Wire-free fixation of jaw fractures

Dental trauma simulation training using four splinting models: A cross sectional study

BACKGROUND/AIM

Opportunities for dental students to obtain clinical experience in the management of traumatic dental injuries are scarce, and most dentists encounter difficulties with their first trauma patients after graduation. The aim of this study was to question students on the ease of handling of four types of flexible splints, with two common methods of bonding to the tooth.

MATERIAL AND METHODS

A total of 161 fourth year dental students completed a simulated treatment of an avulsed tooth using orthodontic wire, Twistflex wire, nylon fishing line, and Powermesh as splints. The bonding materials were composite resin (Spectra ST LV) or glass ionomer cement (GC Fuji LC Ortho). The students then answered 16 questions on a 5-point Likert scale, or with an open answer field.

RESULTS

Most students agreed (48.8%) or strongly agreed (31.3%) that the simulated trauma exercise assisted their learning. There was strong agreement (68.8%) and agreement (28.7%) that the simulation added value to their dental training compared to didactic training only. Similarly, 52.3% of participants strongly agreed and 40% agreed that they felt engaged in the learning activity. Only 53.8% of the participants agreed and 7.5% strongly agreed that the simulation felt realistic. Most students (56.2%) found a Powermesh/composite splint was the easiest to place, and nylon fishing line/GC Fuji LC Ortho splints was the least difficult to remove (35%).

CONCLUSION

Wire-free splints with composite bonding were judged as the easiest to place by students, while glass ionomer cement was the easiest to remove.

Use of oral screen for preventing soft tissue injuries associated with use of arch bars: a prospective randomized clinical study

PURPOSE

The purpose of the present study was to access the efficacy of oral screen in protection of arch bar-induced soft tissue injury after achieving maxillomandibular fixation (MMF).

MATERIALS AND METHODS

This study is a randomized clinical trial. The study sample was derived from the population of patients who required MMF and reported from January 2017 to December 2017. A total of 60 patients in whom application of an Erich arch bar was indicated for MMF were selected for the study. The patients were divided into two groups. In group I, only MMF was done; however, in group II, oral screen was used after MMF. The patients were assessed for soft tissue injury, pain, and maintenance of oral hygiene. All parameters were compared statistically using the chi-square test and Student's t test.

RESULTS

The soft tissue injury in group I (73.33%) was greater than that in group II (3.33%). The pain was worse in group I than in group II. The mean value of plaque index in group II is 1.20 and in group I is 2.89. It signifies that plaque deposition was more in group I.

CONCLUSION

Soft tissue injury and pain were less, as well as oral hygiene maintenance is better in patients who used oral screen after the placement of Erich arch bars.

Novel Arch Bar Fabricated With a Computer-Aided Design and Three-Dimensional Printing: A Feasibility Study

PURPOSE

The aim of the present study was to evaluate the feasibility of the design and fabrication of a novel arch bar using 3-dimensional printing. Furthermore, the study assessed its use in a preliminary clinical study of intermaxillary fixation.

PATIENTS AND METHODS

Seven patients who met the inclusion criteria were enrolled in the present study. Plaster dental casts were created of each patient and scanned using cone-beam computed tomography to obtain digital casts. Computer-aided design software was then used to complete the virtual building of the arch bars, which were manufactured using 3-dimensional printing and a cobalt-chrome alloy. The clinical results were observed after the arch bars were fixed to the dentition with steel wires.

RESULTS

The arch bar contacted the dentition with a "surface-to-surface" pattern. The utility of these novel arch bars was verified by successfully fitting them to the dental arches of the patients. All the patients achieved their desired occlusion.

CONCLUSION

The results of the present study have illustrated that this digital method is feasible for constructing a novel arch bar, showing promise for clinical use.

[Intermaxillary intraoperative fixation of mandibular fractures: arch bars or fixation screws?]

INTRODUCTION

The gold standard management of mandibular fractures is open reduction and osteosynthesis associated with intermaxillary fixation. The use of intermaxillary fixation screws for 20 years has considerably reduced the number of intermaxillary fixation with arch bars. The aim of our review was to identify current indications and contraindications of each technique.

INTERMAXILLARY FIXATION TECHNIQUES

We present a short history and compare the two techniques with recently published assets, drawbacks, and complications.

DISCUSSION

The indications of intermaxillary fixation screws are uni- or bifocal fractures without or with minimal displacement. Their use is contraindicated in any other type of fracture, which should still be treated with arch bar fixation.

Spiral intermaxillary fixation

Intermaxillary fixation (IMF) remains an important component in the management of many facial fractures. During IMF, dental occlusion plays an important role as a guide and therapeutic tool. Since time immemorial there is a constant quest of oral and maxillofacial surgeons to find a quick way for IMF. The desire to develop an alternate interdental fixation technique, which not only would decrease the risk to the operator and gingival trauma but also accurately satisfy dental occlusion, lead to the development of this novel technique of "spiral IMF."

Conservative treatment of comminuted mandibular fracture involving maxillomandibular fixation with miniplates

Bars and steel wires are the most commonly used methods to achieve maxillomandibular fixation, although there are numerous alternatives described for this same purpose. In cases of edentulous candidates for the conservative treatment of facial fractures, none of the conventional methods can be instituted for maxillomandibular fixation. Fixation in such cases is achieved with the aid of the total dentures of the patient or the confection of splints, but these methods lead to eating and oral hygiene problems. This article reports the case of an edentulous patient with a comminuted mandible fracture treated with a rarely described technique in which intermaxillary fixation was achieved with titanium miniplates.

What are we reading? A study of downloaded and cited articles from the British Journal of Oral and Maxillofacial Surgery in 2010

A large number of papers related to oral and maxillofacial surgery are published in many specialist journals. With the ever-increasing use of the internet it is easy to download them as part of a journal subscription on a fee per paper basis, or in some cases for free. Online access to the British Journal of Oral and Maxillofacial Surgery (BJOMS) is free to British Association (BAOMS) members with a $30 fee per paper download for non-members. Many colleagues use the online version of the journal, and this provides valuable information about downloading trends. Other data on articles that have been cited in subsequent publications are also readily available, and they form the basis for the calculation of a journal's impact factor. We evaluated the top 50 downloaded papers from the BJOMS website in 2010 to ascertain which articles were being read online. We also obtained data on the number of citations for papers published in 2009-2010 to see whether these papers were similar to the articles being downloaded. In 2010 there were over 360000 downloaded articles. The most popular papers were leading articles, reviews, and full length articles; only one short communication featured in the top 50 downloads. The papers most cited in subsequent publications were full length articles and leading articles or reviews, which represent 80% of the total citations of the 50 papers. Ten papers were in both the top 50 downloaded and most cited lists. We discuss the implications of this study for the journal and our readers.

A summary of trauma and trauma-related papers published in BJOMS during 2008-2009

This paper provides a summary of the 49 trauma and related papers published in British Journal of Oral and Maxillofacial Surgery during the period January 2008 to December 2009. 16/49 (32%) of these publications were full length articles, which covered areas such as epidemiology, service provision, materials and operative surgery. In addition there were other articles including short communications, technical notes, letters to the editor and interesting cases. Whilst fewer full length articles were published compared to the other sub-specialties, it was reassuring to see that the studies represent all aspects of trauma. More basic science and randomized control studies relating to trauma need to be encouraged.