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This investigation presents a critical analysis of mouthguard production, focusing on the evaluation of conventional vs additive manufacturing methods, the materials involved, and aspects such as their failure and prevention. It also summarizes the current trends, perspectives, and the main limitations. It is shown that some of the shortcomings can be solved by implementing additive manufacturing technologies, which are systematically reviewed in this research. Due to the specific materials used to produce mouthguards, there are certain additive manufacturing technologies that dominate and a wide variety of raw materials. The costs vary depending on the technology.

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BACKGROUND/AIM: Mouthguards are used to prevent dental trauma and orofacial injuries. The aim of this study was to evaluate the influence of ethylene-vinyl acetate (EVA) aging by thermocycling on elastic modulus, stress, strain and shock absorption ability of different ethylene-vinyl acetate brands used for mouthguards. METHODS: Thirty EVA samples with a dimension of 70 × 10 × 3 mm were obtained from four commercial brands (Bioart®, Erkodent®, Polyshok® and Proform®). Fifteen samples were submitted to 10,000 cycles (5°C-55°C) in a thermocycling machine with an immersion time of 30 s and a transfer time of 5 s. The samples were submitted to a uniaxial tensile test in a universal testing machine to calculate the elastic modulus. Data were statistically evaluated by two-way ANOVA and Holm-Sidak test. A three-dimensional model of the anterior maxilla was created using Rhinoceros 5.0. A 3 mm custom-fitted mouthguard was simulated. The three-dimensional volumetric mesh was generated using the Patran software (MSC Software) with isoparametrics, 4-noded tetrahedral elements and exported to Marc/Mentat (MSC Software) as element number 134. A non-linear dynamic impact analysis was performed in which a rigid object struck the central incisor at a speed of 5 m/s. The stresses were evaluated by the modified von Mises criteria and the strains were also recorded. RESULTS: Statistically significant differences were observed for elastic modulus values (p < .001). Mean and standard deviation values (MPa) without thermocycling were: Bioart (34.5 ± 0.9), Erkodent (15.0 ± 0.4), Polyshok (17.3 ± 0.4), Proform: (20.6 ± 0.8); and with thermocycling: Bioart (25.4 ± 0.8), Erkodent (10.7 ± 0.5), Polyshok (13.3 ± 0.6), Proform (13.1 ± 0.6). The thermocycling process reduced stress and strain levels regardless of the mouthguard materials. Shock absorption ability calculated based on the strain values was increased with thermocycling process. CONCLUSION: The thermocycling process, regardless of the commercial brand, reduced the stress/strain and increased the shock absorption ability of mouthguards.

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BACKGROUND/AIMS: Athletes are susceptible to oral injuries. To reduce the incidence and severity of oral trauma, a custom-made mouthguard, a device positioned in the mouth to prevent damage to teeth and surrounding structures, is recommended. In field hockey, according to the international rules of this sport, using mouthguards is not mandatory, but it is recommended to wear them at all times while practicing this discipline. We aimed to determine characteristics and differences regarding mouthguard usage among field hockey players from different countries participating in the XII ODESUR Games. METHODS: We conducted a cross-sectional study that included 78 voluntary hockey athletes that met the inclusion criteria. The questionnaire used was validated by Panam Sports, collecting information on the type of mouthguard (custom-made or prefabricated), and the time of use of the mouthguard (range of 5 years). RESULTS: Of the total number of athletes, 96% used mouthguards, of which 64% were custom-made type, and 32% were prefabricated (p < .001). Custom-made mouthguards were used by 100%, 89%, and 64% of athletes in Argentina, Chile, and Peru, respectively, while only 40% of athletes in Paraguay and Uruguay used them. It has also been observed that more than 50% of the individuals have not controlled and replaced their intraoral devices for more than 10 years. CONCLUSIONS: Our results reveal a problem with a public health dimension and thus invite the standardization of guidelines with an educational approach to promoting and adopting good sports practices. This report is the first on using mouthguards in high-performance athletes during an international multisport event.

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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.

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BACKGROUND/AIM: Mouthguards (MTG) are used to prevent dental trauma. However, their protective effect on esthetic restorations and whether modified MTGs are beneficial is uncertain. The aim of this study was to evaluate the effect of hard inserts and air spaces in MTGs in protecting direct resin composite veneers during impact. MATERIALS AND METHODS: Twenty resin composite veneers (1.0 mm) were prepared on upper right central incisors on printed maxilla models using polyether. The effect of the MTGs was evaluated in four groups (n = 5): Con-MTG, conventional custom-fit MTGs made with two layers of ethylene vinyl acetate (EVA); Air-MTG, MTGs with the insertion of 2.0 mm air space between the two layers of EVA and tooth surface; PETG-MTG, MTGs with 1.0 mm of polyethylene terephthalate glycol-modified (PETG) inserted between the EVA layers; and No-MTG, comprising resin composite veneers without MTG. The printed models were fixed in a pendulum device, and the impact was performed at 30°. The strain (µS) and shock absorption (%) of the MTG were recorded using strain gauges. Failure modes and cracks were evaluated using macro photography and transillumination and analyzed using the chi-square test. Strain and shock absorption data were analyzed using the one-way analysis of variance followed by Tukey's test (α = 0.05). RESULTS: Mouthguards reduced strain and enhanced shock absorption, regardless of the MTG type (p < .001). Con-MTG, Air-MTG, and PETG-MTG had shock absorption rates of 76.1%, 72.3%, and 33.4%, respectively (p < .001). The single No-MTG model had a root fracture, while all the others had superficial damage. None of the MTG models had cracks or fractures. CONCLUSIONS: Mouthguards protected the resin composite veneers. The Con-MTG and Air-MTG groups had lower strain and greater shock absorption than the PETG-MTG. Resin veneers had no cracks or damage following MTG use. However, 80% of the veneers had surface damage when no MTG was used.

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BACKGROUND/AIM: Contamination of ethylene vinyl acetate (EVA) during mouthguard fabrication can cause delamination. The study evaluated the effects of different EVA surface treatments on the contact angle, laminate bond strength, and elongation capacity. MATERIALS AND METHODS: Specimens of two bonded EVA plates were prepared (n = 30). The Shore A hardness of standardized EVA plate specimens was measured before and after thermo-plasticization. The EVA plates were randomly allocated to one of five different surface treatment groups: no treatment (control); isopropyl alcohol, 100%; chloroform, 99.8%; self-cure acrylic resin monomer (methacrylate, ethylene glycol dimethacrylate, and chemical initiator-amine type); and ethyl alcohol, 70%. The maximum breaking force and elongation at the site of fracture were recorded using a universal testing machine. The contact angle surface was measured using ImageJ software. Scanning electron microscopy of the EVA surface was performed. The laminate bond strength was obtained by dividing the maximum breaking force by the bonding area between the two EVA plates. The laminate bond strength and maximum elongation data were analyzed by one-way ANOVA, followed by the Tukey's and the Dunnet test. The failure mode data was analyzed using the chi-square test (α = .05). RESULTS: EVA surface treatment significantly influenced the laminate bond strength and maximum elongation (p < .001). The control group had a higher contact angle and significantly lower laminate bond strength and maximum elongation than the other groups (p < .001). The acrylic resin monomer and chloroform-treated specimens had similar laminate bond strength and maximum elongation. The acrylic resin monomer group had a significantly lower contact angle (p < .001). CONCLUSIONS: All treatments had a significantly higher laminate bond strength and maximum elongation than the control group. The acrylic resin monomer and chloroform groups had a significantly higher laminate bond strength and maximum elongation and the acrylic resin monomer group had a lower contact angle than the other groups. The chloroform should be avoided due its hazardous effects.

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Esse estudo avaliou in vitro e in silico as respostas dentoalveolares em incisivos centrais frente a traumas na região anterior da maxila, com uso de protetores bucais (PB) reforçados por malha em poliamida em três diferentes localizações. Os grupos de estudo foram divididos em crânio com PB convencional em EVA (etileno vinil acetato) com 4mm de espessura; PB em EVA 4mm de espessura (controle) com reforço a 1mm (Mg 1+3), 2mm (Mg 2+2) e 3mm (Mg 3+1) do limite vestibular. No estudo in vitro um modelo do crânio foi impresso em Resina Spin Red - Quanton 3D abrangendo a região maxilar e os dentes individualmente em resina Resilab Clear - Wilcos e o ligamento periodontal foi simulado em silicone de adição. Para mensurar as microdeformações, foram colocados extensômetros no processo alveolar da maxila e no centro das coroas dos dentes 11 e 21, paralelos ao longo eixo destes. Os PB foram produzidos em EVA com reforços de acordo com cada grupo (n=10). O impacto foi realizado por meio de uma máquina específica desenvolvida aplicando a energia de Ep=0,5496 J, com força dentro do limite elástico do material do crânio no sentido horizontal paralelo ao solo e perpendicular à superfície de contato da esfera de 35mm. No estudo in silico, os quatro grupos foram modelados e analisados por análise explícita dinâmica simulando impacto por meio de uma esfera de aço com 35mm de diâmetro e 7.8 g/cm³ de densidade a 1m/s com todas as condições semelhantes ao estudo in vitro. Os materiais foram considerados isotrópicos, homogêneos e lineares. Os contatos seguiram as mesmas condições físicas do ensaio in vitro (friccional e colado). As malhas foram definidas com tetraedros após convergência de 10%. As deformações e tensões máximas principais nos dentes e na maxila foram apresentadas em gráficos colorimétricos. Os dados obtidos do estudo in vitro foram submetidos aos testes de Shapiro-Wilk, Kruskal-Wallis e ao teste de comparação múltipla de Dunn (significância de 5%). Os resultados mostram diferença estatística para o grupo sem reforço em relação aos demais grupos (p = 6,8x10-5), em relação às as microdeformações (µÎµ) nas diferentes áreas de impacto, não foi possível observar diferença estatística (p = 0,879). Os resultados da análise por elementos finitos corroboraram com o estudo in vitro por extensometria, o que permite validação dos modelos teóricos e práticos para análises futuras. (AU)

This study evaluated in vitro and in silico dentoalveolar responses in central incisors to trauma in the anterior region of the maxilla, using mouthguards (MG) reinforced with polyamide mesh in three different locations. The study groups were divided into skull with conventional PB in EVA (ethylene vinyl acetate) with 4 mm thickness; PB in 4mm thick EVA (control) with reinforcement at 1mm (Mg 1+3), 2mm (Mg 2+2) and 3mm (Mg 3+1) from the vestibular limit. In the in vitro study, a skull model was printed in Spin Red Resin - Quanton 3D covering the maxillary region and teeth individually in Resilab Clear - Wilcos resin and the periodontal ligament was simulated in addition silicone. To measure the microdeformations, extensometers were placed in the alveolar process of the maxilla and in the center of the crowns of teeth 11th and 21th, parallel to their long axis. The BP were produced in EVA with reinforcements according to each group (n=10). The impact was performed by a specific machine developed, applying Ep=0.5496 J of energy, with force within the elastic limit of the skull material in the horizontal direction parallel to the ground and perpendicular to the contact surface of the 35mm sphere. In the in silico study, the four groups were modeled and analyzed by dynamic explicit analysis, simulating impact through a steel sphere with 35mm in diameter and 7.8 g/cm³ of density at 1m/s with all conditions similar to the in vitro study. The materials were considered isotropic, homogeneous and linear. The contacts followed the same physical conditions of the in vitro test (frictional and glued). Meshes were defined with tetrahedrons after 10% convergence. The main maximum deformations and stresses in the teeth and in the maxilla were presented in colorimetric graphs. The data obtained from the in vitro study were submitted to the Shapiro-Wilk, Kruskal-Wallis and Dunn's multiple comparison test (5% significance). The results show a statistical difference for the group without reinforcement in relation to the other groups (p = 6.8x10-5), in relation to the microdeformations (µÎµ) in the different areas of impact, it was not possible to observe a statistical difference (p = 0.879). The results of the finite element analysis corroborated the in vitro study by extensometry, which allows validation of theoretical and practical models for future analysis. (AU)

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BACKGROUND/AIM: The use of custom-fitted mouthguards can effectively prevent dentoalveolar trauma during sports practice. The aims of this study were to (1) Evaluate the elastic modulus of different EVA commercial brands used for custom-fitted mouthguards, and (2) Evaluate whether the different EVA brands can influence the stress and strain generated during an impact simulated by three-dimensional finite element analysis. METHODS: The elastic modulus of five EVA commercial brands (Essence® , Bio-Art® , Proform® , PolyShok® , and Erkodent® ) were calculated through uniaxial tensile tests. The obtained values were evaluated statistically by Kruskal-Wallis and Dunn's test. A three-dimensional model of the anterior maxilla was created using the Rhinoceros 5.0. A 3 mm custom-fitted mouthguard was simulated. The three-dimensional volumetric mesh was generated using the Patran software (MSC.Software) with isoparametrics, 4-noded tetrahedral elements, and exported to Marc/Mentat (MSC.Software) as element number 134. A non-linear dynamic impact analysis was performed in which a rigid object struck the central incisor at a speed of 5 m/s. The stresses were evaluated by the modified von Mises criteria, and the strains were also recorded. RESULTS: Statistically significant differences were observed for elastic modulus values (p < .001). Median values and the results of the Dunn's test were Essence® (38.1 A), Bio-Art® (34.9 AB), Proform® (20.8 BC), PolyShok® (17.4 CD), and Erkodent® (15.0 D) (different capital letters mean statistical differences among the groups). Stresses and strains generated in the model with mouthguards were significantly lower than the model without a mouthguard regardless of the commercial brand. There was no significant difference in the stress and strain on the enamel and dentin with the different EVA brands. The shock absorption ability was high for all the brands (more than 80%). CONCLUSION: The custom-fitted mouthguards, independently of the commercial brand, reduced stresses and strains during the impact.

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All sporting activities have an associated risk of orofacial injuries that can affect the oral health-related quality of life (OHRQoL). A custom-made mouthguard can be used as an adjuvant treatment for faster recovery of an athlete to resume sporting activities. This case report described a minimally invasive approach by use of mouthguard for treating sport-related root fracture and its impact on OHRQoL. In a dental trauma care program, the patient was treated by repositioning the coronary portion and the confection of a splint. It was opted to not realize the endodontic treatment and the patient was inserted in a rigorous clinical and radiographic follow-up. A custom-made mouthguard was made, which allowed for the immediate return of athletes to practicing sports. The athlete's OHRQoL was negatively impacted by dental trauma, but the treatment proposed was associated with the use of custom-made mouthguards. After 2 years, the absence of radiographical lesions and a positive response to sensibility tests were observed. The success of the minimally invasive approach was attributed to immediate conduct following dental trauma, the implementation of follow-up, and associated with the use of custom-made mouthguard.

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BACKGROUND/AIM: Rugby union represents a high-risk sport for orofacial trauma due to its impact collisions and repetitive tackles. The aim of this study was to investigate the prevalence of orofacial trauma according to mouthguard use among a sample of Brazilian rugby union players. METHODS: An online questionnaire was sent to the 16 best rugby union clubs in Brazil. The questionnaire contained questions about the training history of each athlete, prevalence of orofacial trauma, and details about mouthguard use. Only participants who reported using a mouthguard were selected for this analysis. RESULTS: A total of 244 individuals were included. The prevalence of orofacial trauma was 34.4%, and 61.9% of them did not wear a mouthguard at the time of the incident. The only type of mouthguard reported was the pre-fabricated ("boil and bite" and "ready-to-wear") type. A stronger association was observed between the reason for using a mouthguard and the outcome, whereas a lower proportion of trauma was observed among individuals who claimed mandatory mouthguard use at the gym/sport (20.0%). Time since the respondent started playing rugby union and who instructed them to use a mouthguard were not associated with orofacial trauma. CONCLUSION: Prevalence of orofacial trauma was high among this sample of rugby union players from Brazil, even with the use of pre-fabricated mouthguards. This study encourages further investigation on the use of custom-made mouthguards in rugby union and the role of coach/physical educators to reduce the prevalence of orofacial trauma.

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BACKGROUND: CrossFit is an activity that can provide positive influences on body composition and physical fitness. However, the occurrence or pattern of possible injuries, especially in the orofacial region, has not yet been studied. The aim of this study was to investigate the occurrence and patterns of orofacial injuries in CrossFit practitioners. MATERIAL AND METHODS: This was a cross-sectional study carried out using an online questionnaire on the Google Forms platform. The volunteers were self-selected men and women who practice CrossFit and reside in Brazilian municipalities. The online survey was conducted during April 2020 and comprised 12 questions. The data were analyzed, categorized, and presented as percentages. RESULTS: These were 65 (27.8%) participants who reported having suffered at least one episode of orofacial trauma and they were more prevalent during training sessions 58 (89.2%). Among the regions with the highest frequency of injuries, the head 23 (21%), mental protuberance 22 (19.6%), upper lip 19 (16.9%), and maxillary teeth 14 (12.5%) were the most cited. CONCLUSIONS: The prevalence of injuries in the head region indicates a potential concern. Preference should be given to making mouthguards for the maxillary teeth, as they are significantly more affected by trauma during CrossFit when compared to the mandibular teeth.

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BACKGROUND/AIM: Little is known about the effect of dental trauma and mouthguards (MG) on teeth with ceramic laminate veneers (CLV). The aim was to evaluate the influence of CLV thickness and the presence of a MG with and without antagonist tooth contact on impact stresses during dental trauma. MATERIALS AND METHODS: Twelve 2D-finite element models of a head with maxillary structures and upper incisors, six with and six without antagonist tooth, were created in three CLV conditions: sound incisor (no CLV), 0.3 mm CLV, and 1.0 mm CLV. These were evaluated with and without a 4.0-mm ethylene-vinyl acetate MG, with and without an antagonist tooth. An impact analysis was performed in which the head frontally hits a rigid surface at a speed of 1 m/s (3.6 km/h). The results were analyzed using Critical modified von Mises (MPa). The mean of the 10% highest modified von Mises stresses in each structure was collected. RESULTS: MG presence substantially reduced impact stresses in the CLV and tooth structures. The contact of the antagonist tooth promoted better stress distribution and reduced the stress levels in the traumatized tooth. Critical stress areas were found in the palatal enamel, incisal enamel, labial cervical area, and enamel under the CLV for all models without MG. In the models with MG, the stresses reduced significantly. Critical modified von Mises stress showed that sound or prepared enamel experienced more critical impact stresses than 0.3 or 1.0-mm thick CLV. CONCLUSIONS: The use of 4.0 mm EVA mouthguard reduced the impact stress levels in models with 0.3-mm CLV and 1.0-mm CLV, similar to a sound tooth. The contact of an antagonist tooth and the MG better distributed the stresses and reduced the impact stress in the traumatized tooth.

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(1) Background: Trauma is a very common experience in contact sports; however, there is an absence of data regarding the effect of athletes wearing mouthguards (MG) associated with ankylosed maxillary central incisor during a traumatic impact. (2) Methods: To evaluate the stress distribution in the bone and teeth in this situation, models of maxillary central incisor were created containing cortical bone, trabecular bone, soft tissue, root dentin, enamel, periodontal ligament, and antagonist teeth were modeled. One model received a MG with 4-mm thickness. Both models were subdivided into finite elements. The frictionless contacts were used and a nonlinear dynamic impact analysis was performed in which a rigid object hit the model at 1 m·s-1. For each model, an ankylosed periodontal ligament was simulated totaling 4 different situations. The results were presented in von-Mises stress maps. (3) Results: A higher stress concentration in teeth and bone was observed for the model without a MG and with ankylosed tooth (19.5 and 37.3 MPa, respectively); the most promising mechanical response was calculated for patients with healthy periodontal ligament and MG in position (1.8 and 7.8 MPa, respectively). (4) Conclusions: The MG's use is beneficial for healthy and ankylosed teeth, since it acts by dampening the generated stresses in bone, dentin, enamel and periodontal ligament. However, patients with ankylosed tooth are more prone to root fracture even when the MG is in position compared to a healthy tooth.

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La odontología deportiva es la rama de la medicina deportiva que se ocupa de la prevención y el tratamiento de las lesiones bucodentales y las enfermedades orales asociadas al deporte y el ejercicio. Por lo que se hace necesario la intervención de profesionales de la salud bucodental para hacer evaluaciones del deportista y el deporte que practica para ver los riesgos que puede tener de desarrollar y sufrir lesiones bucodentales como traumas dentoalveolares y lesiones no cariosas. Y de este modo realizar las recomendaciones a cada paciente que practica deporte, de los elementos que deben usar como equipamiento bucodental para evitar o reducir el daño dentoalveolar (AU)

Sports dentistry is the branch of sports medicine that deals with the prevention and treatment of oral injuries and oral diseases associated with sports and exercise. Therefore it is necessary the intervention of oral health professionals to make evaluations of the athlete and the sport he practices to see the risks that may have to develop and suffer oral injuries such as dentoalveolar trauma and non-carious lesions. And in this way make the recommendations to each patient who practices sports, of the elements that should be used as oral equipment to avoid or reduce dentoalveolar damage (AU)

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BACKGROUND/AIM: Maxillary canines have a high incidence of impaction which may be associated with unexpected damage during maxillofacial trauma. The aim of this study was to evaluate how an impacted canine could influence the stress distribution in the dentoalveolar complex during a simulated impact before and after surgical removal plus the protective effect offered by a mouthguard. MATERIALS AND METHODS: Cross-sectional finite element models of the central incisor and support structures of a patient with an impacted canine in a transverse position were made using ImageJ and Marc/Mentat software. The following impact conditions were simulated: (a) incisor with impacted canine; (b) incisor with surgical socket after impacted canine extraction; and (c) incisor after bone healing. The impacts were also simulated with a 3 mm custom-fitted ethylene vinyl acetate mouthguard. A non-linear dynamic impact finite element analysis was performed in which a rigid object hit the model at 1 m/s. Maximum and minimum principal stresses as well as von Mises stresses were analyzed. RESULTS: Higher values of compressive and tensile stresses occurred on the cortical bone in the models after impacted canine extraction. The highest stress concentrations in the enamel and dentin structures were observed after bone healing. The mouthguard reduced the stress in the alveolar bone and dental structures. CONCLUSIONS: Use of mouthguards during impact reduced the compressive and tensile stresses in the alveolar bone, mainly in the fragile regions of the impacted canine or surgical socket.

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BACKGROUND: Although there is evidence that mouthguards prevent orofacial trauma occurrence during sport practice, the influence of this device on athletic performance has not been systematically quantified. OBJECTIVES: We aim to systematically review the literature to determine the effect of mouthguards on athletic performance and if the type of mouthguard influences this overcome. MATERIALS AND METHODS: A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Scopus, Web of Science and the Cochrane Library from their inception to February 2017. The publications were grouped based on their outcome: (i) the use of mouthguards; or (ii) the type of mouthguards. We conducted descriptive analyses and quality assessments of the included studies. RESULTS: The search identified 489 citations. After screening the studies, we identified 15 trials comprising a population of 312 athletes. According to the risk of bias evaluation, nine studies were considered 'high' risk of bias, and six 'low' risk of bias. Overall, custom-made mouthguards did not interfere or improve athletes' performance when compared with the control group (without mouthguard). Custom-made mouthguards showed the smallest range of changes in players' performance compared with other types of mouthguards. CONCLUSIONS: This systematic review provides evidence for sports professionals to advocate the use of custom-made mouthguards to prevent injury, and these devices do not impair performance. The scientific evidence should be interpreted carefully because there is a great variability in outcome measures and lack of important methodological details.

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BACKGROUND/AIMS: Mouthguards (MGs) are devices that can reduce the risks of facial trauma. However, the large variety of MG types and thicknesses raises the question of which type is the most effective and beneficial for the athletes. The aim of this study was to evaluate stress distribution in the skull, teeth, and jaws as a consequence of a direct impact. MATERIAL AND METHODS: Using modeling software, a human skull was modeled and a human jaw was created with all teeth inserted into the respective alveolus. The models were divided according to the MG type (custom-made or stock) and thickness (1, 2, and 4 mm). Two models without MG were evaluated with and without teeth contact. The geometries were exported to analysis software and the materials were considered ideal. Fixation occurred at the base of the foramen magnum. The load (500 N) was applied on the canine tooth with a ball. Maximum principal (MPa) and Von-Mises results were obtained. RESULTS: Without any protection, the generated tensile stress was of greater magnitude causing more damage in the absence of teeth contact. The presence of a MG significantly reduced the generated stress in all structures, and the customized/individualized type was more efficient than stock MGs. CONCLUSIONS: In extreme situations when it is impossible to use a MG, keeping the teeth in maximum intercuspal position is less harmful. Despite this, the use of any MG is beneficial and assists in dampening the generated stress. The thicker the device, the greater the capacity for decreasing the damage in all structures. The use of individual protectors for each patient is even more beneficial for preventing trauma during at-risk activities of impact.

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A Odontologia do Esporte é uma nova especialidade odontológica, que tem, dentre os seus objetivos, prevenir, tratar e reabilitar atletas. Uma das atuações do cirurgião-dentista que atua nessa área é a confecção de protetores faciais e bucais individualizados. Atualmente, existe um maior número de investigação científica sobre protetores bucais que os faciais; consequentemente, os bucais são normatizados, e os faciais, ainda não. Eles são utilizados somente depois de o atleta ter sofrido traumas, porque evitam que o osso sofra refratura ou deslocamento, permitindo ao atleta não se manter temporariamente afastado da prática dos esportes... (AU)

Sports Dentistry is a new dental specialty whose goal is to prevent, treat and rehabilitate athletes. One of the activities of the dentist that acts with the Sports Dentistry is the confection of individualized facial masks and mouthguards. There is a greater number of scientific research on mouthguards than on facial masks, as a result of which mouthguards are normalized and facial masks not yet. They are used only after the athlete has suffered traumas, so with their use it prevents the bone from suffering refraction or displacement and allows the athlete not to stay temporarily away from the practice of sports... (AU)

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Los deportes de contacto aumentan el riesgo de traumatismo causando alteraciones funcionales, estéticas y psicológicas. Los protectores bucales son parte del equipo de seguridad que protegen al deportista de estos accidentes, es importante que brinde confort para lograr el mejor rendimiento físico. Objetivo: Comparar el confort de los jugadores de fútbol americano con el uso de protectores prefabricados y protectores personalizados. Metodología: Se realizó un estudio cuasiexperimental, analítico y prospectivo donde se incluyeron 15 jugadores de futbol americano de la Facultad de Estudios Superiores Acatlán, UNAM, que firmaron consentimiento informado. La autora principal de este proyecto fabricó los protectores bucales superiores con hoja de copolímero de etilvinilacetato (EVA) #35. El protector prefabricado fue de silicón. Los jugadores realizaron dos prácticas de entrenamientos donde hicieron 30 minutos de carrera, 15 de estiramiento, 60 de fuerza y destreza en donde requerían de estar en constante comunicación verbal y 30 de cardiovascular en gimnasio (usaron un protector en cada entrenamiento). Se aplicó un cuestionario ­previamente validado por consenso de expertos­ para evaluar el confort en la respiración, lenguaje, náuseas, adaptación, comodidad e hidratación bucal con cada tipo de protector. La información se analizó en el programa SPSS v19.0; se usaron proporciones para las variables cualitativas y medidas de tendencia central y dispersión para las cuantitativas. Para comparar el confort con el uso de ambos protectores se empleó la prueba χ2, con un nivel de significancia p < 0.05. Resultados: La media de edad fue de 20 ± 2 años. Con el protector personalizado 11 jugadores (0.73) refirieron que respiraron y hablaron mejor, sintieron menos náusea 12 (0.80), mejor adaptación 11 (0.73) y mayor comodidad 12 (0.80) que, con el uso de protector bucal prefabricado, encontrando diferencias estadísticamente significativas (p < 0.05) y ocho (0.53) refirió menos hidratación bucal (p > 0.05). Doce (0.80) de los jugadores mencionaron tener mayor confort con el protector personalizado. Conclusiones: Con la metodología empleada y en la muestra estudiada, el uso de un protector bucal personalizado fabricado con hoja de copolímero de etilvinilacetato (EVA) #35 ofrece una mejor adaptación y comodidad, después de dos prácticas de entrenamiento (AU)

The contact sports, increase the risk of trauma causing functional, aesthetic and psychological alterations, mouth guards are part of the safety equipment that protects the athlete from this kind of accidents, it is also important that the mouth guard had to provides comfort, for achieve a best physical performance. Objective: Make the comparison with the comfort of American football players with the use of prefabricated protectors and customized protectors. Method: A quasi-experimental, analytical and prospective study was carried out, including 15 American football players from the Facultad de Estudios Superiores Acatlán, UNAM, who signed an informed consent. The lead author of this project manufactured the upper mouth guards with ethylvinylacetate (EVA) #35 copolymer foil. The prefabricated protector was made of silicone. The players performed two practice sessions where they did 30 minutes of running, 15 of stretching, 60 of strength and skill where they required being in constant verbal communication and 30 of cardiovascular in a gymnasium (they used a protector in each training). A questionnaire ­previously validated by expert consensus­ was applied to evaluate comfort in breathing, language, nausea, adaptation, comfort and oral hydration with each type of protector. The information was analyzed in the program SPSS v19.0; proportions were used for the qualitative variables and measures of central tendency and dispersion for the quantitative ones. To compare the comfort with the use of both protectors the test χ2 was used, with a level of signifi cance p < 0.05. Results: The mean age was 20 ± 2 years. With the personalized protector, 11 players (0.73) reported that they breathed and spoke better, feeling less nausea 12 (0.80), better adaptation 11 (0.73) and greater comfort 12 (0.80) than with the use of prefabricated mouth guards, fi nding statistically signifi cant diff erences (p < 0.05) and 8 (0.53) reported less oral hydration (p > 0.05). 12 (0.80) of players mentioned having more comfort with the custom protector. Conclusions: The use of a personalized mouth guard off ers better fi t and comfort made with sheet copolymer of ethylvinylacetate, after two training practices (AU)

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RESUMO

RESUMEN: El traumatismo dentoalveolar incluye un conjunto de lesiones que afectan a los dientes y/o estructuras de soporte a consecuencia de un impacto violento directo o indirecto. Debido a que por lo general comprometen el sector anterior generan cambios físicos, fonéticos, psicológicos y dietarios, que pueden afectar significativamente la calidad de vida de pacientes afectados por este traumatismo. Los protectores bucales son considerados la principal medida para minimizar y/o evitar estos traumatismos. El presente artículo describe el tratamiento y procedimientos para realizar un protector bucal por laminado a presión en un paciente deportista con historia previa de traumatismo dentoalveolar en incisivos centrales superiores.

ABSTRACT: Traumatic dental injuries involve lesions that affect teeth and/or adjacent supporting structures as a consequence of direct or indirect violent impact. Due to As it affects the anterior teeth, in most of the cases, it provokes changes in the physical appearance, altering phonetics, psychology and the diet of the affected subject. These changes may significantly alter the quality of life of patients affected by this type of trauma. Mouthguards are considered the primary appliance for minimizing and/or avoiding dental trauma. The present article describes the treatment and procedures to perform a mouthguard by pressure lamination technique in a patient that who practices sports and with a history of trauma affecting the upper central incisors.

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