Thickness change and deformation of custom-made mouthguards after two years of use by Bangladeshi field hockey players

Changes in oral functions and speech when using custom-fitted mouthguards: An uncontrolled before-and-after study

BACKGROUND/AIM

Mouthguards are crucial for protecting athletes against orofacial injuries, yet concerns persist regarding their potential impact on oral functions. This study aimed to investigate the effects of sports mouthguards on oral functions and speech over time.

MATERIAL AND METHODS

Thirty national rugby players received custom-fitted mouthguards. Questionnaire responses and speech recordings were collected before mouthguard use and at various intervals after using mouthguards: immediately, 1 week, 2 month, and 6 months. Spectrographic analysis was performed to measure voice onset time (VOT) for /p, b, t, d/ phonemes. Questionnaire responses were assessed with Friedman's test, while VOT changes were examined using one-way repeated measure analysis of variance.

RESULTS

Compliance with mouthguard use improved during training and competitions, with consistent wear reported during matches. Over time, speaking difficulties and lisping decreased significantly (p < .001). The perception of nausea improved (p < .001), stabilizing after 1 month (p = .414). Sensations of bulkiness declined (p < .001). Mouth dryness reduced steadily, with no occurrences reported by all players by the end of the study. None of the participants reported bad breath, ulcers, or redness in the mouth. VOT changed immediately after wearing mouthguards (p < .001), gradually regressing toward the baseline, although not completely reaching it. Players held a favorable view of mouthguard use, with comfort and support for mandatory use increasing over time.

CONCLUSIONS

Custom-fitted mouthguards do not lead to significant long-term disruptions in oral functions. Athletes generally adapt to mouthguard use, reporting improved comfort and greater support for their use.

Fabrication of sports mouthguards using a semi-digital workflow with 4D-printing technology

Purpose This technical procedure report explains the fabrication protocol for a newly developed 4D-printed sports mouthguard (MG) based on 4D-printing technology.Methods An intraoral scanner was used to scan a maxillary arch model. A two-layer sports MG was designed based on the scanned model using computer-aided design software and output in a standard tessellation language file format. Two types of filament materials were used for the MG material: a thermoplastic shape memory polyurethane elastomer with a unique glass transition temperature for the external layer and a thermoplastic elastomer for the internal layer. Both MGs were printed using a fused deposition modeling 3D printer and assembled using adhesives after trimming the support material. To confirm the shape-memory performance of the fabricated 4D-printed MG, a deviation analysis was performed by superimposing the internal surface data of the fabricated MG and the MG whose shape was recovered. The distance between the data obtained by deviation analysis was calculated, and the root mean square error value (mm) was determined.Conclusions The 4D-printing technology simplifies the complex processes required with conventional methods. It also overcomes the issues of conventional and 3D-printed MGs, such as the reduced fitting accuracy caused by deformation, because this technology employs shape memory materials.

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.

Evaluation of Mechanical Properties of 3D-Printed Polymeric Materials for Possible Application in Mouthguards

Custom mouthguards are used in various sports disciplines as a protection for teeth, temporomandibular joints, and soft tissues of the oral cavity from impact forces. The purpose of this research was to evaluate the mechanical properties of flexible polymeric 3D-printable materials and to select a material with the most favourable physical properties for making intraoral protectors. Four 3D-printable polymeric materials were selected for the evaluation: IMPRIMO LC IBT (Scheu-Dental, Iserlohn, Germany), Keyortho IBT (EnvisionTEC, Gladbeck, Germany), IBT (Formlabs, Somerville, MA, USA), and Ortho IBT (NextDent, Utrecht, Netherlands). A total of 176 samples (44 from each material) was 3D-printed using the stereolitography (SLA) technique. Tensile strength, flexural strength, notch-toughness, Shore hardness, sorption, and solubility tests were conducted. The materials were compared using a series of analyses of variance (one-way ANOVA) with Bonferroni post hoc tests. Statistical analyses were performed with the use of IBM SPSS Statistics 28.0.0 software (IBM, New York, NY, USA). Each material was assigned a score from 1 to 4 depending on the individual test results, and tests were given indexes according to the significance of the parameter in the mouthguard protective function. The number of points obtained by each material in each test was then multiplied by the test index, and the results were tabulated. The material with the highest result among the ones studied-most suitable for the application in mouthguard fabrication-was Keyortho IBT from EnvisionTEC.

Stress Concentration of Hybrid Occlusal Splint-Mouthguard during a Simulated Maxillofacial Traumatic Impact: 3D-FEA

Mouthguards (MG) are protective devices that can reduce the risks of facial trauma. However, many athletes do not use them. Additionally, MG wear with coincidental parafunctional activity has not been considered. The aim of this study was to evaluate the stress distribution as a consequence of a direct impact comparing a conventional MG with a novel hybrid appliance (HMG). Using computer-aided design (CAD) software, a human skull was modeled with the teeth inserted into their respective alveolus. The models were divided according to the MG type (conventional or hybrid). The geometries were exported to the computer-aided engineering (CAE) software and the materials were considered isotropic. Fixation was defined at the base of the maxilla. The load was applied using a hockey puck. The total deformation (mm) and the von Mises stress (MPa) results were obtained for the MGs (conventional and hybrid), upper teeth, lower teeth, and maxillary bone. Despite the presence of an MG, it is still possible to observe generated stress in all structures. However, the hybrid design was more efficient than the conventional design in reducing the displacement during the impact and consequently the stress on the upper teeth, lower teeth, and maxillary bone. Higher stress magnitude was more concentrated at the inner portion of the hybrid design than the conventional device. The HMG appliance decreased the stress concentration in the teeth and in the bone, limiting the areas susceptible to injuries to the regions directly impacted by the hockey puck. Although the novel HMG may mitigate injury, some stress will still result, and any possible injury should be evaluated by a dental professional.