The effect of model inclination during fabrication on mouthguard calliper-measured and CT scan-assessed thickness

Effect of different materials for conventional and 3D-printed models on the mechanical properties of ethylene-vinyl acetate utilized for fabricating custom-fit mouthguards

BACKGROUND/AIM

The interaction between the ethylene-vinyl acetate (EVA) with distinct materials utilized for obtaining dental models can affect the performance of resulting mouthguards. This study attempted to evaluate the effect of different materials for conventional (dental stone) or 3D-printed (resin) models on EVA's physical and mechanical properties and surface characteristics.

MATERIAL AND METHODS

EVA sheets (Bioart) were laminated over four model types: GIV, conventional Type IV dental stone model (Zhermak); ReG, resin-reinforced Type IV dental stone model (Zero Stone); 3DnT, 3D resin printed model (Anycubic) without surface treatment; 3DT, 3D-printed model (Anycubic) with water-soluble gel (KY Jelly Lubricant, Johnson & Johnson) coating during post-curing process. The EVA specimens were cut following the ISO 37-II standard (n = 30). Shore A hardness was measured before and after plasticization on the contact (internal) or opposite (external) surfaces with the model. The breaking force (F, N), elongation (EL, mm), and ultimate tensile strength (UTS, MPa) were measured using a universal testing machine. Macro-photography and scanning electron microscopy were adopted for classifying the EVA surface alteration. Data were analyzed by one-way ANOVA with repeated measures, followed by Tukey's test (α = .05).

RESULTS

Plasticization significantly decreased Shore A values for the tested EVA regardless of the model type (p < .001). Higher F, El, and UTS values were verified for the EVA with 3DT and GIV models compared to ReG and 3DnT (p < .001). 3DnT models resulted in severe surface alteration and a greater reduction of the mechanical properties of the EVA.

CONCLUSION

The interaction of EVA with 3D resin-printed models without surface treatment or resin-reinforced Type IV dental stone models significantly affected the physical and mechanical properties of this material. The utilization of water-soluble gel coating during the post-curing process of 3D resin printed models improved the mechanical properties of the EVA, similarly when this material was plasticized over conventional Type IV dental stone model.

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.

Prioritizing model trimming to prevent thinning during mouthguard thermoforming: Influence of increased height associated with an acute model angle

BACKGROUND/AIM

The shape of the working model is one of the major factors affecting the thickness of thermoformed mouthguards. The aim of this study was to clarify the priority of model trimming to prevent thinning during mouthguard thermoforming.

MATERIALS AND METHODS

Mouthguards were thermoformed using 4.0 mm thick ethylene-vinyl-acetate sheets and a vacuum forming machine. Working models were trimmed so that the angles of the labial surface to the model base were 100°, 90°, and 80°. The posterior height was unified to 30 mm, and the anterior heights were 30 mm (A100-L), 35 mm (A90-M), and 40 mm (A80-H), respectively. When the sheet temperature reached 100°C, vacuum forming was performed. Six specimens were formed for each condition. Mouthguard thickness (incisal edge, labial surface, cusp, and buccal surface) was measured using a specialized caliper accurate to 0.1 mm. Differences in thickness reduction rate due to model shapes were analyzed by one-way ANOVA and Bonferroni's multiple comparison tests.

RESULTS

At the incisal edge, there were no significant differences in the reduction rate of the thickness of the mouthguard according to model shapes. On the labial surface, cusp, and buccal surface, the smaller the model angle, the smaller the reduction rate of thickness, and significant differences were observed between A100-L and A80-H, and A90-M and A80-H. On the labial and buccal surfaces, A80-H was more than 7.1% thicker compared with A100-L and more than 5.6% thicker compared with A90-M, and the thickness reduction rate was reduced when the model was trimmed to an acute angle. At the cusp, A80-H was more than 4.3% thicker than A100-L and A90-M.

CONCLUSIONS

It is useful to trim the model at an acute angle in order to prevent thinning during mouthguard thermoforming, even if the anterior height of the model is increased.

In vitro study of how the undercut amount on the model labial side affects the reduction rate of laminated mouthguard thickness

BACKGROUND/AIM

An undercut on the model's labial side affects the mouthguard thickness. The aim of this study was to investigate how the undercut amount on the model's labial side affects the reduction rate of laminated mouthguard thickness.

MATERIALS AND METHODS

Mouthguards were thermoformed using 3.0-mm-thick ethylene-vinyl-acetate sheets for the first and second laminates and a pressure molding machine. Working models were three hard plaster models trimmed so that the undercut amount on the model's labial side was 0°, 10°, and 20° (U0, U10, and U20). A specialized caliper was used to measure the thickness of the incisal, labial surface, and buccal surface of the first layer and the laminated mouthguards. Thickness reduction rate of the first layer or laminated mouthguard due to the model undercut amount were analyzed using one-way ANOVA. Additionally, in each model, the difference in the thickness reduction rate between the first layer and the laminated mouthguard were analyzed by Student's t-test or Welch's test.

RESULTS

Differences in the thickness reduction rate depending on the model's undercut amount showed the same tendency between the first layer and the laminated mouthguard. Significant differences were observed between U0 and U10 as well as U0 and U20 at the incisal edge, and these were observed among all models on the labial and buccal surfaces (p < .01). On the labial surface, the rate of decrease in the laminated mouthguard thickness compared to U0 was approximately 10.4% larger for U10 and approximately 14.9% larger for U20 (p < .01). The thickness reduction rate of the laminated mouthguard was significantly smaller than that of the first layer, which was observed in all models at the incisal edge and in U10 and U20 on the labial surface (p < .01).

CONCLUSIONS

The presence of a 10° or 20° undercut on the model's labial side increases the thickness reduction rate on the labial side of the laminated mouthguard by approximately 10% or 15%.

Effect of sheet extrusion direction on laminated mouthguard thickness: An in vitro study

BACKGROUND/AIM

The thermal shrinkage that occurs when the extrusion molding sheet is heated affects the mouthguard thickness. The aim of this study was to investigate the effect of sheet extrusion direction on laminated mouthguard thickness.

MATERIALS AND METHODS

Mouthguards were pressure formed using the extruded sheet and a plaster model. For the first layer, a 3.0-mm-thick sheet was used. For the second layer, a 2.0- or 3.0-mm-thick sheet was used. In each of the first (F) and second (S) layers, the sheet extrusion direction was either vertical (V; FV, SV) or parallel (P; FP, SP) to the model midline. Thickness differences depending on the extrusion direction of the first layer was analyzed by Student's t-test. Differences in the laminated mouthguard thickness depending on the extrusion direction of the first or second layer and the sheet thickness of the second layer were analyzed by three-way ANOVA.

RESULTS

The first layer was significantly thicker in FV by about 0.20 mm than in FP at the incisal edge, labial surface, and cusp (p < .01). No significant difference was observed between SV and SP in the laminated mouthguard. However, at the incisal edge, labial surface, and cusp of the laminated mouthguard, FV were significantly thicker by 0.17 mm or more than FP under all laminating conditions (p < .01). A 3.0-mm-thick laminating condition was thicker than a 2.0-mm-thick laminating condition by 0.47 mm or more at the incisal edge, labial, and buccal surfaces, and by 0.34 mm or more at the cusp.

CONCLUSIONS

The laminated mouthguard thickness can be secured by molding the first-layer sheet so that the extrusion direction is vertical to the model midline. In the second layer, the extrusion direction did not affect the laminated mouthguard thickness, and a thicker sheet material should be used.

Effective thermoforming method for maintaining mouthguard thickness with a circular sheet using a circular frame

BACKGROUND/AIM

Mouthguard thickness is important to prevent oral and facial trauma during sports. The aim of this study was to establish an effective thermoforming method for maintaining mouthguard thickness with a circular sheet using a circular frame.

MATERIALS AND METHODS

Mouthguards were thermoformed using 4.0-mm-thick ethylene vinyl acetate sheets and a vacuum forming machine. Each sheet was pinched at the top and bottom and stabilized by a circular frame. Two heating conditions were compared: (1) condition N, where the sheet was formed when it sagged 10 mm below the level of the sheet frame at the top of the post, and (2) condition L, where the sheet frame was lowered 50 mm below the ordinary level and heated, and the sheet was formed when it sagged 10 mm. In each heating method, two forming conditions were compared: (1) when the sheet softened, the sheet frame was lowered and formed (condition C; N-C, L-C), and (2) after the sheet frame was lowered, the model was moved forward 20 mm and then formed (condition MP; N-MP, L-MP). Six mouthguards were fabricated for each condition. Thickness differences due to heating conditions and forming conditions were analyzed by the two-way ANOVA and Bonferroni's multiple comparison test.

RESULTS

At the incisal edge and at the labial and buccal surfaces, significant differences were observed among all conditions, and the thicknesses were in the order N-C < L-C < N-MP <L-MP. At the cusp, significant differences were not observed depending on the heating conditions.

CONCLUSIONS

The thermoforming method with a circular sheet using a circular frame did not maintain a sufficient thickness only by the method of moving the model position just before formation. However, the results suggest that a single-layer mouthguard with a labial thickness of 3 mm or more could be fabricated by applying the method of lowering the sheet frame and heating the sheet.

Examination of thermoforming techniques to secure mouthguard thickness of the labial and buccal sides with a single sheet: An in vitro study

BACKGROUND/AIM

Mouthguards must have an appropriate thickness to prevent oral trauma during sports. The aim of this study was to establish a thermoforming technique to secure the labial and buccal thicknesses of the mouthguard with a single sheet.

MATERIALS AND METHODS

Mouthguards were thermoformed using 4.0-mm thick sheets manufactured by extrusion molding, a plaster model, and a vacuum forming machine. Two sheet installation conditions were compared: the sheet extrusion direction was either parallel (P) or vertical (V) to the model's centerline. In each extrusion direction, two forming conditions were compared: (1) the sheet was formed when it sagged 15-mm below the sheet frame at the top of the post (control group; C-P, C-V); and (2) the sheet frame was lowered 50-mm below the ordinary level and heated, the frame was lowered when it sagged 15-mm, and the model was moved forward 20-mm before formation (experimental group; E-P, E-V). Difference in thickness (incisal edge, labial surface, cusp, and buccal surface) due to sheet extrusion direction and forming conditions were analyzed by two-way ANOVA and the Bonferroni method.

RESULTS

At all measurement sites, a significant difference in thickness depending on the sheet extrusion direction was observed in the experimental group (p < .01), but not in the control group. Difference in thickness depending on the forming condition was observed at all measurement sites, and the thickness was in the order C-P, C-V < E-P < E-V. Thicknesses of E-P and E-V were 3.01 ± 0.03 mm and 3.25 ± 0.02 mm on the labial surface, and 2.81 ± 0.02 mm and 3.02 ± 0.02 mm on the buccal surface.

CONCLUSIONS

It was possible to obtain 3 mm or more thickness on the labial and buccal sides with a single sheet by adjusting the sheet extrusion direction and the heating method of the sheet, and by applying the thermoforming method where the model is moved forward just before formation.

Mouthguards in dentistry: Current recommendations for dentists

Properly fitted mouthguards reduce the risk and severity of orofacial injury, to both hard and soft tissues, preventing thousands of dollars of trauma management. In this review, findings from recent research will be evaluated to discuss the strengths and limitations of the different types of mouthguards, including their indications by sport. Design, ideal dimensions, and other characteristics will also be explored. Additionally, patient education and motivation will be examined, with a focus on the dentist's role in this regard. Finally, in addition to proper oral hygiene, the importance of proper mouthguard maintenance and evaluation will be discussed. This review will therefore be able to act as a guide for dentists looking to provide patients of all ages with personal protective equipment and stay up-to-date on recent developments in this branch of the sports dentistry field.

Effect on thickness of a single-layer mouthguard of positional relationship between suction port of the vacuum forming device and the model

BACKGROUND/AIM

Wearing a mouthguard reduces the risk of sport-related injuries, but the thickness has a large effect on its efficacy and safety. The aim of this study was to investigate the effect on the thickness of a single-layer mouthguard of the positional relationship between the suction port of the vacuum forming device and the model.

MATERIALS AND METHODS

Ethylene-vinyl-acetate sheets of 4.0-mm-thickness and a vacuum forming machine were used. Two hard plaster models were prepared: Model A was 25-mm at the anterior teeth and 20-mm at the molar, and model B was trimmed so the bucco-lingual width was half that of model A. Three model positions on the forming table were examined: (a) P20, where the model anterior rim was located in front of the suction port, (b) P30, where the model anterior rim and front edge of the suction port were close, and (c) P43, where the model anterior rim and palatal rim were located on the suction port. Six mouthguards were fabricated for each condition. Thickness differences due to model form and model position were analyzed.

RESULTS

Thickness differences due to model form were observed at the incisal edge and labial surface, and model A was significantly thicker than model B in P43 (P<.01). The thickness of the incisal edge and labial surface was significantly greatest in P43 for model A, but in P30 for model B.

CONCLUSIONS

The effect of the model position on the forming table on suppressing the labial thickness reduction of the mouthguard depended on the bucco-lingual width of the model. It is important to position the model anterior rim away from the sheet frame if the bucco-lingual width of the model is large and to place the model anterior rim in front of the suction port if the width is small.

Effect of acute angle model on mouthguard thickness with the thermoforming method and moving the model position just before fabrication

BACKGROUND/AIM

The effectiveness and safety of mouthguards are affected by their thickness. The aim of this study was to investigate the effect of an acute angle model on the mouthguard thickness with the thermoforming method in which the model position was moved just before fabrication.

MATERIALS AND METHODS

Mouthguards were thermoformed using 4.0 mm thick ethylene vinyl acetate sheets and a vacuum forming machine. Three hard plaster models were prepared: 1) the angle of the labial surface to the model base was 90°, and the anterior height was 25 mm (model A); 2) the angle was 90°, and the anterior height was 30 mm (model B); and 3) the angle was 80°, and the anterior height was 30 mm (model C). The sheet was softened until it sagged 15 mm, after which the sheet frame was lowered to cover the model. The model was then pushed from behind to move it forward, and the vacuum was switched on (MP). The model was moved 20 mm whereas a control model was not moved. Mouthguard thickness was measured using a specialized caliper. The differences in mouthguard thicknesses due to model forms and forming conditions were analyzed by two-way ANOVA and Bonferroni's multiple comparison tests.

RESULTS

The MP tended to be thicker than the control in all models. In the controls, model C was significantly thicker than models A and B at the labial and buccal surfaces. In MP, model A was significantly thicker than models B and C on the labial surface. On the labial and buccal surfaces in MP, model C was significantly thicker than model B.

CONCLUSIONS

This study suggested that in the thermoforming method in which the model position was moved just before fabrication, reducing the height was more effective than changing the angle of the model to ensure the appropriate thickness.

Fabrication method to maintain mouthguard thickness regardless of the model angle

BACKGROUND/AIM

The safety and effectiveness of mouthguards depend on the sheet material and thickness. The aim of this study was to investigate the fabrication method for a mouthguard with appropriate thickness using a single sheet regardless of the model angle.

MATERIALS AND METHODS

Mouthguards were thermoformed using 4.0 mm thick ethylene vinyl acetate sheets and a vacuum forming machine. The working models were three hard plaster models trimmed so that the angle of the anterior teeth to the model base was 90°, 100°, and 110°. The model position was 40 mm from the front of the forming unit. The sheet was softened until it sagged 15 mm, after which the sheet frame was lowered to cover the model. Next, the vacuum was turned on and held for 30 seconds for the control. Under the forming conditions in which the model position (MP) was moved, after the model was covered with the sheet, a scissors handle was positioned at the rear of the model and used to push it forward 20 mm, and then, the vacuum switch was turned on for 30 seconds. Six specimens were formed for each condition. Mouthguard thickness after formation was measured using a specialized caliper. The differences in mouthguard thickness due to forming conditions and model angle were analyzed.

RESULTS

The MP was significantly thicker than the control in each model (P < .01). The mouthguard thickness tended to decrease as the model angle increased. The average thickness of the labial surface in the MP was 3 mm or more and was not affected by the model angle.

CONCLUSIONS

This study suggested that the fabrication method in which moving the model forward by 20 mm just before formation could produce a mouthguard with approximately 3 mm thickness on the labial side with a single sheet regardless of the model angle.

The Role of Mouthguards in Preventing and Reducing Sports-related Trauma

a mouthguard, also known as a gumshield, mouth protector or sports guard is an appliance that covers the teeth and surrounding mucosa with the aim of preventing or reducing trauma to the teeth, gingival tissue, lips and jaws. The device is usually worn on the maxillary arch and works by separating the maxillary and mandibular dentition, protecting the teeth from the surrounding soft tissue, absorbing or redistributing shock and/or stabilising the mandible during traumatic jaw closure. They may also play a role in preventing and reducing concussion by absorbing impact forces that would otherwise be transmitted through the base of the skull to the brain, although the evidence for this is less conclusive. A mouthguard will usually fall into one of three categories: stock mouthguards (which are made ready to use and are believed to give the least protection), the mouth-formed or 'boil and bite' type (which are heated in hot water, placed in the mouth and moulded to the teeth) and custom-made mouthguards (which are usually made on a stone model of the maxillary teeth and surrounding tissue and are thought to give the most protection). These devices can be made from various materials but ethylene-vinyl acetate is by far the most popular material, probably because of the ease with which it can be used for the production of custom-made mouthguards. This paper gives a review of the role of mouthguards in preventing and reducing sports-related trauma and examines the materials that are used to fabricate them.