Mouthguard Biomechanics for Protecting Dental Implants from Impact: Experimental and Finite Element Impact Analysis

Purpose: The purpose of this study was to evaluate mouthguard shock absorption ability, strain, and stress generation during impact on dental implants placed in the anterior maxilla. The mouthguard material was also characterized. Materials and Methods: Sixty experimental models were created and divided into six groups (n = 10): implant type, external hexagon (EH) and Morse taper (MT); without and with two mouthguards (MTG), EVA custom-fitted (Ct-MTG) and standard self-adapted (St-MTG). The Shore A hardness, EVA sheet and mouthguard thickness, and elastic modulus were measured to characterize the mouthguard material. A strain gauge was attached to the palatal surface of the implant abutment, which was subjected to an impact test. Distortion of the abutment and implant was determined after impact from centroid displacements in standardized radiographic images. Two-dimensional finite element models were created to represent the six groups and were submitted to nonlinear dynamic impact analysis. The data were statistically analyzed using analysis of variance (ANOVA) and Tukey test (alpha = .05). Results: Ct-MTG resulted in higher Shore A hardness (P < .001). After the heat-forming process, the St-MTG maintained the original thickness, but the Ct-MTG thickness had decreased. The elastic modulus of EVA was 18.1 +/- 0.5 MPa. The mouthguard presence reduced strain values significantly (P < .001), particularly for Ct-MTG. There was no significant difference between implant connection types EH and MT (P = .547). Conclusion: The external hexagon abutment resulted in higher stress and micro-displacement values. The mouthguard was able to absorb 40% to 46% of the energy caused by the impact on the dental implant.