AccScience Publishing / IJB / Volume 10 / Issue 3 / DOI: 10.36922/ijb.2469
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RESEARCH ARTICLE

Optimizing additively manufactured mouthguards: An evaluation of multi-layer materials for improved shock absorption and durability compared to conventionally fabricated samples

Chenyuan Li1 Takahiro Wada2 Yumi Tsuchida3 Kairi Hayashi1 Gen Tanabe1,4 Toshiaki Ueno1,4 Hiroshi Churei1*
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1 Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
2 Department of Advanced Biomaterials, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
3 Department of Digital Dentistry, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
4 Department of Sports Dentistry, School of Dentistry, Meikai University, Sakado, Japan
IJB 2024, 10(3), 2469 https://doi.org/10.36922/ijb.2469
Submitted: 18 December 2023 | Accepted: 23 January 2024 | Published: 18 March 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Although sports mouthguards (MGs) are mandatory in some contact sports, the use of conventional fabricated materials for making MGs is time-consuming and lacks precision, limiting their widespread application. In this study, we compared mouthguards designed using digital software with conventional ones. The conventional mouthguards were categorized into two types: those constructed from a poly-(ethylene vinyl acetate)-base material, and those constructed from MG21, a polyolefin-base material. The shock absorption and durability were assessed through a free-falling steel ball test and a fatigue test. The durability of the MGs was evaluated by measuring the retention force in the inner layer and deviations at consistent points on the outer layer during various fatigue test stages. Additively manufactured samples showed superior shock absorption performance, except for the double-layer samples with an inner layer of Shore A hardness 95. All single-layer additively manufactured MGs were damaged during the mid-fatigue test stage, while both double-layer additively manufactured and conventional MGs remained undamaged. Throughout all fatigue test stages, the retention force of double-layer additively manufactured MGs was significantly lower than that of conventional MGs. However, the retention force of double-layer additively manufactured samples with an inner layer of Shore A hardness 70 (D-A70) was superior to the average of all MGs in the wet condition, which was 6.4 ± 2.5 N in the previous study. The results of this study demonstrated the benefits of a hybrid design of hard and soft materials, particularly the promising combination of D-A70, which exhibited comparable shock absorption and durability to conventional MGs.

Keywords
Sports mouthguards
Additively manufactured
Photoinitiator
Shock absorption
Durability
Retention force
Funding
This work was supported by the Pioneering Research Initiated by the Next Generation (SPRING) under the Japan Science and Technology Agency (JST) (grant no. JPMJSP 2120). The funding organization did not play a role in the design or conduct of this study
Conflict of interest
The authors declare no conflicts of interest.
References
  1. FDI World Dental Federation. FDI policy statement on Sports dentistry: Adopted by the FDI General Assembly, September 2016, Poznan, Poland. Int Dent J. 2017;67(1):18-19. doi: 10.1111/idj.12314
  2. Elena-Lito E, Ioannis K, Nikolaos K. Use of mouthguards by amateur basketball athletes in Greece and the USA. Trauma Cases Rev. 2019;5(1). doi: 10.23937/2469-5777/1510071
  3. Galic T, Kuncic D, Poklepovic Pericic T, et al. Knowledge and attitudes about sports-related dental injuries and mouthguard use in young athletes in four different contact sports-water polo, karate, taekwondo and handball. Dent Traumatol. 2018;34(3):175-181. doi: 10.1111/edt.12394
  4. Gomez-Gimeno A, Zamora-Olave C, Cordobes-Navarro M, Willaert E, Martinez-Gomis J. Satisfaction with shortening the palatal extension of a mouthguard for water polo players: a randomized crossover study. Dent Traumatol. 2019;35(2):135-141. doi: 10.1111/edt.12455
  5. Knapik JJ, Hoedebecke BL, Rogers GG, Sharp MA, Marshall SW. Effectiveness of mouthguards for the prevention of orofacial injuries and concussions in sports: systematic review and meta-analysis. Sports Med. 2019;49(8):1217-1232. doi: 10.1007/s40279-019-01121-w
  6. Allison P, Tamimi F. Mouthguards should be worn in contact sports. Br J Sports Med. 2020;54(17):1016-1017. doi: 10.1136/bjsports-2020-102041
  7. Chisholm DA, Black AM, Palacios-Derflingher L, et al. Mouthguard use in youth ice hockey and the risk of concussion: nested case–control study of 315 cases. Br J Sports Med. 2020;54(14):866-870. doi: 10.1136/bjsports-2019-101011
  8. Green JI. The role of mouthguards in preventing and reducing sports-related trauma. Prim Dent J. 2017;6(2):27-34. doi: 10.1308/205016817821281738
  9. Mizuhashi F, Koide K, Takahashi M. Variations in mouthguard thickness according to fabrication method. Dent Traumatol. 2015;31(2):130-135. doi: 10.1111/edt.12128
  10. Rajkumari K, Chandra P, Balaji P. Three-dimensional printing- a revolutionary technology. J Clin Diagn Res. 2018;12(12):12-18. doi: 10.7860/jcdr/2018/37752.12410
  11. Mancilla-De-la-Cruz J, Rodriguez-Salvador M, An J, Chua CK. Three-dimensional printing technologies for drug delivery applications: processes, materials, and effects. Int J Bioprint. 2022;8(4):622. doi: 10.18063/ijb.v8i4.622
  12. Dawood A, Marti Marti B, Sauret-Jackson V, Darwood A. 3D printing in dentistry. Br Dent J. 2015;219(11):521-529. doi: 10.1038/sj.bdj.2015.914 
  13. Pillai S, Upadhyay A, Khayambashi P, et al. Dental 3D-printing: transferring art from the laboratories to the clinics. Polymers (Basel). 2021;13(1). doi: 10.3390/polym13010157
  14. Li Z, Wang S, Ye H, et al. Preliminary clinical application of complete workflow of digitally designed and manufactured sports mouthguards. Int J Prosthodont. 2020;33(1):99-104. doi: 10.11607/ijp.6348  
  15. Hada T, Komagamine Y, Kanazawa M, Minakuchi S. Fabrication of sports mouthguards using a semi-digital workflow with 4D-printing technology. J Prosthodont Res. 2024;68(1):181-185. doi: 10.2186/jpr.JPR_D_22_00274
  16. Sousa AM, Pinho AC, Piedade AP. Mechanical properties of 3D printed mouthguards: influence of layer height and device thickness. Mater Des. 2021;203:109624. doi: org/10.1016/j.matdes.2021.109624
  17. Pinho AC, Piedade AP. Sandwich multi-material 3D-printed polymers: influence of aging on the impact and flexure resistances. Polymers (Basel). 2021;13(22). doi: 10.3390/polym13224030
  18. ISO. Additive Manufacturing — General Principles — Fundamentals and Vocabulary. ASTM; 2021. https://www.iso.org/obp/ui/#iso:std:iso-astm:52900:ed-2:v1:en
  19. Palanisamy C, Raman R, Dhanraj PK. Additive manufacturing: a review on mechanical properties of polyjet and FDM printed parts. Polym Bull. 2022;79(9):7065-7116. doi: 10.1007/s00289-021-03899-0
  20. Aung TK, Churei H, Tanabe G, et al. Air permeability, shock absorption ability, and flexural strength of 3D-printed perforated ABS polymer sheets with 3D-knitted fabric cushioning for sports face guard applications. Polymers (Basel). 2021;13(11). doi: 10.3390/polym13111879
  21. Tun PS, Churei H, Hikita K, et al. Fabrication of shock absorbing photopolymer composite material for 3D printing sports mouthguard. J Photopolym Sci Technol. 2020;33(6):615-622. doi: 10.2494/photopolymer.33.615
  22. Handa J, Takeda T, Kurokawa K, Ozawa T, Nakajima K, Ishigami K. Influence of pre-laminated material on shock absorption ability in specially designed mouthguard with hard insert and space. Journal of Prosthodontic Research. 2011;55(4):214-220. doi: 10.1016/j.jpor.2011.02.003
  23. Kawamura S, Nakajima K, Handa J, Nara K, Miyajima S, Suda S, et al. The influence of repeated impact loads on the impact absorption ability of mouthguard materials. J Prosthodont Res. 2006/7;50:500-500. doi: mol.medicalonline.jp/library/journal/abstract? GoodsID=dv5hotet/2006/005003/024&name=0500- 0500j&UserID=202.242.187.105
  24. Longridge NN, Milosevic A. The bilaminar (dual-laminate) protective night guard. Dent Update. 2017;44(7):648-654. doi: 10.12968/denu.2017.44.7.648
  25. ASTM. Standard Test Methods for Vulcanized Rubber and Thermoplastic Elastomers–Tension. ASTM; 2021. https://www.astm.org/d0412-16r21.html
  26. Fukasawa S, Churei H, Chowdhury RU, et al. Difference among shock-absorbing capabilities of mouthguard materials. Dent Traumatol. 2016;32(6):474-479. doi: 10.1111/edt.12275
  27. Ioannidis K, Beltes P, Lambrianidis T, Kapagiannidis D, Karagiannis V. Crown discoloration induced by endodontic sealers: spectrophotometric measurement of Commission International de I’Eclairage’s L*, a*, b* chromatic parameters. Oper Dent. 2013;38(3):E1-12. doi: 10.2341/11-266-l
  28. Sherfudhin H, Hobeich J, Carvalho CA, Aboushelib MN, Sadig W, Salameh Z. Effect of different ferrule designs on the fracture resistance and failure pattern of endodontically treated teeth restored with fiber posts and all-ceramic crowns. J Appl Oral Sci. 2011;19(1):28-33. doi: 10.1590/s1678-77572011000100007
  29. Sugimoto A, Abe M, Gonda T, Yamaguchi S, Maeda M, Ikebe K. Fit of custom-made mouthguards after cyclic loading. In: Proceedings of the 30th Annual Meeting of Japanese Academy of Sports Dentistry. 2020. doi: mol.medicalonline.jp/library/journal/download?GoodsID = d v 2 s p o s i / 2 0 2 0 / s 0 2 3 0 2 / 0 1 8 & n ame = 0 0 6 2 - 0062j&UserID=202.242.187.110 
  30. Karaganeva R, Pinner S, Tomlinson D, et al. Effect of mouthguard design on retention and potential issues arising with usability in sport. Dent Traumatol. 2019;35(1):73-79. doi: 10.1111/edt.12446
  31. Tsuchida Y, Shiozawa M, Handa K, Takahashi H, Nikawa H. Comparison of the accuracy of different handheld-type scanners in three-dimensional facial image recognition. J Prosthodont Res. 2023;67(2):222-230. doi: 10.2186/jpr.JPR_D_22_00001
  32. Muta S, Ikeda M, Nikaido T, et al. Chairside fabrication of provisional crowns on FDM 3D-printed PVA model. J Prosthodont Res. 2020;64(4):401-407. doi: 10.1016/j.jpor.2019.11.004
  33. Diken Turksayar AA, Donmez MB, Olcay EO, Demirel M, Demir E. Effect of printing orientation on the fracture strength of additively manufactured 3-unit interim fixed dental prostheses after aging. J Dent. 2022;124:104155. doi: 10.1016/j.jdent.2022.104155
  34. Guerra Silva R, Torres MJ, Zahr Viñuela J. A comparison of miniature lattice structures produced by material extrusion and vat photopolymerization additive manufacturing. Polymers. 2021;13(13):2163. doi: 10.3390/polym13132163
  35. Layani M, Wang X, Magdassi S. Novel materials for 3D printing by photopolymerization. Adv Mater. 2018;30(41):e1706344. doi: 10.1002/adma.201706344
  36. Unkovskiy A, Huettig F, Kraemer-Fernandez P, Spintzyk S. Multi-material 3D printing of a customized sports mouth guard: proof-of-concept clinical case. Int J Environ Res Public Health. 2021;18(23):12762. doi: 10.3390/ijerph182312762
  37. Schewe P, Roehler A, Spintzyk S, Huettig F. Shock absorption behavior of elastic polymers for sports mouthguards: an in vitro comparison of thermoplastic forming and additive manufacturing. Materials. 2022; 15(8):2928. doi: 10.3390/ma15082928
  38. Johnson A, Wildgoose DG, Wood DJ. The determination of freeway space using two different methods. J Oral Rehabil. 2002;29(10):1010-1013. doi: 10.1046/j.1365-2842.2002.00950.x
  39. ISO. Standard Atmospheres for Conditioning and/or Testing. ISO; 1976. https://www.iso.org/obp/ui/#iso:std:iso:554:ed-1:v1:en
  40. Hayashi K, Chowdhury RU, Chowdhury NU, et al. Thickness change and deformation of custom-made mouthguards after two years of use by Bangladeshi field hockey players. Dent Traumatol. 2021;37(4):617-622. doi: 10.1111/edt.12666
  41. Popkin R, Lobo F, Stubbs J. Multimaterial 3D printing for the fabrication of functional stethoscopes. In: Proceedings of the 2019 Design of Medical Devices Conference. ASME; 2019. doi: 10.1115/DMD2019-3297
  42. Singh R, Singh R, Suri A. Personalized 3D printed eye gear for microscopic surgeons amidst and beyond COVID-19. Bioengineering. 2023;10(10):1129. doi: 10.3390/bioengineering10101129
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International Journal of Bioprinting, Electronic ISSN: 2424-8002 Print ISSN: 2424-7723, Published by AccScience Publishing