Maxillomandibular Fixation Screws Research Articles

Does Maxillomandibular Fixation Technique Affect Occlusion Quality in Segmental LeFort I Osteotomy?

BackgroundSegmental maxillary osteotomies require precise occlusal control due to variability in individual segment positioning. The role of maxillomandibular fixation (MMF) technique on occlusal control has not been validated. PurposeThe purpose is to measure and compare the accuracy of occlusal positioning among MMF techniques. Study design, setting, sampleThis was a double-blinded in vitro study on experiment models to simulate a 3-piece LeFort I osteotomy. The models were constricted posteriorly and expanded using 3 different MMF techniques and compared to the unaltered baseline occlusion. Based on sample size calculation, 32 separate attempts were made for each MMF technique. Predictor variableThe predictor variable was MMF technique (brackets, MMF screws, embrasure wires). Main outcome variablesThe primary outcome variable was the visual occlusal analysis score (VOAS), a 1.00 to 4.00 continuous scale measuring the similarity of the achieved occlusion to the planned (control) occlusion assessed by an oral and maxillofacial surgeon and an orthodontist. High VOAS indicated greater occlusal accuracy, with 3.50 defined as the threshold for accuracy. The secondary outcome variable was the linear error of the achieved occlusion at the canine and first molar teeth, with lower error indicating greater accuracy. An a priori accuracy threshold of 0.5mm was set for this variable. CovariatesNone. AnalysesKruskal-Wallis test with post hoc testing was used to analyze the difference in the outcome variables of interest. P-value < 0.05 was considered statistically significant. ResultsThirty-two attempts for each technique showed that brackets had higher VAOS than MMF screws and embrasure wires (median differences 1.49 and 0.48, P<0.001), and had lower linear occlusal error (median differences 0.35 to 0.99mm, P<0.001). Conclusions and RelevanceMMF technique influences the quality of occlusal control, with greater visual rating scores and lower linear errors seen with brackets than with embrasure wires or MMF screws.

Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures.

The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.

Updates in Management of Craniomaxillofacial Gunshot Wounds and Reconstruction of the Mandible.

This article includes updates in the management of mandibular trauma and reconstruction as they relate to maxillomandibular fixation screws, custom hardware, virtual surgical planning, and protocols for use of computer-aided surgery and navigation when managing composite defects from gunshot injuries to the face.

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.

Are Bondable Buttons a Better Option than Intermaxillary Fixation Screws for Achieving Maxillomandibular Fixation? A Prospective Randomized Clinical Study.

The aim of this study was to identify a better option in achieving maxillomandibular fixation (MMF) comparing bondable buttons and Maxillomandibular Fixation screws in achieving Maxillomandibular Fixation. In this randomized clinical trial, study sample was derived from the population of patients who reported with minimally displaced mandibular fractures and who requiredMaxillomandibular Fixation. The patients were divided into two groups. In Group I (n = 20), Maxillomandibular Fixation was done with Maxillomandibular Fixation screws; on the other hand, in Group II (n = 20), bondable buttons were used. In both the groups the patients were analyzed for the time duration required in minutesfor securing and removal ofMaxillomandibular Fixation, plaque accumulation and postoperative stability. Plaque accumulation was evaluated using TURESKY-GILMORE-GLICKMAN modification of the Quigley-Hein plaque index. The complications encountered during and after the surgery were also analyzed. The plaque accumulation and time required for placement and removal in group I were more as compared to group II. In Group I, there were more complications as compared to Group II such as tooth root damage, screw loosening, screw breakage and infection. Bondable buttons are a better choice for achieving Maxillomandibular Fixation in comparison with Maxillomandibular Fixation screws for the treatment of minimally displaced mandibular fractures. Further studies with a bigger sample size must be carried out.

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.

To compare the efficiency of maxillomandibular fixation screws over erich arch bar in achieving intermaxillary fixation in maxillofacial trauma: A clinical study

Introduction: Intermaxillary fixation (IMF) is regarded as a significant step in the management of maxillofacial trauma. Various techniques have been mentioned in the literature for achieving maxillomandibular fixation (MMF). The conventional methods such as arch bars and eyelet wiring are the most commonly used, but these methods have their own shortcomings. With the introduction of self-tapping MMF screws in 1989, many of the drawbacks with the use of arch bars can be eliminated. Hence, the aim of this study was to compare the efficiency of MMF screws over arch bars in achieving IMF. Materials and Methods: Thirty patients that required IMF as a part of their treatment and reported to the Department of Oral and Maxillofacial Surgery KLE VKIDS and Dr. Prabhakar Kore charitable hospital, K LE, Belgaum, were included in the study. Patients were divided randomly into two groups: Group A: Patients treated using MMF screws and Group B: Patients treated using arch bars. Statistical analysis was performed using the Mann–Whitney U-test and unpaired t-test. Results: There was a significant difference in oral hygiene index between the two groups at the end of the 14th postoperative day. The time taken for the placement of MMF screws was significantly less (mean 18.7 min) as compared to arch bars (mean 41.2 min). Screw loosening was seen in 4 (26%) out of 15 patients and 3 screws (4.5%) out of 66 screws used showed partial mucosal coverage at the end of 2 weeks. There were no cases of penetration injury in Group A, while in Group B, penetration injury to the surgeon was noted in 5 (33.3%) cases. Conclusion: MMF screws provided good intraoperative MMF. Placement of screws consumes less time and reduces the intraoperative period and also the risk of penetration injury to the surgeon. We also observed better oral hygiene, better patient compliance, and no major complications with the use MMF screws. Hence MMF screws proved to be an efficient alternative to the conventional methods of achieving IMF.

Comparison of the Efficiency of Maxillomandibular Fixation Screws over Erich Arch Bars in achieving Intermaxillary Fixation in Maxillofacial Trauma: A Clinical Study

Comparison of the Efficiency of Maxillomandibular Fixation Screws over Erich Arch Bars in achieving Intermaxillary Fixation in Maxillofacial Trauma: A Clinical Study

Efficacy of Standard Costochondral Grafting in Patients With Bilateral Craniofacial Microsomia

Craniofacial microsomia remains the second most common craniofacial deformity after cleft lip and palate. Mandibular pathology has been classically scored from type I to type III by the modified Pruzansky-Kaban classification. The authors report a case of a 5-year-old patient with Goldenhar syndrome and bilateral type III craniofacial macrosomia. The patient had absence of bilateral glenoid fossas, condyles, coronoids, and rami as well as hypoplasia of the symphysis, parasymphysis, and mandibular body. Reconstruction was performed using 2 costochondral rib autografts to reconstruct a ramus and assist in the development of a neo-glenoid fossa at the cranial base. An additional portion of costal rib graft was used to augment the deficient symphysis. The patient was placed in class III occlusion postoperatively using maxillo-mandibular fixation screws and heavy elastics. The bone grafts healed without complications with no evidence of ankylosis, nonunion, or resorption to date. For the most severe forms of craniofacial microsomia, costochondral grafting remains an effective initial technique for lengthening the hypoplastic mandible and providing a foundation for future distraction.

Maxillomandibular Fixation by Plastic Surgeons: Cost Analysis and Utilization of Resources.

Maxillomandibular fixation (MMF) can be performed using various techniques. Two common approaches used are arch bars and bone screws. Arch bars are the gold standard and inexpensive, but often require increased procedure time. Bone screws with wire fixation is a popular alternative, but more expensive than arch bars. The differences in costs of care, complications, and operative times between these 2 techniques are analyzed. A chart review was conducted on patients treated over the last 12 years at our institution. Forty-four patients with CPT code 21453 (closed reduction of mandible fracture with interdental fixation) with an isolated mandible fracture were used in our data collection. The operating room (OR) costs, procedure duration, and complications for these patients were analyzed. Operative times were significantly shorter for patients treated with bone screws (P < 0.002). The costs for one trip to the OR for either method of fixation did not show any significant differences (P < 0.840). More patients with arch bar fixation (62%) required a second trip to the OR for removal in comparison to those with screw fixation (31%) (P < 0.068). This additional trip to the OR added significant cost. There were no differences in patient complications between these 2 fixation techniques. The MMF with bone screws represents an attractive alternative to fixation with arch bars in appropriate scenarios. Screw fixation offers reduced costs, fewer trips to the OR, and decreased operative duration without a difference in complications. Cost savings were noted most significantly in a decreased need for secondary procedures in patients who were treated with MMF screws. Screw fixation offers potential for reducing the costs of care in treating patients with minimally displaced or favorable mandible fractures.

Root contact with maxillomandibular fixation screws in orthognathic surgery: incidence and consequences

The use of maxillomandibular fixation (MMF) screws in orthognathic surgery has become common in recent years. The risk of injury to adjacent roots with their placement in this population has not been studied extensively. The aim of this study was to review the incidence and consequences of root contact/injury in patients undergoing orthognathic surgery. A retrospective analysis of the treatment and radiographic records of patients who underwent orthognathic surgery between January 2013 and September 2014 at a university in Kentucky, USA was performed. The mean number of screws used was correlated to the mean number of roots affected using Spearman's test, set to a level of significance of 5%. Of 125 patients who underwent orthognathic surgery, 15 (12%) had evidence of root contact. Subsequent radiographs showed resolution of the bone defects. There was no clinical evidence of pulpal necrosis or pain during follow-up. The average number of screws used was 3.14±0.35 per patient, with an average of 0.17±0.52 root contacts per patient. There was no correlation between the number of screws used and the number of roots injured (P=0.279). Based on these results, MMF screws can safely be used to establish interim fixation during orthognathic surgery. Caution should be taken during placement to avoid direct injury to the roots of teeth.

Fracture management of an edentulous mandible in a geriatric osteoporotic patient

Fracture of an edentulous mandible is a difficult task primarily due to the absence of teeth. The management becomes even more difficult if the patient is geriatric and osteoporotic. A simple technique of using bite block splint, maxillomandibular fixation screws, and intermaxillary fixation has been presented to enable healing of fracture of mandible in such cases. The technique, which crosses the boundaries of conventional fracture management provides, promising results with minimum morbidity thus imparting optimum quality of life ahead for the patient.

Treatment Outcomes With the Use of Maxillomandibular Fixation Screws in the Management of Mandible Fractures

The purpose of this prospective randomized study was to assess whether uncomplicated mandible fractures could be treated successfully in an open or closed fashion using maxillomandibular fixation (MMF) screws. This was a prospective institutional review board-approved study involving 20 adult patients who presented to the university emergency department or oral and maxillofacial surgical clinic with uncomplicated mandible fractures. Patients who met the exclusion criteria consented to enter the study in the open reduction internal fixation (ORIF) or the closed (MMF) study group. Six to 8 MMF screws were used to obtain intermaxillary fixation (IMF) in the 2 groups. Screw failure was documented. All screws were removed at 5 to 6 weeks postoperatively. Insertional torque (IT) was measured at time of screw placement to assess primary stability. Clinical and photographic documentation was performed to assess fracture healing, occlusion, and gingival health. Ten-centimeter visual analog scales were used to assess patient-centered outcomes. Cone-beam computed tomography was performed to assess the long-term effects on the periodontium and roots. A cost comparison was performed to determine whether the use of screws was cost effective compared with arch bars. Fifteen men and 5 women (mean age, 25.2 yr) entered the study. All patients displayed adequate fracture healing based on clinical examination. All patients had acceptable occlusion at 5 to 6 weeks postoperatively. Total screw failure was 27 of 106 screws (25.5%). Forty percent of screws placed in the MMF group failed compared with only 6% in the ORIF group. Gingival health scores were favorable. Factors that had a significant effect on screw failure included a lower IT (P = .002), use in closed (MMF) treatment (P < .001), and use in the posterior jaw (P = .012). Minimal pain was associated with the MMF screws and pre-existing occlusion was re-established based on patients' subjective responses. The MMF group reported a statistically significant lower quality of life (P < .001) compared with the ORIF group. There was only 1 screw site that had a facial cortical bone defect noted at 6-month follow-up CBCT examination. There were no discernible long-term root defects. Cost analysis showed that the use of MMF screws saved around $600 per patient in operating room usage cost alone compared with the estimated use of arch bars. Uncomplicated mandible fractures were successfully treated using MMF screws in open and closed treatments. However, the utility in closed treatment was decreased because of significant screw failure and patient noncompliance. The screws were well tolerated by the patients. There was minimal long-term damage to the periodontium and dental roots. The cost of screws was more than offset by time savings.

Are Maxillomandibular Fixation Screws a Better Option Than Erich Arch Bars in Achieving Maxillomandibular Fixation? A Randomized Clinical Study

The aim of this study is to see the efficacy of maxillomandibular fixation (MMF) screws with arch bars and to compare the plaque index in between 2 methods of MMF. This study is a randomized clinical trial. The study sample was derived from the population of patients who reported to Department of Oral and Maxillofacial Surgery, Wardha, Maharasthra, India between October 2006 and September 2008 and who required MMF. The patients were assessed for the time required in minutes for the placement and removal of screws and arch bar. Postoperative stability after achieving the MMF of both groups was analyzed and the plaque that was accumulated in both groups was evaluated by using TURESKY-GILMORE-GLICKMAN modification of the QUIGLEY-HEIN plaque index. Statistical analysis was performed with SPSS statistical software for Windows, version 8.0 (SPSS, Inc, Chicago, IL) using the χ(2) test and Student t test. The average working time for placement and removal of MMF screws is 18.67 minutes and 10.20 minutes, respectively, and for arch bars is 95.06 minutes and 29 minutes, respectively. The mean value of plaque index in group I is 1.88 and in group II is 2.69. It signifies that plaque deposition was more in group II. No occlusal disturbance was seen in both groups. Incidence of MMF screws causing damage to tooth root is 5.81% and incidence of screw breakage was seen in 3.33% of patients. Oral hygiene maintenance is better in patients with MMF screws than with arch bars with fewer complications and less operating time. Erich arch bars are the preferred choice in patients who require long-term MMF, because the screws start loosening after 5 to 6 weeks.

Maxillomandibular Fixation Screws for Early Removal of Hardware and Correction of Lingual Tilting in Alveolar Distraction Osteogenesis

Alveolar distraction osteogenesis is a well-known technique used for the management of deficient alveolar ridges. Vector control of the transport segment is the main problem during distraction. This article describes a new technique for early removal of distractor and correction of tilted transport segment in partially edentulous patients.

The use of maxillomandibular fixation screws with essig wiring in the treatment of symphyseal fracture of deep bite patients

Today, the use of the arch bars in the treatment of mandibular fractures is common [1]. But it has complications such as damaged teeth, periodontal tissue [2], risk of blood transmitted disease [3] and premature contact with maxillary incisor teeth in anterior deep bite occlusion. Many techniques are used for resolving these problems.In this paper, we describe the technique of using Maxillo-Mandibular Fixation Screws (MMFS) with essig wiring of anterior mandibular teeth in the management of symphyseal fracture of deep bite patients.

Result of Maxillomandibular Fixation Using Intraoral Cortical Bone Screws for Condylar Fractures of the Mandible

Treatment of mandibular condylar fractures is not standardized. The maxillomandibular cortical bone screw fixation technique carries many advantages. The aim of this work was to evaluate this technique for routine method. Fifty patients treated by maxillomandibular fixation (MMF) by use of cortical bone screws from 2004 to 2006 were retrospectively analyzed. In our maxillofacial surgery unit in Bordeaux, France, our indication is to treat extra-articulated fractures without severe displacement by MMF. The mean time required for MMF was 13 minutes, and fixation occurred after a mean of 16 days. Screw removal was performed after a mean of 26 days, and this required local anesthesia. Of the patients, 48 had good occlusion. Two patients had persistent lateral cross bites. Two patients had mandible deviation when they opened their mouths, and mouth opening was limited in one patient. Two patients had temporomandibular joint pain. MMF screws have more advantages and fewer disadvantages than arch bars when closed treatment has been selected as the treatment of choice.

Mandibular Fractures Treated with Maxillomandibular Fixation Screws (MMFS Method)

The purpose of the treatment of mandibular fractures is to restore proper dental occlusion and stable temporomandibular joint movement, as well as the reduction of the displaced fracture. Consideration must be given to the selection of the most appropriate surgical and rehabilitation methods in such patients. Typical surgical methods for the treatment of mandibular fractures include the arch bar method or plating at the location of the fracture combined with fixing the mandible to the maxilla using the arch bar method. However arch bars and circumdental wires, which require teeth for fixation, damage teeth and periodontal tissue, and tend to be uncomfortable for patients during the fixation period. Moreover, daily maintenance of oral hygiene is difficult for patients with an arch bar. Surgeons are also exposed to the risk of blood-transmitted diseases through skin punctures by wires when affixing these devices. For these reasons, we chose to study the potential of the MMFS method, which is thought to lessen all of the following problems: tissue damage, operating time, patient discomfort, and possible exposure to percutaneous infectious disease due to puncture of gloves and skin by the wires. We demonstrated the utility of the MMFS method in the present study.