Jan Akervall1,2*, Valarie Thomas1, Daniel Nicoli2 and Johannes W Schwank1,3
1Akervall Technologies Inc, USA
2St. Joseph Mercy Hospital, USA
3Department of Chemical Engineering, University of Michigan, USA
Background: Dental injuries from intubations and transoral endoscopic surgical procedures are still frequent and represent one of the primary reasons for legal claims against anesthesiologists and hospitals. The lifetime cost of an avulsed or chipped or tooth can be $5,000 to $20,000 because a chipped tooth may ultimately fail and require a dental implant . In many cases, the patient incurs this cost outside of the window of insurance coverage, impacting the doctor-patient relationship and potentially leading to litigation. In attempts to prevent dental injury during intubations and transoral endoscopic surgical procedures, inexpensive pre-shaped dental guards are provided on anesthesia carts. These dental guards are made of relatively soft materials such as Ethylene-Vinyl Acetate (EVA), tend to have poor fit, and are easily dislodged during a procedure. They also undergo plastic deformation or even fracture when severely loaded, and therefore provide inadequate dental protection. The goal of this laboratory study was to identify a better material and dental guard design that minimizes the transfer of forces to the teeth.
Methods: 24 dental guard prototypes with a range of design parameters were crafted from a thermoplastic polymer, fitted to faux dentitions, and systematically tested for their force dampening features to identify a dental guard with optimal characteristics capable of preventing force transmission to the faux teeth by a rigid laryngoscope.
Results: Among the dental guard design parameters, two were found to impart the most significant force dissipating capacity: extending the dental guard onto the palate region of the oral cavity, and adding a flap portion to the guard with a center cusp that extended over the gingiva-teeth intersection. Dental guards with these design elements had much lower force transmittance compared to the standard hospital-issued dental guards. Conclusions: In the present study we challenged the widely used soft EVA-based mouth guard concept by introducing a meticulously engineered hard thermoplastic polymer based device. In contrast to the standard guard that transfers significant forces to the teeth, the optimized guard design emerging from this study suppressed force transfer, thanks to a superior polymer , strategically placed perforations, and a stabilizing palate extension. The dental guard can be custom fitted in a minute and remolded if needed. We believe that this device could save patients from dental injuries, and protect anesthesiologists, otolaryngologists, and hospitals from lawsuits.
Dental protection; Mouth guards; Intubation; Transoral surgery; Rigid endoscopy
Akervall J, Thomas V, Nicoli D, Schwank JW. Intuguard – A Novel, Thin and Hard Dental Guard for Intubations, Rigid Endoscopies, and Transoral Procedures That Eliminates Transfer of Impact Forces to the Teeth. Am J Otolaryngol Head Neck Surg. 2018;1(1):1004.