Post thermoforming dimensional changes of ethylene vinyl acetate used in custom-made mouthguards for trauma prevention--a pilot study.

It is important that mouthguards have an adequate thickness of material if they are to be effective in the prevention of trauma. The aim of this study was to quantify dimensional changes that occur on thermoforming ethylene vinyl acetate (EVA) sheets used in the construction of mouthguards. Fourteen batches of 3 mm thick sheet EVA were thermoformed over dental models under a number of common processing conditions including, model height, inclination, shape and model temperature, model position on thermoforming platform, plasticizing time and evacuation method. Thickness of thermoformed material was determined at anterior and posterior sites and measurements were compared to determine the magnitude and patterns of stretching collectively and within each processing condition. Overall, sheets of 3-mm EVA stretched by 52% during the thermoforming conditions tested. Incisal/cuspal sites were found to be significantly thinner when compared with all other locations measured. A number of thermoforming conditions were demonstrated to have a significant effect on the degree to which the EVA material stretched. For the combination of materials and equipment tested in this study, current thermoforming practices may cause excessive thinning of EVA in critical areas including incisal edges and cusp tips, thereby reducing the protective effect for professionally made mouthguards. To optimize protection in vulnerable areas, it is important that clinicians distinguish between EVA sheet thickness and the cross-sectional dimensions achieved in the finished mouthguards. They need to be specific in their prescription of the thickness of material they require especially in critical areas.