-cured polyurethane dimethacrylate), thus minimizing the impact on individual teeth and better preventing dental traumas. The technical construction of the mouth protectors is illustrated, as is the need for instrumentation and its costs and the materials required to manufacture these mouth protectors.     

An in vitro study of the efficacy of mouthguard protection for dentoalveolar injuries in deciduous and mixed dentitions

Abstract Sports-related dental trauma remains a risk for children and adolescents. Although mouthguards provide protection, up to 25% of dentoalveolar injuries can occur with a mouthguard in place. This study examined the effect of mouthguard protection in an in vitro model. A total of 97 sheep mandibular segments with incisors at four developmental stages (early deciduous, ED, 11 = 37; middle deciduous, MD, n = 20; late deciduous, LD, n=18; mixed dentition, PD, 11 = 22) was used. Customised pressure formed mouthguards (MG) provided protection from trauma produced by a servohyclraulic materials testing machine to test incisors. Injuries were examined clinically, radiographically and by dissection. Mean forces required to produce dentoalveolar injury were significantly greater in test (with MG) teetli than control (no MG) teeth. Mean forces to produce injury in test teeth decreased with resorbing root lengths. Deciduous incisors differed in injury type: subluxalions and horizontal root fractures predominated in test teeth; lateral luxations and horizontal root fractures in control teeth. Predominant injuries in test and control permanent incisors were enamel infractions and snblnxations. The magnitude of lateral luxation measurements of individual teeth was reduced significantly by mouthguard protection in both deciduous and permanent dentitions. The mouthguard tended to increase the mobility of the teeth it encompassed and, in some instances, promoted dentoalveolar injury of adjacent teeth.     

Forces transmitted through EVA mouthguard materials of different types and thickness

Previous studies into sporting mouthguards have been mainly attitudinal or epidemiological. The aim of the present study was to build an impact rig to measure the impact absorbed by mouthguard materials of various thicknesses. The acceleration of the pendulum of the rig was measured and used to calculate the force transmitted to the materials.
Impact tests were also performed on three commercially available mouthguard materials. Tests showed that the force transmitted through mouthguard materials was inversely related to the material thickness.
Mouthguard construction techniques with ethylene vinyl acetate (EVA) plastics should be monitored to avoid occlusal thinning especially on the incisal edges. Thinning results in reduction in the protection offered by the mouthguard.     

Fabricating a better mouthguard. Part I: Factors influencing mouthguard thinning

Abstract –  There is some concern regarding the amount of material thinning that occurs during the fabrication of custom-fabricated mouthguards. It is unclear if this thinning is merely a consequence of the fabrication process or related to other factors such as jaw size. Thus, the purpose of this study was to evaluate the contribution that various dimensional characteristics of the dental arch and the height of the stone model would have on mouthguard thinning. Fifteen subjects participated in this investigation. Alginate impressions from each subject were used to produce three replicas of the maxillary dentition with only the height of the base varying amongst them. The total height of the three models were 20, 25, and 30 mm. A single mouthguard was produced using each of the stone models. The material thickness of the mouthguard was assessed at the labial and occlusal surfaces. Additionally, the dimensions of the stone models were documented. Pearson product moment correlation coefficients were calculated to determine the linear relationship between material thickness and (i) the height of the stone models, (ii) the arch length and (iii) the area covered by the stone model. Statistical tests performed using the mean thickness values collected from the incisors and canines revealed a high negative correlation between the height of the stone model and material thickness ( r  = −0.82). In addition, a low to moderate positive linear correlation was noted between arch length and occlusal thickness at the molars ( r  = 0.57) and between the area of the stone model with the occlusal thickness ( r  = 0.49). The results of the present study indicate that the height of the model used to fabricate custom mouthguards should be kept as low as possible but still allow for the production of a properly fitting mouthguard.     

Sports mouthguard overview: Materials,fabrication techniques,existing standards,and future research needs

Sports mouthguards are proven devices that reduce both the probability of and damage to orofacial tissues. While commonly used, clinicians may be unaware of the different sports mouthguard materials, proposed fabrication techniques, design recommendations, and newer digital fabrication methods. An overview of existing sports mouthguard standards is presented. It identifies that identify that the present requirements, while historically chosen in good faith, appear to be arbitrarily selected and not from clinical evidence-based derived data. In addition, identified sports mouthguard heterogeneous testing and data acquisition methods distinguishes that little possibility is afforded for the correlation of results. Furthermore, updated evidence with concussion prevention and/or alleviation is presented with evidence provided by sports mouthguard imbedded technology. The need for continued research is stressed to provide evidence-based data for concussion alleviation/prevention, digital fabrication methods and materials, and clinically based information for the revision of existing standards.     

Influence of pre-laminated material on shock absorption ability in specially designed mouthguard with hard insert and space

Purpose

We have developed a new type of laminated mouthguard, the Hard & Space mouthguard, which incorporates a hard material insert and a space to prevent contact between the mouthguard and the buccal surfaces of the teeth. The purpose of this study was to investigate the effect of this new design on shock absorption.

Methods

Three types of mouthguard (a conventional laminated EVA mouthguard and two 3-layer type “Hard & Space” mouthguards made of 1.8-mm or 3.0-mm thick pre-laminated material (Konbiplast) and EVA with a 1.0-mm space) were impacted. Shock absorption was measured by means of a pendulum type steel ball impact testing machine at impact distances of 10, 20, and 30 cm and a dental study model with strain gauges attached to the lingual surfaces and an accelerometer fixed to the maxilla.

Results

Distortion of the impacted tooth and acceleration of the model were significantly reduced by all types of mouthguard at all 3 impact distances. The effect of the mouthguard was remarkable in terms of tooth distortion: both thicknesses of Hard & Space mouthguard showed more than 90% shock absorption, compared with only approximately 55–78% with an EVA mouthguard. Furthermore, shock absorption with the thicker 3.0-mm Hard & Space mouthguard reached more than 95% at the highest impact power.

Conclusion

Within the limitations of this laboratory study, Hard & Space mouthguards showed significantly greater buffer capacity than a conventional EVA mouthguard in terms of tooth distortion at the 3 impact powers tested.     

Orofacial injury in a Brazilian professional basketball player: case report

Abstract –  The frequency of dental trauma has increased among children and athletes of all ages who play contact sports. This kind of trauma may result in irreversible damage to the patient. The aim of this report is to present a case of an orofacial trauma involving a professional basketball player who was elbowed by another player. The athlete reported loss of sensitivity in three teeth and computerized tomography showed fractures in three points of the malar bone. After the incident and dental follow-up, the player was made aware of the need to wear a mouthguard.     

Comparison of forces transmitted through different EVA mouthguards

Abstract –  Athletic mouthguards have been recommended for decades with varying levels of athlete acceptance. Issues related to compliance center around the ability to breath and speak while wearing the mouthguards. Fabrication techniques have changed over time to a two-layer ethylene vinyl acetate mouthguard fabricated on a high-pressure machine. The reported ideal thickness of these mouthguards has been somewhat variable depending on the sport and anticipated level of risk. Recent research however, has identified 4 mm as the optimal thickness of EVA. In this study an acrylic dental cast was fabricated and mounted to a drop impact fixture. Mouthguards of varying ply, thickness and palatal coverage were fabricated and tested in the fixture. Strain gauges and load cells were used to evaluate the effect of ply, thickness, and palatal coverage on the ability of these mouthguards to minimize transmitted forces. The purpose of this study was to identify those variables of mouthguard construction that will minimize the overall transmitted force of impact to the anterior dentition.     

Dental hygiene procedure in a patient with Giardia lamblia infection

INTRODUCTION: Giardiasis, or Giardia lamblia infection, is the most common parasitosis of the human digestive tract. It is highly contagious and mostly occurs in warm climates. Children are especially susceptible to infection. MICROBIOLOGICAL FEATURES: The infection can sporadically occur anywhere and waterborne outbreaks have been reported in some countries. Hence, the prevention of giardiasis depends on proper sanitation. Once ingested through contaminated water, Giardia cysts adhere to the intestinal surface. The parasite feeds on the mucous secretions of the intestine and may produce severe infections which can interfere with nutrient absorption. Symptoms in affected individuals usually include diarrhoea, dehydration, stomach cramps, gas, and weight loss. DIAGNOSIS: Diagnosis is based on the detection of cysts in fecal samples. Treatment includes the use of metronidazole and other drugs that are effective in clearing the infection within a few days. CASE REPORT: We report the recent case of a patient with Giardiasis who received dental hygiene procedures and discuss the interventions required in consideration of the patient's concomitant heart condition.     

Impact absorption and force dissipation of protective mouth guards with or without titanium reinforcement

BackgroundMouth guards are used to reduce the risk of experiencing dental injuries. Various individual and commercial designs are available.MethodsThe authors prepared 20 artificial maxillae from a polyether-resin to simulate teeth, jaw bone and gingiva. They customized two designs of mouth guards by using stone models from impressions of the artificial maxillae; one (n = 10) was constructed of four layers of ethylene vinyl acetate (EVA) (total thickness = 4.0 millimeters) (group EVA), and the other (n = 10) was constructed of EVA with an intermediate layer of 1.0-mm–thick sheet titanium from the left maxillary canine to the right maxillary canine (total thickness = 4.0 mm) (group EVA-Ti). They used a drop-weight impact testing machine (DTM 1000-S, Omnipotent Instruments, Seremban, Negeri Sembilan Darui Khusus, West Malaysia) for a frontal impact with 1.7 kilograms of mass dropped at 0.34 meter per second. The force of the drop was verified by means of a laser Doppler vibrometer (laser model OFV-323 and controller model OFV-3020, Polytec, Irvine, Calif.) to calculate the absorbed energy. They used a high-speed camera (FastCam APX-RS, Photron, San Diego) to obtain images of energy dissipation over the length of the mouth guard.ResultsThe mean effective total impact energy that reached the maxillae–mouth guard models was 5.66 (standard deviation [SD], 0.035) joules. The mean absorbed energy in group EVA was 4.39 (0.023) J (77.8 percent of total impact energy). The mean (SD) absorbed energy in group EVA-Ti was 4.28 (0.013) J (75.9 percent of total impact energy). The mean (SD) total dissipated energy was 1.26 (0.21) J in group EVA and 1.36 (0.11) J in group EVA-Ti. The mean (SD) transmitted energy for the mouth guards was 1.08 (0.19) J in group EVA and 0.99 (0.05) J in group EVA-Ti. There was no statistically significant difference between the groups in terms of any energy transmission or absorption.ConclusionThe results of this study suggest that an additional intermediate titanium layer in the anterior area of a mouth guard may not have a beneficial effect on impact absorption and dissipation.Practical ImplicationsThe use of mouth guards is a general requirement for physical sports activities, and it should be strongly encouraged for people playing contact sports in particular. However, the authors’ results indicate that the total thickness of a mouth guard is more important than is the use of an additional intermediate layer (in this case, titanium).     

定制牙托膜片切牙区厚度变化的影响因素

佩戴运动牙托可以缓冲外力,降低颌面部损伤的风险.运动牙托种类较多,其中个性化定制运动牙托具有较好的保护作用和较高的舒适度而备受欢迎.个性化定制运动牙托的膜片加热后可发生延展,随后发生厚度变化,尤以切牙区膜片的厚度变化更能影响其保护性能;因此,笔者就影响个性化定制运动牙托膜片切牙区的厚度变化的膜片硬度、膜片形状和膜片表面设计等膜片因素,工作模厚度和工作模摆放角度等工作模因素,加压方法,夹持托盘形状、夹持方式和夹持托盘与工作模底座的距离等夹持因素,加压时间等的研究进展作一综述.     

Dental trauma prevention with mouthguard in a nose fracturing blow to the face: Case report

Orofacial injuries are common in sports activities and may vary in complexity and the tissues involved. Most sports‐related trauma occurs when a player hits another player, an object or the ground. This report presents a case of an injury caused by a punchlike blow to the face during a handball college team practice session. The patient suffered a traumatic blow to the left side of the nose and mouth and promptly attended a dentist. After a clinical examination and a CBCT scan, the following injuries were diagnosed: upper lip laceration, upper left lateral incisor subluxation and anterior nasal spine fracture. More severe teeth injuries were likely prevented because the patient was wearing a mouthguard.