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Schopper H, Krane NA, Sykes KJ, Yu K, Kriet JD, Humphrey CD. Trends in Maxillomandibular Fixation Technique at a Single Academic Institution. Craniomaxillofac Trauma Reconstr 2024; 17:119-123. [PMID: 38779397 PMCID: PMC11107819 DOI: 10.1177/19433875231176339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Study Design Retrospective chart review. Objective Restoration of premorbid occlusion is a key goal in the treatment of mandibular fractures. Placement of the patient in maxillomandibular fixation (MMF) is performed during mandibular fracture repair to help establish occlusion. A number of techniques are available to achieve MMF. We sought to examine trends in MMF technique at our institution. Methods A retrospective chart review was conducted to evaluate patients who underwent surgical treatment of mandibular fractures between January 1, 2011 and March 31, 2021. Data including fracture characteristics, mechanism of injury, patient demographics, complication rates, and MMF technique utilized were collected. Results One hundred sixty-three patients underwent MMF (132 males). The most common etiology of fracture was assault (34%). There was an increasing preference for rapid MMF techniques over time, as opposed to standard Erich arch bars. No significant difference in obtaining adequate fracture reduction as determined by postoperative imaging or complications were noted between those who underwent MMF with newer rapid techniques vs traditional MMF techniques. Conclusions Our institution has demonstrated changing trends in the technique utilized for establishing occlusion intraoperatively, more recently favoring rapid MMF techniques, with similar rates of complications and ability to adequately reduce fractures.
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Affiliation(s)
- Heather Schopper
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Natalie A. Krane
- Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Kevin J. Sykes
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Katherine Yu
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - J. David Kriet
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Clinton D. Humphrey
- Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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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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Madhu SK, Dominic S, Baptist J, Shetty P. Simple Method for Re-tightening IMF Wires without Breakage. J Contemp Dent Pract 2024; 25:289-291. [PMID: 38690704 DOI: 10.5005/jp-journals-10024-3650] [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: 05/02/2024]
Abstract
AIM This clinical technique aims to retighten intermaxillary fixation (IMF) wires when loosened intra/postoperatively. BACKGROUND Intermaxillary fixation is one of the most important steps to obtain stable and functional occlusion in maxillofacial trauma. However, IMF wires tend to loosen over time. This loosened wire is generally removed and a new wire is used for IMF. Removal and refixation is time-consuming for surgeon and unconformable for the patient. TECHNIQUE We recommend a simple technique for re-tightening IMF wires without breakage, with the use of shepherd's crook explorer by making a small circular loop. CONCLUSION This technique of re-tightening by looping further stretches and tightens the wire to regain stabilized occlusion with maximal intercuspation. CLINICAL SIGNIFICANCE This technique eliminates the need for removal and refixation of IMF wires, thereby improving patient comfort, yet obtaining stable occlusion over a long period of time. How to cite this article: Madhu SK, Dominic S, Baptist J, et al. Simple Method for Re-tightening IMF Wires without Breakage. J Contemp Dent Pract 2024;25(3):289-291.
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Affiliation(s)
- Sandeep K Madhu
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India, Orcid: https://orcid.org/0000-0002-6167-0388
| | - Shiney Dominic
- Department of Oral and Maxillofacial Surgery, Government Dental College, Thrissur, Kerala, India, Orcid: https://orcid.org/0000-0002-1977-9646
| | - Joanna Baptist
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India, Phone: +91 9480528512, e-mail: , Orcid: https://orcid.org/0000-0003-1075-8950
| | - Premalatha Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India, Orcid: https://orcid.org/0000-0002-3474-1726
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Fernandes IA, Al-Moraissi EA, Galvão EL, Falci SGM. Erich arch bars vs intermaxillary fixation screws for mandibular fracture reduction during ORIF: a randomized clinical trial. Clin Oral Investig 2023; 27:6063-6071. [PMID: 37603168 DOI: 10.1007/s00784-023-05220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE This randomized clinical trial aimed to compare the efficacy of Erich arch bars (EAB) and intermaxillary fixation (IMF) screws in reducing mandibular fractures during open reduction and internal fixation (ORIF). METHODS A total of 28 patients with mandibular fractures were randomly allocated to either the EAB group or the IMF screws group. The study evaluated various parameters including occlusal stability, complications, duration of application, oral hygiene status, quality of life, and patient characteristics. RESULTS The study found no significant differences in occlusal stability between the EAB and IMF screw groups. However, the application and removal times were longer for EAB compared to IMF screws. The EAB group showed a higher presence of biofilm on teeth, indicating poorer oral hygiene status compared to the IMF screws group. In terms of quality of life, patients in the EAB group reported worse results in the "handicap" domain at the 15th postoperative day. No significant differences were observed in other quality-of-life parameters. Patient characteristics were well distributed between the two groups, enhancing the reliability of the results. CONCLUSION Both EAB and IMF screws demonstrated comparable occlusal stability for minimally displaced mandibular fractures. However, IMF screws offered advantages such as shorter application and removal times, better oral hygiene maintenance, and potentially improved quality of life in the "handicap" domain. Further studies with larger sample sizes are necessary to validate these findings and explore the stability of IMF methods in cases requiring postoperative malocclusion correction or prolonged IMF.
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Affiliation(s)
- Ighor Andrade Fernandes
- Department of Dentistry, Section of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Centro - Oral Surgery Clinic, Diamantina, Minas Gerais, Brazil.
| | | | - Endi Lanza Galvão
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- Department of Dentistry, Oral and Maxillofacial Section, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
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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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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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Fernandes IA, Lopes ABS, Fonseca PG, da Silva Torres A, Rodrigues AB, Galvão EL, Falci SGM. Comparison between Erich arch bars and intermaxillary screws in maxillofacial fractures involving the dental occlusion: a meta-analysis. Int J Oral Maxillofac Surg 2020; 50:83-95. [PMID: 32798159 DOI: 10.1016/j.ijom.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/08/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
This systematic review aimed to compare the Erich arch bars (EABs) with intermaxillary fixation (IMF) screws in maxillofacial fractures involving dental occlusion on perioperative parameters. Four electronic databases were searched: MedLine (Pubmed), Web of Science, VHL, and Cochrane Library. Inclusion criteria comprised clinical trials comparing the two IMF methods, assessing at least one of the outcomes: occlusal stability, oral hygiene, quality of life, time to apply and remove IMF appliances, and complications. Risk of bias was evaluated through the Cochrane risk of bias tool. Fifteen papers were included in the qualitative analysis and 12 of those in the meta-analysis. Times for EABs application (mean difference (MD) 46.83; 95% confidence interval (CI): 30.63-63.02) and removal (MD 22.89; 95% CI 14.61-31.17) were longer compared with IMF screws. There is higher risk of glove perforation (risk ratio (RR) 3.81; 95% CI 2.41-6.04) and lower risk of iatrogenic injuries (RR 0.21; 95% CI 0.09-0.48) when placing EABs compared with IMF screws. No significant differences in plaque index were found (MD 1.07; 95% CI -0.17 to 2.31). The quality of this evidence ranged from very low to low and was mainly compromised by risk of bias assessment. Further studies are necessary to evaluate transurgical IMF stability and postoperative occlusal quality and quality of life when comparing EABs with IMF screws.
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Affiliation(s)
- I A Fernandes
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - A B S Lopes
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - P G Fonseca
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - A da Silva Torres
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - A B Rodrigues
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E L Galvão
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - S G M Falci
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
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Comparing Outcomes in Orthognathic Surgery Using Clear Aligners Versus Conventional Fixed Appliances. J Craniofac Surg 2019; 30:1488-1491. [PMID: 31299750 DOI: 10.1097/scs.0000000000005572] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Orthognathic surgery for dentofacial deformities is typically preceded and followed by orthodontic treatment. Traditionally, orthodontic hardware is secured to the dentition to allow dental movement and stabilization. Clear-aligner therapy (eg, Invisalign) provides an aesthetic alternative, consisting of a series of transparent trays. Its use has not been described in complex triple-jaw orthognathic surgery. The purpose of this study is to evaluate perioperative outcomes and 3-dimensionally quantify postoperative edema in Invisalign patients undergoing triple-jaw orthognathic procedures, comparing this to patients treated with conventional fixed appliances. The surgical approach to patients with clear-aligners is also outlined. METHODS The authors conducted a retrospective chart review and 3-dimensional morphometric study of Invisalign patients undergoing triple-jaw surgery (LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty). An identical assessment of demographically matched patients treated with conventional fixed appliances was performed and compared with the Invisalign group. RESULTS Thirty-three patients, with a mean age of 19.99 years, were included: 13 with Invisalign and 20 with conventional fixed appliances. No significant difference was observed in operating time, concurrent extraction of teeth, fat grafting, duration of hospital stay, diet advancement, and use of narcotic analgesics between the 2 groups. Nine patients had sufficient 3-dimensional images for volumetric analysis (4 with Invisalign and 5 with conventional fixed appliances). Postoperative edema was not significantly different (P = 0.712) when comparing conventional fixed appliances (44.29 ± 23.16 cm) to Invisalign (37.36 ± 31.19 cm). CONCLUSION The present study demonstrates that complex multiple-jaw orthognathic procedures can be successfully performed in Invisalign patients. Perioperative and short-term clinical outcomes are not compromised.
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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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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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11
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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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Kiwanuka E, Iyengar R, Jehle CC, Mehrzad R, Kwan D. The use of Synthes MatrixWAVE bone anchored arch bars for closed treatment of multiple concurrent mandibular fractures. J Oral Biol Craniofac Res 2017; 7:153-157. [PMID: 29123991 DOI: 10.1016/j.jobcr.2017.08.006] [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: 07/24/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022] Open
Abstract
Background Maxillomandibular fixation (MMF) is an important tool in the treatment of facial fractures and bone-anchored arch bar systems have emerged as treatment options. This study illustrates our experience with the Synthes MatrixWAVE MMF system and the novel application in closed treatment of patients with multiple concurrent mandibular fractures. Methods We enrolled eight patients with concurrent mandibular fractures and treated them with the MatrixWAVE MMF system. The malleable arch bars were fitted and then secured using 6-8 mm screws. The arch bar was and either stretched or compressed to ensure optimal positioning. 24-gauge interdental fixation wiring was placed using the fish loop technique on either side of the fracture to achieve stabilization of the mandible fractures. Results All eight patients were retained in MMF until stable occlusion was achieved with clinical evidence of healing, approximately 4-6 weeks. Post-operative Panorex scans did not reveal any evidence of damage to tooth roots. None of the screws became overly embedded in the mucosa secondary to overgrowth; the arch bars were successfully removed in an outpatient setting without local anesthesia. Conclusions The Synthes MatrixWAVE MMF system has unique features such as prominent screw anchor heads and horizontal malleability unique from other bone anchored arch bars. These features allow for completely closed treatment of patients with multiple concurrent mandible fractures.
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Affiliation(s)
- Elizabeth Kiwanuka
- Department of Plastic Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence, RI, United States
| | - Rajiv Iyengar
- Department of Plastic Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence, RI, United States
| | - Charles Christopher Jehle
- Department of Plastic Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence, RI, United States
| | - Raman Mehrzad
- Department of Plastic Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence, RI, United States
| | - Daniel Kwan
- Department of Plastic Surgery, Rhode Island Hospital, Brown University School of Medicine, Providence, RI, United States
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13
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New method of arch bar fixation. Br J Oral Maxillofac Surg 2017; 55:631-632. [PMID: 28457589 DOI: 10.1016/j.bjoms.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 04/02/2017] [Indexed: 11/22/2022]
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14
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Hayase T, Nakajima Y, Kato-Kogoe N, Nakano H, Sano K, Yoshimura H, Ariyoshi Y, Ueno T. Intermaxillary Fixation of Mandibular Fractures using a Bilayer Thermoforming Plate. J HARD TISSUE BIOL 2017. [DOI: 10.2485/jhtb.26.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tomoyoshi Hayase
- Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College
| | - Yoichiro Nakajima
- Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College
| | - Nahoko Kato-Kogoe
- Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College
| | - Hiroyuki Nakano
- Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College
| | - Kazuo Sano
- Department of Dentistry and Oral Surgery, Unit of Senory and Locomotor Medicine, Division of Medicine, Faculty of Medical Science, University of Fukui
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Senory and Locomotor Medicine, Division of Medicine, Faculty of Medical Science, University of Fukui
| | | | - Takaaki Ueno
- Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College
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15
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Hartwig S, Boettner A, Doll C, Voss JO, Hertel M, Preissner S, Raguse JD. Drill-related root injury caused by intraoperative intermaxillary fixation: an analysis of 1067 screw applications. Dent Traumatol 2016; 33:45-50. [PMID: 27681036 DOI: 10.1111/edt.12305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS Intermaxillary fixation is a standard procedure for the treatment of mandibular fractures or in orthognathic surgery. Predrilling for screws poses the risk of accidental tooth root injury, potentially leading to further pathological processes. Limited evidence about accidental tooth injury during intermaxillary fixation is available due to heterogenous study designs. The aim of this study was to evaluate the risk of root trauma using predrilled transgingival fixation screws and the clinical consequences for the affected teeth. MATERIALS AND METHODS In this retrospective study, the data of open reduction and internal fixation surgery files with intraoperative application of predrilled intermaxillary fixation screws were analysed. The postoperative radiographic images were evaluated for the occurrence of tooth root injury. Patients diagnosed with root injury were clinically followed up with respect to the dental health for the affected teeth. RESULTS A total of 133 radiologically diagnosed tooth root injuries were recorded (12.5% of screws). The median follow-up interval was 16 months (range: 3-77 months). The return rate was 49.5% for all patients. Of these, four of the injured teeth (3%) needed endodontic treatment. No toothache was reported, no tooth was lost, and no negative impact on periodontal health was clinically evident. CONCLUSION Intermaxillary fixation with predrilled transgingival screws is a safe way to manage mandibular fractures. The incidence of tooth root injury is not uncommon, but the adverse side effects are rare and the health of the affected teeth is mostly not compromised.
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Affiliation(s)
- Stefan Hartwig
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Boettner
- Department of Biometry and Clinical Epidemiology, Campus Benjamin-Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan O Voss
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Hertel
- Department of Oral Medicine, Dental Radiology and Oral Surgery, Campus Benjamin-Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Saskia Preissner
- Department of Operative and Preventive Dentistry, Campus Benjamin-Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan D Raguse
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Clinic, Charité - Universitätsmedizin Berlin, Berlin, Germany
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