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Dastgir R, Bemudez PF, Valiathan M, Baur DA, Quereshy FA. The use of clear aligners in orthognathic surgeries: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:e22-e40. [PMID: 38160198 DOI: 10.1016/j.oooo.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 01/03/2024]
Abstract
Pre- and postoperative fixed orthodontic appliances are the customary and standard practice for patients with treatment planned for undergoing orthognathic surgery. Traditionally, most patients undergoing orthognathic surgeries are in their late teens. Although these patients still compose the greatest pool of the orthognathic surgery population, many patients seek orthognathic surgery later in life. This older patient population often has different concerns and goals than the younger patient population. One of these concerns is often the aesthetic appearance of fixed appliances and the time required to wear these appliances pre- and postoperatively. Today, removable orthodontic appliances consisting of a series of clear aligners have gained immense popularity due to their aesthetic appeal over traditional braces. Additional benefits of removable orthodontic appliances include improved oral hygiene leading to a decreased risk of gingivitis. Whereas clear aligner systems are commonly used in the nonsurgical orthodontic population, there has been limited use of Invisalign in the orthognathic surgery population. In this article, we present a case series of 5 patients who successfully underwent orthognathic surgery using clear aligners for pre- and postoperative orthodontic treatment.
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Affiliation(s)
- Ramtin Dastgir
- Research Fellow, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Paul F Bemudez
- Faculty, Ascension Macomb-Oakland Hospital-Warren Campus, Detroit, MI, USA
| | - Manish Valiathan
- Professor and Director, Department of Orthodontics, Case Western Reserve University, Cleveland, OH, USA
| | - Dale A Baur
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Faisal A Quereshy
- Professor and Program Director, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA.
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Lee MY, Park JH, Park SJ, Chang NY, Chae JM. A finite element analysis of stress distribution with various directions of intermaxillary fixation using orthodontic mini-implants and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy. Orthod Craniofac Res 2024; 27:102-109. [PMID: 37496461 DOI: 10.1111/ocr.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This finite element analysis (FEA) aimed to assess the stress distribution in the mandible and fixation system with various directions of the intermaxillary fixation (IMF) using mini-implants (MIs) and elastics following mandibular advancement with a bilateral sagittal split ramus osteotomy (BSSRO). MATERIALS AND METHODS A total of nine mandibular advancement models were set according to the position of the MIs (1.6 mm in diameter, 8 mm in length) and direction of the IMF elastics (1/4 inch, 5 oz). Major and minor principal stresses in the cortical and cancellous bones, von Mises stresses in the fixation system (miniplate and monocortical screws), and bending angles of the miniplate were analysed. RESULTS Compressive and tensile stress distributions in the mandible and von Mises stress distributions in the fixation system were greater in models with a Class III IMF elastic direction and a higher IMF elastic force than in models with a Class II IMF elastic direction and a lower IMF elastic force. The bending angle of the miniplate was negligible. CONCLUSIONS Stress distributions in the bone and fixation system varied depending on the direction, amount of force, and position of IMF elastics and MIs. Conclusively, IMF elastics in the Class II direction with minimal load in the area close to the osteotomy site should be recommended.
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Affiliation(s)
- Mi-Young Lee
- Department of Orthodontics, Seoul National University Gwan-ak Dental Hospital, Seoul, South Korea
| | - Jae Hyun Park
- Postgraduate Orthodontic Program, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, Arizona, USA
- Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea
| | - Sung-Jin Park
- Department of Oral and Maxillofacial Surgery, GangNam CHA Hospital, CHA University School of Medicine, Seoul, South Korea
| | - Na-Young Chang
- Department of Orthodontics, School of Dentistry, University of Wonkwang, Wonkwang Dental Research Institute, Iksan, South Korea
| | - Jong-Moon Chae
- Postgraduate Orthodontic Program, Arizona School of Dentistry and Oral Health, A.T. Still University, Mesa, Arizona, USA
- Department of Orthodontics, School of Dentistry, University of Wonkwang, Wonkwang Dental Research Institute, Iksan, South Korea
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Elhadidi MH, Awad S, Elsheikh HAE, Tawfik MAM. Comparison of Clinical Efficacy of Screw-retained Arch Bar vs Conventional Erich's Arch Bar in Maxillomandibular Fixation: A Randomized Clinical Trial. J Contemp Dent Pract 2023; 24:928-935. [PMID: 38317388 DOI: 10.5005/jp-journals-10024-3613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
AIM This study aimed to compare the clinical outcomes of a conventional Erich's arch bar vs a modified screw-retained arch bar in maxillomandibular fixation of mandibular fracture. MATERIALS AND METHODS This parallel-arm randomized control trial included patients from the outpatient clinic with single favorable mandibular fractures that are indicated for closed reduction. They were subjected to maxillomandibular fixation using conventional Erich's arch bars in the control group and modified screw-retained arch bars in the study group. The outcome measures included operating time, glove perforations, postoperative pain, oral hygiene, fixation stability, occlusion, and mucosal coverage. RESULTS A total of 20 patients (12 males and 8 females) with a 1:1 allocation ratio were included. There was a significant statistical difference regarding operation time and number of glove perforations in favor of group B as p < 0.001, p = 0.007, respectively. There was a significant statistical difference regarding pain after 1 day (p < 0.001), 1 week (p < 0.001) in favor of group B, and at 4 weeks (p = 0.015), and 6 weeks (p = 0.002) in favor of group A. Regarding oral hygiene at 1 week (p = 0.021) and at 6 weeks (p < 0.001), there was a significant statistical difference in favor of group B. Regarding mucosal coverage at 6 weeks, there was a significant statistical difference in favor of group A (p = 0.005). CONCLUSION The modified screw-retained arch bar can be considered an alternative to conventional arch bar as it provided less application time and better operator safety. It also showed better patient satisfaction regarding pain and oral hygiene. CLINICAL SIGNIFICANCE Maxillomandibular fixation with the conventional technique was modified to screw-retained arch bar which is less time-consuming and provides better patient and operator satisfaction. How to cite this article: Elhadidi MH, Awad S, Elsheikh HAE, et al. Comparison of Clinical Efficacy of Screw-retained Arch Bar vs Conventional Erich's Arch Bar in Maxillomandibular Fixation: A Randomized Clinical Trial. J Contemp Dent Pract 2023;24(12):928-935.
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Affiliation(s)
- Merna Hosny Elhadidi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Aldakhlia, Egypt
| | - Sally Awad
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Aldakhlia, Egypt
| | - Heba Abo-Elfetouh Elsheikh
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Aldakhlia, Egypt, Phone: +20 1024461010, e-mail:
| | - Mohamed Abdel-Monem Tawfik
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Aldakhlia, Egypt
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Guo J, Liu H, Lu L, Shen Y. Surgical management of recurrent apical abscess and root defect in a vital premolar caused by intermaxillary fixation screw placement. J Dent Sci 2023; 18:1901-1903. [PMID: 37799871 PMCID: PMC10548026 DOI: 10.1016/j.jds.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/17/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Jianliang Guo
- Department of Endodontics, Suzhou Stomatological Hospital, Suzhou, China
| | - He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia Vancouver, Canada
| | - Le Lu
- Department of Endodontics, Suzhou Stomatological Hospital, Suzhou, China
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia Vancouver, Canada
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Sankar H, Rai S, Jolly SS, Rattan V. Comparison of Efficacy and Safety of Hybrid Arch Bar with Erich Arch Bar in the Management of Mandibular Fractures: A Randomized Clinical Trial. Craniomaxillofac Trauma Reconstr 2023; 16:94-101. [PMID: 37222977 PMCID: PMC10201193 DOI: 10.1177/19433875221080019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design A clinical randomized control trial. Objective To compare the efficacy and safety of Hybrid arch bar (HAB) with Erich arch bar (EAB) in fracture management of the mandible. Methods In this randomized clinical trial, 44 patients were divided into 2 groups:- Group 1, N = 23 (EAB group) and Group 2, N = 21 (HAB group). The primary outcome was time taken for the application of arch bar, while the inner and outer glove puncture, operator prick, oral hygiene, arch bar stability, complications of HAB, and cost comparison were secondary outcomes. Results The time taken for the application of arch bar in group 2 was significantly shorter than group 1 (55.66 ± 17.869 min vs 82.04 ± 12.197 min) and the frequency of outer glove puncture was also significantly lesser for group 2 (0 punctures vs 9 punctures). Better oral hygiene was found in group 2. EAB was cost-effective than HAB (Rs 700 ± 239.79 vs Rs 1742.50 ± 257.14). The stability of the arch bar was comparable in both groups. Group 2 had associated complications of root injury in 2 out of 252 screws placed and the screw head got covered by soft tissue in 137 out of 252 screws placed. Conclusions Thus, HAB was better than EAB with a shorter time of application, less risk of prick injury, and improved oral hygiene.Clinical trial registry name- clinical trials registry- India, URL-http://ctri.nic.in, registration number- CTRI/2020/06/025966.
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Affiliation(s)
- Hariram Sankar
- Unit of Oral and Maxillofacial Surgery,
Oral Health Sciences Centre, Postgraduate Institute of Medical Education and
Research, Chandigarh, India
| | - Sachin Rai
- Unit of Oral and Maxillofacial Surgery,
Oral Health Sciences Centre, Postgraduate Institute of Medical Education and
Research, Chandigarh, India
| | - Satnam S. Jolly
- Unit of Oral and Maxillofacial Surgery,
Oral Health Sciences Centre, Postgraduate Institute of Medical Education and
Research, Chandigarh, India
| | - Vidya Rattan
- Unit of Oral and Maxillofacial Surgery,
Oral Health Sciences Centre, Postgraduate Institute of Medical Education and
Research, Chandigarh, India
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Upson SJ, Benning MJ, Fulton DA, Corbett IP, Dalgarno KW, German MJ. Bond Strength and Adhesion Mechanisms of Novel Bone Adhesives. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010078. [PMID: 36671649 PMCID: PMC9854805 DOI: 10.3390/bioengineering10010078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/10/2023]
Abstract
Bone adhesives offer distinct advantages over the use of screws to attached internal fixation plates (IFPs). As the chemical composition of bone is similar to dentine, it is possible that the types of monomers used to make dentine adhesives could be utilised to affix IFPs to bone. The ability to attach a bio-resorbable IFP to porcine bone was assessed for the monomer 10-methacryloyloxydecyl dihydrogen phosphate (MDP), used either as a homopolymer or a copolymer with urethane dimethacrylate (MDP + U). Additionally, the addition of a priming step (MDP + U + P) was evaluated. The chemical interactions of the monomers with bone were assessed using XRD and imaged using TEM, revealing the formation of nano-layered structures with the MDP primer, something we believe has not been reported on bone. In a 6-week artificial aging study both MDP + U and MDP + U + P demonstrated adequate shear bond strength to affix bio-resorbable IFPs. The cytotoxicity profiles of the adhesive formulations were determined using indirect and direct contact with MC3T3 cells, with indirect conditions suggesting the MDP + U + P is as cytocompatible as the resorbable IFP. The findings of this study suggest our newly developed adhesive has the potential to be used as a bone adhesive to affix bioresorbable IFPs.
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Affiliation(s)
- Sarah J. Upson
- Department of Life and Environmental Sciences, Faculty of Science and Technology, Bournemouth University, Poole BH12 5BB, UK
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Correspondence:
| | - Matthew J. Benning
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - David A. Fulton
- Chemical Nanoscience Laboratory, Chemistry-School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Ian P. Corbett
- School of Dental Sciences, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AZ, UK
| | - Kenneth W. Dalgarno
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Matthew J. German
- School of Dental Sciences, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AZ, UK
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Khatib B, Gelesko S, Amundson M, Cheng A, Patel A, Bui T, Dierks EJ, Bell RB. Updates in Management of Craniomaxillofacial Gunshot Wounds and Reconstruction of the Mandible. Oral Maxillofac Surg Clin North Am 2021; 33:359-372. [PMID: 34210400 DOI: 10.1016/j.coms.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article includes updates in the management of mandibular trauma and reconstruction as they relate to maxillomandibular fixation screws, custom hardware, virtual surgical planning, and protocols for use of computer-aided surgery and navigation when managing composite defects from gunshot injuries to the face.
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Affiliation(s)
- Baber Khatib
- Advanced Craniomaxillofacial and Trauma Surgery/Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Surgery, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Portland Hospital, 4805 NE Glisan Street, Portland, OR 97213, USA; Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA.
| | - Savannah Gelesko
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA
| | - Melissa Amundson
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - Allen Cheng
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, 1015 NW 22nd Avenue, Portland, OR 97210, USA
| | - Ashish Patel
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
| | - Tuan Bui
- Oral and Maxillofacial Pathology, Sanford Health, E - 1717 S University Drive Fargo, ND 58103, USA
| | - Eric J Dierks
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - R Bryan Bell
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA; Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
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8
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Venugopalan V, Satheesh G, Balatandayoudham A, Duraimurugan S, Balaji TS. A Comparative Randomized Prospective Clinical Study on Modified Erich Arch Bar with Conventional Erich Arch Bar for Maxillomandibular Fixation. Ann Maxillofac Surg 2020; 10:287-291. [PMID: 33708569 PMCID: PMC7943981 DOI: 10.4103/ams.ams_20_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/04/2020] [Accepted: 08/20/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Erich arch bar used for maxillomandibular fixation (MMF) since decades has several disadvantages such as risks of injury, additional operating room time, and gingival trauma. To overcome these downsides, modified Erich arch bar was introduced; however, there is not much available literature, indicating the efficacy of modified Erich arch bar over that of conventional arch bar wire. Therefore, the present study focuses on comparing efficiency of modified arch bar with conventional arch bar. Materials and Methods This comparative randomized study was conducted on 32 patients that required MMF and were divided into Group A patients who received intermaxillary fixation (IMF) with modified Erich arch bars and Group B patients with conventional Erich arch bars. The parameters recorded were average surgical time required, wire prick injuries, IMF stability, occlusal stability, screw loosening, oral hygiene status, and vitality response of the teeth. The variables were statistically analyzed using Student's t-test and Wilcoxon signed-rank test. Results The wire prick injury, intraoperative time noted in Group A was significantly reduced in comparison to Group B (P < 0.0001). Debris indices were significantly good in Group A in comparison to Group B (P < 0.0001). Nonvitality response of tooth was significantly more in Group B than in Group A patients (P < 0.05). Discussion The efficiency of modified Erich arch bar group was superior to the conventional arch bar with very limited restrictions.
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Affiliation(s)
- V Venugopalan
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - G Satheesh
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - A Balatandayoudham
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - S Duraimurugan
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - T S Balaji
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
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Aslam-Pervez N, Caccamese JF, Warburton G. A randomized prospective comparison of maxillomandibular fixation (MMF) techniques: "SMARTLock" hybrid MMF versus MMF screws. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:640-644. [PMID: 32981874 DOI: 10.1016/j.oooo.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/27/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy of the "SMARTLock" hybrid system and determine whether it results in fewer intraoperative and postoperative complications compared with placement of intermaxillary fixation (IMF) screws in trauma patients. STUDY DESIGN This prospective study, which was approved by the institutional review board, compared the results of MMF in mandibular fractures by using the Stryker "SMARTLock" hybrid system versus traditional IMF screws. Patients were recruited and assigned randomly to either group. The 2 groups were compared for placement time, intraoperative complications, loosening of hardware, postoperative complications, and time to device removal. RESULTS We enrolled 32 patients in the study, with 13 patients randomized to the group receiving hybrid MMF (HMMF) with the SMARTLock system and 19 to the group of patients receiving MMF with traditional IMF screws. The mean application time for HMMF was 25.92 minutes compared with 18.28 minutes for IMF screws. After removal, the HMMF was associated with gingival overgrowth and gingival edema. CONCLUSIONS This is the first study to compare HMMF with MMF with the use of IMF screws. Hybrid arch bars do require more manipulation for ideal placement compared with individually placed bone screws to achieve ideal MMF. Compared with IMF screws, the hybrid device was associated with gingival edema and overgrowth, but there was decreased incidence of loosening in the postoperative period.
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Affiliation(s)
- Nawaf Aslam-Pervez
- Consultant Oral & Maxillofacial Surgeon, Children's Hospital, M Health Fairview Southdale Hospital, Minneapolis, MN, USA.
| | - John F Caccamese
- Professor, Vice-Chairman, Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, MD, USA
| | - Gary Warburton
- Associate Professor, Program Director, Department of Oral and Maxillofacial Surgery, University of Maryland Dental School, Baltimore, MD, USA
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10
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Fernandes IA, Lopes ABS, Fonseca PG, da Silva Torres A, Rodrigues AB, Galvão EL, Falci SGM. Comparison between Erich arch bars and intermaxillary screws in maxillofacial fractures involving the dental occlusion: a meta-analysis. Int J Oral Maxillofac Surg 2020; 50:83-95. [PMID: 32798159 DOI: 10.1016/j.ijom.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/08/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
This systematic review aimed to compare the Erich arch bars (EABs) with intermaxillary fixation (IMF) screws in maxillofacial fractures involving dental occlusion on perioperative parameters. Four electronic databases were searched: MedLine (Pubmed), Web of Science, VHL, and Cochrane Library. Inclusion criteria comprised clinical trials comparing the two IMF methods, assessing at least one of the outcomes: occlusal stability, oral hygiene, quality of life, time to apply and remove IMF appliances, and complications. Risk of bias was evaluated through the Cochrane risk of bias tool. Fifteen papers were included in the qualitative analysis and 12 of those in the meta-analysis. Times for EABs application (mean difference (MD) 46.83; 95% confidence interval (CI): 30.63-63.02) and removal (MD 22.89; 95% CI 14.61-31.17) were longer compared with IMF screws. There is higher risk of glove perforation (risk ratio (RR) 3.81; 95% CI 2.41-6.04) and lower risk of iatrogenic injuries (RR 0.21; 95% CI 0.09-0.48) when placing EABs compared with IMF screws. No significant differences in plaque index were found (MD 1.07; 95% CI -0.17 to 2.31). The quality of this evidence ranged from very low to low and was mainly compromised by risk of bias assessment. Further studies are necessary to evaluate transurgical IMF stability and postoperative occlusal quality and quality of life when comparing EABs with IMF screws.
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Affiliation(s)
- I A Fernandes
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - A B S Lopes
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - P G Fonseca
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - A da Silva Torres
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - A B Rodrigues
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E L Galvão
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - S G M Falci
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
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11
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Ali AS, Graham RM. Perils of intermaxillary fixation screws. Br J Oral Maxillofac Surg 2020; 58:728-730. [PMID: 32418762 PMCID: PMC7200358 DOI: 10.1016/j.bjoms.2020.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Affiliation(s)
- A S Ali
- Oral and Maxillofacial Surgery Department, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, M8 5RB
| | - R M Graham
- Oral and Maxillofacial Surgery Department, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, M8 5RB.
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12
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Pabst AM, Blatt S, Epperlein P, Schmidtmann I, Krüger M, Schiegnitz E, Goetze E, Ziebart T, Al-Nawas B. The risk of tooth root injuries using cortical screws for intermaxillary fixation and osteosynthesis plates - A retrospective analysis. J Craniomaxillofac Surg 2019; 47:1767-1778. [PMID: 31711997 DOI: 10.1016/j.jcms.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/28/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022] Open
Abstract
Intermaxillary fixation (IMF) and osteosynthesis plates (OP) are widely used for the non-surgical and surgical treatment of mandible and condyle fractures. The aim of this retrospective study was to analyze the frequency of tooth root injuries by IMF and OP screws. Electronic patient reports (2004-2013) were screened for patients treated with either IMF screws and/or OP in the Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Germany. The frequency and the position of endangered and injured teeth were analyzed by orthopantomogram (OPTG) and cone beam computer tomography (CBCT). Next, possible predictive factors for tooth root injuries, namely interdental- and crestal distance, screw length and distance between tooth root and screw were evaluated. Further, the accuracy of OPTG vs. CBCT concerning the diagnosis of tooth root injuries was analyzed. Three-hundred sixty-six patients were included and 3388 teeth were defined as endangered by IMF- and OP screws. Overall, 16 injured teeth (0.5%) in 13 patients (3.55%) were detected. Nine injuries (56.3%) were caused by IMF- and seven injuries (43.8%) by OP screws. Three teeth were non-vital, one tooth had to be extracted. No correlation between the predictive factors crestal distance, screw length and tooth root injuries was found. If tooth injury occurred, a significant correlation between the interdental distance and the distance between tooth root and screw was found (κ = 0.48; p < 0,0001). Comparison between OPTG vs. CBCT demonstrated that many of the injuries that were seen in the OPTG (n = 230) could not be verified in the CBCT scans (n = 16) (κ = 0.12). To conclude, screws for IMF and OP can be considered as a safe procedure concerning the risk of tooth root injuries.
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Affiliation(s)
- Andreas Max Pabst
- Department of Oral- and Maxillofacial Surgery, Federal Armed Forces Hospital, (Head: Prof. Dr. Dr. R. Werkmeister), Rübenacherstrasse 170, 56072 Koblenz, Germany; Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany.
| | - Sebastian Blatt
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Pia Epperlein
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center, (Head: Prof. Dr. S. Singer), Obere Zahlbacherstr. 69, 55131 Mainz, Germany
| | - Maximilian Krüger
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Eik Schiegnitz
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Elisabeth Goetze
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Thomas Ziebart
- Department of Oral- and Maxillofacial Surgery, University Hospital Giessen and Marburg, Campus Marburg, (Head: Univ.-Prof. Dr. Dr. Andreas Neff), Baldingerstrasse, 35043 Marburg, Germany
| | - Bilal Al-Nawas
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
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Comparing Outcomes in Orthognathic Surgery Using Clear Aligners Versus Conventional Fixed Appliances. J Craniofac Surg 2019; 30:1488-1491. [PMID: 31299750 DOI: 10.1097/scs.0000000000005572] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Orthognathic surgery for dentofacial deformities is typically preceded and followed by orthodontic treatment. Traditionally, orthodontic hardware is secured to the dentition to allow dental movement and stabilization. Clear-aligner therapy (eg, Invisalign) provides an aesthetic alternative, consisting of a series of transparent trays. Its use has not been described in complex triple-jaw orthognathic surgery. The purpose of this study is to evaluate perioperative outcomes and 3-dimensionally quantify postoperative edema in Invisalign patients undergoing triple-jaw orthognathic procedures, comparing this to patients treated with conventional fixed appliances. The surgical approach to patients with clear-aligners is also outlined. METHODS The authors conducted a retrospective chart review and 3-dimensional morphometric study of Invisalign patients undergoing triple-jaw surgery (LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty). An identical assessment of demographically matched patients treated with conventional fixed appliances was performed and compared with the Invisalign group. RESULTS Thirty-three patients, with a mean age of 19.99 years, were included: 13 with Invisalign and 20 with conventional fixed appliances. No significant difference was observed in operating time, concurrent extraction of teeth, fat grafting, duration of hospital stay, diet advancement, and use of narcotic analgesics between the 2 groups. Nine patients had sufficient 3-dimensional images for volumetric analysis (4 with Invisalign and 5 with conventional fixed appliances). Postoperative edema was not significantly different (P = 0.712) when comparing conventional fixed appliances (44.29 ± 23.16 cm) to Invisalign (37.36 ± 31.19 cm). CONCLUSION The present study demonstrates that complex multiple-jaw orthognathic procedures can be successfully performed in Invisalign patients. Perioperative and short-term clinical outcomes are not compromised.
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Fracture propagation associated with intermaxillary fixation screws in maxillofacial trauma. Int J Oral Maxillofac Surg 2019; 49:491-495. [PMID: 31570287 DOI: 10.1016/j.ijom.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/17/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022]
Abstract
Intermaxillary fixation (IMF) screws are commonly used for maxillomandibular immobilization in the management of mandible fractures as definitive closed reduction treatment or in adjunct intraoperatively. In this report, we present three cases of isolated unilateral mandible fractures, in which IMF screws were used and resulted in propagation of a second fracture on the contralateral side, at the site where IMF screws were placed during the surgery. The use of IMF screws has many advantages with an overall low risk of morbidity, however, there are potential complications that must be recognized.
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Edmunds MC, McKnight TA, Runyan CM, Downs BW, Wallin JL. A Clinical Comparison and Economic Evaluation of Erich Arch Bars, 4-Point Fixation, and Bone-Supported Arch Bars for Maxillomandibular Fixation. JAMA Otolaryngol Head Neck Surg 2019; 145:536-541. [PMID: 30946454 DOI: 10.1001/jamaoto.2019.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Erich arch bars, 4-point fixation, and bone-supported arch bars are currently used in maxillomandibular fixation, although to what extent they differ in terms of overall charges and clinical outcomes has yet to be reported. Objective To determine the association of Erich arch bars, 4-point fixation, and bone-supported arch bars in maxillomandibular fixation with hospital charges and clinical outcomes. Design, Setting, and Participants This historical cohort included 93 patients with mandible fracture who underwent maxillomandibular fixation from January 1, 2005, to June 30, 2015, at a tertiary care center. Statistical analysis was conducted from October 4, 2015, to September 8, 2017. Main Outcomes and Measures Charge analysis from an institutional perspective, operative time, necessity for a secondary procedure, and postoperative complications. Results Of the 93 patients in the study (18 women and 75 men; median age, 28.0 years [interquartile range, 23.0-40.0 years]), 27 (29%) received Erich arch bars, 51 (55%) received 4-point fixation, and 15 (16%) received bone-supported arch bars. The mean operative time for Erich arch bars (98.7 minutes; 95% CI, 89.2-108.2 minutes) was significantly longer than for 4-point fixation (48.8 minutes; 95% CI, 41.8-55.7 minutes) and bone-supported arch bars (55.9 minutes; 95% CI, 43.1-68.6 minutes). A total of 17 patients who received Erich arch bars (63%), 37 patients who received 4-point fixation (72%), and 1 patient who received bone-supported arch bars (7%) needed to return to the operating room for hardware removal. Patients who received Erich arch bars and those who received 4-point fixation had significantly higher odds of requiring a secondary procedure than did patients who received bone-supported arch bars (Erich arch bars: odds ratio, 27.1; 95% CI, 2.7-274.6; and 4-point fixation: odds ratio, 42.8; 95% CI, 4.4-420.7). Mean total operative charges for application of the hardware alone were significantly less for 4-point fixation ($5290; 95% CI, $4846-$5733) and bone-supported arch bars ($6751; 95% CI, $5936-$7566) than for Erich arch bars ($7919; 95% CI, $7311-$8527). When secondary procedure charges were included, the mean total charge for Erich arch bars ($9585; 95% CI, $8927-$10 243) remained significantly more expensive than the mean total for 4-point fixation ($7204; 95% CI, $6724-$7684) and bone-supported arch bars ($6924; 95% CI, $6042-$7807). No clinically meaningful difference in complications between groups was found (Erich arch bars, 3 [11%]; 4-point fixation, 5 [10%]; and bone-supported arch bars, 2 [13%]). Conclusions and Relevance Bone-supported arch bars have comparable complication outcomes, operative time for placement, and overall charges when compared with Erich arch bars and 4-point fixation, and have a lower likelihood of requiring removal in an operative setting.
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Affiliation(s)
- Meade C Edmunds
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - T Alex McKnight
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Christopher M Runyan
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Brian W Downs
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Jordan L Wallin
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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Batbayar EO, Malwand S, Dijkstra PU, Bos RRM, van Minnen B. Accuracy and outcome of mandibular fracture reduction without and with an aid of a repositioning forceps. Oral Maxillofac Surg 2019; 23:201-208. [PMID: 31055659 PMCID: PMC6531395 DOI: 10.1007/s10006-019-00759-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/12/2019] [Indexed: 11/28/2022]
Abstract
Purpose It is presumed that adequate reduction of a fracture of the mandible favors bone healing and diminishes the risk of complications. In this retrospective study, we compared the accuracy of fracture alignment and complication rate of mandibular fractures reduced without or with aid of a repositioning forceps. Methods Retrospective analysis of consecutive 252 patients with mandibular fractures treated between January 2010 and December 2016. Eligible for this study were patients with isolated mandibular fractures needing open reduction and internal fixation in whom pre- and postoperative radiographs and patient records were available. In total, 131 (252 fractures) patients fulfilled the inclusion criteria. Results Seventy-one (54%) patients were men. Mean age of the patients was 33 ± 16.5 years, and the median and interquartile range of age was 25 (20;41). In 54 patients, mandibular fractures were reduced without the aid of repositioning forceps, and in the remaining 77 patients, the fractures were reduced with the aid of the repositioning forceps. Anatomical alignment of the fractures was poor in the non-forceps-aided group (48%) compared to the forceps-aided group (58%) (P = .067). Overall complication rate was higher in the group of fractures reduced without the aid of forceps (17%) than in the forceps-aided group (7%) (P = .045; OR, 2.7; 95% CI, 1.0–7.4). Conclusions Mandibular fractures reduced with the aid of repositioning forceps are accompanied by a lower complication rate and better alignment. This is an important observation as better alignment of the fracture fragments favors bone healing and reduces complications.
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Affiliation(s)
- Enkh-Orchlon Batbayar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands.
| | - Somaia Malwand
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands.,Department of Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Ruud R M Bos
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
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Selvaraj D, Daniel Sathiya SS, Stephen E, Kota A, Samuel V, Premkumar P, Agarwal S. Extending the boundaries of carotid body tumor excision with a maxillofacial surgeon. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_15_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Satpute AS, Mohiuddin SA, Doiphode AM, Kulkarni SS, Qureshi AA, Jadhav SB. Comparison of Erich arch bar versus embrasure wires for intraoperative intermaxillary fixation in mandibular fractures. Oral Maxillofac Surg 2018; 22:419-428. [PMID: 30302602 DOI: 10.1007/s10006-018-0723-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Intermaxillary fixation (IMF) is a fundamental principle in the management of mandibular fractures but with recent advent of open reduction and internal fixation (ORIF), use of IMF is almost limited intraoperatively. Therefore, we compared the efficacy of Erich arch bar versus embrasure wires for intraoperative IMF in mandibular fractures. METHOD This prospective study was comprised of 50 patients with mandibular fractures who required ORIF with intraoperative IMF. Patients were categorized into two groups of 25 patients each: Erich arch bar technique was used for group A and embrasure wire technique for group B. Parameters were time taken for IMF, needle stick injury, occlusal stability, iatrogenic complications, and periodontal status of patients. STATISTICAL ANALYSIS Chi-squared test and unpaired t test analyses was run on IBM SPSS 21.0 version (2015) software. RESULT Mean time for placing embrasure wire (3.48 min) was significantly less than that for Erich arch bar (48.08 min). Needle stick injury rates to the operator as well as the assistants were significantly less when using the embrasure wire than the Erich arch bar. The Erich arch bar had significantly superior postoperative occlusion stability. Iatrogenic injury was more common when placing the Erich arch bar than the embrasure wire. Postoperative oral hygiene status was good in patients that received the embrasure wire. CONCLUSION Embrasure wire technique is a quick, easy, and reliable technique for minimally or moderately displaced fractured mandible and had better clinical outcomes than did patients that underwent the Erich arch bar technique.
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Affiliation(s)
- Ashish Shrikant Satpute
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India.
| | - Syed Ahmed Mohiuddin
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Amol Madhukar Doiphode
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Sujay Sanjay Kulkarni
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Ahtesham Ahmad Qureshi
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Swapnil Bharat Jadhav
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
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Ketoff S, Sigaux N, Raberin M, Bouletreau P. [Dental complications during orthodontic preparation and orthognathic surgery]. Orthod Fr 2018; 89:137-144. [PMID: 30040613 DOI: 10.1051/orthodfr/2018010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/12/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Orthodontic-surgical treatment can present risks to the dental organ and the periodontium. Despite the low incidence of such cases, these complications can compromise a treatment plan. Practitioners should be aware of these potential complications, take them into account during treatment in order to reduce their negative impact and, if necessary, manage them by orthodontic-surgical collaboration. MATERIALS AND METHODS In this article, the authors present several potential complications that can occur during treatment. CONCLUSION The information given to the patient about the risks inherent in the implementation of an orthodontic-surgical protocol must necessarily include the risks of lesion to the dental organ and the periodontium.
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Affiliation(s)
- Serge Ketoff
- Service de Chirurgie maxillo-faciale, Hôpital Paris Saint-Joseph, 185 rue Raymond-Losserand, 75014 Paris, France
| | - Nicolas Sigaux
- Service de Chirurgie maxillo-faciale, Centre hospitalier Lyon-Sud, 165 chemin du Grand-Revoyet, 69495 Pierre Bénite cedex, France
| | | | - Pierre Bouletreau
- Service de Chirurgie maxillo-faciale, Centre hospitalier Lyon-Sud, 165 chemin du Grand-Revoyet, 69495 Pierre Bénite cedex, France
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Khatib B, Gelesko S, Amundson M, Cheng A, Patel A, Bui T, Dierks EJ, Bell RB. Updates in Management of Craniomaxillofacial Gunshot Wounds and Reconstruction of the Mandible. Facial Plast Surg Clin North Am 2018; 25:563-576. [PMID: 28941508 DOI: 10.1016/j.fsc.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article includes updates in the management of mandibular trauma and reconstruction as they relate to maxillomandibular fixation screws, custom hardware, virtual surgical planning, and protocols for use of computer-aided surgery and navigation when managing composite defects from gunshot injuries to the face.
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Affiliation(s)
- Baber Khatib
- Advanced Craniomaxillofacial and Trauma Surgery/Head and Neck Oncologic and Microvascular Reconstructive Surgery, Department of Surgery, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Portland Hospital, 4805 NE Glisan Street, Portland, OR 97213, USA; Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA.
| | - Savannah Gelesko
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA
| | - Melissa Amundson
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - Allen Cheng
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, 1015 NW 22nd Avenue, Portland, OR 97210, USA
| | - Ashish Patel
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
| | - Tuan Bui
- Oral and Maxillofacial Pathology, Sanford Health, E - 1717 S University Drive Fargo, ND 58103, USA
| | - Eric J Dierks
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA
| | - R Bryan Bell
- Head & Neck Surgical Associates, 1849 NW Kearney Street #302, Portland, OR 97209, USA; Department of Surgery, Trauma Service, Legacy Emanuel Medical Center, 2801 N Gantentenbein Avenue, Portland, OR 97227, USA; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA; Robert W. Franz Cancer Research Center, Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan Street, Portland, OR 97213, USA
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Kumar P, Menon G, Rattan V. Erich arch bar versus hanger plate technique for intermaxillary fixation in fracture mandible: A prospective comparative study. Natl J Maxillofac Surg 2018; 9:33-38. [PMID: 29937656 PMCID: PMC5996650 DOI: 10.4103/njms.njms_63_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Various methods have been described for intermaxillary fixation (IMF) for treatment of faciomaxillary injuries. Many studies have been described to evaluate the efficacy of different methods. Hanger plate method has not been commonly used. The aim of the present study was to compare the advantages and disadvantages of this method over Erich arch bar in mandibular fracture. Materials and Methods: Sixty patients of only mandibular fracture presenting to trauma center requiring open reduction and internal fixation under general anesthesia were randomly allocated to Group A and Group B comprising thirty patients in each. Group A included patients who received IMF with Erich arch bar. Group B included patients who received IMF with hanger plate method. The two groups were compared for time duration of intermaxillary procedure, total duration of surgery, oral hygiene score, postoperative occlusion, and complications. Results: The average time of intermaxillary procedure, total duration of surgery, and wire prick injuries were more in Group A. Oral hygiene score was significantly better in Group B. Postoperative occlusion was comparable between the two groups. There was screw loosening in four patients in Group B, but none had tooth root injury. The cost of material for IMF was more in Group B. Conclusion: IMF with hanger plate method is more safe and efficacious compared to Erich arch bar in the treatment of mandibular fractures.
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Affiliation(s)
- Parmod Kumar
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Govind Menon
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidya Rattan
- Department of OHSC, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
PURPOSE Maxillomandibular fixation (MMF) can be performed using various techniques. Two common approaches used are arch bars and bone screws. Arch bars are the gold standard and inexpensive, but often require increased procedure time. Bone screws with wire fixation is a popular alternative, but more expensive than arch bars. The differences in costs of care, complications, and operative times between these 2 techniques are analyzed. METHODS A chart review was conducted on patients treated over the last 12 years at our institution. Forty-four patients with CPT code 21453 (closed reduction of mandible fracture with interdental fixation) with an isolated mandible fracture were used in our data collection. The operating room (OR) costs, procedure duration, and complications for these patients were analyzed. RESULTS Operative times were significantly shorter for patients treated with bone screws (P < 0.002). The costs for one trip to the OR for either method of fixation did not show any significant differences (P < 0.840). More patients with arch bar fixation (62%) required a second trip to the OR for removal in comparison to those with screw fixation (31%) (P < 0.068). This additional trip to the OR added significant cost. There were no differences in patient complications between these 2 fixation techniques. CONCLUSIONS The MMF with bone screws represents an attractive alternative to fixation with arch bars in appropriate scenarios. Screw fixation offers reduced costs, fewer trips to the OR, and decreased operative duration without a difference in complications. Cost savings were noted most significantly in a decreased need for secondary procedures in patients who were treated with MMF screws. Screw fixation offers potential for reducing the costs of care in treating patients with minimally displaced or favorable mandible fractures.
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Abstract
Facial trauma is a significant cause of morbidity in the United States. Despite the large volume of trauma surgeries at most academic institutions, there is still controversy regarding management of many traumatic injuries. The literature lacks clear-cut best practices for most fractures. In orbital trauma, there is debate about the optimal timing of repair, preferred biomaterial to be used, and the utility of evaluation afterward with intraoperative computed tomographic scan. In repair of mandible fractures, there is debate regarding open versus closed reduction of subcondylar fractures, or alternatively, endoscopic repair.
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Andrei Florescu V, Kofod T, Pinholt EM. Intermaxillary Fixation Screw Morbidity in Treatment of Mandibular Fractures-A Retrospective Study. J Oral Maxillofac Surg 2016; 74:1800-6. [PMID: 27206626 DOI: 10.1016/j.joms.2016.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 04/16/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of the present retrospective study was to investigate the morbidity of screws used for intermaxillary fixation (IMF) in the treatment of mandibular fractures. A review of the published data was also performed for a comparison of outcomes. Our hypothesis was that the use of screws for IMF of mandibular fractures would result in minimal morbidity. MATERIALS AND METHODS Patients treated for mandibular fractures from 2007 to 2013, using screws for IMF, using the international diagnosis code for mandibular fracture, DS026, were anonymously selected (Department of Oral and Maxillofacial Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark). The fracture type, radiographic findings, treatment modality, screw type and number, and root damage were recorded. For the outcome comparison, a review of the published data regarding iatrogenic dental root damage caused by screw fixation was performed in May 2015. RESULTS A total of 156 patients had undergone IMF with screws. The total number of screws was 793. The incidence of root lesions was 0.25% centrally and 0.88% peripherally. The incidence of screw loss was 0.13% and that of screw loosening was 1.89%. In the review, 737 related reports were identified in a search of PubMed and the Cochrane Library. Of these, 25 were considered suitable for inclusion. A lack of valid evidence resulted in a descriptive analysis, because a meta-analysis of the data was not possible. CONCLUSIONS The results of the present retrospective study have shown that the use of screws is a valid choice for IMF in mandibular fracture treatment with minimal morbidity. The 793 screws used for IMF resulted in a negligible amount of central and peripheral tooth root trauma.
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Affiliation(s)
- Vlad Andrei Florescu
- PhD Fellow, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas Kofod
- Department Head and Consultant Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Else Marie Pinholt
- Professor, University of Southern Denmark, Faculty of Health Sciences, Institute for Regional Health Sciences, University of Southern Denmark Hospitals, Hospital of South West Denmark, Esbjerg, Denmark
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Falci SG, Douglas-de-Oliveira DW, Stella PEM, Santos CRRD. Is the Erich arch bar the best intermaxillary fixation method in maxillofacial fractures? A systematic review. Med Oral Patol Oral Cir Bucal 2015; 20:e494-9. [PMID: 26034929 PMCID: PMC4523263 DOI: 10.4317/medoral.20448] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 03/25/2015] [Indexed: 11/11/2022] Open
Abstract
Background Intermaxillary fixation is used to achieve proper occlusion during and after oral and maxillofacial fracture surgery. The aim of this systematic review was to compare Erich arch bar fixation with other intermaxillary fixation methods in terms of the operating time, safety during installation, oral health maintenance and occlusal stability. Material and Methods An electronic online search was conducted of the Scirus, PubMed, Ovid, Cochrane Library and VHL databases. A clinical trial dating from the inception of the data bases until August 2013 was selected. Studies that compared Erich arch bars with other intermaxillary fixation methods in patients older than 18 years-old were included. The studies were assessed by two independent reviewers. The methodological quality of each article was analyzed. Results Nine hundred and twenty-five manuscripts were found. Seven relevant articles were analyzed in this review. The risk of bias was considered moderate for four studies and high for three clinical trials. Conclusions There is not enough evidence to conclude that the Erich arch bar is the best intermaxillary fixation method in cases of oral and maxillofacial fractures. Key words:
Facial injuries, jaw fixation techniques, mandible, maxilla.
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The Use of a Rubber Seal to Prevent Mucosal Injury in the Treatment of Mandibular Fractures With Intermaxillary Fixation. J Craniofac Surg 2015; 26:1431. [DOI: 10.1097/scs.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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van den Bergh B, Blankestijn J, van der Ploeg T, Tuinzing D, Forouzanfar T. Conservative treatment of a mandibular condyle fracture: Comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial. J Craniomaxillofac Surg 2015; 43:671-6. [DOI: 10.1016/j.jcms.2015.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 11/16/2022] Open
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Bins A, Oomens MAE, Boffano P, Forouzanfar T. Is There Enough Evidence to Regularly Apply Bone Screws for Intermaxillary Fixation in Mandibular Fractures? J Oral Maxillofac Surg 2015; 73:1963-9. [PMID: 25930955 DOI: 10.1016/j.joms.2015.03.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/24/2015] [Accepted: 03/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Intermaxillary fixation (IMF) is traditionally achieved with arch bars; however, this method has several well-known disadvantages and other techniques, such as bone screws, are available. This study evaluated current evidence regarding these IMF screws (IMFSs) for mandibular trauma and to assess whether this allows a change of treatment protocol for IMF. MATERIALS AND METHODS A systematic electronic literature search was conducted in the PubMed, Embase, and Cochrane databases. Titles and abstracts retrieved from the search were screened and evaluated for inclusion and exclusion criteria. The full text of all relevant articles was read and citation lists were checked for any missing references. All randomized controlled trials (RCTs) were subjected to a quality assessment. Included articles were checked for outcome measurements concerning occlusion, operative time, oral hygiene, root trauma, wire-stick injuries, and mucosa overgrowth. RESULTS Twenty-two articles (17 case series, 4 RCTs, and 1 cohort study) were included. None of the RCTs scored high methodologic results in the quality assessment. The results suggest IMFSs have similar malocclusion rates as arch bars, fewer wire-stick injuries, improved oral hygiene, and shorter operative time. Root damage is less likely to occur with self-drilling screws and seldom requires treatment. CONCLUSIONS Although the methodologic quality of the included studies is poor, self-drilling IMFSs are recommended for temporary per-operative IMF of noncomminuted mandibular fractures. More high-quality studies are required to allow an evidence-based change of protocol.
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Affiliation(s)
- Arjan Bins
- Ph.D. Student, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Marjolijn A E Oomens
- Resident, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), The Netherlands
| | - Paolo Boffano
- Research Associate, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), The Netherlands
| | - Tymour Forouzanfar
- Head, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Center for Dentistry Amsterdam (ACTA), The Netherlands
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Son S, Kim SS, Son WS, Kim YI, Kim YD, Shin SH. Miniscrews versus surgical archwires for intermaxillary fixation in adults after orthognathic surgery. Korean J Orthod 2015; 45:3-12. [PMID: 25667912 PMCID: PMC4320316 DOI: 10.4041/kjod.2015.45.1.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/05/2014] [Accepted: 07/21/2014] [Indexed: 12/11/2022] Open
Abstract
Objective We compared the skeletal and dental changes that resulted from the use of two methods of intermaxillary fixation (IMF)-miniscrews and surgical archwire-in 74 adult patients who had Class III malocclusion and were treated with the same orthognathic surgical procedure at a hospital in Korea. Methods All the patients underwent Le Fort I osteotomy and bilateral sagittal split ramus osteotomy with rigid fixation. They were divided into two groups according to the type of IMF used-group 1 underwent surgical archwire fixation and group 2 underwent orthodontic miniscrew fixation. In a series of cephalograms for each patient, we compared vertical and horizontal tooth-position measurements: (a) immediately after surgery (T0), (b) 3 months after surgery (T1), and (c) 6 months after surgery (T2). Cephalometric changes within each group were examined using one-way analysis of variance (ANOVA) while the independent samples t-test procedure was used to compare the two groups. Results After surgery, the maxillary incisors tended to be proclined in both groups although there were no significant differences. Incisor overbite increased significantly in both groups from T0 to T1, and the miniscrew group (group 2) showed slightly greater overbite than the archwire group (group 1). Conclusions This study suggest that the use of orthodontic miniscrews and orthodontic surgical archwire for IMF in adult patients results in similar skeletal and dental changes.
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Affiliation(s)
- Sieun Son
- Department of Orthodontics, Pusan National University Dental Hospital, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Seong Sik Kim
- Department of Orthodontics, Pusan National University Dental Hospital, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Woo-Sung Son
- Department of Orthodontics, Pusan National University Dental Hospital, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yong-Il Kim
- Department of Orthodontics, Pusan National University Dental Hospital, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yong-Deok Kim
- Department of Oral and Maxillofacial Surgery, Pusan National University Dental Hospital, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial Surgery, Pusan National University Dental Hospital, School of Dentistry, Pusan National University, Yangsan, Korea
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McCulloch NA, Hardman JC, Millar J, Larkin EB. Novel prosthesis for retention of endotracheal tube in patients with burns. Br J Oral Maxillofac Surg 2014; 53:107-8. [PMID: 25468317 DOI: 10.1016/j.bjoms.2014.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 10/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- N A McCulloch
- Department of Otolaryngology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom.
| | - J C Hardman
- Department of Otolaryngology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom
| | - J Millar
- Department of Oral and Maxillofacial Surgery, NHS Lothian, St John's Hospital, Howden Road West, Livingston EH54 6PP, United Kingdom
| | - E B Larkin
- Department of Oral and Maxillofacial Surgery, NHS Lothian, St John's Hospital, Howden Road West, Livingston EH54 6PP, United Kingdom
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A novel designed screw with enhanced stability introduces new way of intermaxillary fixation. J Craniofac Surg 2014; 25:e555-7. [PMID: 25364969 DOI: 10.1097/scs.0000000000001079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION This article represents new design of a fixation screw-spike screw-for the intermaxillary elastic fixation application after the first surgery in orthognathic surgery. This new type called spike screw is easily placed and provides enough rigidity for the intermaxillary fixation (IMF) with increased stability that was a common problem using screw-type fixation. MATERIALS AND METHODS Spike screw has a unique design: a washer with soldered stainless hook that adds stability and fixation to the screw done by a miniscrew. It increases stability by reducing the high peak stress-often occurs in miniscrew-and obtaining the advantage of miniplate system with miniscrew fixation. It allows noninvasive screw placement unlike miniplate. The 8 spike screws were placed on the posterior lesion to provide secure IMF, and 2 I-type C-tubes were placed on the anterior lesion. RESULTS By modifying the length of the hook attached to a washer can accommodate each patient's IMF length variation like a custom-made screw. The stability of the screw was kept well for 6 weeks even with minor gingival irritation in some of the area. This proved that spike screw could be one of the methods for IMF. The closeness of the hook to the teeth eliminated further gingival irritation around the elastic attachment site. Finally, it provided easy manipulation of the hook to change vectors of the elastic force application. CONCLUSIONS The novel design of the screw permits easy placement and removal for the IMF. In addition, its advantages include increased stability with unique design, less gingival irritation, and simple vector modification of the IMF elastics by adjusting the hook length and shape.
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Abstract
Orthognathic surgical treatment conventionally relies on the use of full arch fixed orthodontic appliances. However, the introduction of orthodontic mini-implants has altered surgical options in terms of providing an alternative to fixation (intermaxillary fixation, IMF) screws and even to maxillary osteotomy. This paper describes the integration of mini-implants within orthognathic treatments in terms of 'surgery first' treatments and by introducing the concept of the conversion of bimaxillary cases into mandible-only surgery treatments.
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Affiliation(s)
- Richard R J Cousley
- Orthodontic Department, Peterborough and Stamford Hospitals NHS Foundation Trust, UK
| | - Mark J Turner
- Department of Oral and Maxillofacial Surgery, Peterborough and Stamford Hospitals NHS Foundation Trust, UK
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West GH, Griggs JA, Chandran R, Precheur HV, Buchanan W, Caloss R. Treatment outcomes with the use of maxillomandibular fixation screws in the management of mandible fractures. J Oral Maxillofac Surg 2013; 72:112-20. [PMID: 24075236 DOI: 10.1016/j.joms.2013.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/02/2013] [Accepted: 08/05/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this prospective randomized study was to assess whether uncomplicated mandible fractures could be treated successfully in an open or closed fashion using maxillomandibular fixation (MMF) screws. MATERIALS AND METHODS This was a prospective institutional review board-approved study involving 20 adult patients who presented to the university emergency department or oral and maxillofacial surgical clinic with uncomplicated mandible fractures. Patients who met the exclusion criteria consented to enter the study in the open reduction internal fixation (ORIF) or the closed (MMF) study group. Six to 8 MMF screws were used to obtain intermaxillary fixation (IMF) in the 2 groups. Screw failure was documented. All screws were removed at 5 to 6 weeks postoperatively. Insertional torque (IT) was measured at time of screw placement to assess primary stability. Clinical and photographic documentation was performed to assess fracture healing, occlusion, and gingival health. Ten-centimeter visual analog scales were used to assess patient-centered outcomes. Cone-beam computed tomography was performed to assess the long-term effects on the periodontium and roots. A cost comparison was performed to determine whether the use of screws was cost effective compared with arch bars. RESULTS Fifteen men and 5 women (mean age, 25.2 yr) entered the study. All patients displayed adequate fracture healing based on clinical examination. All patients had acceptable occlusion at 5 to 6 weeks postoperatively. Total screw failure was 27 of 106 screws (25.5%). Forty percent of screws placed in the MMF group failed compared with only 6% in the ORIF group. Gingival health scores were favorable. Factors that had a significant effect on screw failure included a lower IT (P = .002), use in closed (MMF) treatment (P < .001), and use in the posterior jaw (P = .012). Minimal pain was associated with the MMF screws and pre-existing occlusion was re-established based on patients' subjective responses. The MMF group reported a statistically significant lower quality of life (P < .001) compared with the ORIF group. There was only 1 screw site that had a facial cortical bone defect noted at 6-month follow-up CBCT examination. There were no discernible long-term root defects. Cost analysis showed that the use of MMF screws saved around $600 per patient in operating room usage cost alone compared with the estimated use of arch bars. CONCLUSIONS Uncomplicated mandible fractures were successfully treated using MMF screws in open and closed treatments. However, the utility in closed treatment was decreased because of significant screw failure and patient noncompliance. The screws were well tolerated by the patients. There was minimal long-term damage to the periodontium and dental roots. The cost of screws was more than offset by time savings.
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Affiliation(s)
- Griffin Harold West
- Resident, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS
| | - Jason Alan Griggs
- Professor, Department of Biomedical Materials Science, University of Mississippi Medical Center, Jackson, MS
| | - Ravi Chandran
- Assistant Professor, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS
| | - Harry Vincent Precheur
- Professor Emeritus, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS
| | - William Buchanan
- Professor, Department of Periodontics and Preventive Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Ron Caloss
- Associate Professor, Interim Chairman and Program Director, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS.
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Delbet-Dupas C, Pham Dang N, Mondié JM, Barthélémy I. [Intermaxillary intraoperative fixation of mandibular fractures: arch bars or fixation screws?]. ACTA ACUST UNITED AC 2013; 114:315-21. [PMID: 24007800 DOI: 10.1016/j.revsto.2013.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/24/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- C Delbet-Dupas
- Service de chirurgie maxillo-faciale et stomatologie, service de chirurgie plastique et reconstructrice de la face, CHU Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France.
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Design and Application of Hybrid Maxillomandibular Fixation for Facial Bone Fractures. J Craniofac Surg 2013; 24:1801-5. [DOI: 10.1097/scs.0b013e3182a21163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Orthognathic surgery of a patient with oligodontia: alternative technique for intermaxillary fixation. J Craniofac Surg 2012; 23:e407-10. [PMID: 22976687 DOI: 10.1097/scs.0b013e31825c77d5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Oligodontia may cause various problems during orthognathic surgery because it may be difficult to fix the surgical guide splints. The aim of this clinical report was to present an alternative technique for intermaxillary fixation of a patient with oligodontia and facial deformity. A 20-year-old male patient, whose 8 maxillary and 11 mandibular teeth were congenitally missing, was treated using bimaxillary orthognathic surgery. Before the surgical approach, fixed mandibular prosthesis containing pins on the vestibule sides of the crowns was constructed to provide anchorage for intermaxillary splint and to achieve occlusal stability and vertical dimension during the surgery. This prosthesis was also used to hang intraoral elastics during the postoperative orthodontic treatment. At the end of treatment, these pins were cut, composite restoration material was applied to camouflage the places of the pins, and the patient continued to use this prosthesis. The patient gained an appropriate facial aesthetics and oral function using multidisciplinary approach.
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Fowell C, Bhatia S, Castling B. A novel use of intermaxillary fixation screws for post-maxillectomy obturator retention. Br J Oral Maxillofac Surg 2012; 51:e195-6. [PMID: 22749617 DOI: 10.1016/j.bjoms.2012.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/21/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Christopher Fowell
- Oral and Maxillofacial Surgery, Shrewsbury and Telford Hospitals NHS Trust, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury SY3 8XQ, United Kingdom.
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