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Fernandes IA, Al-Moraissi EA, Galvão EL, Falci SGM. Erich arch bars vs intermaxillary fixation screws for mandibular fracture reduction during ORIF: a randomized clinical trial. Clin Oral Investig 2023; 27:6063-6071. [PMID: 37603168 DOI: 10.1007/s00784-023-05220-x] [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: 05/26/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE This randomized clinical trial aimed to compare the efficacy of Erich arch bars (EAB) and intermaxillary fixation (IMF) screws in reducing mandibular fractures during open reduction and internal fixation (ORIF). METHODS A total of 28 patients with mandibular fractures were randomly allocated to either the EAB group or the IMF screws group. The study evaluated various parameters including occlusal stability, complications, duration of application, oral hygiene status, quality of life, and patient characteristics. RESULTS The study found no significant differences in occlusal stability between the EAB and IMF screw groups. However, the application and removal times were longer for EAB compared to IMF screws. The EAB group showed a higher presence of biofilm on teeth, indicating poorer oral hygiene status compared to the IMF screws group. In terms of quality of life, patients in the EAB group reported worse results in the "handicap" domain at the 15th postoperative day. No significant differences were observed in other quality-of-life parameters. Patient characteristics were well distributed between the two groups, enhancing the reliability of the results. CONCLUSION Both EAB and IMF screws demonstrated comparable occlusal stability for minimally displaced mandibular fractures. However, IMF screws offered advantages such as shorter application and removal times, better oral hygiene maintenance, and potentially improved quality of life in the "handicap" domain. Further studies with larger sample sizes are necessary to validate these findings and explore the stability of IMF methods in cases requiring postoperative malocclusion correction or prolonged IMF.
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Affiliation(s)
- Ighor Andrade Fernandes
- Department of Dentistry, Section of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Centro - Oral Surgery Clinic, Diamantina, Minas Gerais, Brazil.
| | | | - Endi Lanza Galvão
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- Department of Dentistry, Oral and Maxillofacial Section, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
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Cui MX, Qi Y, Xue LF, Xu YX, Yue J, Zhao JZ, Li C, Xiao WL. Comparative study of stress characteristics around the adjacent teeth tissues during insertion of mini-screws with different insertion angles: A three-dimensional finite element study. J Mech Behav Biomed Mater 2023; 142:105879. [PMID: 37141745 DOI: 10.1016/j.jmbbm.2023.105879] [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: 02/09/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/06/2023]
Abstract
With a limited alveolar bone position, there is a high risk that mini-screws (MS) implants could cause damage to the adjacent teeth. To reduce this damage, the position and tilt angle of the MS must be optimized. The aim of this study was to assess the effect of MS implantation angle on the stress exerted on adjacent periodontal membrane and roots. A three-dimensional finite element model containing dentition, periodontal ligament, jaw and MS were established based on the CBCT images and MS scanning data. The MS was first inserted perpendicular to the surface of the bone at specific locations and then tilted at an angle of 10° and 20° to the mesial and distal teeth, respectively. The stress distribution in the periodontal tissue of the adjacent teeth was analyzed after MS implantation at different angles.The stress on the adjacent tooth root and periodontal ligament was most uniformly distributed when the MS was inserted vertically. It changed 9.4-97.7% when the axis of MS was tilted at 10-degree and 20-degree angles from the point of vertical insertion. The stresses experienced by the periodontal ligament and the root are similar. When the horizontal angle of the MS insertion was changed, the MS was closer to the adjacent tooth, resulting in greater stress near the PDL and root. It was recommended to insert the MS vertically into the alveolar bone surface to avoid root damage due to excessive stress.
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Affiliation(s)
- Ming-Xue Cui
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China; School of Stomatology, Qingdao University, Qingdao, Shandong, 266071, China
| | - Yan Qi
- Department of Stomatology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, 250014, China
| | - Ling-Fa Xue
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China
| | - Yao-Xiang Xu
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China
| | - Jin Yue
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China
| | - Jin-Ze Zhao
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China; School of Stomatology, Qingdao University, Qingdao, Shandong, 266071, China
| | - Cong Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China; School of Stomatology, Qingdao University, Qingdao, Shandong, 266071, China
| | - Wen-Lin Xiao
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, China; School of Stomatology, Qingdao University, Qingdao, Shandong, 266071, China.
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Jain A, Rai A. Is the Use of Intermaxillary Fixation Screws an Alternative to Erich Arch Bars for Maxillomandibular Fixation During Management of Maxillofacial Fractures? A Systematic Review and Meta-Analysis. Craniomaxillofac Trauma Reconstr 2021; 14:236-245. [PMID: 34471480 DOI: 10.1177/1943387520971410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design Systematic review and meta-analysis. Objective Maxillomandibular fixation (MMF) is a step of paramount importance during the management of maxillofacial trauma. Erich arch bars are being used for this purpose for decades but with advances in maxillofacial trauma management, intermaxillary fixation screws came into existence and are being used routinely. The present study was designed to identify if the intermaxillary fixation screws are really an alternative to Erich arch bars for management of maxillofacial trauma. Methodology An exhaustive literature search was conducted in May 2020 on various electronic databases and studies comparing Erich arch bars and intermaxillary fixation screws were recruited for the analysis. Random-effects model with Mantel Haenszel statistics was used to analyze oral hygiene and duration of achieving MMF. Results A total of 96 studies were identified, out of which 8 studies were included in the meta-analysis. There was no statistically significant difference in oral hygiene status of the patients in both the groups. Intermaxillary fixations screws required statistically significantly less time in achieving MMF. Needle stick injury was prominently seen with the use of Erich arch bar whereas other complications like mucosal coverage, root injury, screw loosening and screw fracture makes the use of intermaxillary fixation screws questionable. Conclusion The present meta-analysis suggests that there is not enough evidence to recommend the use of intermaxillary fixation screws as an alternative to Erich arch bars. Further research with large sample size, high quality evidence and better methodology is recommended in this direction.
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Affiliation(s)
- Anuj Jain
- Consultant Oral and Maxillofacial Surgeon, Nagpur, Maharashtra, India
| | - Anshul Rai
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Rai A, Jain A, Datarkar A, Purohit S. Are Bondable Buttons a Better Option than Intermaxillary Fixation Screws for Achieving Maxillomandibular Fixation? A Prospective Randomized Clinical Study. J Maxillofac Oral Surg 2019; 18:551-554. [PMID: 31624435 DOI: 10.1007/s12663-019-01238-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/09/2019] [Indexed: 11/26/2022] Open
Abstract
Aim The aim of this study was to identify a better option in achieving maxillomandibular fixation (MMF) comparing bondable buttons and Maxillomandibular Fixation screws in achieving Maxillomandibular Fixation. Patients and Methods In this randomized clinical trial, study sample was derived from the population of patients who reported with minimally displaced mandibular fractures and who required Maxillomandibular Fixation. The patients were divided into two groups. In Group I (n = 20), Maxillomandibular Fixation was done with Maxillomandibular Fixation screws; on the other hand, in Group II (n = 20), bondable buttons were used. In both the groups the patients were analyzed for the time duration required in minutes for securing and removal of Maxillomandibular Fixation, plaque accumulation and postoperative stability. Plaque accumulation was evaluated using TURESKY-GILMORE-GLICKMAN modification of the Quigley-Hein plaque index. The complications encountered during and after the surgery were also analyzed. Results The plaque accumulation and time required for placement and removal in group I were more as compared to group II. In Group I, there were more complications as compared to Group II such as tooth root damage, screw loosening, screw breakage and infection. Conclusion Bondable buttons are a better choice for achieving Maxillomandibular Fixation in comparison with Maxillomandibular Fixation screws for the treatment of minimally displaced mandibular fractures. Further studies with a bigger sample size must be carried out.
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Affiliation(s)
- Anshul Rai
- 1Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
| | - Anuj Jain
- 2Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh India
| | - Abhay Datarkar
- 3Department of Oral and Maxillofacial Surgery, Government Dental College, Nagpur, Maharashtra India
| | - Subodh Purohit
- 3Department of Oral and Maxillofacial Surgery, Government Dental College, Nagpur, Maharashtra India
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Vadepally AK, Sinha R. Is it better to bend wires occlusally or apically during placement of arch bars for intermaxillary fixation? Br J Oral Maxillofac Surg 2017; 56:67-69. [PMID: 29198481 DOI: 10.1016/j.bjoms.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/13/2017] [Indexed: 11/15/2022]
Abstract
We evaluated 78 patients who had intermaxillary fixation (IMF) of fractured mandibular condyles with arch bars and wires. Depending on whether the wires were bent apically or occlusally during placement of the arch bars, we randomly divided the patients into two groups (n=39 in each), then compared pain, satisfaction with oral hygiene, and complications between the groups at five to six weeks postoperatively when the arch bars were removed. Outcomes were significantly better in the occlusal group than in the apical group.
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Affiliation(s)
- Ashwant Kumar Vadepally
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India.
| | - Ramen Sinha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
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Hartwig S, Boettner A, Doll C, Voss JO, Hertel M, Preissner S, Raguse JD. Drill-related root injury caused by intraoperative intermaxillary fixation: an analysis of 1067 screw applications. Dent Traumatol 2016; 33:45-50. [PMID: 27681036 DOI: 10.1111/edt.12305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS Intermaxillary fixation is a standard procedure for the treatment of mandibular fractures or in orthognathic surgery. Predrilling for screws poses the risk of accidental tooth root injury, potentially leading to further pathological processes. Limited evidence about accidental tooth injury during intermaxillary fixation is available due to heterogenous study designs. The aim of this study was to evaluate the risk of root trauma using predrilled transgingival fixation screws and the clinical consequences for the affected teeth. MATERIALS AND METHODS In this retrospective study, the data of open reduction and internal fixation surgery files with intraoperative application of predrilled intermaxillary fixation screws were analysed. The postoperative radiographic images were evaluated for the occurrence of tooth root injury. Patients diagnosed with root injury were clinically followed up with respect to the dental health for the affected teeth. RESULTS A total of 133 radiologically diagnosed tooth root injuries were recorded (12.5% of screws). The median follow-up interval was 16 months (range: 3-77 months). The return rate was 49.5% for all patients. Of these, four of the injured teeth (3%) needed endodontic treatment. No toothache was reported, no tooth was lost, and no negative impact on periodontal health was clinically evident. CONCLUSION Intermaxillary fixation with predrilled transgingival screws is a safe way to manage mandibular fractures. The incidence of tooth root injury is not uncommon, but the adverse side effects are rare and the health of the affected teeth is mostly not compromised.
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Affiliation(s)
- Stefan Hartwig
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Boettner
- Department of Biometry and Clinical Epidemiology, Campus Benjamin-Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan O Voss
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Hertel
- Department of Oral Medicine, Dental Radiology and Oral Surgery, Campus Benjamin-Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Saskia Preissner
- Department of Operative and Preventive Dentistry, Campus Benjamin-Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan D Raguse
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Trupthi DV, Chowdhury S, Shah A, Singh M. Treatment of Mandibular Fractures Using Intermaxillary Fixation and Vacuum Forming Splints: A Comparative Study. J Maxillofac Oral Surg 2015. [PMID: 26225022 DOI: 10.1007/s12663-013-0573-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The study was done to compare the clinical efficacy of vacuum formed splints and arch bar in treating minimally displaced mandibular fractures. METHOD Forty patients were included in two groups. Group 1 was treated with custom made splints and group 2 with conventional arch bar. Patients were recalled on 3rd, 7th, 14th day and on the day of removal of the appliance. Periodontal status, stability of appliance and chair side time were evaluated. RESULTS The mean chair side time taken by vacuum formed splint was 18.05 min and conventional arch bar fixation was 68.25 min. 8.3 % of patients with vacuum formed splints had poor oral hygiene in comparison with 25 % of patients with conventional arch bar. 70 % of patients with vacuum formed splints and 60 % of the patients with conventional arch bars were comfortable in mastication during treatment. CONCLUSION Vacuum formed splints has better advantages over arch bar with respect to chair side time, periodontal health, patient's compliance of maintaining oral hygiene, mastication and speech. Vacuum formed splints avoid needle stick injuries. So, they can be used for intermaxillary fixation in minimally displaced mandibular fractures.
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Affiliation(s)
- D V Trupthi
- Hosmat Superspeciality Hospital, Bangalore, India
| | - Shouvik Chowdhury
- Institute of Dental Sciences, Pilibhit Byepass Road, Bareilly, Uttar Pradesh India
| | - Anjan Shah
- Raja Rajeswari Dental College and Hospital, Bangalore, India
| | - Madhumati Singh
- Raja Rajeswari Dental College and Hospital, Bangalore, India
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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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Ingole PD, Garg A, Shenoi SR, Badjate SJ, Budhraja N. Comparison of intermaxillary fixation screw versus eyelet interdental wiring for intermaxillary fixation in minimally displaced mandibular fracture: a randomized clinical study. J Oral Maxillofac Surg 2014; 72:958.e1-7. [PMID: 24642133 DOI: 10.1016/j.joms.2014.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present randomized study was to evaluate the efficacy of intermaxillary fixation screw (IMFS) versus eyelet interdental wiring for intermaxillary fixation (IMF) in minimally displaced mandibular fractures. MATERIALS AND METHODS A total of 50 patients with a minimally displaced mandibular fracture were enrolled, with 25 patients randomly selected for each group. In group I (study group, n = 25), the patients were treated using IMFS, and in group II (control group, n = 25), they received eyelet interdental wiring. Both techniques were assessed for the following parameters: time required for placement and removal of each type of IMF technique, time required for placement of IMF wires, postoperative occlusion, stability of the IMF wire, local anesthesia requirement during removal of each fixation type, oral hygiene status, glove perforation rate, and complications associated with both techniques. The collected data were analyzed using Student's unpaired t test or χ2 test. P < .05 was considered significant and the Statistical Package for Social Sciences software, version 10, was used for analysis. RESULTS The average time required for placement in groups I and II was 17.56 and 35.08 minutes, respectively (P = .000). The time required for placement of the IMF wire in group I was 2.1 minutes and in group II was 6 minutes. The oral hygiene status was assessed, and the mean plaque index score for groups I and II was 1.44 and 2.12, respectively (P = .00). The glove perforation rate was much less in group I than in group II. Finally, the most common complication in both groups was mucosal growth. CONCLUSIONS The results established the supremacy of IMFS compared with eyelet interdental wiring. Thus, we have concluded that IMFS, in the present scenario, is a safe and time-saving technique. IMFS is a cost-effective, straightforward, and viable alternative to cumbersome eyelet interdental and other wiring techniques for providing IMF, with satisfactory occlusion during closed reduction or intraoperative open reduction internal fixation of fractures. In addition, oral hygiene can be maintained, and the glove perforation rate was very low using IMFS. The relatively small sample size and limited follow-up period were the study limitations.
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Affiliation(s)
- Pranav D Ingole
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Vidya Shikshan Prasarak Mandal Dental College and Research Centre, Nagpur, Maharashtra, India.
| | - Anoop Garg
- Professor, Department of Oral and Maxillofacial Surgery, Vidya Shikshan Prasarak Mandal Dental College and Research Centre, Nagpur, Maharashtra, India
| | - S Ramakrishna Shenoi
- Professor and Head, Department of Oral and Maxillofacial Surgery, Vidya Shikshan Prasarak Mandal Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Samprati J Badjate
- Associate Professor, Department of Oral and Maxillofacial Surgery, Vidya Shikshan Prasarak Mandal Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Nilima Budhraja
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Vidya Shikshan Prasarak Mandal Dental College and Research Centre, Nagpur, Maharashtra, India
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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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Rai A, Datarkar A, Borle RM. Are Maxillomandibular Fixation Screws a Better Option Than Erich Arch Bars in Achieving Maxillomandibular Fixation? A Randomized Clinical Study. J Oral Maxillofac Surg 2011; 69:3015-8. [DOI: 10.1016/j.joms.2010.12.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 10/25/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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Cornelius CP, Ehrenfeld M. The Use of MMF Screws: Surgical Technique, Indications, Contraindications, and Common Problems in Review of the Literature. Craniomaxillofac Trauma Reconstr 2011; 3:55-80. [PMID: 22110819 DOI: 10.1055/s-0030-1254376] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Mandibulo-maxillary fixation (MMF) screws are inserted into the bony base of both jaws in the process of fracture realignment and immobilisation. The screw heads act as anchor points to fasten wire loops or rubber bands connecting the mandible to the maxilla. Traditional interdental chain-linked wiring or arch bar techniques provide the anchorage by attached cleats, hooks, or eyelets. In comparison to these tooth-borne appliances MMF screws facilitate and shorten the way to achieve intermaxillary fixation considerably. In addition, MMF screws help to reduce the hazards of glove perforation and wire stick injuries. On the downside, MMF screws are attributed with the risk of tooth root damage and a lack of versatility beyond the pure maintenance of occlusion such as stabilizing loose teeth or splinting fragments of the alveolar process. The surgical technique of MMF screws as well as the pros and cons of the clinical application are reviewed. The adequate screw placement to prevent serious tooth root injuries is still an issue to rethink and modify conceptual guidelines.
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Affiliation(s)
- Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität München, Munich, Germany
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Widar F, Kashani H, Kanagaraja S, Dahlin C, Rasmusson L. A retrospective evaluation of iatrogenic dental root damage with predrilled vs drill-free bone anchor screws for intermaxillary fixation. Dent Traumatol 2011; 28:127-31. [DOI: 10.1111/j.1600-9657.2011.01051.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Are we consenting for IMF screws correctly? Int J Oral Maxillofac Surg 2011; 40:769. [PMID: 21459555 DOI: 10.1016/j.ijom.2011.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 02/11/2011] [Indexed: 11/23/2022]
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Chen Y, Lee JW, Cho WH, Kyung HM. Potential of self-drilling orthodontic microimplants under immediate loading. Am J Orthod Dentofacial Orthop 2010; 137:496-502. [DOI: 10.1016/j.ajodo.2008.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 06/01/2008] [Accepted: 06/01/2008] [Indexed: 11/29/2022]
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Estelita S, Janson G, Chiqueto K, Janson M, de Freitas MR. Predictable drill-free screw positioning with a graduated 3-dimensional radiographic-surgical guide: a preliminary report. Am J Orthod Dentofacial Orthop 2009; 136:722-35. [PMID: 19892291 DOI: 10.1016/j.ajodo.2007.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 12/01/2007] [Accepted: 12/01/2007] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Mini-implants are placed in restricted sites, requiring an accurate surgical technique. However, no systematic study has quantified technique accuracy to reliably predict the surgical risks. Therefore, a graduated 3-dimensional radiographic-surgical guide (G-RSG) was proposed, and its inaccuracy and risk index (RI) were estimated. METHODS The sample consisted of 6 subjects (4 male, 2 female), who used mini-implant anchorage. Ten drill-free screws (DFS) were placed by using the G-RSG. The central point of the mesiodistal septum width (SW) was the selected implant site on the presurgical radiograph. The distances between DFS and the adjacent teeth (5-DFS and 6-DFS) were measured to evaluate screw centralization and inaccuracy degree (ID). These distances were statistically compared by independent t tests, and inaccuracy was determined by the expression ID = (5-DFS - 6-DFS)/2, which represents deviation of the mini-implant's final position regarding the central point initially selected. Then SW, ID, and screw diameter (SØ) were combined to estimate the surgical risk with RI expressed by RI = SØ/SW - ID. RESULTS The 5-DFS and 6-DFS distances were not significantly different. The ID of the G-RSG was 0.17 mm. The low ID ensured a safe RI (<1) in spite of the restricted SW. CONCLUSIONS The G-RSG accuracy allowed fine prediction of the final DFS position in the interradicular septum, with a low RI, which is a helpful tool to estimate surgical risks.
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Affiliation(s)
- Sérgio Estelita
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil.
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Güler N, Cabbar F, Duygu G. Correction of malocclusion by anterolateral osteotomy in a traumatized maxilla. Dent Traumatol 2009; 25:447-50. [DOI: 10.1111/j.1600-9657.2009.00802.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Rai AJ, Datarkar AN, Borle RM. Customised screw for intermaxillary fixation of maxillofacial injuries. Br J Oral Maxillofac Surg 2009; 47:325-6. [PMID: 19193476 DOI: 10.1016/j.bjoms.2008.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Anshul J Rai
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Sawangi, Wardha, Maharasthra, India.
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Self-tapping and self-drilling screws for intermaxillary fixation in management of mandibular fractures. J Craniofac Surg 2009; 20:68-70. [PMID: 19164992 DOI: 10.1097/scs.0b013e318190df2f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The current study evaluated the success and the possible complication of intermaxillary fixation with self-tapping and self-drilling screws (STSDSs) in nondislocated or slightly dislocated mandibular fractures.Forty patients with mandibular fractures, treated with intermaxillary fixation using STSDSs, were clinically assessed by means of a dental vitality test and evaluation of tooth mobility adjacent to the cortical screw holes, and radiologically by means of a panoramic dental radiograph upon removal of the screws.The main complication was screw loss in 4.4% of cases, followed by coverage by oral mucosa in 1.2% of cases. However, no dental root damage, screw breakage, malocclusion, or poor consolidation of mandibular fractures was observed.The use of STSDSs for intermaxillary fixation is a useful alternative to the use of arch bars in the treatment of some types of mandibular fractures. In addition, there is no risk of dental lesions as with self-tapping screws.
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Kim SH, Kook YA, Lee W, Kim I, Chung KR. Two-component mini-implant as an efficient tool for orthognathic patients. Am J Orthod Dentofacial Orthop 2009; 135:110-7. [DOI: 10.1016/j.ajodo.2007.01.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 01/01/2007] [Accepted: 01/01/2007] [Indexed: 10/21/2022]
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Gibbons A, Cousley R. Use of mini-implants in orthognathic surgery. Br J Oral Maxillofac Surg 2007; 45:406-7. [DOI: 10.1016/j.bjoms.2006.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2006] [Indexed: 11/29/2022]
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Gibbons AJ. Bone screw stabilization of a dentoalveolar fracture. J Oral Maxillofac Surg 2007; 65:1439. [PMID: 17577521 DOI: 10.1016/j.joms.2007.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Accepted: 04/03/2007] [Indexed: 11/24/2022]
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Gibbons AJ, Khattak O. Self-drilling intermaxillary fixation screws in the closed treatment of a condylar fracture. J Oral Maxillofac Surg 2007; 65:357. [PMID: 17236950 DOI: 10.1016/j.joms.2006.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 08/16/2006] [Accepted: 10/03/2006] [Indexed: 11/22/2022]
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Imazawa T, Komuro Y, Inoue M, Yanai A. Mandibular fractures treated with maxillomandibular fixation screws (MMFS method). J Craniofac Surg 2006; 17:544-9. [PMID: 16770195 DOI: 10.1097/00001665-200605000-00026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of the treatment of mandibular fractures is to restore proper dental occlusion and stable temporomandibular joint movement, as well as the reduction of the displaced fracture. Consideration must be given to the selection of the most appropriate surgical and rehabilitation methods in such patients. Typical surgical methods for the treatment of mandibular fractures include the arch bar method or plating at the location of the fracture combined with fixing the mandible to the maxilla using the arch bar method. However arch bars and circumdental wires, which require teeth for fixation, damage teeth and periodontal tissue, and tend to be uncomfortable for patients during the fixation period. Moreover, daily maintenance of oral hygiene is difficult for patients with an arch bar. Surgeons are also exposed to the risk of blood-transmitted diseases through skin punctures by wires when affixing these devices. For these reasons, we chose to study the potential of the MMFS method, which is thought to lessen all of the following problems: tissue damage, operating time, patient discomfort, and possible exposure to percutaneous infectious disease due to puncture of gloves and skin by the wires. We demonstrated the utility of the MMFS method in the present study.
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Affiliation(s)
- Takashi Imazawa
- Department of Plastic and Reconstructive Surgery, Juntendo University, School of Medicine, Tokyo, Japan.
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Pigadas N, Whitley S, Avery CME. Temporary intermaxillary fixation and cross infection control. Br J Oral Maxillofac Surg 2003; 41:363. [PMID: 14581039 DOI: 10.1016/s0266-4356(03)00135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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