Does Fibula Free Flap Harvesting Affect Donor Site of Patients in Facial Reconstructions: A Gait Analysis Study.

BACKGROUND: Vascularized fibula free flap (VFFF) remains gold standard for reconstruction of bony defects of the maxilla or mandible. Research and publications in recent years essentially focused on the evolution and improvement of the recipient reconstructed area but very few concerning the donor site morbidity. PURPOSE: The aim of this study was to analyze walking ability of patients following VFFF operation and to determine if there are long term walking disabilities. STUDY DESIGN, SETTING, SAMPLE: The retrospective cohort study involved healthy controls and patients who had undergone VFFF between 2012 and 2019 at the oral and maxillo-facial department of the University Hospital in Lausanne, Switzerland. Patients with cardiovascular, pulmonary, neuromuscular or musculoskeletal pathologies that could impair walking were excluded from the study. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Primary predictor is the reconstruction status, VFFF versus healthy patients (controls). MAIN OUTCOME VARIABLES: Main outcomes were gait parameters. Objective evaluation of walking abilities was assessed using the Gait Up system (Gait Up SA, EPFL Innov'Park-C, Lausanne, Switzerland), which are wearable motion sensors that provides 3D analytics of the gait. COVARIATES: Covariates implied patient characteristics such as age, sex, time after surgery and subjective evaluation of the gait obtained with two orthopedic validated questionnaires. RESULTS: This study implied 10 healthy controls and 11 patients who had undergone VFFF. Results showed statistically significant differences in the speed [m/s] (1.3 vs 1.1 for a P value of .001), the stride length [m] (1.4 vs 1.2 for a P value of 0.003), the flat foot phase [%] (55.0 vs 63.3 for a P value of .006) and the pushing phase [%] (34.1 vs 25.1 for a P value of .008). CONCLUSION AND RELEVANCE: Reconstruction using vascularized autograft in maxillofacial surgery is substantial and well described. Our attention focusing on donor site morbidity has demonstrated subjective and objective long-term alterations. These results will have to be confirmed with gait analysis in a prospective project including preoperative and postoperative analysis of the gait of the patient acting himself as his own control, with a larger scale of patients.

Aesthetic results in children with single suture craniosynostosis: proposal for a modified Whitaker classification.

OBJECTIVE: Aesthetic assessment after surgery for non-syndromic single suture craniosynostosis (SSC) is crucial. Surgeons' evaluation is generally based on Whitaker classification, while parental impression is generally neglected. The aim of this paper is to compare aesthetic perceptions of parents and surgeons after surgery for SSC, expressed by a 10-item questionnaire that complement Whitaker's classification. METHODS: The authors submitted a 10-item questionnaire integrating Whitaker's classification in order to evaluate the degree of satisfaction, the detailed aesthetics results and the need for surgical revision, to surgeons and parents of a consecutive series of patients operated for SSC between January 2007 and December 2018. The results were collected blindly. RESULTS: A total of 70 patients were included in the study. Scaphocephaly and trigonocephaly were the two most frequent craniosynostosis. Parents and surgeons general aesthetics evaluation and average rating for Whitaker's classification were 1.86 vs 1.67 (p = 0.69) and 1.19 vs 1.1 (p = 0.45) respectively. Parents' evaluation for scar perception and alopecia (p < 0.00001), the presence of bony crest (0.002), bony bump (p < 0.00001), or other bone irregularities (p = 0.02) are significantly worse when compared to surgeons' perception. CONCLUSIONS: Parents seem to be more sensitive to the detection of some aesthetic anomalies and their opinion should not be neglected. The authors propose a modified Whitaker classification based on their results to better stratify the aesthetic outcome after surgery for SSC.

Surgical Margins in 3D Planned Mandibular Resections for Squamous Cell Carcinomas of the Oral Cavity.

PURPOSE: Three-dimensional (3D) planned mandibular resections using cutting guides and preplanned plates are now widely used in oncological surgery. The main advantages are the gain of time, precision, and esthetic outcomes. The drawbacks include costs, time for planning, and printing the surgical tools. This time between the radiological data and the surgery may allow tumor progression, rendering the custom-made guides useless. There is no consensus regarding surgical margins that should be planned to ensure a safe oncologic outcome. The purpose of this retrospective study is to evaluate if the planned bony margins are adequate. MATERIALS AND METHODS: Inclusion criteria were: Squamous cell carcinomas of the anterior and lateral floor of mouth with mandibular invasion (T4); mandibular resection using 3D planning and cutting guides. Between June 2015 to December 2019, 16 patients met the criteria. The time between the planning and the surgery was recorded. The authors decided to use a margin of at least 1 cm on the preoperative computerized tomography scans on each side of the tumors in our planning for all patients. The authors then measured the distance of the bone resection on the pathological specimen. RESULTS: All 16 patients had safe bone surgical margins (R0). The average time from the scanners used for the planning to the surgery was 33 days. DISCUSSION: All the cutting guides could be used. The pathology examination showed safe oncological margins and no patients required further resection. A 1 cm margin during 3D planning for mandibular resections with 3D printed cutting guides, in patients with T4 Squamous Cell Carcinomas can therefore be considered safe.

Cryoneurolysis of alveolar nerves for chronic dental pain: A new technique and a case series.

BACKGROUND: Chronic neuropathic dental pain has a poor prognosis with a low chance of significant spontaneous improvement. Local or oral therapies may be efficient, however short in terms of duration with potential side effects. Cryoneurolysis has been described to prevent acute postoperative pain or to treat some chronic pain conditions; however, application to dental orofacial pain has not been reported so far. CASE SERIES: Following a positive diagnostic block on the corresponding alveolar nerve, neuroablation was performed using a cryoprobe on three patients suffering from persistent pain after a dental extraction and 1 after multiple tooth surgeries. The effect of treatment was assessed using a Pain Numeric Rating Scale (NRS) and determined by changes in medication dosage and quality of life at day 7 and 3 months. Two patients experienced more than 50% of pain relief at 3 months, 2 by 50%. One patient was able to wean off pregabalin medication, one decreased amitriptyline by 50%, and one decreased tapentadol by 50%. No direct complications were reported. All of them mentioned improvement in sleep and quality of life. CONCLUSION: Cryoneurolysis on alveolar nerves is a safe and easy-to-use technique allowing prolonged neuropathic pain relief after dental surgery.

Unilateral Cleft lip and Palate: Long-Term Results of the Malek Technique.

To review at 18 years-old the results of surgery and follow-up of children born in our hospital with unilateral cleft lip and palate (uCLP). They were operated at the time by the same surgeon, following the same primary surgical procedure (Malek).Retrospective cohort study.Tertiary Children's Hospital.All children born with uCLP between 1996 and 2001 and operated in our hospital. Syndromic children were excluded.Results of the primary surgery, ear-nose-throat interventions, maxillo-facial surgery and final phonatory results.Seventy-nine files of children born with a cleft were reviewed: 34 were taken into consideration for uCLP: 15 right and 19 left. They were operated in two stages, following the inverse Malek procedure. Sixty per cent had a fistula. Eighty-eight percent had grommets. Ninety-seven percent had an alveolar graft at a median age of nine (5-10) and 22% underwent a Le Fort osteotomy. Seven percent were operated for a pharyngeal flap, 29% for a secondary lip surgery at a mean age of 12.8 and 29% for a late rhinoplasty at a mean age of 14.8 years. A median of 5.7 multidisciplinary consultations was realized with a median number of general anesthesia of 7.1 (4-13).This retrospective study shows that the Malek procedure for children born with uCLP is related to a high risk of fistula but good long-term phonatory results. Twenty percent of children were operated for a Le Fort procedure and one-third for a secondary lip procedure and rhinoplasty.

[Temporomandibular joint disorders: current concepts for conservative management]. / Dysfonction de l'articulation temporo-mandibulaire: concepts actuels pour le traitement conservateur.

The temporomandibular joint is subject to repeated stress. The overloading of the compensation system leads to dysfunction, which manifests itself in the form of muscular and articular damage. Pain, joint noises and limitation of mouth opening are the most frequent reasons for a temporomandibular dysfunction (TMD) consultation. The diagnosis is mainly clinical. The therapeutic concepts are still controversial. The aim of this article is to offer a management strategy based on evidence through the analysis of literature reviews.

L'articulation temporo-mandibulaire est sujette à des contraintes répétées. La surcharge du système de compensation engendre une dysfonction qui se manifeste par des atteintes musculaires et articulaires. La douleur, les bruits articulaires et la limitation de l'ouverture buccale sont les motifs les plus fréquents pour une consultation de dysfonction temporo-mandibulaire (DTM). Le diagnostic positif est essentiellement clinique et les concepts thérapeutiques sont controversés. Le but de cet article est de proposer une prise en charge basée sur l'évidence et l'analyse de revues de la littérature.

[Temporomandibular joint dysfunctions: evolution in patient care]. / Dysfonction de l'articulation temporo-mandibulaire: modification de la prise en charge.

Temporomandibular joint dysfunctions are a frequently occurring condition that can have a considerable impact on the quality of life. The treatment modalities vary according to the anatomical involvement and symptomatology of the patient. Conservative and surgical management is still controversial and has evolved significantly in recent decades. The temporomandibular joint prosthesis is one of them. Through improvements in material and case management, the joint prosthesis has gained in popularity and has moved from being a treatment of last resort to being part of standard management.

Les dysfonctions de l'articulation temporo-mandibulaire sont une pathologie à incidence fréquente qui peut avoir un impact considérable sur la vie quotidienne. Leur traitement varie selon l'atteinte anatomique et la symptomatologie du patient. La prise en charge conservatrice et chirurgicale est encore controversée et a connu une évolution notable au courant des dernières décennies. Plus particulièrement, le remplacement prothétique de l'articulation, grâce à l'amélioration des matériaux et de la planification préopératoire, a gagné en popularité et est passé du traitement de dernier recours à un élément de la prise en charge standard.

An Intrinsically-Adhesive Family of Injectable and Photo-Curable Hydrogels with Functional Physicochemical Performance for Regenerative Medicine.

Attaching hydrogels to soft internal tissues is crucial for the development of various biomedical devices. Tough sticky hydrogel patches present high adhesion, yet with lack of injectability and the need for treatment of contacting surface. On the contrary, injectable and photo-curable hydrogels are highly attractive owing to their ease of use, flexibility of filling any shape, and their minimally invasive character, compared to their conventional preformed counterparts. Despite recent advances in material developments, a hydrogel that exhibits both proper injectability and sufficient intrinsic adhesion is yet to be demonstrated. Herein, a paradigm shift is proposed toward the design of intrinsically adhesive networks for injectable and photo-curable hydrogels. The bioinspired design strategy not only provides strong adhesive contact, but also results in a wide window of physicochemical properties. The adhesive networks are based on a family of polymeric backbones where chains are modified to be intrinsically adhesive to host tissue and simultaneously form a hydrogel network via a hybrid cross-linking mechanism. With this strategy, adhesion is achieved through a controlled synergy between the interfacial chemistry and bulk mechanical properties. The functionalities of the bioadhesives are demonstrated for various applications, such as tissue adhesives, surgical sealants, or injectable scaffolds.

Three-Dimensional Printed Nasal Prostheses After Oncologic Rhinectomies: Workflow and Patients' Satisfaction.

ABSTRACT: Reconstructions after oncologic full-thickness rhinectomies are often deferred from the ablative surgery. Definitive silicone prostheses are usually not used for transitional rehabilitation, and therefore, patients may deal with major facial defects for a long time before reconstruction. The aim was to develop a time- and cost-effective digital workflow to three-dimensional print temporary nasal prostheses and to assess patients' satisfaction. This prospective study enrolled all consecutive patients after full thickness ablative surgery and deferred reconstruction, from May 2018 to October 2019, at a tertiary care academic institution. With a dedicated software, the pre- and postoperative scans were three-dimensional processed to create the prosthesis and they were directly printed in elastic transparent resin. A cross-sectional survey was conducted 4 months after the rehabilitation to assess patients' satisfaction regarding comfort, aesthetics, and security of the retaining system. Seven patients were enrolled and they were all rehabilitated using this workflow. Mean time of design was 2h48 (SD 40 minutes), and mean printing time was 5h18 (SD 1 hour). Mean cost of production was 753 U.S. Dollars (SD 144 U.S. Dollars). Median scores of the visual analog scales were 8 out of 10 for each topic with interquartile range of 4 to 7 for aesthetics, 7 to 9 for comfort, and 7 to 10 for security of the retaining system. It has shown its feasibility in terms of costs and time of production. Patients were satisfied and it can be considered as a mean to help patients to deal with treatment sequelaes before definitive reconstruction.

[Anosmia and COVID-19]. / Anosmie et COVID-19.

Anosmia associated or not with dysgeusia seems to be a frequent symptom in cases of infection with SARS-CoV-2 responsible for COVID-19. It can be the initial symptom of the disease or remain isolated in pauci-symptomatic patients. Waiting for scientific confirmation and in the context of the current pandemic, it seems essential to consider any patient with a new anosmia as being infected with SARS-CoV-2 until proven otherwise. These patients should therefore isolate themselves and remain alert to the occurrence of other symptoms suggestive of the infection and/or be tested. Topical and systemic corticosteroids and nose washes are contraindicated. The natural course of anosmia seems to be favorable in most cases.

L'anosmie associée ou non à la dysgueusie semble être un symptôme fréquent en cas d'infection au SARS-CoV-2 responsable du COVID-19. Elle peut être le symptôme initial de la maladie ou rester isolée chez certains patients paucisymptomatiques. Dans l'attente de confirmations scientifiques et dans le contexte de pandémie actuelle, il semble primordial de considérer tout patient présentant une anosmie nouvelle comme étant infecté par le SARS-CoV-2 jusqu'à preuve du contraire. Ces patients devraient donc s'auto-isoler et rester attentifs à l'apparition des autres symptômes évocateurs de l'infection et/ou se faire tester. Les corticoïdes topiques et systémiques ainsi que les rinçages nasaux sont contre-indiqués. L'évolution naturelle de l'anosmie semble favorable dans la plupart des cas.

[New features in the management of labio-maxillo-palatal clefts at the CHUV]. / Nouveautés dans la prise en charge des fentes labio-maxillo-palatines au CHUV.

The labio-maxillofacial cleft (LMFC) penalizes the child from birth by its aesthetic, functional, psychological and social repercussions. The prognosis is conditioned by a multidisciplinary care that starts from the antenatal period to continue until the end of growth. The treatment is long and complex. This explains the multiplicity of techniques and the variability of schedules according to the teams. The purpose of this article is to describe the protocol of management of the LMFC within the multi-disciplinary team in Lausanne and to emphasize the novelties in both surgical and organizational plan.

La fente labio-maxillo-palatine (FLMP) pénalise l'enfant dès sa naissance par ses retentissements esthétiques, fonctionnels, psychologiques et sociaux. Le pronostic est conditionné par une prise en charge multidisciplinaire qui commence dès la période anténatale pour se poursuivre jusqu'à la fin de la croissance. Le traitement est long et complexe. Ceci explique la multiplicité des techniques et la variabilité des calendriers selon les équipes. Le but de cet article est de décrire le protocole de prise en charge des FLMP au sein de l'équipe pluridisciplinaire lausannoise et en mettant l'accent sur les nouveautés tant sur le plan chirurgical qu'organisationnel.

The Mandibular Ramus: An Alternative Donor Site for Secondary Alveolar Bone Grafting in Clefts of the Alveolus.

The authors describe the use of the mandibular ramus as an autologous bone graft material for secondary alveolar bone grafting in cleft patients. This technique represents a safe and effective alternative to currently used donor sites. Furthermore, it allows to minimize patient discomfort, so that they can be treated as outpatients.

[Internal medicine, seen from the mouth]. / La médecine interne vue depuis la bouche.

Many diseases affect the oral cavity. Therefore, the mouth is an organ that internists should observe carefully. Hereafter we present five illustrations of oral semiology that reflect a systemic condition: a strawberry tongue, an ulceration, a labial lesion, a gingival hyperplasia and a gingival hyperpigmentation. Each time, a differential diagnosis is to be considered, potentially allowing the identification of severe diseases.

Un grand nombre de pathologies ont une répercussion sur la sphère buccale. Pour l'interniste, la bouche est par conséquent un organe à observer soigneusement. Nous présentons cinq illustrations de sémiologie buccale qui traduisent une affection systémique : une langue framboisée, une ulcération, une lésion labiale, une hyperplasie gingivale et une hyperpigmentation gingivale. À chaque fois, un diagnostic différentiel doit être évoqué, permettant potentiellement l'identification de maladies sévères.

Should You Buy a Three-Dimensional Printer? A Study of an Orbital Fracture.

The use of three-dimensional (3D) printing has been growing significantly in medicine for the past 10 years, especially in maxillofacial surgery. A lot a different softwares and printers are available on the market, and it can be difficult to choose which one fits best one's needs. In the authors' institution, the authors regularly print orbits to prepare the reconstruction. The authors then compared the 3D printing of an orbital fracture between a professional and nonprofessional software and between a bottom of the range and a more elaborated printer. The results show that there is a wide variation between the quality of the printing, as well as the time used for the preparation. Costs between free or professional software must also be considered. In conclusion, an analysis of needs and what is available on the market must be studied before investing in 3D printing.

[Sleep apnea : diagnostic and therapeutic modalities in case of failure of the CPAP]. / Apnées du sommeil : modalités diagnostiques et thérapeutiques en cas d'échec de la CPAP.

Obstructive sleep apnea (OSA) is a sleep disorder that affects 49 % of men and 23% of women over 40 years old. CPAP is currently the treatment of choice for severe OSAS, but there are mild to moderate cases of OSAS with poor compliance or intolerance to CPAP, for which alternative treatments should be considered. In this article, we present a tool for evaluation of the upper airways, the DISE (Drug-induced sleep endoscopy), the OAM (mandibular advancement device), the bimaxillary advancement osteotomy, the hypoglossal nerve stimulation and the positional treatment.

Le syndrome d'apnées obstructives du sommeil (SAOS) est un trouble du sommeil qui affecte 49 % des hommes et 23 % des femmes de plus de 40 ans. La CPAP est actuellement le traitement de choix pour les SAOS sévères, mais il existe des cas de SAOS de degré léger à modéré qui présentent une mauvaise compliance, voire une intolérance à la CPAP, pour lesquels il faut envisager des traitements alternatifs. Dans cet article, nous vous présentons un outil d'évaluation des voies aériennes supérieures, le DISE (Drug-induced sleep endoscopy), l'OAM (orthèse d'avancement mandibulaire), l'ostéotomie d'avancement bimaxillaire, la pose d'un stimulateur du nerf hypoglosse et le traitement positionnel.

Jaw Immobilization for Gamma Knife Surgery in Patients with Mandibular Lesions: A Newly, Innovative Approach.

BACKGROUND: The purpose of our report is to describe an innovative system used for mandibular immobilization during Gamma Knife surgery (GKS) procedures. It is based on an approach originally developed in Marseille in extracranial lesions, close to or involving the mandible, which may imply a certain degree of movement during the therapeutic image acquisitions and/or GKS treatment. METHODS: The maxillofacial surgeon applied bone titanium self-tapping monocortical screws (4; 2 mm diameter, 10 mm length) between roots of the teeth in the fixed gingiva (upper and lower maxillae) the day before GKS (local anesthesia, 5-10 min time). Two rubber bands were sufficient for the desired tension required to undergo GKS. We further proceeded with application of the Leksell stereotactic G frame and carried out the usual GKS procedure. RESULTS: The mean follow-up period was 2.3 years (range 0.6-3). Three patients have been treated with this approach: 2 cases with extracranial trigeminal schwannomas involving the mandibular branch, with decrease in tumor size on MR follow-up; 1 case with residual paracondylian mandibular arteriovenous malformation following partial embolization, completely obliterated at 7 months (digital subtraction angiography programmed 1 year after treatment). CONCLUSIONS: Jaw immobilization appears to be a quick, minimally invasive, safe and accurate adjunctive technique to enhance GKS targeting precision.

Are virtual planning and guided surgery for head and neck reconstruction economically viable?

PURPOSE: Virtual planning and guided surgery with or without prebent or milled plates are becoming more and more common for mandibular reconstruction with fibular free flaps (FFFs). Although this excellent surgical option is being used more widely, the question of the additional cost of planning and cutting-guide production has to be discussed. In capped payment systems such additional costs have to be offset by other savings if there are no special provisions for extra funding. Our study was designed to determine whether using virtual planning and guided surgery resulted in time saved during surgery and whether this time gain resulted in self-funding of such planning through the time saved. MATERIALS AND METHODS: All consecutive cases of FFF surgery were evaluated during a 2-year period. Institutional data were used to determine the price of 1 minute of operative time. The time for fibula molding, plate adaptation, and insetting was recorded. RESULTS: During the defined period, we performed 20 mandibular reconstructions using FFFs, 9 with virtual planning and guided surgery and 11 freehand cases. One minute of operative time was calculated to cost US $47.50. Multiplying this number by the time saved, we found that the additional cost of virtual planning was reduced from US $5,098 to US $1,231.50 with a prebent plate and from US $6,980 to US $3,113.50 for a milled plate. CONCLUSIONS: Even in capped health care systems, virtual planning and guided surgery including prebent or milled plates are financially viable.

Rhinopharyngeal autologous fat injection for treatment of velopharyngeal insufficiency in patients with cleft palate.

Patients with cleft palate are prone to velopharyngeal insufficiency. In minor cases or when hypernasal speech does not resolve after velopharyngoplasty, an augmentation pharyngoplasty with autologous fat can be proposed. The aim of the present study is to evaluate the short-term (within 2 months) and long-term efficiency (during the 24 months following the procedure) of our procedure in the setting of velopharyngeal insufficiency related to a cleft palate. Twenty-two patients with cleft palate related velopharyngeal insufficiency were included in this retrospective study. All patients were operated following the same technique, in the same institution. The pre- and postoperative evaluations included a nasometry, a subjective evaluation using the Borel-Maisonny score, and a nasofibroscopy to assess the degree of velopharyngeal closure. Scores of Borel-Maisonny and nasometry were compared before, shortly after the procedure (within 2 months) and long term after the procedure (within 24 months). Forty-one procedures in 22 patients with a cleft palate performed in our institution between October 2004 and January 2012 were included in the study. Nine patients had a previous velopharyngoplasty with persistent rhinolalia despite intensive speech therapy. In 14 patients the procedure was repeated because of recurrent hypernasal speech after the first injection. The average number of procedures per patient was 1.8. Postoperative nasometry and Borel-Maisonny scores were statistically significantly improved and remained stable until the end of the follow-up (median 42 months postoperative) in most patients. Complications were rare and minor. Autologous fat injection is a simple procedure for treatment of minor velopharyngeal insufficiencies in patients with cleft palate, with good long-term results and few complications.

Isolated bilateral zygomatic arch fracture: an unusual pattern.

Isolated fractures of the zygomatic arch represent 5% to 14% of all zygomatic complex fractures. Bilateral isolated zygomatic arch fractures, which are defined as fractures of both zygomatic arches without any other facial fracture, are extremely rare. In this case report, we present a rare case of this facial fracture pattern.

Design of Customized Mouthguards with Superior Protection Using Digital-Based Technologies and Impact Tests.

BACKGROUND: In contact sports, an impact on the jaw can generate destructive stress on the tooth-bone system. Mouthguards can be beneficial in reducing the injury risk by changing the dynamics of the trauma. The material properties of mouthguards and their geometrical/structural attributes influence their protective performance. Custom-made mouthguards are the gold standard, and different configurations have been proposed to improve their protection and comfort. However, the effects of different design variables on the performance of customized mouthguards are not well understood. RESULTS: Herein, we developed a reliable finite element model to analyze contributing factors to the design of custom-made mouthguards. Accordingly, we evaluated the isolated and combined effect of layers' stiffness, thickness, and space inclusion on the protective capability of customized mouthguards. Our simulations revealed that a harder frontal region could distribute load and absorb impact energy through bending if optimally combined with a space inclusion. Moreover, a softer layer could enlarge the time of impact and absorb its energy by compression. We also showed that mouthguards present similar protection with either permanently bonded or mechanically interlocked components. We 3D-printed different mouthguards with commercial resins and performed impact tests to experimentally validate our simulation findings. The impact tests on the fabricated mouthguards used in this work revealed that significantly higher dental protection could be achieved with 3D-printed configurations than conventionally fabricated customized mouthguards. In particular, the strain on the impacted incisor was attenuated around 50% more with a 3D-printed mouthguard incorporating a hard insert and space in the frontal region than a conventional Playsafe® Heavypro mouthguard. CONCLUSIONS: The protective performance of a mouthguard could be maximized by optimizing its structural and material properties to reduce the risk of sport-related dental injuries. Combining finite element simulations, additive manufacturing, and impact tests provides an efficient workflow for developing functional mouthguards with higher protectiveness and athlete comfort. We envision the future with 3d-printed custom-mouthguards presenting distinct attributes in different regions that are personalized by the user based on the sport and associated harshness of the impact incidences.