Efficacy of Different Mouthguard Designs in Preventing Dentoalveolar Trauma and Assessing Factors Influencing Athlete Compliance: A Comprehensive Review

Abstract

Background. Dentoalveolar trauma sustained during contact sports presents severe clinical challenges and lifelong economic burdens. Intraoral mouthguards serve as the primary preventive mechanism, yet protective efficacy varies significantly across commercial designs (Type I stock, Type II boil-and-bite, and Type III custom-made). 

Aim. This systematic review evaluated the biomechanical shock absorption, upper airway physiological impacts, athlete compliance dynamics, and socio-economic cost-effectiveness of different intraoral mouthguard modalities. 

Material and methods: A structured literature search of PubMed/MEDLINE, Scopus, and CENTRAL databases (2001–2026) was conducted to identify trials, biomechanical impact analyses, and epidemiological cohorts comparing mouthguard types. A core cohort of 20 seminal publications was systematically analyzed. 

Results: Type I and Type II mouthguards offer poor biomechanical defense due to uncontrolled material thinning (<1.0–1.5 mm at primary impact zones), structural instability, speech impairment, and increased respiratory resistance. Conversely, Type III multi-layered laminated custom appliances maintain critical protective thickness (3.0–4.0 mm), optimize force dissipation, preserve baseline airway parameters (VO2 max, tidal volume), and demonstrate superior long-term athlete compliance. Economic modeling confirms that upfront investment in custom appliances prevents compounding costs of lifelong restorative care. 

Conclusions. Type III custom-made mouthguards represent the clinical gold standard for maxillofacial protection in athletic populations. Implementing mandatory custom mouthguard protocols in organized contact sports preserves respiratory performance, reduces injury incidence, and provides a highly cost-effective public health strategy.