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

View Article: PubMed Central - PubMed

ABSTRACT

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

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

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

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

No MeSH data available.


Open reduction and fixation done after arch bar fixation
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Figure 2: Open reduction and fixation done after arch bar fixation

Mentions: After appropriate anesthesia, a prefabricated arch bar with hooks incorporated on the outer surface with flat malleable stainless steel metal strip was cut accurately to the length of both upper and lower dental arches. On the upper jaw, the hooks were arranged in an upward direction and to the lower jaw in a downward direction. The arch bar was adapted to the buccal surface of each arch and given shape of the arch by bending it, starting from the mesial part of last tooth progressing past the midline and finishing at the other end. It was fixed to each tooth, using prestretched 26-gauge stainless steel wire, which is passed from mesial surface of tooth to the lingual side and back on the buccal side from the distal surface of the tooth, making sure that one end of the wire is passing above the arch bar and the other below it. After this, both ends of the wire were twisted together in a clockwise manner and the arch bar was attached securely and firmly to the necks of each tooth on the buccal surface of the arch. Open reduction and internal fixation were then carried out using conventional miniplate/screw system with a single design and configuration, i.e., 2 mm thickness, 4-hole plate with gap in all cases based on Champy's lines of osteosynthesis. Arch bar was left in place for 4–6 weeks to enable the postoperative traction to correct the small discrepancies in occlusion [Figures 1 and 2].


Intermaxillary fixation screws versus Erich arch bars in mandibular fractures: A comparative study and review of literature
Open reduction and fixation done after arch bar fixation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979336&req=5

Figure 2: Open reduction and fixation done after arch bar fixation
Mentions: After appropriate anesthesia, a prefabricated arch bar with hooks incorporated on the outer surface with flat malleable stainless steel metal strip was cut accurately to the length of both upper and lower dental arches. On the upper jaw, the hooks were arranged in an upward direction and to the lower jaw in a downward direction. The arch bar was adapted to the buccal surface of each arch and given shape of the arch by bending it, starting from the mesial part of last tooth progressing past the midline and finishing at the other end. It was fixed to each tooth, using prestretched 26-gauge stainless steel wire, which is passed from mesial surface of tooth to the lingual side and back on the buccal side from the distal surface of the tooth, making sure that one end of the wire is passing above the arch bar and the other below it. After this, both ends of the wire were twisted together in a clockwise manner and the arch bar was attached securely and firmly to the necks of each tooth on the buccal surface of the arch. Open reduction and internal fixation were then carried out using conventional miniplate/screw system with a single design and configuration, i.e., 2 mm thickness, 4-hole plate with gap in all cases based on Champy's lines of osteosynthesis. Arch bar was left in place for 4–6 weeks to enable the postoperative traction to correct the small discrepancies in occlusion [Figures 1 and 2].

View Article: PubMed Central - PubMed

ABSTRACT

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

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

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

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

No MeSH data available.