Abstract
Experimental research studies have shown that wearing a mouthguard (MG) is an effective way to prevent tooth or maxillofacial trauma. However, there is a lack of scientific information regarding how the material arrangement within the mouthguard can modify its mechanical response during an impact. Hence, this study aimed to evaluate the influence of material arrangement within custom-made mouthguards on stress transmitted to anterior teeth, bone, and soft tissue after impact. Four 3D finite element models of a human maxilla were reconstructed based on the CBCT of a young patient and analyzed according to the presence or absence of a mouthguard and the type of material arrangement within those with a mouthguard: model NMG with no mouthguard; model CMG representing the conventional arrangement with a single 4 mm-thick ethylene-vinyl acetate (EVA) foil; model FMG presenting layer arrangement with two 1 mm-thick foils of EVA in the outer shell and one 2 mm-thick foil of EVA foam in the core; model HMG presenting a 1 mm-thick compact inner and outer shell of EVA and a 2 mm wide air-filled zone in the core. Linear quasi-static analysis and frontal load were used to simulate an impact with an energy of 4.4 J. Isotropic linear elastic properties were assumed for the bone and teeth but not for the mouthguard protection and oral soft tissues. The results were evaluated and compared in terms of displacement, stretches, and stresses. All the mouthguards analyzed reduced the risk of injury to teeth and bone, reducing the displacement and stress of these structures. However, the implementation of a honeycomb structured layer allowed more significant displacement and deformation of the mouthguard’s external layer, thus promoting higher protection of the anatomic structures, namely the root dentin and the bone tissue. Nevertheless, the results also indicate that improving the mouthguard flexibility might increase the soft tissue injuries.
Highlights
The oral health condition of an individual is a determining factor in their health and in their quality of life
The most popular material used for mouthguard production is a low-stiffness 28% ethylene vinyl acetate (EVA) [10], mainly due to its shock-absorbing capabilities and high flexibility
The results show that the Hollow EVA Mouthguard (HMG) model presents higher values of first principal stretches and lower values of third principal stretches, i.e., it shows greater elongation and compression due to the flexibility of its outer layer, compared to Foam EVA Mouthguard (FMG) and Compact EVA Mouthguard (CMG)
Summary
The oral health condition of an individual is a determining factor in their health and in their quality of life. The attributes of mouthguards are not easy to identify because they are influenced by the impact absorption ability of the material and by the occlusal relationship and the conformability of the mouthguards’ construction [7]. The most popular material used for mouthguard production is a low-stiffness 28% ethylene vinyl acetate (EVA) [10], mainly due to its shock-absorbing capabilities and high flexibility. Both characteristics allow relatively high deformation under loads, increasing contact area and time and decreasing the magnitude of peak efforts [4]. In terms of energy absorption and transmission of forces, 4 mm seems to be the ideal thickness
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