a clinical report

CLINICAL DENTISTRY AND RESEARCH 2014; 38(2): 36-40
Case Report
FABRICATION OF AN INDIVIDUAL EXTRA-ORAL FACIAL SHIELD
TO PREVENT DENTAL TRAUMA IN CONTACT SPORTS: A CLINICAL
REPORT
Seda Cengiz, DDS, PhD
Assistant Professor, Department of Prosthodontics,
Faculty of Dentistry, Bülent Ecevit University,
Zonguldak, Turkey
Murat Büyükbaş, DDS
Private Practice,
Samsun, Turkey
ABSTRACT
Facial shields are used when practicing contact sports. Examples
of facial shields are commercially available per branch of sport
standardized helmets. Fabricating individual protective shields is
primarily restricted to mouth guards. In individual cases, a more
extensive facial shield is demanded, for instance in case of a
surgically stabilized facial bone fracture. This clinical report describes
Neslin Velioğlu, DDS, PhD
Assistant Professor, Department of Prosthodontics,
the fabrication of an individual extra-oral facial shield to prevent
dental trauma in a football match.
Faculty of Dentistry, Bülent Ecevit University,
Zonguldak, Turkey
Correspondence
Seda Cengiz, DDS, PhD
Department of Prosthodontics,
Faculty of Dentistry,
Key words: Contact Sports, Dental Trauma, Facial Shield
Bülent Ecevit University, Zonguldak, Turkey
Phone: ­+90 372 2613604
Fax: +90 372 2613603
E-mail: sedabc@hotmail.com
36
Submitted for Publication: 08.09.2013
Accepted for Publication : 04.03.2014
CLINICAL DENTISTRY AND RESEARCH 2014; 38(2): 36-40
Olgu Bildirimi
Temas Sporlarında Dental Travmadan Korunmak İçİn
Ekstra-oral Yüz Kalkanı Yapımı: Bİr Vaka Raporu
Seda Cengiz
Yar. Doç. Dr., Bülent Ecevit Üniversitesi, Diş Hekimliği Fakültesi,
Protetik Diş Tedavisi Anabilim Dalı,
Zonguldak, Türkiye
Murat Büyükbaş
Serbest Diş Hekimi,
Samsun, Türkiye
ÖZET
Temas sporları uygulanırken yüz kalkanları kullanılmaktadır. Yüz
kalkanları örnekleri ilgili sporun her branşı için standart hazır kask
olarak piyasada mevcuttur. Bireysel koruyucu kalkanların öncelikli
yapımı ağız koruyucuları ile sınırlıdır. Bireysel vakalarda, örneğin
cerrahi olarak stabilize edilmiş yüz kemik kırığı vakasında daha geniş
bir yüz kalkanı talep edilmektedir. Bu klinik rapor, bir futbol maçında
Neslin Velioğlu
Yar. Doç. Dr., Bülent Ecevit Üniversitesi, Diş Hekimliği Fakültesi,
diş travmalarını önlemek için bireysel bir ekstra-oral yüz kalkan
üretimini anlatmaktadır.
Protetik Diş Tedavisi Anabilim Dalı,
Zonguldak, Türkiye
Sorumlu Yazar
Seda Cengiz
Bülent Ecevit Üniversitesi,
Diş Hekimliği Fakültesi,
Protetik Diş Tedavisi Anabilim Dalı,
Anahtar kelimeler: Temas Sporları, Dental Travma, Yüz Kalkanı
Zonguldak, Türkiye
Telefon: +
­ 90 372 2613604
Faks: +90 372 2613603
E-mail: sedabc@hotmail.com
Yayın Başvuru Tarihi : 09.08.2013
Yayına Kabul Tarihi : 03.04.2014
37
CLINICAL DENTISTRY AND RESEARCH
INTRODUCTION
CASE REPORT
Sports injuries are one of the most common injuries in
A 27-year old male patient referred to our clinic with the
complaint of maxillary fracture while playing in a football
match. Previously the surgical treatment including the
splinting of maxilla and maxillary teeth had been completed
and the patient referred to prosthodontic department for
fabrication of a facial shield. The desired border of the
facial shield did not require coverage of the nasal cavity,
therefore the patient could breathe through his nose during
the impression-making procedure. A moulage was made
with a layer of regular set irreversible hydrocolloid (Cavex
Impressional, Cavex Holland BV: Haarlem, The Netherlands).
After the initial setting of the hydrocolloid the impression
was poured in a dental stone, (Glastone 3000, Dentsply
Inc, PA 17405-0872, USA) (Figure 1). After trimming the
facial cast (Figure 2), model waxing was performed with a
modelling wax, (Dentsply Inc, KT 15 2SE, England) (Figure
3) and covered with light-curing base plate (Lead Dent
Light Curing Baseplates, 482, Germany). The lip area was
cut for easy breathing. The model was polymerized with a
light curing unit (Tray-Lux cure-unit, Monitek Industrial Co,
Ltd. M5, SN 06C0119) in 3 seconds. The undesired facial
areas were marked with a black marker and the adjustments
were done to define the outline of the facial shield by a
hard bur. A tungsten carbide bur was used to smoothen the
margins. The shield was fitted on the patient to ensure the
proper coverage of the desired facial areas. 5 mm thickness
of foam rubber (Safaş, Sünger-Styrapor, İstanbul, Türkiye)
modern western societies. Treatment of sports injuries is
often difficult, expensive and time consuming.1 There is a
lack of publication on helmets and face masks worn for the
prevention of facial injuries in contact sports.2
Dental injuries in contact sports consist dental avulsions,
fractures,
luxations,
soft
tissue
hemorrhage
and
ecchymosis; lacerations or contusions to the gums, cheeks,
tongue, lips, or jaws; jaw fractures; jaw locked open or
closed; temporomandibular joint pain or chewing difficulty;
and concussion from a blow under the chin.3 A common
universal finding is that the majority of injuries affect the
upper jaw, with the maxillary incisors being most prone to
injury, often accounting for as many as 80% of all cases.4,5
Highly significant differences exist between the number of
teeth injured and the causes of injury.6 A blow or kick from
another player mostly cause injury to a tooth, while a fall or
blow from a hard object often result in injury to two teeth.
In addition to the damage caused by a traumatic impact to
the dento-alveolar structures, damage can also result in
facial bone fracture and more seriously, neck or brain injury
resulting from increased cranial pressure and deformation.7
Besides, mouthguards are not just effective for the
prevention of dento-alveolar injuries. Chapman suggested
that use of mouthguards should be encouraged in all contact
sports, as the most important value of the mouthguard is the
concussion-saving effect following impact to the mandible.
This fact alone should make the wearing of mouthguards
compulsory in all contact sports.7,8
Facial shields are used when practicing contact sports,
high speed sports, sports using hard balls, sticks or bats,
sports using protective shields or covers, and sports using
hard boardings around the sports ground. Examples of
facial shields are commercially available, per branch of sport
standardized helmets. Fabricating individual protective
shields is primarily restricted to mouth guards. In individual
cases, a more extensive facial shield is demanded, for
instance in case of a surgically stabilized facial bone
fracture.9
This clinical report describes the fabrication of an individual
extra-oral facial shield to prevent dental trauma in a football
match.
38
Figure 1. A moulage was made with irreversible hydrocolloid
Facial shield for contact sports
be used by injured athletes while recovering from a facial
injury is fabricated and described in this case report, so
that these athletes can continue their sports practice. In
order to fabricate an extensive individual facial shield, an
accurate model of the anterior part of the head is required.
Such a model can be provided by making an impression of
the face, which is poured in a dental stone. Another method
Figure 2. Facial cast.
Figure 4. 5 mm thickness of foam rubber inside the facial shield.
Figure 3. Model covered with light curing base plates.
was cut for the inner part of the facial shield and stuck
on the shield with an adhesive (Pattex, Henkel, Turkey)
(Figure 4). Holes were created in the lateral edges of the
shield to place the elasticated strip (Avortho Orthopedics,
İstanbul, Turkey) that provides retention and stability of the
facial shield (Figure 5). The adjustment of the facial shield
was performed and the patient was followed up after his
football match without any complaints.
DISCUSSION
Injured players returning to sports practice after
experiencing a trauma or undergoing surgery have a high
risk of reinjury, which affects the athlete’s overall training
and performance.10 An individual protective shield that can
Figure 5. Elasticated strip that provides retention and stability of the
facial shield.
39
CLINICAL DENTISTRY AND RESEARCH
is producing a stereolithographic model using computed
tomography or magnetic resonance imaging. On the accurate
model, the facial shield can be designed and fabricated
from a strictly safe material, such as polyvinylchloride or
polycarbonate.9 The light curing acrylic base-plate that is
one of the easy fabricated dental clinic material was used in
this case. The outer layer was rigid but the inner layer was
composed of foam rubber to promote comfort and to reduce
impact load. This simple procedure is applicable for athletes
who participate in many contact sports.
CONCLUSION
Dentists may have a role in the prevention and treatment
of sports-related dental and orofacial injuries. Therefore,
dentists may be participants as sporting club consultants,
and the use of mouthguards has to be widened among the
athletes performing contact sports for the prevention of
dental trauma.
ACKNOWLEDGEMENT
Presented at the 12th EBDO International Scientific
Congress, İzmir, Turkey, November 2009. Clinical report of
fabrication of an individual extra-oral facial shield.
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