Properly Fitted Custom-Made Mouthguards 11/20/2009

Resident: Hencler
Date: 11/20/2009

Article title: Properly Fitted Custom-Made Mouthguards
Author(s): Howard H Chi, DMD, MA
Journal: Compendium- January 2007; 28(1): 36-41

Major topic: Mouthguard (MG) fabrication

Type of Article: Review/Instructional

Main Purpose:
1. Explain the importance of custom made MG use in amateur and professional sports
2. Discuss advantages and disadvantages of the 3 types of MGs
3. Describe the steps required to fabricate a custom-made MG

Background:
According to The National Youth Sports Safety Foundation, there are about 15 million dental injuries and 5 million avulsed teeth with 13% t0 39% of those injuries related to sporting activities in the US annually. A properly fitted MG has been shown to provide protection against orofacial injuries and trauma to the teeth and supporting tissues such as the lips, cheeks, and tongue. MG can also provide protection of the mandible, TMJ, neck, and also prevent concussions. Reasons athletes do not like to wear a MG include difficulty with breathing and speaking as well as ill fit. Special considerations are needed for MGs for athletes in the mixed dentition and orthodontic treatment. Space must be incorporated into the MG for tooth movement and growth of arches. For the orthodontic athlete with brackets rope wax can be used before an impression or brackets can be blocked out on the model with stone. The 3 type of MGs are:
1. Type I Stock
2. Type II Mouth-formed
3. Type III Custom-fabricated

Key points in the article discussion:
Preferred material for MGs is ethylene vinyl acetate with a shore hardness of 80. For class I and II a maxillary MG should be made and for class III a mandibular MG. A MG should meet the following criteria:
1. Minimal labial thickness: 3mm
2. Minimal palatal thickness: 2mm
3. Minimal occlusal thickness: 3mm
4. Extensions into the vestibular borders
The 4 stages of MG fabrication are impression and model, fabrication, trimming, and delivery.

Summary of conclusions:
1. Impression with custom tray and polyvinyl material is best to catch all anatomy and vestibular regions. Use microstone golden ADA type III to pour cast. Trim to vestibular border removing the palatal area. Allow cat to dry.
2. MG material is heated on vacuum machine until it droops 1 inch at which time suck-down vacuum is turned on for 1 minute to ensure proper adaptation to cast. Allow to cool.
3. Trim with utility scissors then trim borders to vestibular borders allowing relief for frenum attachments. Lingually the MG should extend minimally 1mm from the teeth and the distal extension should cover the 1st molar. Feather margins of MG for comfort. Place MG back on cast and an alcohol torch is used lightly for a final finish.
4. When delivering check relief of frenum attachments and adequate extension of MG margins into vestibule. Lightly warm posterior of MG. Have patient bite lightly until all tetth are in occlusion
MG care instructions:
· Rinse with water before use
· Wash after each use to prevent build up of saliva, bacteria, and debris
· Hot water will distort MG
· Toothpaste with soft bristle brush to clean
· Store MG in protective plastic case
· Periodic check MG is recommended
MG should be usable for 2 seasons

Assessment of article:
Great step by step instruction on MG fabrication