Most impact force and impact energy absorption tests for mouthguards have used a steel ball in a drop-ball or the pendulum device. However, in reality most sports-related trauma is caused by objects other than the steel ball, e.g. various sized balls, hockey puck, or bat or stick. Also, the elasticity, the velocity and the mass of the object could change the degree and the extent of injuries. In this study, we attempted to measure the impact force from actual sports equipment in order to clarify the exact mechanism of dental-related sports injuries and the protective effects of mouthguards. The present study was conducted using the pendulum impact device and load cell. Impact objects were removable. Seven mobile impact objects were selected for testing: a steel ball, baseball, softball, field hockey ball, ice hockey puck, cricket ball, and wooden baseball bat. The mouthguard material used in this study was a 3-mm-thick Drufosoft (Dreve-Dentamid GmbH, Unna, Germany), and test samples were made of the one-layer type. The peak transmitted forces without mouthguard ranged from the smallest (ice hockey stick, 46.9 kgf) to the biggest (steel ball, 481.6 kgf). The peak transmitted forces were smaller when the mouthguard was attached than without it for all impact materials but the effect was significantly influenced by the object type. The steel ball showed the biggest (62.1%) absorption ability while the wooden bat showed the second biggest (38.3%). The other balls or the puck showed from 0.6 to 6.0% absorbency. These results show that it is important to test the effectiveness of mouthguards on specific types of sports equipment. In future, we may select different materials and mouthguard designs suitable for specific sports.

Mouthguards are expected to reduce sports-related orofacial injuries. Numerous studies have been conduced to improve the shock absorption ability of mouthguards using air cells, sorbothane, metal wire, or hard material insertion. Most of these were shown to be effective; however, the result of each study has not been applied to clinical use. The aim of this study was to develop mouthguards that have sufficient prevention ability and ease of clinical application with focus on a hard insertion and space. Ethylene vinyl acetate (EVA) mouthguard blank used was Drufosoft and the acrylic resin was Biolon (Dreve-Dentamid GMBH, Unna, Germany). Three types of mouthguard samples tested were constructed by means of a Dreve Drufomat (Type SO, Dreve-Dentamid) air pressure machine: the first was a conventional laminated type of EVA mouthguard material; the second was a three layer type with acrylic resin inner layer (hard-insertion); the third was the same as the second but with space that does not come into contact with tooth surfaces (hard + space). As a control, without any mouthguard condition (NOMG) was measured. A pendulum type impact testing machine with interchangeable impact object (steel ball and baseball) and dental study model (D17FE-NC.7PS, Nissin, Tokyo, Japan) with the strain gages (KFG-1-120-D171-11N30C2: Kyowa, Tokyo, Japan) applied to teeth and the accelerometer to the dentition (AS-A YG-2768 100G, Kyowa) were used to measure transmitted forces. Statistical analysis (anova, P < 0.01) showed significant differences among four conditions of NOMG and three different mouthguards in both objects and sensor. About acceleration: in a steel ball which was a harder impact object, shock absorption ability of about 40% was shown with conventional EVA and hard-insertion and about 50% with hard + space. In a baseball that was softer compared with steel ball, a decrease rate is smaller, reduction (EVA = approximately 4%, hard-insertion = approximately 12%, hard + space = approximately 25%) was admitted in the similar order. A significant difference was found with all the combinations except for between EVA and hard-insertion with steel ball (Tukey test). About distortion: both buccal and lingual, distortions had become small in order of EVA, hard-insertion, and hard + space, too. The decrease rate is larger than acceleration, EVA = approximately 47%, hard-insertion = 80% or more, and hard +space = approximately 98%, in steel ball. EVA = approximately 30%, hard-insertion = approximately 75%, and hard + space = approximately 98% in baseball. And a significant difference was found with all the combinations (Tukey test). Especially, hard + space has decreased the distortion of teeth up to several percentages. Acceleration of the maxilla and distortions of the tooth became significantly smaller when wearing any type of mouthguard, in both impact objects. But the effect of mouthguard was clearer in the distortion of the tooth and with steel ball. Considering the differences of mouthguards, the hard-insertion and the hard + space...

The manufacture of laminated-type mouthguards requires skill in fusing sheets of mouthguard materials together. Adequate adhesive strength is required to use mouthguards in a stable condition for a long time. Therefore, in this study, the exfoliation test was applied and some treating techniques and conditions that improve the adhesive strength on a laminated surface were examined. Samples were laminated with two pieces of mouthguard material (3 mm thickness) having an adhesive area of 5 x 5 mm2, and whose other end was the holding part. The experimental factors used were as follows: heating time, use of solvent, elimination and direct heating of the laminate surface, colour of materials and water sorption. The result was measured at the time of breakage of the maximum load (N) and the form of destruction was examined. At 165 s of heating time, material failure was shown at under a load exceeding 5.0 N when compared to an untreated condition. Material failure was measured when a solvent was used and during the elimination of the laminated surface at a heating time of 150 s, which is 15 s lesser than in an untreated condition. Material failure was also measured by direct heating on the bonding surface of a second sheet of material at a heating time of 135 s, which is 30 s lesser than in an untreated condition. The differences in colour of the materials influence adhesion. Clear and light coloured materials showed higher adhesion ability. One-way analysis of variance confirmed a statistically significant difference in heating time differences, usage of solvent, elimination, direct heating on bonding surface and colour (P < 0.05). The decrease of adhesive strength by water sorption at 23 degrees and 37 degrees C was not observed significantly. Maximal laminated bond strength can be obtained by minimal heating time and proper treatment with the use of solvent, elimination and direct heating on bonding surface. The differences in the colour of the materials influenced adhesion. Clear and light coloured materials showed higher adhesive ability. Water sorption did not affect the adhesive strength. Therefore, if laminated-type mouthguards were manufactured properly, it can be used for a longer time and in a good condition.

A full-balanced occlusion is essential for mouthguards. It has been reported that a balanced occlusion for upper and lower anterior teeth is essential for prevention of injuries occurring to the maxillary anterior teeth and alveolar bone caused by horizontal direct impact. The support of the mandibular teeth through the mouthguard is critical to prevent maxillary front tooth injury from a direct impact force. However, some vacuum mouthguard designs may not achieve a full-balanced occlusion. For example, when a player has a malocclusion, an elongated molar or premolar tooth, an open bite, a large over jet or a maxillary protrusion. An improved vacuum fabrication method is necessary to obtain full balanced occlusion in these cases as opposed to conventional vacuum type single-layer mouthguard technique.

Bureau of health education. Mouthguards and sports team dentists. J Am Dent Assoc 109: 84-87, 1984. 4) Chapman PJ. Attitudes to mouthguards and prevalence of orofacial injuries in international rugby: a