Ya. Vares¹, N. Chegrynec²

¹Danylo Halytsky Lviv National Medical University

²Private stomatologic clinic «ODC», Kyiv

Introduction.  Intermaxillary fixation is an important and inseparable constituent part of treatment of trauma patients which provides an adequate interocclusal relationship. It can be employed as a solely conservative moda lity for fracture treatment as well as obligatory assistance of jaw osteosynthesis in case of its traumatic injury. The essential drawbacks of the existing methods of intermaxillary fixation, particularly dental arch bars and ligatures, are negative infl  uence on periodontium, complicated hygiene, non-balanced muscular loading, pain and psychological discomfort to the patient etc, which requires a search for alternative methods.

A stream development and inculcation to the clinical practice of various orthodontic systems in recent decades allow extrapolating the indications for their employment from orthodontics to other dental directions, especially maxillofacial traumatology.

The purpose of the study is a retrospective analysis with clarification of historical aspects and generalization of own experience of employment of non-removable orthodontic technique (bracket system) for fixation of bone fragments in cases of traumatic mandibular fractures.

Materials and research methods. Since 2012 in the Department of Surgical Dentistry and Maxillofacial Surgery of The Danylo Galytsky LNMU 57 patients (men – 45, women – 12; age 18 – 45) with traumatic mandibular fractures were examined and treated surgically (control group, 35 patients) and conservatively (main group, 22 patients).

In all patients of the main group the intermaxillary fixation was carried out using the elements of non-removable orthodontic technique – brackets VictoryÒ with hooks (specification 0° TQ, 0° ANG, 022) (3М Unitek, USA), which were fixed on teeth according to standard protocol, including acid enamel etching, employment of adhesive, fixation of brackets with light-curing composite). Later the hooks of opposite brackets were joined together by elastic rubber rings in proper occlusal relationship. Control inspection of patients was carried out on 1, 3, 7, 14, 21, 30, 60 and 90 days post-operatively.

Results. The obtained results of employment of non-removable orthodontic elements (brackets) for bone fragments fixation in 22 patients with traumatic mandibular fractures were evaluated by us as satisfactory. The mean period of intermaxillary fixation was 19 ± 2 days. On that time clinical and roentgenological signs of fracture consolidation were observed in all patients and there were no occlusal disturbances in any case as well as other complications except of unglue of brackets from the teeth surface. There were no patients’ complaints regarding laboured oral hygiene and service of orthodontic appliance. Positive results of investigation are confirmed by the demonstration and description of a clinical case.

Conclusions. Summarizing the results of a brief retrospective literary analysis as well as our own clinical experience it could be asserted that employment of elements of non-removable orthodontic technique (bracket system) for fixation of bone fragments in cases of traumatic mandibular fractures creates a serious alternative to the existing methods of an intermaxillary fixation. The proposed method allows to reestablish an adequate anatomical and functional status of the mandible in short terms, facilitates oral hygienic maintenance, requires no local anaesthesia and is suitable for both balanced occlusal loading distribution and, oppositely, correction of occlusal relationship by means of directed elastic pull.

References

1. Vares Ya, Filipska T, Filipsky A, Lunochkina O. Modern methods of intermaxillary immobilization. Theory and рractice. Lviv: Galdent, 2010. 32 p. (Ukrainian).
2. Vares Ya. To the problem of intermaxillary splinting in cases of mandibular miniplate osteosynthesis. Dental News. 2007;4(53):71-75. (Ukrainian).
3. Vares YaE, Мedvid YuО, Chegrynec NV, inventor, assignee. A method of treatment of mandibular fractures. Patent Ukraine N 83216U. 2013 Aug 27. (Ukrainian).
4. Vares YaE, Мedvid YuО, Chegrynec NV, inventor, assignee. A method of intermaxillary immobilization in cases of mandibular fractures. Patent Ukraine N 83217U. 2013 Aug 27. (Ukrainian).
5. Vares Ya, Chegrynec N, Medvid Yu. Comparative assessment of methods of temporary intermaxillary immobilization. Perspectives of Medical Sciences: Mater. Intern. Sci. Pract. Conf. Odessa: Southern Medical Foundation, 2012. p. 44-46. (Ukrainian).
6. Vares Ya, Chegrynec N, Medvid Yu. Comparative assessment of oral cavity and periodontium hygiene state in patients with mandibular fractures in cases of different methods of intеrmaxillary fixation. Mater. XIV Congr. WFUDS. Donetsk; Kyiv; Chicago, 2012. p. 329-330. (Ukrainian).
7. Baurmash H, Farr D, Baurmash M. Direct bonding of arch bars in the management of maxillomandibular injuries. J Oral Maxillofac Surg. 1988;46(9):813-815. https://doi.org/10.1016/0278-2391(88)90197-8
8. Baurmash H. Bonded arch bars in oral and maxillofacial surgery. Oral Surg Oral Med Oral Pathol. 1993;76(5):553-556. https://doi.org/10.1016/0030-4220(93)90060-H
9. Behbenahi F, Al-Aryan H, Al-Attar A, Al-Hamad N. Perceived effectiveness and side effects of intermaxillary fixation for diet control. Int J Oral Maxillofac Surg. 2006;35(7):618-623. https://doi.org/10.1016/j.ijom.2006.01.010
10. Sindet-Pedersen S, Jensen J. Intermaxillary fixation of mandibular fractures with bracket-bar. J Craniomaxillofac Surg. 1990;18(7):297-298. https://doi.org/10.1016/S1010-5182(05)80535-9
11. Smith AT. The use of orthodontic chain elastic for temporary intermaxillary fixation. Br J Oral Maxillofac Surg. 1993;31(4):250-251. https://doi.org/10.1016/0266-4356(93)90150-U
12. Ueki K, Marukawa K, Shimada M, Nakagawa K, Yamamoto E. The Use of an Intermaxillary Fixation Screw for Mandibular Setback Surgery. J Oral Maxillofac Surg. 2007;65(8):1562-1568. https://doi.org/10.1016/j.joms.2006.10.071