Intermaxillary Fixation Screws Research Articles

IMF screws with orthodontic E chains as a novel technique for intermaxillary fixation

AbstractIntroductionEither in conservative or in surgical management of maxillo‐mandibular fractures, intermaxillary fixation (IMF) provides stable occlusion, while offering reduction in the fractured segments. Various techniques have been used for achieving IMF, among which Erich arch bar is the most conventional and routinely used technique. However, it poses a risk of percutaneous injury to the surgical team with every wire used in the technique, causes trauma to the periodontium of the teeth secured by wires and it is not very comfortable for the patient. The few IMF techniques that are recommended without wire require special armamentarium that are not universally available.Materials and MethodsOur novel IMF technique employing multiple looping of orthodontic E chains around IMF screws can provide adequate reduction and stabilization of the fractured segments with good occlusion before plating of the maxillo‐mandibular fractures. It can also be utilized for extended periods for closed reduction or postoperatively for guiding the occlusion.ResultsAs seen in our clinical experience using this novel technique, there is no risk of percutaneous injury to the surgical team. It provides stable occlusion, optimal reduction in the fractured segments and is accepted well by patients as no wires are used.ConclusionThis novel technique can be used in all patients who require IMF and is particularly useful in patients with periodontally compromised teeth or in those who are partially edentulous where conventional arch bar fixation cannot be performed. This technique will considerably reduce the operative time and aid in better patient compliance.

Postoperative Intermaxillary Elastic Traction Contributes to the Stability of Absorbable Plates Fixation for Bilateral Mandibular Fracture.

The use of absorbable plates can be challenging for mandibular fractures involving bilateral dentition. Chewing and mouth opening movements may cause loosening or breakage of absorbable materials, leading to displacement of bone segments and resulting in malocclusion. The use of absorbable materials for bilateral mandibular fracture surgery itself raises concerns for surgeons. Timely intermaxillary elastic traction is essential for these patients after surgery to maintain correct occlusion. The surgical approaches were performed with intraoral mandibular sulcus incisions. During the surgery, intermaxillary fixation screws were implanted and steel wires were used for intermaxillary ligation and fixation to restore the occlusal. After the fractured segments were sequentially reduced, they were fixed with inion 2.0 absorbable plates. The patient underwent intermaxillary elastic traction for 1 week. Elastic mask was used to assist in stabilizing the position of the jawbone and maintaining occlusion. After discharge, the patient continued traction at home for 3 weeks before removing the intermaxillary fixation screws. The patient recovered well after surgery without any complications. The postoperative occlusal relationship is good. Postoperative CT showed good reduction of the fractured segments. For the case reported in this article, elastic traction was promptly implemented after surgery. We emphasize that restoring occlusion is always the treatment goal for jawbone fractures. We believe that keeping the intermaxillary fixation screws for a month is a wise choice to be prepared for unexpected needs.

A Novel Minimally Invasive and Cost-Effective Internal Fixation of the Le Fort I Fracture by Using Intermaxillary Fixation Screw and Wire: A Technical Note

A Novel Minimally Invasive and Cost-Effective Internal Fixation of the Le Fort I Fracture by Using Intermaxillary Fixation Screw and Wire: A Technical Note

Comparison of Efficacy Between New Method and Conventional Arch Bar Fixation Technique in Facial Bone Fracture Management – A Randomised Clinical Trail

Introduction - In this study efficacy of new method for arch bar fixation was compared with conventional technique in facial bone fracture management Material and Methods - 20 Patients with facial bone fracture reported to the Department of Oral and maxillofacial Surgery requiring open reduction were included in the study. The clinical parameters that were evaluated are Oral hygiene and Gingival index. Results - The mean OHI-S score in new technique and conventional technique in 1st week was 1.36 ± 1.19 and 0.81±0.53 respectively. In 2nd week the mean OHI-S score in new technique was 1.22 ±0.77 and in conventional technique the mean OHI-S score was 1.39 ± 1.51.In the 3rd week the mean OHI-S scores of new technique and conventional technique were 1.8 ±0.55 and 1.6 ±1.73 respectively. The mean GI score in new technique and conventional technique in 1st week was 0.69 ± 0.5 and 0.38 ± 0.3 respectively. In 2nd week the mean GI score in new technique was 0.63 ±0.4 and in conventional technique the mean GI score was 0.36 ± 0.3. In the 3rd week the mean GI scores of new technique and conventional technique were 0.65 ±0.3 and 0.35 ± 0.3 respectively. Conclusion - In a whole we can conclude from this clinical study that both the techniques were equally effective in terms of Oral hygiene, gingival health and stability. Key Words - Erich arch bar; Intermaxillary fixation; Intermaxillary fixation screws; maxillofacial trauma; oral hygiene status.

Erich arch bars vs intermaxillary fixation screws for mandibular fracture reduction during ORIF: a randomized clinical trial.

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). 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. 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. 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.

Evaluation of the Patient-Reported Outcome Measures (PROMs) With Temporary Skeletal Anchorage Devices in Fixed Orthodontic Treatment: A Systematic Review.

Analysis of patient-reported outcome measures(PROMs) is essential to ensure that the skeletal and traditional anchoring methods are appropriately and effectively utilized in the context of patient acceptance and satisfaction. This review's objective was to assess the available data on the levels of discomfort, soft-tissue irritation, functional impairment, and other patient-reported outcomes related to the usage of mini-implants in the context of fixed orthodontic treatment for adult patients. A total of seven electronic bibliographic databases were searched between January 1995 and February 2022. Moreover, a manual search was done in the selected orthodontic journals. This systematic review (SR) covered cohort studies, retrospective studies, randomized clinical trials (RCTs), and controlled clinical trials (CCTs) that studied the use of mini-implants, mini-plates, or onplants as anchorage devices on patients receiving orthodontic treatment. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2 tool). Three RCTs and two cohorts were included in this SR with a total of 468 patients. Three of the four included studies were at high risk of bias. The pain level was in the "mild-to-moderate" category on the first day following the insertion of mini-implants, then decreased to a mild level from the fifth day to the seventh day of insertion (mean values are 36.61, 16.36, and 11.33, respectively). The levels of functional impairments were found to be located between the "mild-to-moderate" and "moderate" categories after the placement of mini-plates and intermaxillary fixation screws, while they experienced a mild level with mini-implants. The greatest pain levels were found after the insertion of the temporary anchorage devices (TADs) and then decreased until they became mild or disappeared completely after one month. Speaking, chewing, and cleaning difficulties were more problematic when using TADs compared to conventional anchorage. To obtain good evidence in this area, more high-quality RCTs are needed.

Quality of life in patients with mandible fracture treated with closed reduction using Erich arch bar vs intermaxillary fixation screws

The aim of this study is to compare the quality of life (QoL) in patients with mandibular fractures undergoing closed reduction with conventional arch bar versus intermaxillary fixation screws at 4th week follow up. Objective is to assess the quality of life by GOHAI index in the 2 groups.A prospective analytical study was conducted on 50 patients between the age group of 18-50 years with dentate mandibular fractures as the study sample. Patients were divided into two groups. The control group underwent four weeks of maxillomandibular fixation with arch bar and test group underwent closed reduction with intermaxillary fixation screws. Both techniques were compared in terms of GOHAI index for assessment of QoL. QoL scores were recorded at 4th week follow up. Oral hygiene, operator injuries and time taken for the procedure was also observed on day of procedure and 4th week after procedure.The GOHAI’s total value score of ≤ 50 indicates a good QoL, 51-56 indicates a fair living quality, and 57-70 demonstrates the poor QoL. In this study the mean rank for the control group was found to be 43.5 and 35.36 for the test group suggesting a good QoL for the test group. Conclusion: There was significant difference between QoL of control group and test group, with test group (IMF Screws) having better QoL. Arch bar placement (control) is time consuming and had more oral hygiene problems when compared to IMF screws. Operator injury is less in IMF groups, but chances of dental complications are higher.

Effect of a digital guide on the positional accuracy of intermaxillary fixation screw implantation in orthognathic surgery

Intermaxillary fixation screw (IMFS) implantation is a common procedure in orthognathic surgery (OGS) performed to the temporary maxillary-mandibular fixation and stable bite relationships. The study aims to assess the accuracy of IMFS implantation with a digital guide to reduce the occurrence of root damage. This prospective study involved 40 patients undergoing OGS at the Affiliated Hospital of Qingdao University from August 2017 to May 2021. The patients were randomly divided into two groups according to whether the IMFS implantation was with or without digital guide (20 patients in the experimental group and 20 controls). The digital guides used in the experimental group were designed according to a virtual implantation plan and printed using stereolithography. In the control group, IMFSs were directly implanted by a surgeon based on clinical experience. Postoperatively, cone-beam computed tomography was performed to compare root proximity of IMFSs between the two groups and verify the accuracy of IMFS placement. In the experimental group, there was no case of root damage, the incidence of the periodontal ligament (PDL) injured was 22.1%, and 77.9% IMFSs were placed without contacting adjacent anatomic structures. In the control group, the incidence of root damage had been up to 20.8%, 31.7% IMFSs injured the PDL, and only 47.5% IMFSs were placed between the roots (P<0.001). IMFSs can be placed more accurately with surgical guides, reducing the incidence of root and PDL damages.

Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience.

BackgroundIntermaxillary fixation (IMF) is a technique that allows for the reduction and stabilization of mandibular fractures. Several methods of IMF, such as self-tapping screws or arch bars, have been developed. This study aimed to validate the usefulness of IMF with a self-tapping screw compared to IMF with arch bars with focus on the patients’ perspective.MethodsWe retrospectively reviewed the medical records of all patients who were treated for mandibular fractures at our hospital between August 2014 and February 2021. A total of 57 patients were enrolled in this study. Thirteen patients were excluded from the analysis: three patients were lost to follow-up, and 10 patients did not undergo IMF. Finally, 44 patients were analyzed, of which 31 belonged to the arch bar group, and 13 belonged to the screw group. Patient discomfort and pain during IMF application and removal were analyzed using a patient self-assessment questionnaire. The surgeon also assessed oral hygiene, IMF stability, and occlusion.ResultsWe applied IMF to 34 men (77%) and 10 women (23%). The mean age of the patients was 37.3 years. The most common fracture site was the angle (30%), followed by the parasymphysis (25%), the body (23%), the condyle (11%), and the ramus (11%). Patient discomfort and oral hygiene were statistically favorable in the screw group. The IMF application time was statistically shorter in the screw group (p<0.001). IMF stability was not statistically different between the two groups. The pain score during IMF removal was lower in the screw group (p<0.001).ConclusionCompared to arch bars, IMF screws provide more comfort during the IMF period, help maintain favorable oral hygiene, and have a shorter application time. From the patient’s perspective, IMF screws are an excellent alternative to conventional arch bars when applicable.

A better way to perform orthognathic surgery in partially edentulous patients: A novel modified wafer design

Introduction: Orthognathic surgery in the partially edentulous population presents multiple challenges. This case series aims to evaluate the success a novel modified wafer in orthognathic surgery for partially edentulous patients. Methods: Six partially edentulous patients eligible for orthognathic surgical treatment are included in this study; including one who had a fully edentulous maxilla. In two cases, the indication for surgery was to replace defective TMJ prostheses. 3-dimensional surgical planning was undertaken with computerised software. Three patients had bimaxillary osteotomies and one had a bilateral sagittal split osteotomy of the mandible. New prosthetic TMJs were placed in two cases in addition to orthognathic movements. Novel modified wafers and intermaxillary fixation screws were used intra-operatively in all cases. Results: All patients had good functional outcomes from surgery. Long-term occlusal stability was achieved with acrylic dentures. Mean age of the cohort was 55.8 years. The post-operative length of stay in hospital is comparable to the literature. Two patients had fixation plates removed after surgery. Conclusions: Using novel modified wafers, and intermaxillary fixation screws, in orthognathic surgery is safe and effective for partially edentulous patients. This technique has proven effective in both orthognathic and TMJ replacement surgery. Introduction: Orthognathic surgery in the partially edentulous population presents multiple challenges. This case series aims to evaluate the success a novel modified wafer in orthognathic surgery for partially edentulous patients. Methods: Six partially edentulous patients eligible for orthognathic surgical treatment are included in this study; including one who had a fully edentulous maxilla. In two cases, the indication for surgery was to replace defective TMJ prostheses. 3-dimensional surgical planning was undertaken with computerised software. Three patients had bimaxillary osteotomies and one had a bilateral sagittal split osteotomy of the mandible. New prosthetic TMJs were placed in two cases in addition to orthognathic movements. Novel modified wafers and intermaxillary fixation screws were used intra-operatively in all cases. Results: All patients had good functional outcomes from surgery. Long-term occlusal stability was achieved with acrylic dentures. Mean age of the cohort was 55.8 years. The post-operative length of stay in hospital is comparable to the literature. Two patients had fixation plates removed after surgery. Conclusions: Using novel modified wafers, and intermaxillary fixation screws, in orthognathic surgery is safe and effective for partially edentulous patients. This technique has proven effective in both orthognathic and TMJ replacement surgery.

Functional Rehabilitation after Mandibular Fracture - A Systematic Review.

The objective of this study was to evaluate the efficiency of functional rehabilitation in terms of mouth opening, quality of life, healing process, occlusion and dysfunction, between different treatment methods, after condylar fractures, based on the current literature. Using the PRISMA guidelines in search of clinical trials published between 2011 and 2021, a literature analysis was performed. This search was conducted using the following Medical Subject Headings (MeSH) terms: rehabilitation OR mouth opening recovery OR function recovery AND mandibular fracture OR condylar fracture. The literature search resulted in a total of 110 study articles, of which seven publications were used in the present review, according to a selection based on the pre-established eligibility criteria. The review showed that open reduction resulted in a better three-dimensional recovery of mandibular movements and revealed greater results regarding the absence of the symptoms after applied treatment. However, studies assessing closed reduction, especially performed with intermaxillary fixation screws (IMFS), revealed excellent results in terms of quality of life, mouth opening and occlusal parameters. This systematic literature review showed that open reduction resulted in a better three-dimensional recovery of mandibular movements and showed greater results regarding the absence of symptoms. However, studies assessing CR, especially those performed with IMFS, revealed excellent results in terms of quality of life, mouth opening and occlusal parameters.

Evaluation of Intermaxillary Fixation (IMF) Screw Therapy with Craniomandibular Index Analysis for Chronic Recurrent Dislocation in the Temporomandibular Joint.

Temporomandibular joint (TMJ) hypermobility is classified as a subluxation, complete (luxation), unilateral, or bilateral, acute, chronic protracted, or chronic recurrent dislocation. This controlled randomized clinical study aims to evaluate the effectiveness of intermaxillary fixation (IMF) screw application and autologous blood injections in the treatment of chronic recurrent dislocation of TMJ in comparison with the placebo group. The patients who were admitted to the Faculty of Dentistry of the Atatürk University between October 2018 and January 2020 were evaluated. Three hundred patients diagnosed with bilateral chronic recurrent dislocation of TMJ based on clinical findings and radiographs were included in the study. The patients were randomly divided into three groups according to the evaluation criteria. Group 1 received IMF, group 2 received autologous blood injection, and group 3 (placebo group) received an intraarticular saline injection. The results of the patients who received IMF, autologous blood injection, and saline injection were evaluated by the craniomandibular index. The IMF group showed significant improvement after 1 month and 6 months (P < 0.001), while the patients who received autologous blood injection and saline injection showed no significant improvement (P > 0.05). The data were analyzed with IBM SPSS V23. The significance level was P < 0.05. In our study, the IMF gave the best results among all the study groups. The IMF technique can be used in patients with protracted chronic recurrent dislocation in whom autologous blood injection has failed.

Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience

Verrucous carcinoma (VC) is a rare subtype of squamous cell carcinoma that commonly occurs in the oral cavity. However, VC of the facial skin is relatively rare. We report a case of a 91-year-old woman with VC of the facial skin in the left zygoma area. She was diagnosed with actinic keratosis (4 × 3 cm) of the same site approximately 12 years previously, but declined further treatment. The mass was excised with a minimum of 0.4 cm from gross margins with the result of free from tumor of all margins by frozen section, allowing for primary closure after skin undermining. Basal resection was performed in the preplatysmal plane. The diagnosis of VC was confirmed by histopathological examination. Postoperatively, the wound healed without incident and with no signs of facial nerve injury. To our knowledge, this is the first reported case of VC of facial skin arising from actinic keratosis.

COMPARISON OF CONVENTIONAL ARCH BARS WITH FIXATION SCREWS FOR INTERMAXILLARY FIXATION IN MANDIBULAR FRACTURES: A RANDOMIZED PROSPECTIVE CLINICAL STUDY.

Introduction: Occlusion is the way in which one’s maxillary and mandibular teeth relate to each other when the jaw is closed. When treating fractures of the mandible, the first and primary objective is to re-establish the patient’s premorbid occlusion which is required for the mastication and also the other objective is to achieve esthetics. Inter-maxillary fixation (IMF) plays a vital role in management of fractures involving maxilla and mandible & helps in stabilizing the patient’s occlusion and thus reduction in fracture segments. Many modalities for obtaining intermaxillary fixation like Arch bars, eyelets, interdental wiring, orthodontic braces and intermaxillary fixation screws have been considered. Every method used for intermaxillary fixation has its own merits and demerits. Materials and Method: A prospective randomized clinical study was conducted between 2015 to 2017 in Patients who reported with mandibular fractures to the department of Oral & Maxillofacial Surgery at Vydehi Institute of Dental Sciences and Research Centre. A total of 50 patients with mandibular fractures requiring internal fixation were divided into two groups. Group A consisted of patients in whom Erich’s arch bars were placed for IMF and Group B consisted of patients in whom IMFS were placed for IMF. Patients included were those who required IMF, Subjects in good health i.e; ASA I,II and III. Patients excluded were completely edentulous, ASA IV subjects, Comminuted fractures, Pediatric patients, Panfacial fractures. Results: Use of arch bars as seen in our results has a few disadvantages over IMF screws like time consumed in application and removal is more, Increased pain scores, Increased number of needle stick injuries and difficulty in maintaining oral hygiene, however it has its own advantages like it can be used in the treatment of dentoalveolar fractures, multiple teeth bearing fractured fragments can be reduced into an arch form. Use of IMF screws provide better oral hygiene status as well as same occlusal results as of arch bars. Decreased number of needle stick injuries and takes lesser time to apply and remove. IMF screws are useful in mandibular fractures which are not grossly displaced or comminuted. Conclusion: Use of both the techniques in achieving IMF is efficacious with both the techniques having merits and demerits over each other. Although both the techniques offer good temporary intermaxillary fixation, the benefits and risks of both the techniques should be weighed depending on the type of fracture we are dealing with. Keywords: IMF

A Distinct Technique of Intermaxillary Fixation Screw Application to Condylar Process to Fracture Reduction in Open Approach of Condylar Fracture Treatment.

The aim of this letter is to present the surgical experience obtained from a patient, in whom the proximal segment was better manipulated for precise alignment after application of the intermaxillary fixation screw.

Computer Assisted Guided Placement of IMF Screws in Craniomaxillofacial Trauma: An Evolving Technique

Intermaxillary fixation (IMF) screws have been introduced into maxillofacial trauma practice to reduce operation time and the complications associated with the placement of wire ligatures around teeth. Wires continue to be used to secure arch bars to teeth, form eyelets and long ligatures prior to putting a patient into maxillomandibular fixation (MMF). The application of wires to dental arches may result in sharp injuries to the operator, whereas injury to roots and nerves may arise from incorrect positioning of IMF screws in the jaws. The purpose of this technical note is to demonstrate how 3D patient specific (PS) surgical guides can be planned and fabricated to assist in the safe placement of IMF screws in the maxilla and mandible. It is proposed that PS IMF screw guides can be further developed to incorporate removable spoons and semi-circular access ports that not only facilitate safe screw placement but allow the guide to remain in position until all screw are secured. The potential benefits of PS IMF surgical guides include diminished risk of injury to facial structures and reduced operation time. The technique also lends itself to the placement of IMF screws via a robotic arm contributing to a safer operating environment for the maxillofacial surgery team.

Is the Use of Intermaxillary Fixation Screws an Alternative to Erich Arch Bars for Maxillomandibular Fixation During Management of Maxillofacial Fractures? A Systematic Review and Meta-Analysis.

Systematic review and meta-analysis. Maxillomandibular fixation (MMF) is a step of paramount importance during the management of maxillofacial trauma. Erich arch bars are being used for this purpose for decades but with advances in maxillofacial trauma management, intermaxillary fixation screws came into existence and are being used routinely. The present study was designed to identify if the intermaxillary fixation screws are really an alternative to Erich arch bars for management of maxillofacial trauma. An exhaustive literature search was conducted in May 2020 on various electronic databases and studies comparing Erich arch bars and intermaxillary fixation screws were recruited for the analysis. Random-effects model with Mantel Haenszel statistics was used to analyze oral hygiene and duration of achieving MMF. A total of 96 studies were identified, out of which 8 studies were included in the meta-analysis. There was no statistically significant difference in oral hygiene status of the patients in both the groups. Intermaxillary fixations screws required statistically significantly less time in achieving MMF. Needle stick injury was prominently seen with the use of Erich arch bar whereas other complications like mucosal coverage, root injury, screw loosening and screw fracture makes the use of intermaxillary fixation screws questionable. The present meta-analysis suggests that there is not enough evidence to recommend the use of intermaxillary fixation screws as an alternative to Erich arch bars. Further research with large sample size, high quality evidence and better methodology is recommended in this direction.

Late removal of an upper third molar displaced into the infratemporal space using an intermaxillary fixation screw: a case report

Teeth displacement during extractions even tough rare are extremely unwanted, especially for infra temporal space. This accident generally necessitate additional treatment for their resolution, being either immediate or late. Several authors discribed surgical techniques for removal displaced teeth into the infratemporal space, varying according to the degree of displacement, being that in some of this cases, is necessary the utilization of complementary tools. This case describes the technique utilized for late removal of tooth 18 (upper right third molar) dislocated into the lower portion of the infratemporal space (confirmed by the Cone Bean Computer tomography Scan), exam was performed after the patient reported pain in the operated region and during mandibular movement too, with an interincisal opening maximum of 20 millimeters. The procedure was realized under local anesthesia by a conservative intraoral approach and aid of intermaxillary fixation screw to facilitate extraction. The patient recovered well, without complications, with remission of pain and restoration of mouth opening.

Improving accuracy of the intermediate splint in substantial intermaxillary sagittal discrepancies using an extra anterior anchorage point: technical note.

Background To describe a technical feature that increases the stability of the intermediate splint in patients where bimaxillary surgery with great maxillary/mandibular advancements are planned. Material and Methods Prospective evaluation of the intermediate splint dental vertical penetration in patients undergoing bimaxillary surgery where great sagittal discrepancy occur in the anterior sector between the upper and lower jaws when the intermediate splint is placed by adding an extra intermaxillary fixation (IMF) screw (2x9 mm) placed between the central incisors of the maxilla and fixed to the most anterior aspect of the intermediate splint following the direction of the sagittal maxillo-mandibular discrepancy from January to September 2018. Results The postoperative evaluation comparing the accuracy of conventional fixation versus fixation with an extra anterior anchorage point through photographic assessment and intraoral digital scanner demonstrated better dental penetration, and therefore improved intermediate splint precision with the latter in all cases Conclusions Our results suggest that this is a simple and safe technique that can be easily reproduced and optimizes the outcomes by increasing the accuracy of translation of the planned surgical movements to the operating room. Key words:Orthognathic surgery, intermediate splint, accuracy, intermaxillary fixation, bone screw.

A randomized prospective comparison of maxillomandibular fixation (MMF) techniques: “SMARTLock” hybrid MMF versus MMF screws

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. 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. 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. 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.