Custom Mouth Guards for Today s Athlete Northsideoralsurgery.net.

Transcription

1 1 Custom Mouth Guards for Today s Athlete Northsideoralsurgery.net.

2 2 Properly Fitted Mouthguard An athletic mouth guard is a resilient device made of FDA approved material placed inside the mouth to reduce oral-facial injuries to the teeth and surrounding structures. Speech considerations should be equal to the demands of the playing status of the athlete. The properly fitted mouth guard should be routinely and professionally examined for fit and function on an individual basis. In contact sports, it is critical the mouth guard provide protection from direct and indirect impact. It must fit accurately, stay in position during impact, and redistribute the impact s energy. It should be fabricated to adequately cover and protect teeth and the surrounding tissues. It should have adequate thickness in all areas to provide for the reduction of impact forces. In particular, it should have a minimum of 3mm thickness in the occlusal/labial area. Approved by the Academy for Sports Dentistry Board of Directors 6/24/2015.

3 3 The criteria for the fabrication of a properly fitted mouth guard must include the following considerations: 1. Pertinent medical history. 2. Dental status that considers: a. Dental caries. b. Periodontal status. c. Developmental occlusion. d. Orthodontic or prosthodontic appliances. e. Congenital/pathological conditions. f. Jaw relationships. 3.Type of sport played. Properly Fitted Mouthguard Approved by the Academy for Sports Dentistry Board of Directors 6/24/2015.

4 4 Basic Mouthguard Types 1. Stock. 2. Mouth formed: Boil & bite. Shell liner. 3. Custom fitted: Vacuum formed. Pressure formed laminates (PFL).

5 5 Custom Fitted Mouthguards Resilient material fitted to a model of an athlete s teeth. Excellent retention. High level of patient acceptance. Can be adapted to a mixed dentition and ortho patients.

6 Sports & Injuries to Face and Teeth 6 Common: football, basketball, hockey, wrestling

7 Sports & Injuries to Face and Teeth 7 Uncommon: field hockey, baseball, extreme sports, weight lifting

8 8 Sports Injury Statistics National Youth Sports Foundation for Safety: Dental injuries are the most common type of orofacial injury sustained during participation in sports. Over 80 % of all dental related sport injuries are to the front four teeth of the upper jaw Boys = Girls Basketball is has the highest injury rate

9 9 Orofacial Sports Injuries INJURY SITE Sport Tooth Intra-oral Extra-oral Bony Basketball Baseball/softball Track/field Hockey/lacrosse/FH Sled/ski Football R blade/skateboard Gym/equipment Water sports Bike/scooter Credit: Soporowski, Tesini, Weiss 1994.

10 10 Properly Worn Proper Fit Cost Effective Concussion Prevention? Accessible IDEAL MOUTHGUARD Dental Protection Joint Protection Soft Tissue Protection Hard Tissue Protection

11 Athletic Mouthguard Functions Protect the soft tissues of the orofacial structures lips, cheeks, tongue, etc. 2. Protect the teeth from fracture cushions the teeth from forces that may chip, fracture, or avulse them. 3. Protect the supporting structures from injury. 4. Protect the mandible from fracture. 5. Prevent temporomandibular joint (TMJ) injury. 6. May help reduce the incidence and severity of concussion. Refer to ASD Position Statement on this issue.

12 12 Picture courtesy of Dr. C. R. Castaldi.

13 13 Concussion Concussion is recognized as a clinical syndrome of biomechanically induced alteration of brain function, typically affecting memory and orientation which may involve loss of consciousness (LOC). American Academy of Neurology, 2013

14 14 Sports-Related Concussion Methods of Prevention On-field recognition and cautious return to play. Education/reporting of concussion. Properly fitted equipment. Proper tackling techniques/instruction. Properly fitted custom mouthguard Increased neck strength. Source: Collins, et al (2002).

15 15 ASD Position Statement Academy for Sports Dentistry Position Statement on the use of Mouthguards and other Oral Appliances for the Prevention of Concussion and Enhancement of Strength and Performance The Academy for Sports Dentistry supports continued validated scientific research on the issues of concussion injury reduction and performance enhancement by athletes wearing properly fitted and properly worn mouthguards. ASD is aware of new published research suggesting that a properly fitted mouthguard with a thickness of 3.0+ mm in the posterior occlusal area might reduce the incidence of concussion injury when trauma is delivered to the athlete, but is not as yet ready to support or refute the conclusion. Approved by the Academy for Sports Dentistry Board of Directors 07/16/2015.

16 16 Mouthguards and Concussion In this study, we concluded that wearing of custom LM MG with 3.00+mm thickness in the posterior occlusal area statistically reduced the incidence of MTBI/concussion injury (3.6 %) when compared to OTC MGs (8.3%). Academy of General Dentistry s Journal, General Dentistry May/June 2014 ~ Volume 62 Number 3 Credit: Dr. Jack Winter.

17 17 Proper Care of Avulsed Tooth Hold the crown, not the root. Do not dry the tooth. Do not brush or clean the tooth. Place tooth in Hank s Balanced Salt Solution (HBSS) ( Save-A-Tooth or EMT Toothsaver). If HBSS is not immediately available, keep moist with: Milk (skim, low fat is best). Saliva (hold tooth in the mouth). Saline. Rush the athlete and tooth to the dentist ASAP.

18 18 Tooth avulsion.

19 19 An avulsed tooth needs to be reimplanted as soon as possible.

20 20 Proper care of avulsed teeth can save them. Currently, Emergency Medical Treatment (EMT) Toothsaver by Smart Practice and Save-A-Tooth are two examples of available products.

21 21 Patients with Braces Contrary to dental mythology: Patients undergoing orthodontic treatment should wear mouthguards when practicing or competing in sports activities. For additional information on orthodontics and many other topics related to sports dentistry, see Athlete Resources under the Resources tab of the ASD website,

22 22 Although the teeth are splinted with braces, the soft tissues could have been protected with a mouthguard. Picture courtesy of Dr. Jack Winters.

23 23 Don t let this happen to your child!

24 24 Nutrition Be careful with liquids. Hydration is very important, and plain water is the best option. Minimize consuming sports drinks, flavored water, and juices due to their acidity and high sugar content. Even sugar-free liquids can contain acid, causing lasting damage to your teeth. Foods that contain sugars of any kind, including soft drinks, candy, cookies, and pastries, can contribute to tooth decay. For additional information on nutrition and many other topics related to sports dentistry, see Athlete Resources under the Resources tab of the ASD website,

25 25 Dental Trauma Treatment

26 26 Immediate Treatment Extrusion. Lateral luxation (permanent teeth). Intrusion (permanent teeth). Avulsion (permanent teeth). Fracture of alveolar process. Jaw fracture. Soft tissue trauma. Penetrating lip lesion.

27 27 Extrusion 1. Partially out of the socket. 2. Usually displaced palatally. 3. Very loose plus bleeding. 4. Radiographically appears dislocated, empty at the end of the socket. 5. PDL and apical neurovascular bundle damage. 6. Pulp test negative. 7. Reposition gently local anesthetic not needed. 8. Check occlusion. 9. Non-rigid splint x 2 weeks. 10. Monitor vitality of pulp essential to diagnosis of root resorption. Open apices extended monitoring of the pulp (RG, sensitivity testing); revascularization usually occurs. Closed apices RCT just before splint removal. Root resorption rare. Inflammatory resorption likely in association with pulp necrosis. Source:

28 28 Pictures courtesy of Dr. J.O. Andreasen,

29 29 1. Appears displaced in socket, usually palatally. 2. Accompanied by comminution or fracture of alveolus. 3. Immobile, locked, high metallic percussion sound. 4. Bleeding maybe, maybe not. 5. Root can be palpated in the sulcus area. 6. Steep (occlusal) x-ray look for widened PDL. 7. Apical segment appears empty. 8. Reposition from locked position (forceps or digital). 9. Local anesthetic yes. 10. Check occlusion and take a RG check position. 11. Non-rigid splint x 4 weeks. 12. If no sign of root resorption or bone loss, remove splint; otherwise, keep splinting another 3-4 weeks. Lateral Luxation Open apices extended testing. Closed apices RCT just before splint removal. Both inflammatory and root resorption may occur. Source:

30 30 Pictures courtesy of Dr. J.O. Andreasen,

31 31 Lateral luxation. Permanent teeth.

32 32 Intrusion 1. Forced into socket and locked. 2. Percussion high metallic sound. 3. RG appears dislocated apically. 4. PDL space may be absent from all or part of the root. 5. Pulp usually becomes necrotic temporary filling of CaOH followed by RCT. Open apices allow for spontaneous eruption. If no movement is noted within 3 weeks rapid orthodontic repositioning. Closed apices reposition orthodontically or surgically ASAP. Source:

33 33 Pictures courtesy of Dr. J.O. Andreasen,

34 34 Avulsion Closed Apex If tooth is replanted prior to arrival at dental office: 1. Clean area but do not extract. 2. Verify normal position of the teeth. 3. Use a non-rigid splint for 2 weeks. 4. Doxycycline bid x 7 days (young child use Penicillin VK). 5. If avulsed tooth contacted soil, consider tetanus shot. 6. Perform a RCT 7-10 days after replantation prior to splint removal. Use CaOH as temporary intra-canal fill. 7. Soft diet for at least 2 weeks. 8. Soft brushing after each meal. 9. Rinse with chlorhexidine (0.1%) bid for at least 1 week. Source:

35 35 Avulsion Closed Apex If tooth is replanted at the dental office (delayed replantation technique): 1. Remove attached necrotic tissue with gauze. 2. RCT prior to replantation, or done 7-10 days later. 3. Remove coagulum from socket with saline. 4. Immerse tooth in 2% NaF for 20 minutes. 5. Replant tooth slowly with slight digital pressure. 6. Non-rigid splint for 4 weeks. 7. Systemic antibiotics. 8. Possible tetanus booster. 9. Patient instructions as before (soft diet, soft brush) for several weeks. Source:

36 36 Avulsion Closed Apex If tooth is kept in media (Hanks, milk, saline, saliva): 1. Clean root surface and apical foramen with saline. 2. Remove coagulum from socket with saline. 3. Replant tooth slowly with slight digital pressure. 4. Suture any gingival lacerations. 5. Follow directions according to the previous slide #6-9. If extra-oral dry time is greater than 1 hour: Very poor prognosis. PDL is necrotic and not expected to heal. Goal = replantation promotes alveolar bone growth to encapsulate. the replanted tooth. Expected outcome = ankylosis and root resorption. Source:

37 37 Pictures courtesy of Dr. J.O. Andreasen,

38 38 Avulsion Open Apex If tooth is replanted prior to arrival at dental office: 1. Same as closed apex. 2. Goal is to allow for revascularization of pulp. If that does not occur RCT may be recommended. 3. Patient instructions same as before. If tooth is kept in media (Hanks, milk, saliva saline,): Same as above. If extra-oral dry time is greater than 1 hour: Same as closed apex. Source:

39 39 Avulsion Follow-up Root Canal Therapy: 1. If indicated (closed apex), ideal time = 7-10 days after replantation. 2. CaOH = recommended medicament for up to 1 month. 3. Exception = Extra-oral time is greater than 1 hr, then do RCT prior to replanting. 4. Monitor once/week during the first month, then monthly after for the months of 1, 3, 6 and 12. Source:

40 40 Avulsion Outcomes Favorable Outcome: Closed apex = asymptomatic, no mobility, normal percussion sound, no resorption or periradicular osteitis, lamina dura looks normal. Open apex = asymptomatic, no mobility, normal percussion sound, x-ray shows arrested or continued root formation and eruption. Unfavorable Outcome: Closed apex = symptomatic, excessive mobility, or no mobility (ankylosis), high pitched percussion sound, x-ray shows resorption (inflammatory, infection related resorption, or ankylosis-related replacement resorption). Open apex = same as closed. Source:

41 41 Fracture of Alveolar Process Jaw Fracture: 1. May or may not involve the socket. 2. Segment displaced with possible mobility. 3. Occlusion disturbed. 4. Percussion dull sound. 5. Gingival lacerations frequent. 6. RG check for fracture line, rule out root fracture. 7. Possible vascular damage with pulp necrosis. 8. Reposition segment and stabilize with semi or rigid splint. 9. Splint for 4 weeks. 10. Pulpal, PDL healing monitored at 4,8, 16 weeks and after 1 year. Source:

42 42 Pictures courtesy of Dr. J.O. Andreasen,

43 43 Jaw Fracture Use of preoperative and perioperative antibiotics in the treatment of jaw fracture is well established to reduce the risk of infection. Surgical intervention is necessary. With jaw fractures and trauma to the body of the mandible, the necks of the condyles must be checked for fractures.

44 44 Jaw fracture. Note multiple fractures.

45 45 Soft Tissue Trauma Soft tissue and gingival tears are best treated with suturing techniques. Tears in the aesthetic zone of the patient may warrant treatment by a periodontist.

46 46 Soft tissue trauma. Gingival tear. Pictures courtesy of Dr. W. Robert Howarth.

47 47 Penetrating Lip Lesion On occasion, deep penetrating lip lesions should be treated with aesthetic suturing and plastic surgeon expertise. Other penetrating lip lesions may be self healing.

48 48 Penetrating lip lesion.

49 49 Splinting Guidelines Subluxation 2 weeks Extrusion 2 weeks Avulsion 2 weeks Lateral luxation 4 weeks Alveolar process fracture 4 weeks Root fracture (middle 1/3) 4 weeks Root fracture (cervical 1/3) 4 months Source:

50 50 Non-immediate Treatment Crown fracture with exposed dentin. Crown fracture with exposed pulp. Crown-root fracture. Lateral luxation or intrusion (primary teeth). Tooth concussion. Subluxation.

51 Crown Fracture-Exposed Dentin 51 Superficial enamel fractures on occasion may be treated with selective contouring of the injured tooth. If a crown fragment is found, it can be attached with adhesives. If no crown fragment is found, dental adhesives and resin can be used to achieve optimal aesthetics. An emergency glass ionomer may be used as a provisional tooth replacement. Source:

52 52 Case I: Tooth fracture. #8 (11) and #9 (21) tooth fractures and gingival tear. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

53 53 Case I: Tooth fracture. Tooth fragments saved. Picture courtesy of Dr. W. Robert Howarth.

54 54 Case I: Tooth fracture. Fragments bonded in place. Pictures courtesy of Dr. W. Robert Howarth.

55 55 Case II: Tooth fracture. Repaired with crown form matrix. Pictures courtesy of Dr. W. Robert Howarth.

56 56 Case III: Tooth fracture. Repaired with mylar strip. Pictures courtesy of Dr. W. Robert Howarth.

57 57 Crown Fracture-Exposed Pulp A fracture involving enamel and dentin with loss of tooth structure and exposure of the pulp. Visible loss of enamel and dentin and exposed pulp tissue. If tenderness is observed, evaluate the tooth for luxation or root fracture injury. Normal mobility. Sensitivity test is usually positive. This test is important in assessing risk of future healing complications. Lack of response at initial examination indicates increased risk of later pulp necrosis. Radiographic findings: Loss of tooth substance is visible. Radiograph of lip or cheek lacerations are needed to search for tooth fragments or foreign material. Source:

58 58 Crown Fracture-Exposed Pulp Treatment In young patients with open apices, it is very important to preserve pulp vitality by pulp capping or partial pulpotomy. This treatment is also the treatment of choice in patients with closed apices. Calcium hydroxide compounds and MTA (white) are suitable materials. In older patients with closed apices and an associated luxation injury with displacement, root canal treatment is usually the treatment of choice. Follow-up: Clinical and radiographic control at 6-8 weeks and 1 year. Source:

59 59 Pictures courtesy of Dr. J.O. Andreasen,

60 60 #7 (12) Horizontal crown fracture at gingival margin with pulpal exposure. #8 (11) MILF fracture with pulpal exposure. #9 (21)MILF fracture with pulpal exposure. Case I: Crown fracture with exposed pulp. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

61 61 #8 (11) and #9 (21) teeth fractures were placed inside the Save-A-Tooth jar. Tooth fragments ready to be bonded. Case I: Crown fracture with exposed pulp. Pictures courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

62 62 #7 (12) Horizontal fracture was bonded at the gingival margin. #8 (11) The tooth fragment MILF was bonded in place and stabilized with composite filling material. #9 (21)The tooth fragment MILF was also bonded in place and stabilized with composite filling material. Case I: Crown fracture with exposed pulp. #7 (12), #8 (11), and #9 (21) Root canal therapy was started to debride pulp and temporary filling material was placed. Occlusal adjustment was performed to relieve occlusal pressure. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

63 63 Final treatments: Completion of root canal therapy on #7 (12), #8 (11), and #9 (21). Fiber post insertion for stabilization. Porcelain crowns on #7 (12), #8 (11), #9 (21). Case I: Crown fracture with exposed pulp. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

64 64 New custom fitted mouthguard. Occlusion was adjusted Case I: Crown fracture with exposed pulp. Picture courtesy of Dr. W. Robert Howarth.

65 65 Crown-Root Fracture Goal is to seal exposed dentinal tubules, protect the pulp, and restore tooth to original function and aesthetics. Several options available: Fragment removal and gingival reattachment. Fragment removal and surgical exposure of subgingival fracture. Fragment removal and orthodontic extrusion. Fragment removal and surgical extrusion. Tooth removal and replacement with provisional partials, bridges or implants. Source:

66 66 #8 (11) post crown fracture. Post removed. Case I: Horizontal root fracture. Pictures courtesy of Dr. W. Robert Howarth. International tooth number in parentheses.

67 67 #8 (11) Fiber post and core crown prep. # 8 (11) Temporary crown. Case I: Horizontal root fracture. Pictures courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

68 68 Case II: Horizontal crown fracture. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

69 69 1. Cord pack 2. Crown cleaned 3. Fiber post fitted 4. Post and crown cemented Case II: Horizontal crown fracture. Pictures courtesy of Dr. W. Robert Howarth.

70 70 Case III: Fractured roots. Teeth #6 (13), #7 (12), #10 (22) and #11 (23) have root fractures and will need extractions. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

71 71 Teeth #6 (13), #7 (12), #10 (22) and #11 (23) had root fractures. The teeth were reduced below the tissue line to allow gingival tissues to over grow. Future treatment: Extract #6 (13), #7 (12), #10 (22) and #11 (23), and place implants in #6 (13)and #11 (23). Case III: Fractured roots. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

72 72 Case III: Fractured roots. Maxillary interim removable partial denture ( flipper ) replaced extracted teeth #6 (13), #7 (12), #10 (22) and #11 (23). Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

73 73 Case III: Fractured roots. Temporary implant abutments on #6 (13) and #11 (23). Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

74 74 Case III: Fractured roots. Temporary crowns on #6 (13), #7 (12), #10 (22) and #11 (23) to allow gingiva to recontour. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

75 75 #6 (13) and #11 (23): Custom implant abutment. #8 (11) and #9 (21): Crown preps. Case III: Fractured roots. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

76 76 #6 (13) and #7 (12): Implant supported bridge (#7 being a pontic) #8 (11) and #9 (21): Individual crowns #10 (22) and #11 (23): Implant supported bridge (#10 being a pontic) Case III: Fractured roots. Final crowns. Picture courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

77 77 Lateral Luxation and Intrusion For primary teeth: Primary teeth at times may be repositioned, depending on permanent tooth location. Repositioning the tooth requires some force and anesthesia. Slightly extrude digitally or with forceps, then reposition in apical direction. Confirm with radiograph and splint for 3-4 weeks with non-rigid splint. After clinical and radiographic exam, splint may need to be maintained for another 3-4 weeks. Source:

78 78 Lateral luxation. Primary teeth.

79 79 Intrusion. Primary tooth.

80 80 Tooth Concussion Injured tooth without abnormal loosening or displacement. Tooth is tender to percussion. If tooth is in occlusion, it can be slightly reduced from occlusion, and patient placed on a soft diet. At times, tooth can be splinted for patient comfort and monitored. Source:

81 81 Tooth concussion. No enamel fracture, but no other evidence of injury.

82 82 Subluxation Tooth is loose but not displaced. If tooth is in occlusion, it can be slightly reduced from occlusion, and patient placed on a soft diet. At times, tooth can be splinted for patient comfort and monitored. Source:

83 83 Subluxation.

84 84 Subluxation and tooth fracture.

85 85 Tooth Replacement Essix Technique

86 86 Fractured Tooth in Place 1. Take study models. 2. Create duplicate sheet. 3. Make tooth replacement inside duplicate sheet. 4. Grind undercut into replacement tooth. 5. Grind tooth off model. 6. Place replacement tooth on model. 7. Use Essix Ace material to make the retainer.

87 87 Fractured Tooth Lost Tooth is out of mouth Use denture tooth. Make tooth using crown forms.

88 88 Study model. Make replacement tooth. Add replacement teeth to model. Case I: Fractured teeth in place.

89 89 Teeth extracted. Essix retainer in place. Case I: Fractured teeth in place. Teeth removed. Pictures courtesy of Dr. W. Robert Howarth.

90 90 #8 (11)Root fractured horizontally. #8 (11) Root fragment inside crown. Case II: Fractured tooth in place. Pictures courtesy of Dr. W. Robert Howarth. International tooth numbers in parentheses.

91 91 Case II: Fractured tooth in place. Essix retainer. Pictures courtesy of Dr. W. Robert Howarth.

92 92 Artificial tooth is shaped to ideal form. Acrylic vacuform tray is created over tooth. Tray is reshaped. Tooth is bonded to tray. Tray seated as a temporary replacement. Case II: Fractured tooth in place. Pictures courtesy of Dr. W. Robert Howarth.

93 93 Additional Tooth Replacement Techniques

94 94 Anterior stayplate ( flipper ).

95 95 Maryland Bridge.

96 96 Resin bonded retainer.

97 97 Dental implant.

98 98 Tooth Trauma Additional Topics

99 99 Snoring and Sleep Apnea

100 100 Snoring and Sleep Apnea Blocked airway Snoring. Sleep apnea (breathing stops). Treatments Snoring An appliance that moves the mandible forward can reduce the tongue from falling backward, which would otherwise block airflow. Sleep apnea A sleep study by an MD is recommended, but for insurance reimbursement it is required. A CPAP (continuous positive airway pressure) machine is the gold standard of care for treating sleep apnea patients. Some appliances that can move the mandible forward with titration may be beneficial in treating mild to moderate cases of sleep apnea.

101 101 Example of a snoring or sleep apnea device. SomnoDent.

102 102 Example of a snoring device. Myerson EMA.

103 103 Example of a snoring or sleep apnea device. Thornton appliance (Thornton Adjustable Positioner).

104 104 Example of a snoring device. Silent Night.

105 105 Mouthguard Fabrication Instructions

106 Impression Model Perforated metal trays (COE) Sizes 1, 3, 4, 5, 7, X1 (extra large) Plastic trays Alginate or polyvinyl Disinfect impression and rinse before pouring model Die stone Model height 25mm Bevel sides Label base with name Clean up bubbles Fill in voids (Ultradent blockout resin) Dry model Spray with Trim Rite Spacer (DENTSPLY) st Press Model toward back of Drufomat Trim with Bard Parker scalpel (size 25) Polish with chamois wheel on lathe or hand polish Name/Logo Mouthguard Box Brother P-Touch label printer (small size) Brother P-Touch label printer (large size) 2 nd Press Remove 1 st press and trim excess material Soak model in water for 10 to 15 minutes Place 1 st press back on model Press 2 nd layer Trim excess with Bard Parker scalpel (size 25) or electric heat knife Polish on chamois wheel on lathe or hand polish Disinfect and rinse mouthguard before delivering to patient

107 107 Position model toward back of Drufomat. 3mm colored EVA material pressed onto model. 1 st Press

108 108 Trim with Bard Parker scalpel (size 25) or electric heat knife. Polish with chamois wheel on lathe or hand polish.

109 109 Name/logo (Brother P-Touch label printer small size). 2 nd press EVA 3mm clear.

110 110 2 nd Press Remove 1st press and trim excess. Soak model in water for 10 to 15 minutes. Place 1st press on model and apply name and/or logo. Press 2nd layer. Trim excess with Bard Parker scalpel (size 25). Polish on chamois wheel on lathe or hand polish. Disinfect and rinse before delivery.

111 111 Orthodontic appliances and/or mixed dentition may need block out and relief to provide for future movement of teeth.

112 112 Use relief wax to cover appliances before taking impressions.

113 113 Another technique is to block out the model using composite block out resin.

114 114 Essix Impression Guard by DENTSPLY The holes fit over the ortho brackets and latex covers over the arch wire without having to remove it.

115 115 Mouthguard Strap Fabrication Instructions

116 116 Strap Option #1 Strap Option #2 Finish Disinfect Delivery Heat wax spatula on the incisal edge Place plastic spacer 4mm(D) X 12mm(L) Round bur size 10-12, straight Push spacer (plastic) out and save Tygon tubing (black) inches; ID 1.6mm, OD 3.2mm Connection weed wacker - superglue Tape strap with black tape Heat wax spatula on incisal edge and edge of strap Attach preformed strap (Raintree Essix) Alcohol torch (Hanau) - Denatured alcohol Properly disinfect prior to delivery Heat adjust occlusion

117 117 Name, logo and strap spacer. EVA 3mm clear.

118 118 2 nd press EVA 3mm clear over strap spacer.

119 119 Round bur size 10-12, straight. Push spacer (plastic) out and save.

120 120 Tygon tubing (black) inches; ID 1.6mm, OD 3.2mm Connection weed wacker - superglue Tape strap with black tape

121 121 Preformed straps.

122 122 ASD Affiliations and Collaborations

123 123 ASD-Certified Team Dentist Can Benefit Medical Team October 16, 2014 Regardless of the level of athlete you treat, the need for qualified dental care, triage and consultation can go well beyond the obvious need for treating injuries at competitive events. The Academy for Sports Dentistry's Certified Team Dentists can initiate programs to reduce the incidence of oral-facial trauma and have the expertise to treat injuries that may occur.

124 124 NATA Affiliation ASD Certified Team Dentist As a NATA member, you know the importance of having a dentist on your sports medicine team who is certified in sports dentistry injury treatment and prevention. ASD has qualified dentists who are committed to sports dentistry and are willing to provide high-level dental care for your athletes. We are interested in placing our certified team dentists in positions where they have the ability to use their training and talents to better support interested athletic trainers and their sports teams. If your team needs a dentist, or if you would like to expand your medical team by adding a dentist, we may have a qualified Team Dentist in your area. Please contact us at:

125 125 Collaboration with USOC The United States Olympic Committee has collaborated with ASD in its efforts to provide dental care to Olympic and other elite athletes. Team Dentist certification approved by ASD is needed in order to be a provider for care. ASD has also supplied oral hygiene sheets for the USOC s direct distribution to its elite athletes and distribution by supporting organizations to their members.

126 126 USOC Dental Volunteer Program is only open to approximately 1000 Team USA athletes who work and train throughout the country. Athletes are referred to approved dentists on a regular or emergency basis. Additional opportunities on a first-come, first-served basis at select Team USA or other USOC events. Volunteer dentists agree to provide certain regular, cosmetic and emergency services at no cost; such services do not jeopardize eligibility for NCAA athletes. Dentist application requirements: ASD membership and approval from ASD. Separate application to USOC to be considered as an approved provider in USOC Online National Medical Network Provider Database.

127 127 US Olympic Women s Field Hockey Team. Pictures courtesy of Dr. Rick Knowlton.

128 128 Team USA Training Center Chula Vista, CA. Picture courtesy of Dr. Rick Knowlton.

129 129 Team Dentist Involvement and ASD Membership

130 130 Why Be a Team Dentist? Advocate for prevention wherever you live at the professional, semiprofessional, college, high school, or middle school level. Give back to the community. Enhance and build your practice.

131 131 Mouthguards made for Rutgers University football team. Picture courtesy of Dr. W.R. Howarth.

132 132 Contact school officials or recreational groups to set up a mouthguard program for your favorite team. Explain to school principals and athletic directors how you can help them. Start a mouthguard night in your dental community to build camaraderie. Enlist volunteers from several offices to help impression one night, fabricate another. Picture courtesy of Dr. Steve Mills.

133 133 ASD Membership Benefits Networking opportunities with current Team Dentists, from amateur to professional, regarding the latest in dental sports injury prevention and treatment. Mentorship program. Opportunity for certification, fellowship, and application for US Olympic Committee Volunteer Dentist Program. Marketing materials specific to sports dentistry. Discounts on ongoing news and training, web-based programming, annual symposium, and emergency treatment cards. Listing on ASD online searchable directory. Members Only section of ASD website. Free subscription to Dental Traumatology and ASD newsletter.

134 134 Team Dentist Certification Be a licensed dentist in compliance with the dental practice act of his/her state. Be a member in good standing of the Academy for Sports Dentistry. Attend and complete the ASD Team Dentist course. Complete a minimum of fifteen credit hours of continuing education in sports dentistry-related subjects every three years. Acquire the knowledge and expertise to educate health care professionals, certified athletic trainers, coaches, athletes and parents on the benefits and methods of prevention of sports-related orofacial injuries and oral diseases. Be proficient in the fabrication and delivery of properly fitted mouthguards, including impression techniques and establishment of occlusion. Be well-versed in the diagnosis and treatment of orofacial trauma, including but not limited to: Orofacial first aid resulting from contusions and lacerations. Emergency/immediate treatment of dental luxations, avulsions and tooth fractures. Identification of maxillary and mandibular fractures. Identification and treatment of TMJ injuries and dislocations. Identification of medical complications of head trauma. Familiarity with doping issues and the effects of illicit and performance enhancing drugs. Establish a support team of dental specialists and auxiliary staff. Cooperate with the other members of the sports medicine team to ensure the health and well being of the athletes.

135 135 ASD Contact Information We invite your calls, questions and membership! (800) / FAX: (217) sportsdentistry@consolidated.net Website:

136 136 Summary Statements

137 137 Summary Statements The ADA and the AGD need to follow what the Academy for Sports Dentistry has been advocating: We can prevent many dental injuries through proper education first with our member dentists, and then with our practices parents and athletes.

138 138 Summary Statements The majority of our profession has stood back and seen our patients spend $ on a set of new sneakers for a sport while being OK putting a $3.50 piece of rubber in their mouths with the belief that their teeth are being protected.

139 139 Summary Statements As a profession, we need to commit to better protecting the teeth and orofacial structures of our athletes. As adults, once an injury occurs, there is no turning back; they must deal with it permanently.

140 140