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Kalluri MH, Edalatpour A, Thadikonda KM, Blum JD, Garland CB, Cho DY. Patient outcomes and complications following various maxillomandibular fixation techniques: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 92:151-176. [PMID: 38520780 DOI: 10.1016/j.bjps.2024.02.075] [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: 12/17/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Currently, there are several methods of achieving maxillomandibular fixation (MMF), each with its unique operative considerations and subsequent patient outcomes and complications. In this study, we reviewed the literature to evaluate and compare all MMF methods. METHODS A systematic review of all MMF types was conducted and post-operative outcome data were analyzed and compared among the different types. Conventional Erich arch bars were compared to hybrid arch bars, MMF screws, and eyelet interdental wiring. A random-effects meta-analysis was used to determine the mean differences, and 95% confidence intervals (CIs) with a statistical significance of P < 0.05. RESULTS Among the 4234 articles identified, 24 were included, and 17 were meta-analyzed. Time to achieve MMF (-43.38 min; 95% CI, -58.20 to -28.56; P < 0.001), total operative time (-30.33 min; 95% CI, -61.05 to 0.39; P = 0.05), incidence of wire puncture injuries and glove perforations (0.11; 95% CI, 0.04 to 0.30; P < 0.001), and incidence of poor oral hygiene (0.08; 95% CI, 0.02 to 0.28; P < 0.001) were lower for alternative MMF interventions compared to those of the conventional Erich arch bars. CONCLUSIONS Alternative MMF methods required shorter operative time to achieve MMF and demonstrated other increased efficiencies of practice such as shorter total operative time and decreased glove perforations, when compared to conventional Erich arch bars. If a patient is a candidate for MMF, the presented alternative MMF techniques should be considered depending on the clinical context and availability of institutional resources.
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Affiliation(s)
- Manasa H Kalluri
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Armin Edalatpour
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kishan M Thadikonda
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jessica D Blum
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Catharine B Garland
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Y Cho
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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2
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Pawa S, Visuttiwattanakorn S. An in vitro study in separating tensile loads during maxillo-mandibular fixation using wire and/or elastics. PLoS One 2024; 19:e0300481. [PMID: 38489338 PMCID: PMC10942067 DOI: 10.1371/journal.pone.0300481] [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: 05/11/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Intermaxillary fixation (IMF) or maxillo-mandibular fixation (MMF) is a fundamental process in stabilizing the maxilla and mandible through dental maximum intercuspation (MIP) during the management of trauma, orthognathic surgery, and reconstruction. Despite the availability of several techniques in achieving adequate maxillo-mandibular fixation, concerns have been raised regarding the sufficiency of using only latex elastics to counter displacing forces during reduction and fixation. To address this, an in vitro study was conducted to compare the efficacy of three maxillo-mandibular fixation methods: wire, elastics, and a combination of both. Custom-made models simulating dental arches were used, and a vertical separation of up to 1 mm was applied at a loading rate of 1 mm/minute using an Instron 5566 Universal Testing Machine. Tensile loads were recorded at 0.5 and 1 mm vertical separation, with each process repeated 10 times in each sample group. The average peak tensile load was then calculated. Statistical analysis using one-way ANOVA at a significance level of p<0.05 revealed significant differences between all three subject groups. The outcomes of this in vitro study suggest that the combination technique (using both wire and elastics) outperformed the individual methods in achieving robust maxillo-mandibular fixation. This positions the combination technique as the most effective among the evaluated fixation methods.
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Affiliation(s)
- Sudeep Pawa
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Surakit Visuttiwattanakorn
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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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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4
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Ghozy EA, Albelasy NF, Shamaa MS, El-Bialy AA. Cephalometric and digital model analysis of dentoskeletal effects of infrazygomatic miniscrew vs. Essix- anchored Carriere Motion appliance for distalization of maxillary buccal segment: a randomized clinical trial. BMC Oral Health 2024; 24:152. [PMID: 38297285 PMCID: PMC10832169 DOI: 10.1186/s12903-024-03925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
TRIAL DESIGN Parallel. OBJECTIVE To compare skeletally anchored Carriere Motion appliance (CMA) for distalization of the maxillary buccal segment vs. Essix anchored CMA. METHODS Thirty-two class II malocclusion patients were randomly allocated into two equal groups. One group was treated with infrazygomatic (IZC) miniscrew- anchored CMA (IZCG) and the other group treated with Essix retainer- anchored CMA (EXG). Two lateral cephalograms and two digital models for upper and lower arches were taken for each patient: immediately before intervention and after distalization had been completed. RESULTS Distalization period was not significantly different between the two groups. In contrast to EXG, IZCG showed insignificant difference in ANB, lower incisor proclination, and mesial movement of the lower first molar. There was significant rotation with distal movement of maxillary canine and first molar in both groups. CONCLUSION IZC anchored CMA could eliminate the side effects of class II elastics regarding lower incisor proclination, mesial movement lower molars with a more significant amount of distalization of the maxillary buccal segment but with significant molar rotation. TRIAL REGISTRATION The ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT05499221) on 12/08/2022.
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Affiliation(s)
- Eglal Ahmed Ghozy
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35116, Egypt.
| | - Nehal Fouad Albelasy
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35116, Egypt
| | - Marwa Sameh Shamaa
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35116, Egypt
| | - Ahmed A El-Bialy
- Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35116, Egypt
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Sheth MD, Arora AV, Kapoor SV. Stabilizing bony plate in guided endodontic surgery using an innovative approach. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:105-109. [PMID: 38389741 PMCID: PMC10880484 DOI: 10.4103/jcde.jcde_178_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 02/24/2024]
Abstract
Endodontic microsurgery in tandem with advanced radiographic techniques has led to the emergence of guided surgeries. Preservation of the cortical bone to enhance the healing and stabilization of tissues surrounding the tooth of concern can now be facilitated by bone cement used in the field of orthopedics. This case report details a guided endodontic surgery technique in 17 years old where a traumatic infliction leads to a phoenix abscess. The technique elaborated emphasizes on the three-dimensional printing of a surgical template with the help of cone-beam computed tomography, followed using a medical-grade bone cement in the most minimal manner to reposition the buccal cortical bone. A 12-month-old follow-up revealed the patient to be asymptomatic with a flawless periapical region radiographically. This case testifies that the optimum use of available biomedical material in surgical endodontics can assure a predictable prognosis.
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Affiliation(s)
- Maulee D. Sheth
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Ankit V. Arora
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Sonali V. Kapoor
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
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Burman S, Rao S, Ankush A, Uppal N. Comparison of hybrid arch bar versus conventional arch bar for temporary maxillomandibular fixation during treatment of jaw fractures: a prospective comparative study. J Korean Assoc Oral Maxillofac Surg 2023; 49:332-338. [PMID: 38155086 PMCID: PMC10761310 DOI: 10.5125/jkaoms.2023.49.6.332] [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: 07/29/2023] [Revised: 10/20/2023] [Accepted: 10/28/2023] [Indexed: 12/30/2023] Open
Abstract
Objectives This study aimed to compare the effectiveness of a hybrid arch bar (hAB) with the conventional Erich arch bar (EAB) for the management of jaw fractures, focusing on their use for temporary fixation in patients undergoing open reduction and internal fixation (ORIF). Materials and Methods Patients presenting with maxillary and mandibular fractures at our institution were included in this prospective, comparative study. Placement time and ease of occlusal reproducibility were recorded intraoperatively for Group A (hAB patients) and Group B (EAB patients). The primary outcome was comparison of the postoperative stability of the two arch bars. Postoperative measurements also included mucosal overgrowth, screw loosening or wire retightening, and replacement rates. The data were tabulated and computed with a P<0.05 considered statistically significant. Results The study included 41 patients. A statistically significant difference was observed in postoperative stability scores (3) between Group A and Group B (85.0% vs 9.5%, P=0.001). The mean placement time in Group A (23.3 minutes) significantly differed from that in Group B (86.4 minutes) (P<0.001). The ease of intraoperative occlusion was not different between the two groups (P=0.413). Mucosal overgrowth was observed in 75.0% of patients (15 of 20) in Group A. Conclusion The hAB was superior to EAB in clinical efficiency, maxillomandibular fixation time reduction, stability, versatility, and safety. Despite temporary mucosal overgrowth, the benefits of hAB outweigh the disadvantages. The choice between hAB and EAB should be based on specific clinical requirements.
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Affiliation(s)
- Samriddhi Burman
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | | | | | - Nakul Uppal
- Department of Dentistry, AIIMS, Raipur, India
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Gibson AC, Merrill TB, Boyette JR. Complications of Mandibular Fracture Repair. Otolaryngol Clin North Am 2023; 56:1137-1150. [PMID: 37353369 DOI: 10.1016/j.otc.2023.05.008] [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: 06/25/2023]
Abstract
Mandible fracture management has evolved dramatically. Therefore, the variety of surgical complications associated with mandibular fractures, and their incidences, have continued to change as well. This article aims to assess the most common and most concerning complications that can occur secondary to management of mandibular fractures by examining categories of complication types. This article also explores factors and techniques associated with reduced rates of complications as well as the management of complications.
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Affiliation(s)
- Anna Celeste Gibson
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA.
| | - Tyler Branch Merrill
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA
| | - Jennings Russell Boyette
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA
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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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Wu B, Lv K. Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures. J Craniofac Surg 2023; 34:e582-e584. [PMID: 37236625 DOI: 10.1097/scs.0000000000009418] [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: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. METHODS To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. RESULTS AND DISCUSSION Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.
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Affiliation(s)
- Benxing Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, People's Republic of China
| | - Kun Lv
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, People's Republic of China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
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Pietzka S, Fink J, Winter K, Wilde F, Schramm A, Ebeling M, Kasper R, Sakkas A. Dental Root Injuries Caused by Osteosynthesis Screws in Orthognathic Surgery-Comparison of Conventional Osteosynthesis and Osteosynthesis by CAD/CAM Drill Guides and Patient-Specific Implants. J Pers Med 2023; 13:jpm13050706. [PMID: 37240877 DOI: 10.3390/jpm13050706] [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: 03/27/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND/AIM The primary aim was to evaluate the prevalence and localisation of dental injuries caused by osteosynthesis screws during orthognathic surgery, comparing two different CAD/CAM planning/surgical approaches through retrospective evaluation of post-operative computed tomography. MATERIAL AND METHODS This study considered all patients who underwent orthognathic surgery from 2010-2019. The examination for dental root injuries between conventional osteosynthesis (Maxilla conventional cohort) and osteosynthesis with patient-specific implant (Maxilla PSI cohort) was performed by evaluating the post-operative CT scans. RESULTS A total of 126 patients were included in the study. Among the 61 patients of the Maxilla conventional cohort, 10 dental root injuries in 8 patients (13.1%) were detected in the post-operative CT scan, representing 1.5% (n = 10/651) of the osteosynthesis screws inserted in proximity of the alveolar crest. No dental injury occurred following osteosynthesis in the 65 patients of the Maxillary PSI cohort (n = 0/773 screws) (p < 0.001). During a mean follow-up period of 13 months after primary surgery, none of the injured teeth showed evidence of periapical alterations and no endodontic treatments were necessary. CONCLUSIONS Maxillary positioning using CAD/CAM-fabricated drill/osteotomy guide and osteosynthesis with PSI can significantly reduce the risk for dental injury compared to the conventional procedure. However, the clinical significance of the detected dental injuries was rather minor.
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Affiliation(s)
- Sebastian Pietzka
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Juliana Fink
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, University of Leipzig, 04109 Leipzig, Germany
| | - Frank Wilde
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Alexander Schramm
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Marcel Ebeling
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Robin Kasper
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
| | - Andreas Sakkas
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, 89081 Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital, 89081 Ulm, Germany
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The Assessment of Intermaxillary Fixation and Open Reduction Using Skeletal Anchorage System Compared With Arch Bar in Mandible Fracture Based on CT Image. J Craniofac Surg 2023:00001665-990000000-00641. [PMID: 36935402 DOI: 10.1097/scs.0000000000009308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/28/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND There are many different techniques to achieve intermaxillary fixation (IMF) for open reduction of mandible fractures. The arch bar has long been used as the gold standard of IMF to assist open reduction. However, owing to its long operating time, risk of needle stick injury, and gingival trauma, surgeons looked into different treatment options for IMF, such as the skeletal anchorage system (SAS). Therefore, this study aimed to compare the stability between IMF with arch bar and IMF with SAS based on computed tomography image. MATERIALS AND METHODS In this retrospective study, postoperative computed tomography and panoramic radiographs were taken 1 week and 6 months after surgery, respectively. The treatment of mandibular fractures using IMF with arch bar and SAS were compared by evaluating changes in the dental midlines and condyle positions. Thirty patients with mandibular fractures were enrolled into 2 groups-IMF with arch bar and IMF with SAS. RESULTS The arch bar showed slightly more deviation in dental midline. In SAS, the condyle moved more medially compared with the arch bar. CONCLUSIONS Skeletal anchorage system could be used for IMF with reliable stability in mandible fracture. There were no significant differences in the treatment outcome between the 2 groups.
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12
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Shenoi R, Rajguru J, Ingole P, Karmarkar J, Rajguru J. Double Loop Interdental Wiring: A Neoteric Technique for Maxillo-mandibular Fixation. J Maxillofac Oral Surg 2022; 21:1404-1405. [PMID: 36896086 PMCID: PMC9989045 DOI: 10.1007/s12663-020-01466-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ramakrishna Shenoi
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra India
| | - Jignesh Rajguru
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra India
| | - Pranav Ingole
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra India
| | - Jui Karmarkar
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra India
| | - Jignesh Rajguru
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, Maharashtra India
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13
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Elkolaly MA, Hasan HS. MH cortical screws, a revolutionary orthodontic TADs design. J Orthod Sci 2022; 11:53. [PMID: 36411811 PMCID: PMC9674939 DOI: 10.4103/jos.jos_49_22] [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: 06/14/2022] [Revised: 07/17/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE MH cortical screws were designed to combine the advantages of thick mini-implants with the versatility of micro-screws while avoiding the disadvantages of both. MATERIALS AND METHODS An MH cortical screw (MH is an abbreviation for the author's name) was made from titanium material. The screw has a 3 mm-long amphora-shaped shank of 2 mm thickness at its thinnest and 3 mm at its thickest part. Uniform 4 mm diameter threads blend into a 1 mm cutting tip. An external hexagonal head with side retentive ligature holes and a central hole for attachments was fabricated on a saucer-shaped gingival collar. Multiple attachments have been prepared for amending to the central hole. RESULTS The shank design allowed cortical plate retention. The uniform threads and the amphora design provided maximum primary and secondary stability, respectively. The self-drilling tip allowed for a flapless technique, while the hexagonal head with side holes facilitated screwdriver control and allows for ligature wire anchorage. Cleats and buttons facilitated the use of elastics and springs, together with bracket-heads and eyelets for titanium molybdenum alloy and nickel-titanium wires inclusion. Adjustable hooks and chains provided versatility of line of action. Cover screws to retain extra-tissue mini-plates applied skeletal anchorage and long-term retention with flapless manipulations. CONCLUSION MH cortical screws are a novel and important introduction to orthodontic anchorage. They combine primary and secondary stability with avoidance of root damage together with insertions into attached gingiva only. Multiple and versatile attachments allow for the application of biomechanical techniques according to the clinician's preferences. Extra-tissue mini-plates facilitate maximum anchorage for skeletal control and long-term retention without surgery.
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Affiliation(s)
| | - Hasan S. Hasan
- Orthodontic Department, Azadi Dental Teaching Center, General Directorate of Hawler-Ministry of Health, Erbil, Iraq,Orthodontic Department, Privet Specialized Dental Clinic, Hawler New, Erbil, Iraq,Address for correspondence: Dr. Hasan S. Hasan, Orthodontic Department, Azadi Dental Teaching Center, General Directorate of Hawler-Ministry of Health, Erbil, Iraq. Orthodontic Department, Privet Specialized Dental Clinic, Hawler New, Erbil, Iraq. E-mail:
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14
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Weill P, Garmi R, Thobie A, Benateau H, Veyssiere A. Focus on the use of maxillomandibular fixation in mandibular fracture oseosynthesis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e614-e618. [PMID: 35093587 DOI: 10.1016/j.jormas.2022.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the efficiency of three methods of isolated mandibular fracture intraoperative reduction. MATERIALS AND METHODS This 6-year retrospective study included patients with isolated extra-articular mandibular fractures who would benefit from osteosynthesis. The endpoint was postoperative occlusion according to the type of intraoperative immobilization: screws, arch, or manual reduction. RESULTS A total of 145 patients were included, with 233 fractures. Forty-five patients underwent manual reduction without maxillo-mandibular fixation (MMF), 51 MMF with screws, and 49 MMF with arch, with 11.1%, 5.9% and 4.1% of patients in these groups experiencing postoperative malocclusion, respectively. The overall malocclusion rate was 6.9%. There was no significant difference among the 3 methods according to univariate statistical analysis (p = 0.42) or after comparing MMF (grouping screws and arches) to manual reduction without MMF (p = 0.29). CONCLUSION This study did not show a significant difference between the different methods of intraoperative reduction of isolated extra-articular mandibular fractures, even though intraoperative MMF was much more commonly used for complex fractures. However, there is a non-significant tendency to get a better post-operative occlusal result with MMF, which remains the reference traitement. Intraoperative manual reduction without MMF may be used within trained teams in some instances.
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Affiliation(s)
- Pierre Weill
- Department of Maxillo-facial and Plastic Surgery, Caen University Hospital, Caen 14000, France; Medecine Faculty of CAEN, University of Caen Basse-Normandie, Caen 14032 Cedex 5, France.
| | - Rachid Garmi
- Department of Maxillo-facial and Plastic Surgery, Caen University Hospital, Caen 14000, France
| | - Alexandre Thobie
- Department of Visceral Surgery, Caen University Hospital, Caen 14000, France
| | - Hervé Benateau
- Department of Maxillo-facial and Plastic Surgery, Caen University Hospital, Caen 14000, France; Department of Visceral Surgery, Caen University Hospital, Caen 14000, France
| | - Alexis Veyssiere
- Department of Maxillo-facial and Plastic Surgery, Caen University Hospital, Caen 14000, France; Medecine Faculty of CAEN, University of Caen Basse-Normandie, Caen 14032 Cedex 5, France; Unicaen, Bioconnect, Normandie Université, CAEN 14000, France
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15
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Afifah N, Maulina T, Yuza AT. Management of A Bad Split Complication: A Systematic Review. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2204181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Bad split is one of the well-known intra-operative complications that occur during the bilateral sagittal split osteotomy (BSSO) procedure, which is a rehabilitation procedure for patients with mandibular deformities. The prevention of further post-surgery complications required sufficient management of bad split complications.
Objective:
This study aimed to analyze the management of bad split complications during a BSSO procedure.
Methods:
The literature review was conducted in the form of library research in the field of bad split complications' management by a BSSO based on the Preferred Reporting Items for Systematic Reviews (PRISMA). Related studies were found through using a manual search using Pubmed, ScienceDirect, Ebscohost, Scopus, Medline, Embase, and Web of Science, among other search engines. The inception of incorporation standards, the process of data extraction, and the determination of the risk of bias were carried out by the authors. The process of data screening was conducted by applying the inclusion and exclusion criteria.
Results:
This paper systematically reviewed seven related studies, four of which were case series and two of which were cross-sectional. The utilization of additional osteosynthetic plates was revealed throughout the extraction process as the most acquainted course of action to manage the bad split complications during the BSSO procedure.
Conclusion:
The osteosynthetic plate and miniplate application with bicortical or monocortical screws were exposed as the most used treatment for bad split complications.
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16
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Tabrizi R, Sarrafzadeh A, Shafiei S, Moslemi H, Dastgir R. Does maxillomandibular fixation affect skeletal stability following mandibular advancement? A single-blind clinical trial. Maxillofac Plast Reconstr Surg 2022; 44:19. [PMID: 35522330 PMCID: PMC9076785 DOI: 10.1186/s40902-022-00350-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background The stability of the results remains a significant concern in orthognathic surgeries. This study aimed to assess the amount of relapse following mandibular advancement with/without maxillomandibular fixation (MMF). Materials and methods A single-blind clinical trial was conducted on patients with mandibular retrognathism who underwent BSSO for mandibular advancement and Lefort I maxillary superior repositioning. Patients were randomly divided into two groups of treatment (MMF) and control (no MMF). In the treatment group, MMF was performed for 2 weeks; meanwhile, MMF was not performed in the control group, and only guiding elastics were applied postoperatively. Lateral cephalograms were obtained preoperatively (T1), immediately after surgery (T2), and at 1 year postoperatively (T3). The distance from points A and B to the X and Y plane were measured to identify the amount of vertical and horizontal relapse in 1 year as a primary outcome. An independent t-test was applied in order to find differences in outcomes between the control and treatment groups. Results Fifty-eight patients were evaluated in two groups (28 patients in the MMF group and 30 in the no-MMF group). The magnitude of mandibular advancement following BSSO was 7.68±1.39 mm and 7.53±1.28, respectively, without significant difference among the groups (p= 0.68). The mean sagittal and vertical changes (relapse) at point B were significantly different between the two groups at 1-year follow-up after the osteotomy (p=0.001 and p=0.05, respectively). Conclusion According to the results of this study, patients with short-term MMF following BSSO for mandibular advancement benefit from significantly greater skeletal stability in the sagittal and vertical dimensions.
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Affiliation(s)
- Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Danshjoo BLVD, Velenjak, Shahid Chamran Highway, Tehran, Iran
| | - Arash Sarrafzadeh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Arak University of Medical Sciences, Arak, Iran.
| | - Shervin Shafiei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Danshjoo BLVD, Velenjak, Shahid Chamran Highway, Tehran, Iran
| | - Hamidreza Moslemi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Danshjoo BLVD, Velenjak, Shahid Chamran Highway, Tehran, Iran
| | - Ramtin Dastgir
- Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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17
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Singh AK, Dahal S, Singh S, Krishna KC, Chaulagain R. Is manual reduction adequate for intraoperative control of occlusion during fixation of mandibular fractures? A systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 60:271-278. [PMID: 35248408 DOI: 10.1016/j.bjoms.2021.07.016] [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: 05/11/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review was to find out if manual intraoperative control of occlusion is adequate for the reduction of mandibular fractures in comparison with intermaxillary fixation (IMF). We searched PubMed, Embase, the Cochrane Library and Clinical Trials Registry, and the references of included trials. Our primary outcomes of interest were the reduction of fracture anatomically and radiographically, occlusal disturbances, and the incidence of revision procedures due to poor occlusion or reduction. Our secondary outcomes of interest were operating time and infective complications. Of the 257 studies retrieved (manual reduction = 136, IMF = 121), four were included. The studies had an unclear risk of bias. Nevertheless, the overall effect was statistically significant and in favour of manual reduction, with a lower number of adverse events in the manual reduction group (n = 43) than in the IMF group (n = 78), odds ratio 0.42 (95% CI 0.27 to 0.64). An absolute reduction in adverse events was seen in occlusion disturbances (120 fewer/1000), revision procedures (164 fewer/1000), and infective complications (178 fewer/1000). The evidence to support manual reduction over IMF for the intraoperative control of fracture fragments and occlusion was derived from few studies with an unclear risk of bias, and the quality was low. The results were not different when condylar fractures were present. The overall certainty of evidence was moderate. Clinicians should select the appropriate technique based on the injury pattern, and the treating surgeon's experience and available resources.
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Affiliation(s)
- Ashutosh Kumar Singh
- Department of Oral and Maxillofacial Surgery, TU dental Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | - Samarika Dahal
- Department of Oral Pathology, TU dental Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Sumit Singh
- Department of Oral and Maxillofacial Surgery, Kantipur Dental College, Kathmandu, Nepal
| | - K C Krishna
- Department of Oral and Maxillofacial Surgery, TU dental Teaching Hospital, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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18
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Burgaz İ, Zengin M, Uckan S. Radiographic assessment of the response of teeth following trauma during screw placement for maxillo-mandibular fixation. Dent Traumatol 2021; 37:474-478. [PMID: 33501703 DOI: 10.1111/edt.12654] [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: 07/19/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIM Maxillo-mandibular fixation (MMF) screws have gained popularity in recent years for inter-maxillary fixation. MMF screw application involves the risk of dental injury. However, knowledge about the healing responses after root damage in humans is limited, thereby warranting the need to classify the radiographic assessment of healing to enable better prediction of the healing response and effective management of the potential complications. The aim of this study was to assess and classify the radiographic assessment of the responses after root damage to evaluate the long-term outcomes. MATERIAL AND METHODS The dental records of patients who underwent orthognathic surgery or trauma management during 2014-2016 at an Oral and Maxillofacial Surgery Department were retrospectively analyzed. The data regarding dental injuries resulting from MMF screw application were evaluated. In total, 16 patients with 34 roots damaged from MMF screw application were enrolled. Post-operative orthopantomographs were analyzed by visual inspection of the affected areas to clarify the extent of root healing. The inter- and intra-rater reliability assessments were subsequently performed. RESULTS The results indicated substantial inter- and intra-rater reliability of the responses. Most cases of root damage that were not radiographically related to the pulp (Schulte-Geers Class III defects) had complete or partial healing responses. In addition, 20% of the defects related to the pulp had additional resorption of the bone/dental tissues during the follow-up period. CONCLUSIONS Three different radiographic responses of root damage following MMF screw trauma were identified. Understanding these different responses is important to guide the management of the potential complications. This proposed radiographic assessment can be used to present root healing data in a more standardized and reliable manner.
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Affiliation(s)
- İlker Burgaz
- Department of Oral and Maxillofacial Surgery, Medipol University, İstanbul, Turkey
| | - Mustafa Zengin
- Department of Oral and Maxillofacial Surgery, Medipol University, İstanbul, Turkey
| | - Sina Uckan
- Department of Oral and Maxillofacial Surgery, Medipol University, İstanbul, Turkey
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19
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Reverse umbrella technique – percutaneous reduction of frontal bone fracture using an intermaxillary fixation screw device. Br J Oral Maxillofac Surg 2021; 59:121-122. [DOI: 10.1016/j.bjoms.2020.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/21/2020] [Indexed: 11/20/2022]
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20
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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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21
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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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22
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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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23
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Pedemonte C, Valenzuela K, González LE, Vargas I, Noguera A. Types of Intermaxillary Fixation and Their Interaction With Palatine Fracture Reduction. J Oral Maxillofac Surg 2019; 77:2083.e1-2083.e8. [PMID: 31310733 DOI: 10.1016/j.joms.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Christian Pedemonte
- Staff, Department of Oral and Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago, Chile.
| | - Katherine Valenzuela
- Resident, Department of Oral and Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago, Chile
| | - L Edgardo González
- Head, Department of Oral and Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago, Chile
| | - Ilich Vargas
- Staff, Department of Oral and Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago, Chile
| | - Alfredo Noguera
- Oral and Maxillofacial Surgeon, Universidad de Los Andes, Santiago, Chile
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Hybrid Arch Bars Reduce Placement Time and Glove Perforations Compared With Erich Arch Bars During the Application of Intermaxillary Fixation: A Randomized Controlled Trial. J Oral Maxillofac Surg 2019; 77:1228.e1-1228.e8. [DOI: 10.1016/j.joms.2019.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
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25
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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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26
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Rothe TM, Kumar P, Shah N, Shah R, Mahajan A, Kumar A. Comparative Evaluation of Efficacy of Conventional Arch Bar, Intermaxillary Fixation Screws, and Modified Arch Bar for Intermaxillary Fixation. J Maxillofac Oral Surg 2018; 18:412-418. [PMID: 31371884 DOI: 10.1007/s12663-018-1110-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 04/16/2018] [Indexed: 11/25/2022] Open
Abstract
Aim Comparative evaluation of efficacy of conventional arch bar, intermaxillary fixation screws, and modified arch bar with respect to plaque accumulation, time required for procedure, postoperative stability after achieving the intermaxillary fixation, mucosal growth, and complication encountered for intermaxillary fixation. Materials and methods This study is a randomized clinical trial in which participants were divided into three groups of 10 each, and designated as Group A, Group B, and Group C. In Group A, intermaxillary fixation was achieved by the conventional method using Erich arch bar, fastened with 26-gauge stainless-steel wires. In Group B, intermaxillary fixation was achieved by the use of 2 mm × 8 mm 4-6 stainless-steel intermaxillary fixation screws. In Group C, intermaxillary fixation was achieved by modified screw arch bar. A conventional arch bar was modified by making perforations in the spaces between the winglets along the entire extension of the bar which was then adapted to the vestibular surface of the maxilla and mandible, close to the cervical portion of the teeth, and perforations were made in the inter-radicular spaces with a 1.1-mm bur, and after this, 1.5-mm screws were placed to fix the bar. Results In the present study, a total of 30 patients were analyzed. The average working time for Group A, Group B, and Group C were 110, 16, and 29 min respectively. Oral hygiene scores through modified Turskey Gilmore plaque index which was taken at immediate postoperative, 15, 30, and at 45 days. Maximum hygiene was maintained in intermaxillary fixation screw group followed by modified arch bar group and conventional arch bar group. Maximum stability was seen in the conventional arch bar group followed by modified arch bar group and intermaxillary fixation screw group. With respect to mucosal coverage, maximum mucosal growth was seen in intermaxillary fixation screws group. When complications were taken into consideration, maximum complications were reported in Group A followed by Group B and Group C. Conclusion This study emphasizes that the use of modified arch bar is quick and easy method than conventional arch bar with least chances of glove puncture and needle stick injury to the operator. Oral hygiene maintenance is comparatively better in patients with modified arch bar than with conventional arch bars. Modified arch bar was significantly stable when compared with IMF screws, and therefore, for the patients who require long-term intermaxillary fixation, modified arch bars can be a viable option.
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Affiliation(s)
- Tushar Manohar Rothe
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Akola, India
| | - Prachur Kumar
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Vadodara, India
| | - Navin Shah
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Paldi, India
| | - Rakesh Shah
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Vadodara, India
| | - Amit Mahajan
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Vadodara, India
| | - Ananth Kumar
- Oral and Maxillofacial Surgery, K M Shah Dental College Piparia, Vadodara, Gujarat India
- Vadodara, India
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FAMI Screws for Mandibulo-Maxillary fixation in mandibular fracture treatment - Clinico-radiological evaluation. J Craniomaxillofac Surg 2018; 46:566-572. [PMID: 29459185 DOI: 10.1016/j.jcms.2018.01.003] [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: 11/07/2017] [Revised: 12/14/2017] [Accepted: 01/15/2018] [Indexed: 11/22/2022] Open
Abstract
Mandibulo-maxillary fixation (MMF) is indispensable for mandibular fracture treatment. Various means for MMF have been proposed, of which arch bars are widely considered to be the mainstay. However, disadvantages to this method have initiated a quest for an alternative, leading to the introduction of MMF screws. MMF screws have frequently been criticized for poor stability of fracture sites, root damage, hardware failure, and nerve damage. We retrospectively evaluate the FAMI (Fixation and Adaptation in Mandibular Injuries) screw in mandibular fracture treatment by scanning for clinically and radiologically visible complications. In total, 534 FAMI screws were used in the successful treatment of 96 males and 34 females. Condylar fractures were most commonly encountered, representing 120 of 241 fracture sites. 15 general fracture-related complications occurred, with the most common being nerve function impairment (3.8%) and postoperative malocclusion (4.6%). In nine cases (7%), clinically visible FAMI-screw-related complications occurred, with the most prevalent being screw loosening (2.3%) and mucosal signs of inflammation (3.1%). Duration of FAMI screws was associated with the occurrence of clinically visible complications (p = 0.042). Radiologically, clinically invisible dental hard tissue damage was noted in 21 individuals (16%). Therefore, FAMI screws seem to be a reliable and safe method for mandibulo-maxillary fixation.
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Rai A, Khan MM. Intermaxillary Fixation with a Single Wire. J Maxillofac Oral Surg 2018; 17:107-109. [PMID: 29383003 DOI: 10.1007/s12663-016-0922-6] [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: 09/13/2015] [Accepted: 05/21/2016] [Indexed: 11/30/2022] Open
Abstract
Intermaxillary fixation (IMF) is required before plating to achieve premorbid relationship of mandibular and maxillary teeth. We recommended the use of single wire for achieving IMF using 24 gauze stainless steel wire, which is an easy, fast, economical and minimally invasive technique.
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Affiliation(s)
- Anshul Rai
- 1Department of Trauma and Emergency Medicine, AIIMS, Saket Nagar, Bhopal, M.P. India
| | - Manal M Khan
- 2Department of Plastic Surgery, AIIMS, Saket Nagar, Bhopal, M.P. India
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Rothe TM, Kumar P, Shah N, Shah R, Kumar A, Das D. Evaluation of efficacy of intermaxillary fixation screws versus modified arch bar for intermaxillary fixation. Natl J Maxillofac Surg 2018; 9:134-139. [PMID: 30546226 PMCID: PMC6251282 DOI: 10.4103/njms.njms_16_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: This study aimed to evaluate the efficacy of intermaxillary fixation (IMF) screws and modified arch bar. Materials and Methods: This study is a randomized clinical trial in which all participants were divided into two groups of ten in each group and designated as Group A and Group B. In Group A, IMF was achieved by the use of four to six 2×8mm stainless steel IMF screws. In Group B, IMF was achieved by modified screw arch bar. Results: In the present study, a total of twenty patients were analyzed. The average working time for Group A and Group B was 16 min and 29 min, respectively. Oral hygiene scores through modified Turesky Gilmore plaque index were calculated at immediate postoperative period and after 15 days, 30 days, and 45 days. Maximum hygiene was maintained in IMF screw group than modified arch bar group, but maximum stability was observed in the modified arch bar group than IMF screw group. Conclusion: This study emphasizes the use of IMF screws as a quick and easy method than modified arch bar. Oral hygiene maintenance was comparatively better in patients with IMF screws than those with modified arch bar. Modified arch bar was significantly stable when compared with IMF screws; therefore, for patients who require long-term IMF, modified arch bars can be a viable option, but the perforation in the original arch bar may lead to the weakening of the arch bar, and therefore the prefabricated modified arch bar would be a better option.
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Affiliation(s)
- Tushar Manohar Rothe
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Prachur Kumar
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Navin Shah
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Rakesh Shah
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Ananth Kumar
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
| | - Devika Das
- Department of Oral and Maxillofacial Surgery, K.M. Shah Dental College, Vadodara, Gujarat, India
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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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Anslem O, Eyituoyo O, Olabode OV, Ademola OA, Adesina AO. A comparative study of intermaxillary fixation screws and noncompression miniplates in the treatment of mandibular fractures: a prospective clinical study. Oral Maxillofac Surg 2017; 21:233-240. [PMID: 28386782 DOI: 10.1007/s10006-017-0622-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The main goal of treatment of mandibular fractures is to restore normal dental occlusion and promote appropriate bone healing and a normal mouth opening. Recently, there has been a resurgent interest in the use of screws for intermaxillary fixation of mandibular fractures. This study was therefore designed to determine how the clinical outcomes of the use of screws for intermaxillary fixation compare with the use of miniplates in the treatment of mandibular fractures in Nigeria. OBJECTIVES The objectives of this study are as follows: 1. To compare the clinical outcomes of the use of 2.0 mm × 9.0 mm screws for intermaxillary fixation with 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures in Lagos, Nigeria 2. To determine the clinical outcomes in the use of 2.0 mm × 9.0 mm screws for intermaxillary fixation (IMF) and 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures 3. To compare the complications associated with the use of 2.0 mm × 9.0 mm screws for IMF and 2.0 mm noncompression miniplates in the treatment of mandibular fractures METHODOLOGY: This randomized controlled clinical study was carried out at the Department of Oral and Maxillofacial Surgery of the study institution. Subjects with simple unilateral mandibular fractures who met the inclusion criteria were randomly allocated into the study (intermaxillary fixation screw) and control (miniplate) groups through balloting. Factors assessed and compared during and after the procedures included intraoperative pain, postoperative nerve impairment, postoperative occlusion, limitation of mouth opening, incidence of hardware failure, incidence of infection and non-union. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20. RESULTS A total of 56 subjects participated in the study, with 28 subjects in each group. Majority (91%) of the subjects were male. Road traffic crash was the highest aetiological factor while sport was the least (3.6%). A higher proportion (25.0%) of subjects in the miniplate group had major complications compared with 14.3% in the IMF screw group. There was no statistically significant association between site of mandibular fracture, time elapsed before treatment and complications (p < 0.05). All cases of mandibular fractures healed successfully at 6 weeks. CONCLUSION The use of screws for IMF is as effective as 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures.
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Affiliation(s)
- Osasuyi Anslem
- Oral and Maxillofacial Surgery, Nigerian Air Force Hospital, Nigerian Air Force Base, Kaduna, Nigeria
| | - Okoturo Eyituoyo
- Head and Neck Surgical Oncology Division, Oral and Maxillofacial Surgery Department, Lagos State University College of Medicine/Teaching Hospital, Lagos, Nigeria.
| | - Ogunbanjo V Olabode
- Oral and Maxillofacial Surgery Department, Lagos State University College of Medicine/Teaching Hospital, Lagos, Nigeria
| | - Olaitan A Ademola
- Oral and Maxillofacial Surgery Department, Lagos State University College of Medicine/Teaching Hospital, Lagos, Nigeria
| | - Ayodele O Adesina
- Oral and Maxillofacial Surgery Department, General Hospital, Lagos, Nigeria
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Yoshimura H, Ohba S, Yasuta M, Nakai K, Fujieda S, Sano K. Infrazygomatico-coronoid fixation in a segmental mandibular reconstruction with a free vascularized flap: A simple and correct repositioning method without interfering with reconstructive and microsurgical procedures. Head Neck 2016; 38:1679-1687. [PMID: 27232524 DOI: 10.1002/hed.24506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 02/26/2016] [Accepted: 04/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In a segmental mandibular reconstruction with a free vascularized flap, reproducing the optimal relationship between the condyle and glenoid fossa, and maintaining correct occlusion are important. We examined the practicality of a repositioning technique that combined bone plate fixation of the infrazygomatic crest and the coronoid process (infrazygomatico-coronoid fixation [IZCF]) with maxillo-mandibular fixation (MMF). METHODS Eight patients were treated with this method. To investigate masticatory function, the status of the dental and temporomandibular joints were examined, and a food scale questionnaire was administered. RESULTS IZCF and MMF resulted in correct repositioning of the segmented mandibles and enabled accurate reconstructions. Most patients recovered to be able to ingest the same preoperative food in scale with stable occlusion. CONCLUSION This method is a simple and correct repositioning method without interfering with reconstructive and microsurgical procedures. We propose this technique as a reliable method for obtaining a functional outcome in mandibular reconstruction. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
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Affiliation(s)
- Hitoshi Yoshimura
- Division of Dentistry and Oral Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Seigo Ohba
- Division of Dentistry and Oral Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Regenerative Oral Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masato Yasuta
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Plastic and Reconstructive Surgery, Saga University Hospital, Saga, Japan
| | - Kunihiro Nakai
- Department of Plastic and Reconstructive Surgery, University of Fukui Hospital, Fukui, Japan
| | - Shigeharu Fujieda
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazuo Sano
- Division of Dentistry and Oral Surgery, Department of Sensory and Locomotor Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Camargo I, Van Sickels J, Laureano Filho J, Cunningham L. Root contact with maxillomandibular fixation screws in orthognathic surgery: incidence and consequences. Int J Oral Maxillofac Surg 2016; 45:980-4. [DOI: 10.1016/j.ijom.2016.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 12/05/2015] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
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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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Intermaxillary fixation with sutures: RAI Modification. Br J Oral Maxillofac Surg 2016; 55:e21-e22. [PMID: 27131986 DOI: 10.1016/j.bjoms.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/11/2016] [Indexed: 11/20/2022]
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36
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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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Predisposing Factors for Orthodontic Mini-Implant Failure Defined by Bone Strains in Patient-Specific Finite Element Models. Ann Biomed Eng 2016; 44:2948-2956. [DOI: 10.1007/s10439-016-1584-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/01/2016] [Indexed: 01/08/2023]
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Beech AN, Farrier JN. Operative use of a vacuum-formed splint in the reduction of displaced mandibular fractures. Br J Oral Maxillofac Surg 2016; 54:224-5. [PMID: 26776322 DOI: 10.1016/j.bjoms.2015.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 12/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea N Beech
- Department of Oral and Maxillofacial Surgery, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust.
| | - Jeremy N Farrier
- Department of Oral and Maxillofacial Surgery, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust.
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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Snyder CJ, Soukup JW, Drees R, Tabone TJ. Caudal Mandibular Bone Height and Buccal Cortical Bone Thickness Measured by Computed Tomography in Healthy Dogs. Vet Surg 2015; 45:21-9. [DOI: 10.1111/vsu.12401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jason W. Soukup
- Department of Surgical Sciences; School of Veterinary Medicine
| | - Randi Drees
- Department of Surgical Sciences; School of Veterinary Medicine
| | - Tom J. Tabone
- Department of Computing and Biometry, College of Agricultural & Life Sciences; University of Wisconsin-Madison; Madison Wisconsin
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Bai Z, Gao Z, Xiao X, Zhang W, Fan X, Wang Z. Application of IMF screws to assist internal rigid fixation of jaw fractures: our experiences of 168 cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:11565-11568. [PMID: 26617892 PMCID: PMC4637708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/20/2015] [Indexed: 06/05/2023]
Abstract
Intermaxillary fixation (IMF) screws were first introduced to achieve IMF as a kind of bone borne appliance for jaw fractures in 1989. Because this method can overcome many disadvantages associated with tooth borne appliance, IMF screws have been popularly used for jaw fractures since then. From March 2011 to February 2014, we treated 168 cases with single or multiple jaw fractures by open reduction and a total of 705 IMF screws were intraoperatively applied in all the cases to achieve IMF and maintain dental occlusion as an adjuvant to open reduction. The numbers, implantation sites and complications of IMF screws were retrospectively analyzed. In our experience, we found that IMF screws were important to assist open reduction of jaw fractures but their roles should be objectively assessed and the reliability of open reduction and internal rigid fixation must be emphasized. Much attention should be paid when implanting.
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Affiliation(s)
- Zhenxi Bai
- Department of Stomatology, Affiliated Hospital of Yan’an UniversityYan’an 716000, Shaanxi, China
| | - Zhibiao Gao
- Department of Stomatology, Affiliated Hospital of Yan’an UniversityYan’an 716000, Shaanxi, China
| | - Xia Xiao
- Department of Stomatology, Affiliated Hospital of Yan’an UniversityYan’an 716000, Shaanxi, China
| | - Wenjuan Zhang
- Department of Stomatology, Affiliated Hospital of Yan’an UniversityYan’an 716000, Shaanxi, China
| | - Xing Fan
- Department of Stomatology, Affiliated Hospital of Yan’an UniversityYan’an 716000, Shaanxi, China
| | - Zhaoling Wang
- Department of Stomatology, General Hospital of Jinan Military CommandJinan 250031, Shandong, China
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Lothamer C, Snyder CJ, Duenwald-Kuehl S, Kloke J, McCabe RP, Vanderby R. Crown Preservation of the Mandibular First Molar Tooth Impacts the Strength and Stiffness of Three Non-Invasive Jaw Fracture Repair Constructs in Dogs. Front Vet Sci 2015; 2:18. [PMID: 26664947 PMCID: PMC4672188 DOI: 10.3389/fvets.2015.00018] [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: 05/05/2015] [Accepted: 07/03/2015] [Indexed: 11/23/2022] Open
Abstract
Repairing mandibular body fractures presents unique challenges not encountered when repairing long bones. Large tooth roots and the presence of the inferior alveolar neurovascular bundle limit safe placement for many types of orthopedic implants. Use of non-invasive fracture repair methods have increasingly become popular and have proven safe and effective at achieving bone healing. Non-invasive fixation constructs have not been tested in dogs using cantilevered bending. Furthermore, non-invasive fracture repair constructs have not been tested at the location of a common fracture location – the mandibular first molar tooth (M1). The objectives of this study were to test the strength and stiffness of three non-invasive mandibular fracture repair constructs and to characterize the impact that tooth crown preservation has on fixation strength for fractures occurring at the M1 location. Specimens were assigned to three treatment groups: (1) composite only, (2) interdental wiring and composite (IWC), and (3) transmucosal fixation screw and composite. For each pair of mandibles, one mandible received crown amputation at the alveolar margin to simulate the effect of crown loss on fixation strength and stiffness. Regardless of the status of crown presence, IWC demonstrated the greatest bending stiffness and load to failure. With the crown removed, IWC was significantly stronger compared to other treatments. All fixation constructs were stiffer when the tooth crown was preserved. In fractures at this location, retaining the tooth crown of M1 significantly increases stiffness of interdental wiring with composite and transmucosal screw with composite constructs. If the crown of M1 was removed, IWC was significantly stronger than the other two forms of fixation.
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Affiliation(s)
- Charles Lothamer
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison , Madison, WI , USA
| | - Christopher John Snyder
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison , Madison, WI , USA
| | - Sarah Duenwald-Kuehl
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison , Madison, WI , USA
| | - John Kloke
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison , Madison, WI , USA
| | - Ronald P McCabe
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison , Madison, WI , USA
| | - Ray Vanderby
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison , Madison, WI , USA
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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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Ma D, Yao H. Transpalatal screw traction: a simple technique for the management of sagittal fractures of the maxilla and palate. Int J Oral Maxillofac Surg 2015; 44:671. [PMID: 25682462 DOI: 10.1016/j.ijom.2015.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/21/2015] [Indexed: 11/25/2022]
Affiliation(s)
- D Ma
- Department of Oral and Maxillofacial Surgery, Lanzhou General Hospital of PLA, Lanzhou, China.
| | - H Yao
- Department of Oral and Maxillofacial Surgery, Lanzhou General Hospital of PLA, Lanzhou, China
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Attishia R, Van Sickels JE, Cunningham LL. Incidence of bracket failure during orthognathic surgery: a comparison of two techniques to establish interim maxillomandibular fixation. Oral Maxillofac Surg 2014; 19:143-7. [PMID: 25260536 DOI: 10.1007/s10006-014-0468-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/15/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study is to review the frequency of bracket failure using two different techniques for establishing interim fixation during orthognathic surgery. METHODS AND MATERIAL The first group (standard technique) had a maxillomandibular fixation (MMF) established during surgery by ligating splints to orthodontic appliances. The second group of patients had an interim fixation established using maxillomandibular screws (alternative technique). Preoperative and immediate postoperative panoramic radiographs were examined for loose and or missing brackets in both groups. Intraoperative observations were also recorded in the second group. The type of surgery (one- or two-jaw) and whether or not cemented bands on the molars were present were noted. A Pearson's chi-square analysis was done comparing the two groups. RESULTS There were 210 patients in the first group and 104 in the second. The overall incidence of missing or loose brackets following surgery in the standard technique group was 16%; 172 of them had a cemented band on either the first or on the first and second molars. There was a higher incident of lost or loose bonded brackets when the patients had no cemented brackets or underwent a two-jaw surgery. In the second group of 104 patients, there was one loose or missing brackets caused by the application of MMF (Pearson's chi-square value = 15.84, p < 0.0001). CONCLUSIONS When using orthodontic brackets to establish interim fixation, the incidence of missing or loose brackets during orthognathic surgery was dramatically higher in two-jaw cases and in cases where only bonded brackets were placed by the orthodontist. When using maxillomandibular screws to establish interim fixation, the problem has been greatly diminished.
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Affiliation(s)
- Reed Attishia
- University of Kentucky, D508 Chandler Medical Center University of Kentucky, 800 Rose Street, Lexington, KY, 40536-0297, USA
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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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Chaudhary Z, Sharma R, Krishnan S. Maxillo Mandibular Fixation in Edentulous Scenarios: Combined MMF Screws and Gunning Splints. J Maxillofac Oral Surg 2014; 13:213-4. [PMID: 24822016 DOI: 10.1007/s12663-013-0481-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/15/2013] [Indexed: 11/24/2022] Open
Abstract
A fracture of the maxillary or mandibular bone requires the afflicted to undergo a maxillo mandibular fixation for the establishment of pre traumatic occlusion. This process is quiet tedious and consumes a considerable period of time before any surgical procedure can commence. Such a situation can be complicated in case the individual with maxillomandibular fracture has sparse or absent dentition; for such cases a splint is fabricated or an erstwhile existing denture is used for maintaining a vertical jaw proportion. Stabilizing such splints to the jaw requires various invasive approaches that can bring into harm's way, adjacent soft tissue vital structures. We describe here an innovative technique combining the time tested method of the "gunning splint" and the advanced minimally invasive MMF screws for obtaining closed reduction in edentulous jaw fractures.
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Affiliation(s)
- Zainab Chaudhary
- MDS Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, B.S Zafar marg, New Delhi, 110002 India
| | - Rakesh Sharma
- MDS Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, B.S Zafar marg, New Delhi, 110002 India
| | - Sriram Krishnan
- MDS Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Complex, B.S Zafar marg, New Delhi, 110002 India
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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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Chang HP, Tseng YC. Miniscrew implant applications in contemporary orthodontics. Kaohsiung J Med Sci 2013; 30:111-5. [PMID: 24581210 DOI: 10.1016/j.kjms.2013.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/31/2013] [Indexed: 11/15/2022] Open
Abstract
The need for orthodontic treatment modalities that provide maximal anchorage control but with minimal patient compliance requirements has led to the development of implant-assisted orthodontics and dentofacial orthopedics. Skeletal anchorage with miniscrew implants has no patient compliance requirements and has been widely incorporated in orthodontic practice. Miniscrew implants are now routinely used as anchorage devices in orthodontic treatment. This review summarizes recent data regarding the interpretation of bone data (i.e., bone quantity and quality) obtained by preoperative diagnostic computed tomography (CT) or by cone-beam computed tomography (CBCT) prior to miniscrew implant placement. Such data are essential when selecting appropriate sites for miniscrew implant placement. Bone characteristics that are indications and contraindications for treatment with miniscrew implants are discussed. Additionally, bicortical orthodontic skeletal anchorage, risks associated with miniscrew implant failure, and miniscrew implants for nonsurgical correction of occlusal cant or vertical excess are reviewed. Finally, implant stability is compared between titanium alloy and stainless steel miniscrew implants.
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Affiliation(s)
- Hong-Po Chang
- Faculty of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Dentistry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Yu-Chuan Tseng
- Faculty of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthodontics, Dental Clinics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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50
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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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