WIRING

TECHNIQUES
IN MAXILLOFACIAL
SURGERY

HISTORIC EVOLVATION

DEFINITION OF IMF & MMF

IMF

Fixation of fracture of the mandible or maxilla

by applying elastic bands or stainless steel wire
between the maxillary and mandibular arch bars
or other types of splint.

MMF

The binding of maxillary and mandibular

teeth together to immobilise the jaw in
patient with a mandibular fracture.

INDICATION FOR MMF

Non-displaced # &favourable #
Grossly communited #
Edentulous atropic mandibular #
# in children
Condylar #

CONTRAINDICATION FOR MMF

Poorly controled seizures

Compromised pulmonary function
Psychatric & neurological disorder

ARNAMENTORIUM USED FOR

MMF

Needle holder, wire cutter, artery forceps, 26

gauge wire, arch bar,tweezer, shepherds
hook probe

PRECAUTION FROM WIRE

INJURY

High risk of sero-transmission to operator

during the placement of MMF wiring can be
reduced by protecting our fingers with
bandage before wearing the gloves.

TWISTING DENTAL WIRE

WIRES IN MMF

26 gauge(0.45mm soft stainless steel) wire

has been found effective.
This wire require stretching(about 10%)
before use.
6 inch(15 cm) length wire is commonly used.
Twisted portion should be parallel(in the long
axis) to wire loop.if not wire will break.
Care should be taken to hold the free end to
avoid the eyeball injury during wire cutting.
Over tightening may cause avulsion of tooth.

PRECAUTION IN WIRING

Recognize the pre-existing occlusal

abnormality like open bite , cross bite.
Wire should be tugged inter dentally/towards
occlusion.
It should not impinge gingival soft tissue& it
should not interfere occlusion.
Finger should be run around patients mouth
to ensure loose end & sharp end-they might
ulcerate the mucosa.
Always ensure tongue is not trapped between
teeth.

TYPES OF WIRING TECHNIQUES

Essigs wiring
Gilmers wiring
Ivy eyelet wiring
Risdons wiring
Arch bar
Erichs arch bar
Jelenko archbar
Two german silver bar

ESSIGS WIRING

GILMERS WIRING

RISDONS WIRING

IVY EYELET WIRING

Whenever required without distrubing the

main wire joining wire can be removed
When there is breakage only the eyelet can
be removed and replace

STEPS IN IVY EYELET FIXATION

ERICHS ARCH BAR

It is effective,quick&inexpensive method of fixation.

Prefabricated,custom made,acraylated arch
bar,erichs,jelanko,german two silver bar are types of arch bar.
Prefabricated flat malleable ss metal strip.
In upper jaw hook towards upward ,in lower jaw hooks towards
downward direction.
It should not cross the fracture line.

STEPS IN ARCH BAR FIXATION

SEMI CIRCLE ARCH BAR

BONDED ARCH BAR

Archbar is modified by micro-wiremesh

incorporation in base surface & sand blasting
to attain the rough surface to bind with resin
for micro-mechanical bond.

ADVANTAGE & DISADVANTAGE OF

BONDED ARCH BAR

Advantage
1.oral hygeine
2.safty to operator(from serotransmission of
blood born virus HBV-30%,HCV-1.85,HIV0.32%)
4.injury to periodontium is reduced
Disadvantage
Attainment of moisture free enamel surface is
difficult.
Stability is lesser than conventional archbar.

COMPARISON OF FREQUENTLY USED

WIRING TECHNIQUE

BUTTONS AS EYELET IN MMF

SCREW RETAINED IMF

SCREW RETAINED MMF

Alternative to conventional MMF.

Titanum screw fixed with maxilla or mandible.
Safe time-sparing,patient comfortable,,no occlusal
disturbance,oral hygeine maintenance are advantage.
Screw loosening,root fracture,loosened wire,screw
shear,malocclusion&ingested hardware are disadvantage.

COMPARISION BETWEEN SCREW V/S

ERICHS ARCHBAR

Self tapping screws are used faster than

erichs arch bar.
Screw need 8.52-11.2 minutes to fix IMF.
Erichs arch bar need 100 minutes to fix IMF.
Oral hygiene status is good in 90% of
patient,fair in 10% of patient.
Iatrogenic injury to root fracture is a
disadvantage .

IMF USING THERMOFORMING

PLATE

In plaster model thermoforming (inner soft

sheet-ethylene vinyl acetate,outer hard
sheet-polycarbonate SCHEU-DENTAL.Co)
adapted(like night guard,soft occlusal
splint).
In articulater after model surgery desiarable
occlusion achieved(indirect method-in lab).
TP is then transferred to patient mouth to do
IMF.
TP strength is appropriate in all case.
Period range-12 days,next 7 days day/night
alternatively imf is used.

ROHTAK DENTAL COLLEGE

(RDC)TECHNIQUE

It is a simple,quick,economical &mininally invasive technique.

Lesser periodontal problem,no specialized instrument or lab
work is required for this technique.
Indicated in minimally displaced #,orthognathic surgery & in
tumor resection surgery.
Could be used in mass casualties such as war injury or natural
calamities.

MATRIXWAVE MMF

BONE-BORN MMF system consist wave shaped

plate attached to maxilla & mandible with selfdrilling locking screws give additional anchorage.

MATRIXWAVE MMF SYSTEM

Plate can be stretched in plane.

Occlusion is brought by wiring around the
hooks & accessible screw heads.
Used in age12 or higher(in whom permanent
teeth have erupted).
Designed to help avoid tooth loosening,for
patient comfort.

SMART LOCK HYBRID MMF

A revolutionary system combines both ARCH

BAR and MMF SCREW.
Strength & rigidity of arch bar with safety &
efficiency of MMF screw.
This omit the need of securing wire
placement , thereby reduce the chance of
wire stick injuries.

ADVANTAGE OF SMART LOCK HYBRID MMF

It can be removed under LA.

Safety to patient protect the gingival soft
tissue & tooth roots.
Placement doesnt contingent on existing
dentition thereby reduce the risk of tooth
avulsion.

PREVELANCE OF MMF

COMPARISON OF COMPLICATION BETWEEN OPEN

REDUCTION & CLOSED REDUCTION (MMF)

PERIOD OF IMMOBILIZATION

Young adult with # of angle : 3 weeks.

Tooth retained in fracture line : add 1 week.
Fracture at the symphysis : add 1 week.
Age 40 years and over : add 1 or 2 weeks.
Children and adolescents : subtract 1 week.

CALCULATING THE DURATION OF MMF

eg: A 40-year old patient , symphysis
fracture, where tooth in fracture line
(base 3 weeks+1 week for less favorable
site+1 week allowed for age+1 week for
tooth retained in fracture line) require 6
weeks immobilization.

ADVANTAGE OF MMF

More conservative.
In presence of sufficient teeth,a simple
fracture is expected for clinical union
within 4 weeks
Useful in medically compromised patient.
Complication of surgery is not present.
Great skill(surgical skill) not required.

PITFALLS OF MMF

Can not be abtain absolute stability.

Decreased nutritional status-weight loss.
Oral hygiene maintenance is difficult.
Thinning &necrosis of articular cartillage.TMJ
sequelae (MPDS).
Osteoporosis,adhesion in joints.
Atrophy & weakening of muscles.

CONCLUSION

Inspite of growing ethusiasm for ORIF, MMF

remain a relevent technique in maxillofacial
surgery.
In some case are more cost effective than
rigid fixation.
By using recent advancement technique in
MMF we can get a faster, safety, better
stable fixation with patient comfortable &
good oral hygeine.

Thank you