This is the superior of the three types and the most expensive to the athlete. Families can spend quite a bit of money on athletic clothing and shoes but might not think about protecting their child’s teeth. We need to educate our patients and their families about the importance of mouthguards when they come in for preventive and other appointments. The custom mouthguard is made of thermoplastic polymer and fabricated over a model of the athlete’s dentition.21 The mouthguard is made by the dentist and fits exactly to the athlete’s mouth. The advantages include fit, ease of speech, comfort and retention.20 By wearing a protective mouthguard, the incidence of a concussion by a blow to the jaw is significantly reduced because the condyle is separated from the base of the skull by placing the mandible in a forward position.25
There are two types of custom mouthguards. The most common is a custom vacuum formed mouthguard. This is the most widely made mouthguard by the dental profession. It offers good protection with the least interference to speaking and breathing. They are fabricated from a single sheet of EVA polyvinyl acetate-polyethylene copolymer. The EVA sheet is heated, placed over the stone model, and suctioned by vacuum to fit to the shape of the mouth and teeth.
Vacuum formed mouthguards have been found to decrease in thickness occlusally by 25%, while the buccal and lingual surfaces can be by more than 50%.40 They have been found to retain their shape for only a few weeks after wearing. They will not provide protection for long periods of time and should be closely monitored.
The other type of custom mouthguards are pressure-laminated mouthguards. They are considered to be a better mouthguard compared to boil and bites. They are made of multiple sheets of laminating EVA materials that are heated, placed over a stone model, and pressed onto the model or previous laminate with a maximum pressure of 6 atmospheres.
Multiple layers can be fused together to form an adequately thick and protective mouthguard allowing for precise adaptation due to increased pressure. This allows them to remain in place better during sport activity. They allow for a more balanced occlusion and shows negligible deformation when worn for prolonged periods of time. There is little to no elastic memory when high heat is combined with high pressure during fabrication. These mouthguards are typically made by dentists or dental laboratories.
Custom pressure-laminated mouthguards allow for effective communication. Interference with breathing is minimized and they show less wear in chewing and biting. They are more comfortable to wear so they are worn more regularly by participants. The laminating machines have 10x the pressure of vacuum systems. Since pressure is even throughout, it allows for a uniform thickness of guard material. Pressure-laminated mouthguards are substantially superior to all other types. According to sports dentistry experts in our dental profession, they are the only type that can be counted on to offer the best protection for our children’s teeth during all types of sporting activities.39 The ASTM recommends the mouthguard cover all teeth in at least once arch to reach maximum protection, cushioning, and retention. Typically, the maxillary arch is the most common arch for mouthguards. However, it’s recommended Class III malocclusion patients receive a mandibular mouthguard. One research study conducted with high school football players showed significantly less dental injury with players who used a properly fitted pressure-laminated custom mouthguard.53 Research studies continue to reinforce the importance of custom mouthguards.