Arch Bar Research Articles

Expanding the Use of Orthodontic Appliance in the Management of Maxillo-Mandibular Fractures

Background: Maxillofacial fractures are common presentationin Plastic Surgery Emergency Department. Many techniquesof maxillary mandibular fixation have evolved overthe years. Orthodontic appliance technique as a reliable methodfor Maxillary-mandibular fixation has been introduced.Methods: Prospective clinical study was conducted on20 patients complaining of different types of maxillo-facialfractures who were candidates for maxillary-mandibularfixation with or without open reduction and internal fixation.The objective of the study is to demonstrate technical feasibility,overall outcomes and complications of the technique,in the period from October 2017 till March 2018 at in theEmergency Plastic Surgery Department in Cairo UniversityHospital.Results: In suitable cases orthodontic brackets and elasticscan be used as an effective method of Maxillary-mandibularfixation with good patients' satisfaction. It can reduce thehospital admission rate and need for general anesthesia; itwill not only reduce costs for the hospital but also costs forthe patient.Conclusion: Orthodontic brackets technique's stabilityallowed using it as a maxillary mandibular fixation even aloneor with open reduction and internal fixation, thus it used asan effective method for maxillary-mandibular fixation, andhas proven to cause a significant impact on returning thepatients to their pre-traumatic bite. This makes it able toreplace the Erich arch bar in maxillofacial fracture as a methodof maxillary-mandibular fixation. Orthodontic brackets techniquehas shown to offer patients better oral hygiene, convenienceand no mucosal injuries.

CENTRAL GIANT CELL GRANULOMA: A CASE REPORT

A 35-year-old male patient had a history of increased volume and discomfort in the right mandibular region for approximately 3 years. Clinical examination revealed a facial asymmetry due to poorly defined swelling in the right body of the jaw. Intraoral examination showed a diffuse swelling in the alveolar part of the 41 to 46 region with obliteration of the buccal vestibule in the same region and tooth mobility, which was proposed on palpation of firm consistency. Computed tomography shows the bone expansion of the buccal and lingual cortices and the bone fenestration. Incisional biopsy results led to diagnosis of central giant cell granuloma. The treatment consists of the Erich´s arch bar followed by resection and reconstruction of the tumor mass with rigid internal fixation material, a 2.4-mm system, and corticoid therapy. After 1 year of follow-up, the patient presented recurrence of the lesion, and curettage was instituted followed by the patient receiving clinical and radiographic follow-up. A 35-year-old male patient had a history of increased volume and discomfort in the right mandibular region for approximately 3 years. Clinical examination revealed a facial asymmetry due to poorly defined swelling in the right body of the jaw. Intraoral examination showed a diffuse swelling in the alveolar part of the 41 to 46 region with obliteration of the buccal vestibule in the same region and tooth mobility, which was proposed on palpation of firm consistency. Computed tomography shows the bone expansion of the buccal and lingual cortices and the bone fenestration. Incisional biopsy results led to diagnosis of central giant cell granuloma. The treatment consists of the Erich´s arch bar followed by resection and reconstruction of the tumor mass with rigid internal fixation material, a 2.4-mm system, and corticoid therapy. After 1 year of follow-up, the patient presented recurrence of the lesion, and curettage was instituted followed by the patient receiving clinical and radiographic follow-up.

Do hybrid arch bar screws pose a risk to the dentition?

Objective Hybrid arch bars have become popular alternatives to traditional Erich arch bars for use in craniomaxillofacial surgery. They offer the benefit of decreased time for application, reduced risk of sharps exposure to healthcare personnel, and decreased risk of compromised periodontal health. However, it has not been established if they pose a significant risk to the dentition. Damage to the teeth, such as violation of the pulpal canal or root fracture, can lead to clinically significant sequelae. The purpose of the study was to examine if the screws contact or violate the tooth structure during placement. Study Design A retrospective radiographic review of 50 patients treated with Stryker SMARTLock Hybrid Maxillomandibular fixation system at University Medical Center Hospital in New Orleans, from January 2018 to August 2018, was conducted. Postoperative axial slices of computed tomography (CT) scans were examined for screw position relative to the adjacent tooth roots. Patients were excluded if they were fully edentulous, were incarcerated, or did not have arch bars applied to both arches. Variables examined were screw violation of the periodontal ligament, gross disruption of tooth root dentin, pulpal violation, and root fracture. The location of the tooth injured with regard to the maxilla versus the mandible and the anterior, premolar, or molar dentition was also examined. Statistical analysis was performed with unpaired t test and 1-wayanalysis of variance with Tukey's post hoc test. Results Fifty patients were analyzed, for a total of 507 screws in 100 arches with 1340 teeth present. Overall, 31.49% of teeth had contact or injury with the screws, with screw violation of the periodontal ligament (7.39%), dentin (19.78%), and pulp (3.81%) and root fracture (0.45%). There was a significantly higher incidence of root fracture in the mandible (N = 5) versus maxilla (N = 1) (P Conclusions Hybrid arch bars offer many benefits to the surgeon, but there is no risk of the screw contacting or violating the tooth structure. There is an increased risk to the anterior dentition and the maxillary dentition. The mandibular teeth are also more likely to experience root fracture compared with the maxillary teeth. The hybrid arch bars should be applied with consideration to patient anatomy and tooth position to prevent injury to the tooth roots.

Management of Maxillofacial Fracture: Experience of Emergency and Trauma Acute Care Surgery Department of Sanglah General Hospital Denpasar Bali.

BACKGROUND:Maxillofacial fracture is one of the major trauma; the cases were increasing because of the high number of motorcycles in Bali. The goal of the treatment is proper positioning of the occlusion, and it depends on rapid diagnosis and proper treatment.AIM:This study aims to know the characteristics of the maxillofacial fracture patients in Sanglah General Hospital Denpasar Bali.METHODS:A retrospective study, based on medical record were concluded, samples taken in Sanglah General Hospital from January to June 2015. Total recorded patient were 35 patients. The data obtained include age, gender, type of the fractures, and operation management.RESULTS:The injury was more common in male compared to female (80% vs 20%). Age 20 to 40 years old were more common (48.57%), followed by the child to adolescent (aged 0 to 20 years old) were 31.43%, and adult to elderly (aged 40 to 60 years old) was 20%. The mandibular fracture was most common (51.43%), other fractures such as a zygomatic fracture (31.43%) and maxillary fracture (17.14%). Internal fixation was the gold standard of the treatment (65.71%), and the other was an arch bar (34.29%).CONCLUSION:Diagnosing the right injury to the facial bone is a key step in determining a treatment plan. Rapid diagnosis and proper treatment lead to good occlusion, both internal fixation and arch bar were an effective treatment. The importance of dealing with almost all maxillofacial fracture problems in the first surgery.

Comparison Between Intermaxillary Fixation With Screws and an Arch Bar for Mandibular Fracture

Intermaxillary fixation (IMF) using the arch bar has been the standard technique for a long time in the management of mandibular fracture. But because of several complications, intermaxillary fixation with screws has been introduced and adopted to use. This investigation compared the outcomes and complications between the traditional IMF and modified intermaxillary fixation with screws techniques in terms of the malocclusion, surgical time, root injury, and screw or arch bar failure. This retrospective review included 66 patients who underwent reconstruction of mandibular fractures that uses traditional arch bar or IMF screws as IMF. Preoperative and postoperative facial bone computed tomography, panoramic x-ray were used to evaluate the patients. The complaints and complications were recorded in electric medical record based on patients' consultation during follow-up. The total complication rate was no higher using anchoring screw as an IMF than using arch bar fixation as an IMF. Mean surgical time was significantly shorter in the anchoring screw group than arch bar fixation (111 versus 157 min; P < .05). After compensation of the number of fracture sites, there was a significant difference in operation time (linear regression model, P = .009). This investigation revealed that the IMF using IMF screw systems could be a good alternative for the management of mandibular fracture. It could minimize the whole operation time with the similar complication ratio.

Comparison of Periodontium Reaction to Fixation of Mandibular Fractures with and Without Erich Arch Bars

Background: There are two general types of fixation methods used in mandibular fractures and osteotomy: closed fixation method with Erich arch bars and the open fixation method (without Erich arch bars). Periodontium inflammation, following mandibular fixation methods, is a complication of the healing period.Objectives: The current study aimed at evaluating and comparing periodontium reaction to fixation of mandibular fractures with and without Erich arch bars.Methods: This cross-sectional study was carried out on 48 patients with mandibular fractures. Twenty-four patients were treated with close method and Erich arch bars and 24 patients with open method and without Erich arch bars. Periodontium clinical indices, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing pocket depth (PPD), were measured immediately before the surgery and four, six, and eight weeks later.Results: After four, six, and eight weeks, subjects with arch bars had significantly greater PI, GI, and PPD (P value 0.001).Conclusions: According to the results, the use of Erich arch barsmore decreased periodontium status compared to the other group.

The Use of Botulinium Toxin as a Nonsurgical Adjuvant in the Closed Management of Condylar/Subcondylar Fractures

Background: Mandibular condylar fractures are common,with prevalence between 25% and 35% of all mandibularfractures. In children, the condylar fractures are usuallymanaged with maxilla-mandibular fixation, where as in adultsthe treatment of condylar fractures remains controversial.Several investigators validated the use of Botulinium Toxin(BTX) for treatment of recurrent temporomandibular jointdislocation. However, there are very limited studies thatassessed (BTX) injection in the management of condylar/subcondylar fractures.Patients and Methods: Ten patients presenting with condylar/subcondylar fractures either isolated or associated withother mandibular fracture were treated by Ultrasound guided(BTX) injection to Lateral Pterygoid Muscle (LPM) followedby application of arch bar and guiding elastics 2-3 days later.Results: Patients retained good occlusion with unrestrictedmouth opening. Minor deviation upon mouth opening wasobserved in some of the cases. Good alignment of the condylar/subcondylar fracture was documented radiologically over aminimum of three-month follow-up period.Conclusion: The use of botulinium toxin in condylarfractures is safe, and can be used as nonsurgical adjuvant inmanagement of condylar/subcondylar fractures

Mandibula kırıklarının prevalansı, tedavisi ve komplikasyonları

Purpose: The purpose of this study was to review and analyze the prevalence, treatment, and complications of mandibular fractures managed by the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Çukurova University between March 2015 and March 2017Materials and Methods: Mandibular fractures were sorted by etiology and fracture location. Open reduction and internal fixation of mandibular fractures were performed using 2.0mm or 2.4mm fixation systems. Closed reduction of fractures was performed using arch bars, intermaxillary fixation screws or wire-composite splints. The following complications were recorded: Temporary paresthesia, permanent paresthesia, malocclusion, infection, temporomandibular joint disorder, plate exposure and root damage.Results: The mean patient age was 32.8±(13.8). Males constituted 77.4%(n=65) and females constituted 22.6%(n=19) of the patients. The most common cause of mandibular fractures in this study was interpersonal violence (27 cases,32.1%), followed by road traffic accidents(22 cases, 26.2%) and falls(21 cases,25%). The least common cause of fractures was sports accident(6 cases,7.1%). The most common fracture localization was the condyle(27,24.5%), followed by the angle (24,21.8%), body (19,17.3%), symphysis/parasymphysis (18, 16.4%) and alveolar bone (17,15.5%). Fifty patients were treated by ORIF (59.5%), 29 patients were treated by closed reduction (34.5%). Complications in varying severity were observed in 25(29.7%) patients. The most common complication in this study was temporary paresthesia(13.1%) followed by TMD(6.0%). Other complications were seen infrequently.Conclusion: It is important to follow contemporary trends to understand how different centers manage their patients in different socio-economic regions and different levels of clinical facilities/resources. The incidence and causes of mandibular fractures may reflect the trauma patterns within the community, which is important for conducting better health policy strategies.

Types of Intermaxillary Fixation and Their Interaction With Palatine Fracture Reduction

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. 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. 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 0mm in the posterior sector. The IMF with self-tapping screws caused a 3-mm separation in the anterior sector and 1mm in the posterior sector. 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.

Profile of maxillofacial injuries in Departement of Emergency Trauma and Acute Care Surgery in Sanglah General Hospital from January 2012 to November 2018

Introduction: Maxillofacial injuries are common cause of trauma in emergency department. The goals in the treatment of maxillofacial injury are to restore premorbid occlusion. This study aimed to evaluate the characteristics and outcome of the maxillofacial injuries patient in Sanglah General Hospital Denpasar Bali.Methods Retrospective study was held in Sanglah General Hospital from January 2012 to November 2018. The samples consisted of 241 patients. Age, gender, type of the fractures and surgical management were evaluated.Results Maxillofacial injuries mostly occurred in male, aged 18-40 years old, the mandible was most frequently involved facial bone. Â Internal fixation was the golden standard of the treatment chosen (83.73%) followed by Arch bar (16.27%).Conclusion Road traffic accidents are the main reason for maxillofacial injury in Sanglah General Hospital Denpasar Bali. Precise diagnosis and proper treatment result in optimal occlusion and integrity nervous system, both internal fixation and arch bar were given good outcome.

Hybrid arch bars reduce placement time and glove perforations compared to Erich arch bars during the application of maxillomandibular fixation: a randomized controlled trial

Purpose The use of a bone-fixated hybrid arch bar system provides an alternative method to Erich arch bars to apply maxillomandibular fixation (MMF) during the treatment for mandibular fractures. The purpose of the study is to compare the time for placement and removal, effect on the gingiva, and operator safety. Methods The authors designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. Patients with mandibular fractures presenting to the authors’ institution were enrolled in the study and randomized into 2 groups: (1) the Erich arch bar group secured with circumdental stainless steel wires and (2) the Hybrid arch bar group secured with bone-borne self-drilling locking screws. The primary outcome variable was arch bar placement time. Secondary outcomes were glove tears or penetrations during application, gingival appearance score at removal, loose hardware at removal, removal time, and glove tears or penetrations at removal. The groups were compared by using the Student t test. Results A total of 90 patients were enrolled in the study. There were 43 patients randomized to the Erich arch bar group and 47 patients randomized to the Hybrid arch bar group. The mean time for application of Erich arch bars was 31.3 Â ± 9.3 minutes and 6.9 Â ± 3.1 for the Hybrid arch bars (P Conclusions Hybrid arch bars with bone-borne locking screws offer a number of advantages, including faster placement, shorter removal time, and a greater margin of safety for the operating surgeons, as demonstrated by significantly fewer glove tears and penetrations.

The Hybrid Arch Bar Is a Cost-Beneficial Alternative in the Open Treatment of Mandibular Fractures.

Obtaining maxillomandibular fixation (MMF) to achieve fracture reduction and functional occlusion is essential in the management of maxillofacial trauma. The aims of this retrospective review were to compare the total time spent in the operating room (OR) when using the Erich arch bar (EAB) versus the bone anchored hybrid arch bar (HAB) as well as performing a cost-benefit analysis (CBA). The study sample comprised patients older than 18 years who underwent open reduction internal fixation of mandible fractures at two separate institutions over a 5-year period. The primary outcome variable was total surgical time in minutes, defined as the time from incision to the completion of closure. Average operative time was significantly longer for the EAB than for the HAB (186.74 ± 70.73 vs. 135.98 ± 2.69 minutes, p < 0.001). A significant amount of time was saved by using the HAB for unilateral (37.17 ± 13.19 minutes; p = 0.007) and bilateral fractures (55.83 ± 18.89 minutes; p = 0.005). In-depth CBA showed that, for average OR fees of $60 per minute, the HAB produced savings of at least 4.01 and 11.63% of the total cost of surgery for unilateral and bilateral fractures. These results support the hypothesis that the HAB is a time-saving maneuver in the open treatment of mandible fractures. The HAB saves more time in bilateral fracture cases despite the longer overall operative times. This study shows the differential time-saving effect of the HAB regardless of fracture laterality as well as its cost minimization benefit compared with the EAB.

A prospective comparative clinical study on modified screw retained arch bar (SRAB) and conventional Erich's arch bar (CEAB).

Intermaxillary fixation (IMF) is commonly performed in the management of facial skeleton fractures. Various conventional methods like Erich's arch bar and Ivy eyelet wiring are the most commonly employed methods for achieving IMF, but they have their own disadvantages. Conventional Erich's arch bar (CEAB) has been modified recently by making perforations in the spaces between the winglets and securing the arch bar using 1mm screws. IMF using intraoral modified screw retained arch bar (SRAB) has been introduced for the treatment of mandibular fractures. The aim of this study was to compare the efficacy, advantages, disadvantages, indications, and potential complications associated with CEAB versus modified SRAB in the management of mandibular fractures. A randomized prospective study included 20 patients with mandibular fracture who were randomly allotted to two groups. Group A patients received modified SRAB and group B patients received CEAB. The parameters considered were time taken to place the arch bar, perforation in the gloves, patient acceptance, oral hygiene, iatrogenic dental injuries, and needle (wire) stick injuries during IMF. The mean time taken for arch bar placement was 27.20min with modified SRAB as compared with 82.50min with CEAB. Incidence of glove perforations was more in group B patients. Oral hygiene status was good in 90% of the patients from group A whereas it was 100% fair in group B patients. This study has shown that both the techniques achieve satisfactory IMF with post-operative occlusion. IMF with modified SRAB reduces the operating time and the incidence of the needle (wire) prick injuries. But modified SRAB has its own limitations in spite of its ease of application.

Use of oral screen for preventing soft tissue injuries associated with use of arch bars: a prospective randomized clinical study.

The purpose of the present study was to access the efficacy of oral screen in protection of arch bar-induced soft tissue injury after achieving maxillomandibular fixation (MMF). This study is a randomized clinical trial. The study sample was derived from the population of patients who required MMF and reported from January 2017 to December 2017. A total of 60 patients in whom application of an Erich arch bar was indicated for MMF were selected for the study. The patients were divided into two groups. In group I, only MMF was done; however, in group II, oral screen was used after MMF. The patients were assessed for soft tissue injury, pain, and maintenance of oral hygiene. All parameters were compared statistically using the chi-square test and Student's t test. The soft tissue injury in group I (73.33%) was greater than that in group II (3.33%). The pain was worse in group I than in group II. The mean value of plaque index in group II is 1.20 and in group I is 2.89. It signifies that plaque deposition was more in group I. Soft tissue injury and pain were less, as well as oral hygiene maintenance is better in patients who used oral screen after the placement of Erich arch bars.

MANDIBULAR FRACTURE MANAGEMENT;

Objectives: To compare the efficacy of Maxillomandibular fixation screws versus Erich Arch bar in the management of mandibular fractures. Study Design: Comparative case series study. Setting: Department of Oral &amp; Maxillofacial Surgery, Faculty of Dentistry, Liaquat University Hospital Hyderabad, Jamshoro. Period: 29/03/2016 to 28/09/2016. Methodology: Forty patients of either gender with age above 18 years with mandibular fracture requiring closed reduction were included. 20 patients of Groups A, treated with Maxillomandibular fixation screws and 20 patients of Group B treated with Erich Arch bar. Mean operative time was noted. All patients were followed up on every week up to four weeks. The statistical analysis via t-test was used and P-value &lt;0.05 was categorized as significant. Results: In MMF screw group 13(65.0%) patients were male and 7(35.0%) patients were female whereas in Arch Bar group, 15(75.0%) were male and 5(25.0%) were female. Evidence of wire stick injury was found positive in 2(10.0%) and 4(20.0%) patients among MMF screw and Arch Bar groups respectively. In MMF screw group, mean operative time was 84.20±18.04 minutes whereas in Arch Bar groups it was 121.80±13.68 minutes. The mean operative time is significantly reduced in MMF screw group as compared to Arch Bar group with p value &lt;0.01. Conclusion: We conclude that Maxillomandibular fixation with screws was more worthwhile mode as matched to the conservative Erich arch bars for managing the mandibular fractures.

A Clinical Comparison and Economic Evaluation of Erich Arch Bars, 4-Point Fixation, and Bone-Supported Arch Bars for Maxillomandibular Fixation

ImportanceErich 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.ObjectiveTo 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 ParticipantsThis 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 MeasuresCharge analysis from an institutional perspective, operative time, necessity for a secondary procedure, and postoperative complications.ResultsOf 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 RelevanceBone-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.

Hybrid Arch Bars Reduce Placement Time and Glove Perforations Compared With Erich Arch Bars During the Application of Intermaxillary Fixation: A Randomized Controlled Trial

The purpose of this study was to compare the time for placement and removal, the effect on the gingiva, and the operator safety of the Stryker Universal SMARTLock Hybrid MMF system (Stryker Craniomaxillofacial, Kalamazoo, MI) with traditional Erich arch bars. We designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. Patients with mandibular fractures presenting to our institution were enrolled in the study and randomized into 1 of 2 groups: the Erich arch bar group and the hybrid arch bar group. The primary outcome variable was arch bar placement time. Secondary outcomes were glove tears or penetrations during application, gingival appearance score at removal, loose hardware at removal, removal time, and glove tears or penetrations at removal. The groups were compared using t tests. We enrolled 90 patients in the study, with 43 randomized to the Erich arch bar group and 47 randomized to the hybrid arch bar group. The mean application time was 31.3±9.3minutes for Erich arch bars and 6.9±3.1minutes for hybrid arch bars (P<.0001). Significantly more glove tears or penetrations occurred during application in the Erich Arch Bar group (0.56±0.91 per application) than in the hybrid group (0.11±0.32 per application) (P=.0025). At removal, no difference in overall gingival appearance or amount of loose hardware was noted. The time for removal was significantly less for the hybrid arch bar group (10.5±5.1minutes vs 17.9±10.7minutes, P=.0007). Hybrid arch bars with bone-borne locking screws offer a number of advantages over traditional Erich arch bars and circumdental wires, including shorter placement and removal times and a greater margin of safety for the operating surgeon as shown by significantly fewer glove tears and penetrations.

ANTERIOR MANDIBLE AND CONDYLAR FRACTURE;

ABSTRACT… Objectives: To compare the outcome of two treatment protocols (open and closed reduction) in the management of Anterior mandible and condyle fracture in our center. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Oral &amp; Maxillofacial Surgery, Liaquat University of Medical &amp; Health Sciences, Jamshoro, Hyderabad. This study was conducted from April 2017 to September 2017. Methodology: This study was consisted of total 48 patients which were equally divided into two groups Group-A(Closed Reduction that is Eyelet or Arch Bar) and Group-B(Open Reduction) having anterior mandible were included. For closed reduction technique, maxillomandibular fixation was applied for 4-6 weeks. For open reduction, fracture was fixed with miniplates after achieving the normal occlusion. Post operatively, occlusal disturbances was considered having poor occlusion and patient with maximum intercuspation was considered as good occlusion. Mouth opening more than 25mm was considered as good mouth opening. Results: In group-A 23(95.8%) patients at 3rd month were found with good occlusion. In group-B, good occlusion was found in 21(87.5%) patients at 3rd month. In group-A 22(91.7%) subjects at 3rd month were found with good range of motion and in group-B good range of motion was found in 20(83.3%) subjects at 3rd month.In group-A, mean deviation was 0.54±0.72 mm at 3rd month while in group-B, mean deviation was 1.12±1.65 mm at 3rd month. Conclusion: Open reduction with two correctly positioned plates for the stabilization of anterior mandibular and condylar fractures yielded better function compared to closed reduction.

Management of traumatic intrusion of permanent teeth with immediate surgical repositioning: A case report from Hasan Sadikin Hospital, Bandung-Indonesia

Introduction: Traumatic dental injuries (TDI) of permanent teeth frequently occur in children and young adults. Intrusive luxation is one of the most severe forms of traumatic injuries in which the affected tooth is forced to displace deeper into the alveolus. As a consequence of this type of injury, maximum damage occurs to the pulp and all the supporting structures. The aim of this study is for proper diagnosis, treatment planning and follow up for improving a favorable outcome. Case: A 14 years old male patient came to the emergency department of Hospital Dr. Hasan Sadikin with bleeding from mouth due to an accident. Through clinical and radiographic examination discovered there was an intrusion of teeth 11,21. The intruded teeth were immediately repositioned and splinted within hours following injury with Arch Bar. Antibiotic therapy was initiated at the time of repositioning and maintained for five days. The splint was removed one month later. Clinical and radiographic examination one month after the surgical extrusion revealed satisfactory progressive apical and periodontal healing. Intrusion injuries have the poorest prognosis and complex treatment among all tooth injuries. No consensus has been reached on the optimal treatment of this type of injuries. The recommended treatment options for intruded teeth include the following such as allowing spontaneous re-eruption of the teeth, immediate surgical repositioning, and fixation and orthodontic repositioning. The treatment has to be adaptable according to complications.Conclusion: Further surgical repositioning in the presented case with one month follow up proved to be a viable treatment method for intruded teeth without any additional risk of resorption.Â

Effectiveness of placement of second miniplates as tension band unit in mandibular parasymphysis fractures

The ideal position of the plates and the need for additional plates are discussed continuously. In mandible, the tensile forces at the fracture line should be neutralized with a tension band. This study evaluated the role of the mandibular arch bar as a tension band eliminating the need for an upper miniplate (tension band plate) in cases of parasymphysis fractures. In this randomized control trial, a total of 90 patients with mandibular parasymphysis fractures underwent treatment in two groups. Group A was treated with one titanium miniplate along with Erich's arch bar. In Group B, two titanium miniplates were placed across the fracture site along with Erich's arch bar. Then, the complications and duration of the operation time were compared between two groups. The results were considered statistically significant when the P < 0.05. No significant difference was observed between the groups regarding postoperative complication rate. 1 month after surgery in Group A, number of patients with sensory impairment (17%) was significantly lower than Group B (37%) (P = 0.029). Furthermore, the operation time of Group A was significantly shorter than Group B (P < 0.001). In the presence of arch bar, placing one miniplate instead of the routine technique of placing two, do not increase complication rates. Furthermore, it reduces the operation time and costs and results in a better neurosensory recovery outcome in short time.