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WIRING TECHNIQUES

Sidra Tul Muntaha


INTERMAXILLARY FIXATION

Establishing a proper occlusal relationship by


wiring the teeth together is termed
intermaxillary fixation or maxillomandibular
fixation.
 Orthognathic surgery to stabilize the pt’s new
occlusion
 Trauma

• Dentoalveolar Trauma , splinting of mobile teeth

• Either with or without Plating for reduction,


fixation and stabilization of fractures.
• Treatment of choice for condylar fractures given
with elastics to guide occlusion
• In children to avoid damage to permanent tooth
buds IMF is done for fracture reduction
Common MMF methods are:
 Arch bars

 Bone supported devices including intermaxillary


fixation (IMF) screws and interarch miniplates .
There other methods of wire fixation such as Ivy
loops, Gilmer wiring, Stout wiring and Kazanjian
buttons to name but a few.
INDICATIONS

Arch bars are preferred:


 For temporary fragment stabilization in
emergency cases before definitive treatment
 As a tension band in combination with rigid
internal fixation
 For long-term fixation in conservative treatment

 For fixation of avulsed teeth and alveolar crest


fractures( dentoalveolar trauma)
GENERAL CONSIDERATIONS
There are important points to consider before
starting.
The occlusion must be checked. In the case of jaw
malformations, such as a deep bite deformity, it
may be impossible to use arch bars.
There should be calculable tension forces on both
bars, so the hooks should be symmetrically
positioned in the upper and lower jaw. This
symmetry is essential for functional training
with elastics.
 One pitfall when using arch bars is the risk of
contamination of bloodborne infection from
patients. Passing the wires to secure the arch bar
can result in a puncture or tear in the surgeon’s
glove and the possibility of disease transmission
to the surgeon
ARCH BAR PREPERATION
Check occlusion
Before inserting the arch bars, check the
occlusion. There should be full interdigitation of
the teeth with regular contacts.
Determine if the patient has a normal occlusion
or a preexisting malocclusion before taking the
patient to the operating room.
Adjusting the shape
The prefabricated arch bar must be adjusted in
shape and length according to the individual
situation. The arch bar should not damage the
gingiva.
Firstly, the bar is adapted closely to the dental
arch. The bar should be placed between the
dental equator and the gingiva.
Trimming the bar
The bar should be trimmed to allow ligation to as
many teeth as possible. The bar should not
extend past the most distal tooth or protrude into
the gingiva as this will be an irritation to the
patient.
ARCH BAR:BAR POSITION
 Symmetric bar position
To achieve calculable tension forces on both bars,
the hooks must be positioned symmetrically in
the upper and lower jaw. This symmetry is
essential for functional training with elastics.
ARCH BARS:BAR FIXATION
Ligature preparation
To fix the arch bar in place, prepare a ligature in
the premolar region of each side. The wire ends
should not damage the surrounding soft tissues.
Attaching the bar
Position the arch bar and fix it using the wire
twister.
In the premolar and molar regions one end of the
wire is above the arch bar and the other end
below it.
 Wire end
Cut the wire with the cutter and turn the ends
away from the gingiva to prevent damage.
 Make sure the wire rosettes do not protrude
away from the arch bar as this will be an
irritation to the patient.
ARCH BARS MAXILLOMANDIBULAR
FIXATION

General considerations
Mandibulomaxillary fixation (MMF) can be used
either intraoperatively to establish the correct
occlusion or as part of postoperative management
of the patient’s injury. MMF may be
accomplished with wires or training elastics
depending on the overall treatment plan for the
patient.
 With wires
The wire loop is placed over the maxillary and
mandibular lugs of the arch bar and the wire loop
is tightened.
MMF completed with wire fixation. At least three
wires, a posterior wire loop in each side, and an
anterior wire loop will provide stable fixation.
 Elastics
Some surgeons prefer MMF with elastics for
intraoperative management of the occlusion.
Additionally, postoperative training elastics can
be used to manage condylar fractures in a closed
manner.
TYPES OF WIRING TECHNIQUES
1. ESSIG’S WIRING
2. GILMER’S WIRING
3. RISDON’S WIRING
4. IVY EYELET WIRING
5. COL. STOUT’S MULTILOOP WIRING
ARMAMENTARIUM
 Presterilized 26 gauge stainless steel wire sloop
or wires cut into of 20cm each.
 Two needle holders or wire holders.

 Wire cutters.
IVY EYELET LOOP WIRING
 Simple and effective method for the reduction
and immobilization of jaw fractures.
 Use in combination with gunning type of splint in
an opposing edentulous arch
ADVANTAGE:
 Fixation may be released by removal of
intermaxillary ligatures.
 Even when there is breakage of a wire during
fixation only that eyelet can be removed and
replaced.
 Eyelets are constructed by holding a 6inch (15cm)
length of wire by a pair of artery forceps at either
end and giving the middle of the wire two turns
around a piece of round bur 3mm in diameter
which is fixed in an upright position.
After selecting the teeth to be wired both ends of
the eyelet wire are inserted through the
interdental space from the outer surfaces of the
teeth. As the wires emerge on the lingual or
palatal side they are gripped by a second pair of
forceps that is manipulated by an assistant who,
passes the wires back through the adjacent
mesial and distal interdental space
The operator grips each wire as it emerges from the
space and pulls it through. The distal wire is
pulled through the loop of the eyelet and both
ends are pulled tight and twisted together with
the wire holder. Push the wires down on the
lingual and palatal aspects below the maximum
diameter of the teeth with an instrument
otherwise eyelet will tend to be displaced up the
tooth and become loose.
The ends of the wires are cut and bent into the
interdental spaces towards the gingiva to prevent
irritation of the lips and cheek.
The wires should be tightened in the molar area
first on one side and then on the other, so
working round to the incisor area. If the wires
are tightened on one side first a cross over bite is
produced and if the anterior wires are tightened
before the wires in the molar area a posterior
open bite results. the wires may be twisted very
tight on the multirooted teeth, but some caution
should be exercised with single rooted teeth for
they may be extracted as a result of force from
twisting the tie wire over-tight.
About five eyelets are applied in upper and five in
the lower jaw and then the eyelets are connected
with the wires passing through the eyelets from
the upper to the lower jaw.