Caution in use of bicortical intermaxillary fixation screws

Clinical Outcomes of ULTRA EZY Bar vs Erich Arch Bar in Conservative Management of Maxillofacial Fractures: A Randomized Controlled Trial

Objective

Various techniques have been employed from time to time to achieve maxillomandibular fixation, and arch bars provide an effective and versatile means of maxillomandibular fixation, and however, some of the issues occurring with it have been eliminated with the introduction of Ultralock EZY bar. The aim of the present study is to compare the advantages and disadvantages of Ultralock Ezy bar over the Erich arch bar in mid-face fracture or maxillary fracture or mandibular fracture or both requiring conservative treatment.

Materials and Methods

A total of 20 patients reported to the Department of Oral and Maxillofacial Surgery in Sudha Rustagi Dental College and Hospital, Faridabad, with mid-face fracture/maxillary fracture, mandibular fracture or both. The treatment plan required intermaxillary fixation. As a part of treatment plan, group was selected randomly divided into 20 arches in each group that is test arch group and control arch group.Test arch group included arches in which Ultralock EZY bar was done. Control arch group included arches in which Erich arch bar was done. The parameters compared in both the groups were surgical time taken, injuries due to wires, arch bar stability, oral hygiene index, patient acceptance and comfort, pulp vitality, and complication (if any).

Results

The average surgical time taken was less, and oral hygiene status and patient acceptance were better in test group. There was not much statistically significant difference in pulp vitality but number of cases with absence of pulp vitality were more in test group.

Conclusion

This study emphasizes the use of Ultralock Ezy bar as a quick and easy method than Erich arch bar. Oral hygiene maintenance was comparatively better in patients with Ultralock Ezy bar than those with Erich arch bar. For the patients who require long-term IMF, Ultralock Ezy bars can be a viable option.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-022-01821-3.

Treatment of pediatric bilateral condylar fractures: A comprehensive analysis

Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.

Mechanical strength of stainless steel and titanium alloy mini-implants with different diameters: an experimental laboratory study

BACKGROUND

The mechanical strength of mini-implants is a critical factor due to their small diameters. Currently, it is not possible to state whether there is a relevant difference between the mechanical properties of stainless steel (SS-MIs) and titanium alloy mini-implants (TA-MIs). The objective of this study was to test the null hypothesis that there is no difference in the mechanical strength of SS-MIs and TA-MIs, and to analyze, by scanning electron microscopy (SEM), the SS-MI, and TA-MI threads resistance to morphological damage after insertion.

METHODS

A standardized sample of 504 SS-MIs and TA-MIs with diameters ranging from 1.2 mm to 1.8 mm was used. Torsional fracture was performed in 154 MIs. Flexural strength of 280 MIs was evaluated at 1 mm and 2 mm-deflection. The threads of 70 MIs were morphologically analyzed by scanning electron microscopy (SEM), before and after their insertion in high-density artificial bone blocks. Comparisons between SS-MIs and TA-MIs were performed with t tests or Mann-Whitney U tests. A multiple linear regression analysis was used to evaluate the influence of variables on the ranging of MI mechanical strength.

RESULTS

SS-MIs had higher fracture torque. The mean difference between the SS-MIs and TA-MIs fracture torque was of 4.09 Ncm. The MI diameter explained 90.3% of the total variation in fracture torque, while only 2.2% was explained by the metallic alloy. The SS-MI group presented a higher deformation force during the 1mm and 2mm-deflection. The mean difference between the flexural strength of SS and TA-MIs at 1 mm and 2 mm-deflection was of 18.21 N and 17.55 N, respectively. There was no noticeable morphological damage to the threads of SS-MIs and TA-MIs.

CONCLUSIONS

The null hypothesis was rejected. SS-MIs were 13.2% and 20.2% more resistant to torsional fracture and deflection, respectively. The threads of the SS-MIs and TA-MIs were not damaged during the insertion and removal process. Thus, the use of SS-MI can reduce the fracture risk without increasing the MI diameter.

Types of Intermaxillary Fixation and Their Interaction With Palatine Fracture Reduction

PURPOSE

To compare 3 types of intermaxillary fixation (IMF) and their behavior when subjected to tension forces in 3 study models with a palatine fracture feature.

MATERIALS AND METHODS

An experimental study of 3 identical acrylic models was performed. All had the same palatine fracture pattern on the maxillary midline. All were reduced with different IMF methods (ie, direct interdental wiring, Erich arch bars, and self-tapping screws). Tension forces were applied to the study models to observe the fracture line behavior.

RESULTS

IMF with direct interdental wiring did not cause significant separation of the fracture feature in the anterior or posterior sector. IMF with the Erich arch bars caused a 2-mm separation in the anterior sector and 0 mm in the posterior sector. The IMF with self-tapping screws caused a 3-mm separation in the anterior sector and 1 mm in the posterior sector.

CONCLUSIONS

IMF using self-tapping screws resulted in the greatest separation of the fracture compared with the results with Erich arch bars and direct interdental wiring. IMF with self-tapping screws tended to displace the fracture lines by application of the vector furthest from the center of resistance.

Intermaxillary fixation screws versus Erich arch bars in mandibular fractures: A comparative study and review of literature

Objective:

Various techniques have been employed from time to time to achieve maxillomamdibular fixation. Although arch bars provide an effective and versatile means of maxillomandibular fixation, their use is not without shortcomings. However the introduction of intermaxillary fixation screws (IMF) has eliminated many of these issues of arch bars. The aim of the present study was to compare the advantages and disadvantages of intermaxillary fixation screws over the Erich arch bars in mandibular fractures.

Materials and Methods:

Sixty dentulous patients who reported to Department of Oral and Maxillofacial Surgery, Al-Ameen Dental College and Hospital, Bijapur with mandibular fractures and required intermaxillary fixation as a part of treatment plan followd by open reduction and internal fixation under GA were selected and randomly divided into 2 groups of 30 patients each that is Group A and Group B. Group A included patients who received intermaxillary fixation with Erich arch bars. Group B includes patients who received intermaxillary fixation with IMF Screws. The parameters compared in both the groups included, surgical time taken, gloves perforation, post-operative occlusion, IMF stability, oral hygiene, patient acceptance and comfort and non-vitality characteristics.

Results:

The average surgical time taken and gloves perforations were more in Group A,the patient acceptance and oral hygiene was better in Group B, there was not much statistically significant difference in postoperative occlusion and IMF stability in both groups. Accidental root perforation was the only limitation of IMF screws.

Conclusion:

Intermaxillary fixation with IMF screws is more efficacious compared to Erich arch bars in the treatment of mandibular fractures.

Is the Erich arch bar the best intermaxillary fixation method in maxillofacial fractures? A systematic review

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.

Miniscrews versus surgical archwires for intermaxillary fixation in adults after orthognathic surgery

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.

The Use of MMF Screws: Surgical Technique, Indications, Contraindications, and Common Problems in Review of the Literature

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.

Management of paediatric mandibular condylar fractures with screw-based semi-rigid intermaxillary fixation

This study was designed to evaluate the feasibility and safety of screw-based semi-rigid intermaxillary fixation (IMF) combined with a specially designed occlusal splint in the conservative treatment of paediatric mandibular condylar fractures. Thirteen paediatric patients with 20 sides of condylar fractures treated with semi-rigid IMF were analyzed retrospectively. Semi-rigid IMF was achieved by inserting self-drilling IMF screws into the anterior alveolar bone of the maxilla and mandible suspended with elastic bands. An occlusal splint with a molar fulcrum was used for functional repositioning of the condylar fragment. After 4 weeks, the screws and occlusal splint were removed. During a mean period of 28.6 months' follow-up, the patients' maximal mouth opening increased to a mean of 37.69 mm. Clinical and radiological examinations revealed satisfactory results in facial symmetry and condylar remodelling. No clinical symptoms or radiographic evidence showed dental injuries associated with screw insertion. This study suggests that this method might be a safe, easy, and effective management of paediatric condylar fractures.

Retrospective Study on Efficacy of Intermaxillary Fixation Screws

BACKGROUND

We evaluated the efficacy of intermaxillary fixation (IMF) screws in the treatment of mandibular fractures.

METHODS

Two hundred patients with mandibular fractures, treated by IMF using these screws, were evaluated by pre and postoperative panoramic radiographs. Clinical testing was carried out for vitality and abnormal mobility of teeth adjacent to the site of screw insertions. Other factors such as possible iatrogenic dental injuries, loss, breakage or screw cover by oral mucosa and postoperative occlusion were also studied.

RESULT

The most important complication noticed was iatrogenic damage to dental roots.

CONCLUSION

Use of intraoral cortical bone screws for IMF is a valid alternative to arch bars in the treatment of mandibular fractures. Iatrogenic injury to dental roots is the commonest problem which can be minimized by an experienced surgeon.

Self Tapping Screws v/s Erich Arch Bar for Inter Maxillary Fixation: A Comparative Clinical Study in the Treatment of Mandibular Fractures

INTRODUCTION AND OBJECTIVE

Numerous methods have been described for achievement of Intermaxillary fixation in the treatment of fractures of facial skeleton. Conventional methods like Erich arch bars and eyelet wires are currently most common methods for achieving intermaxillary fixation (IMF), but they have their own disadvantages. Since 1989, IMF using intraoral self tapping IMF screws has been introduced for treatment of mandibular fractures. The aim of this work was to compare the efficacy, advantages, disadvantages indications and potential complications associated with Erich archbar v/s self tapping IMF screws in the management of mandibular fractures.

METHODS

Twenty patients with mandibular fractures, reporting to Department of Oral and Maxillofacial Surgery, The Oxford Dental College, Bangalore were evaluated, to compare the efficacy of two techniques. The parameters considered were, time taken, perforations in the gloves, patient acceptance, oral hygiene, iatrogenic dental injuries, and needle stick injuries during IMF with Erich arch Bar and self tapping IMF screws.

RESULTS

The mean time taken for IMF was 8.52 ± 2.7 min with screws as compared to 100 min with Erich arch bars. Mean number of perforations were significantly more in Group II. Oral hygiene status was good in 90% and fair in 10% of Group I and 100% fair in Group II patients.

CONCLUSION

Use of self tapping IMF screws for intermaxillary fixation is a valid alternative to conventional Erich arch bars in the treatment of mandibular fractures. Iatrogenic injury to dental roots is the most important problem to this procedure, which can be minimized by careful radiographic evaluation and treatment planning.

Effects of intentional damage of the roots and surrounding structures with miniscrew implants

INTRODUCTION

The purposes of the study were to evaluate the immediate damage to roots and periodontal structures after initial miniscrew implant (MSI) placement and the short- and long-term damage after MSIs were left in situ.

METHODS

The roots of the maxillary second, third, and fourth premolars of 7 mature beagle dogs were randomly assigned to undergo immediate, short-term (left for 6 weeks), or long-term (left for 12 weeks) damage. Intentional damage was inflicted with self-tapping screws (1.8 x 8 mm) placed with a stent. Alternating tetracycline and calcein labels were administered at 6-week intervals. Undecalcified sections were stained and evaluated histologically to determine the extent of damage; healing was evaluated by using fluorescence labels.

RESULTS

Histology showed damage to 73.8% of the teeth, ranging from displacement of bone into the periodontal ligament to invasion of the pulp chamber. Displacement of bone into the periodontal ligament and direct damage to the periodontal ligament occurred in 3 (7.2%) instances. Damage was isolated to the cementum of 8 (19.0%) teeth, whereas damage occurred in the dentin of 11 (26.2%) teeth. Loss of bone in the furcation was evident in 3 (7.2%) teeth, and severe damage into the pulp occurred in 6 (14.2%) teeth. No differences in the amounts of damage were evident between the immediate, short-, and long-term groups. Healing often occurred with cementum around the unloaded MSIs.

CONCLUSIONS

Extensive damage can be caused by MSIs, with little to no differences evident over time. Unloaded MSIs that remain in contact with roots of teeth can show varying degrees of healing.

Self-tapping and self-drilling screws for intermaxillary fixation in management of mandibular fractures

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.

Mandibular fractures treated with maxillomandibular fixation screws (MMFS method)

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.

An audit of mandibular fractures treated by intermaxillary fixation using intraoral cortical bone screws

INTRODUCTION

During the last 10 years, intermaxillary fixation using intraoral cortical bone screws has been introduced for the treatment of mandibular fractures. The aim of this work was to evaluate the indications and possible complications of this method.

MATERIALS AND METHODS

Sixty-two patients with mandibular fractures, treated by intermaxillary fixation using these screws, were evaluated by preoperative and postoperative panoramic radiographs. Clinical testing was carried out for vitality and abnormal mobility of teeth adjacent to the site of screw insertions. To evaluate the efficacy of this method, different factors were considered such as possible iatrogenic dental injuries, loss, breakage or screw cover by oral mucosa and postoperative occlusion.

RESULTS

The most important complication was iatrogenic damage to dental roots (1.5%), 4.9% of the screws were covered by oral mucosa and 1.9% were lost, while none were broken. Malocclusion was observed in one patient (1.6%) and lack of consolidation of a displaced fracture of the mandibular body in another patient.

CONCLUSIONS

Use of intraoral cortical bone screws for intermaxillary fixation is a valid alternative to arch bars in the treatment of mandibular fractures. Iatrogenic injury to dental roots is the most important problem of this procedure, but can be minimized by an experienced surgeon.

A drill-free bone screw for intermaxillary fixation in military casualties

Drill-free bone screws are a simple and quick method of establishing intermaxillary fixation requiring a minimum amount of specialist training or equipment. These screws offer significant advantages over other methods of intermaxillary fixation and are well suited for use in military casualties.

Complications with intermaxillary fixation screws in the management of fractured mandibles

A dedicated bicortical bone screw for temporary intraoperative intermaxillary fixation (IMF) during open reduction and fixation of mandibular fractures offers many benefits to surgeons and patients. We have used this system for 2 years and confirm the benefits over traditional methods of intermaxillary fixation. However, complications can arise. One hundred and twenty-two patients with mandibular fractures had IMF screws of which five (4%) developed complications intraoperatively and postoperatively. Complications included fracture of the screws on insertion, iatrogenic damage to teeth causing loss and bony sequestra around the area of screw placement.