The Orthodontic Patient: The Largest Untapped Population in Your Practice

If you read only one post in this series, make it this one — because there's a population sitting in orthodontic chairs across your referral area, at documented elevated risk, that essentially nobody is protecting.

Start with the numbers

Fixed appliance treatment is concentrated in adolescence, which is a period of high dental injury incidence from leisure and sporting activity. The appliance makes things worse in both directions: it compromises the fit of a mouthguard — both by its own presence and through the tooth movement treatment produces — and it increases the extent of damage after an orofacial injury, through bracket debonding, archwire deformation, and soft tissue laceration.

And only about 35 percent of orthodontic patients report routinely wearing a mouthguard during sport.

Why so low? Because there's been almost no evidence-based guidance in this area, so orthodontists differ significantly in the advice they give. Some have expressed concern that a custom guard might be too adaptive and could prevent desired tooth movement — a concern that, as the trial authors themselves note, has never been formally studied.

So the field defaulted to the "ortho channel" guard and the instant-fit silicone guard.

What the data says about those products

Two papers, both published in the European Journal of Orthodontics in 2022, both open access. Read them. Then forward them.

The impact study. Researchers tested seven mouthguards on a typodont bonded with a 0.022 × 0.028 appliance and 0.017 × 0.025 stainless steel archwire. Three of the seven — including the pre-fabricated instant-fit type — were displaced from the typodont after every single impact, and had to be excluded from load comparison entirely on that basis. All three custom-made designs stayed retained throughout.

A guard that leaves the mouth on contact has a protective value of zero. Not "reduced." Zero.

The randomized clinical trial. A three-arm crossover trial of 24 orthodontic patients in fixed appliances — median age 13, mostly rugby union and field hockey. Custom-made guards were 3.5 times more likely to be rated highly for comfort (95% CI 1.3–9.5) and 4.3 times more likely to be rated highly for stability (95% CI 1.6–11.6) than the pre-fabricated type. Overall preference: 54 percent custom, 29 percent mouth-formed, 17 percent pre-fabricated.

The authors recommend a custom-made or mouth-formed mouthguard for any individual playing contact sport during fixed appliance treatment.

The argument you make to the orthodontist

Here's the strategic point, and it's the thing most people get wrong when they pitch this.

The argument is not about shock absorption. It's about retention and compliance.

A guard that displaces on impact, or that a thirteen-year-old refuses to wear, delivers no protection regardless of what the packaging claims about its material. Perceived comfort is itself a critical determinant of whether the appliance is actually in the mouth when the elbow arrives.

Orthodontists respond to that framing because it's a treatment-outcome argument, not a product argument.

What solves it: Intact® Ortho Shield

This is the problem the Intact® Ortho Shield was designed around — a patented mouthguard built specifically for the patient in fixed appliances. Two design capabilities, both enabled by the digital workflow.

1. Placement and removal without engaging the appliance. The practical objection orthodontists raise most often is fair: a well-retained guard in the hands of an adolescent becomes a bracket-removal tool, and every loose bracket is an unscheduled emergency visit nobody planned and nobody is paid for. The Ortho Shield's patented geometry lets the patient insert and remove the guard with minimal or no engagement of brackets and wires. Reducing those emergency visits is the outcome the design is intended to produce.

2. Digital block-out for planned tooth movement. Because every Ortho Shield case is designed digitally, deliberate buffer space is built between the teeth, the appliance, and the guard material before fabrication. The guard isn't designed to the dentition as scanned. It's designed to accommodate where the dentition is going.

This isn't speculative. Block-out of the labial and buccal surfaces to accommodate anticipated movement has been described in the mouthguard literature since 2008. The digital equivalent — taking the STL from the intraoral scan and virtually preparing the model to build buffer space before fabrication — was described in the orthodontic literature in 2025 as a technique for accommodating tooth movement and extending the service life of the guard.

The consequence: one guard can serve a complete competitive season without interfering with orthodontic tooth movement.

For the orthodontist, that removes the treatment-delay objection. For the family, it removes the cost objection of replacing a guard every few adjustment visits. For you, it removes every reason the patient had to say no.

The aligner patient nobody is serving

The same Ortho Shield design capability extends to aligner therapy — a population commercial products have essentially ignored.

Option A (preferred): a guard designed to fit over the aligners in place. The patient competes without removing them. Wear time isn't sacrificed to sport, and the aligners are protected from the loss and damage that happens the moment a teenager takes them out at the field.

Option B: a guard designed to fit the dentition with aligners removed.

Either way, the same digital block-out applies, so the guard stays serviceable across a season rather than becoming ill-fitting at the next tray change.

Ask any orthodontist how many aligner trays they've replaced because a kid wrapped them in a napkin at a soccer game. Then watch their expression when you offer the alternative.

One indication you're walking past every day

Increased overjet is an independent risk factor for traumatic dental injury.

Sit with that. The Class II patient is at elevated trauma risk during exactly the interval in which they're waiting for that overjet to be corrected.

That's an argument for protection before and during treatment — not a conversation to have after the braces come off. And it means every orthodontic screening you perform is simultaneously a trauma risk assessment.

What to do this week

Pick one orthodontist in your referral area. Send them the two European Journal of Orthodontics papers — both open access, both forwardable as PDFs. Ask for fifteen minutes.

An orthodontist who reads them will understand immediately why the ortho-channel guards in their supply closet aren't doing the job. Then show them the Ortho Shield. That's a referral relationship built on evidence rather than on lunch.

Intact® Ortho Shield is protected by U.S. patent.

Kalra A, Harrington C, Minhas G, Papageorgiou SN, Cobourne MT. Eur J Orthod. 2022;44(1):101–109. doi:10.1093/ejo/cjab062 (Open Access)

Harrington C, Minhas G, Papageorgiou SN, Cobourne MT. Eur J Orthod. 2022;44(1):95–100. doi:10.1093/ejo/cjab023 (Open Access)

Salam S, Caldwell S. J Orthod. 2008;35(4):270–275.

Bastian NE, et al. Am J Orthod Dentofacial Orthop. 2020;157(4):516–525.

Maeda Y, Matsuda S, Tsugawa T, Maeda S. Dent Traumatol. 2008;24(4):475–478.

Gialain IO, Trentin GA, Tolentino AB, Fernandes TMF. J Orthod. 2025;52(4). doi:10.1177/14653125251389982

Arraj GP, Rossi-Fedele G, Doğramacı EJ. Dent Traumatol. 2019;35(4–5):217–232.