Wiring Techniques Ppt

WIRING TECHNIQUES IN MAXILLO MAXILLOF FACIAL 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 # 

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rossly communited # 

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!dentulous atropic mandibular #  # in children

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"ondylar # 

CONTRAINDICATION FOR MMF  

oorly controled sei$ures

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"ompromised pulmonary function

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sychatric & neurological disorder

ARNAMENTORIUM USED FOR MMF  

Needle holder% wire cutter% artery forceps% ' gauge wire% arch bar%twee$er% shepherds hoo( probe)

PRECAUTION FROM WIRE INJURY  

*igh ris( of sero-transmission to operator during the placement of ++F wiring can be reduced by protecting our fingers with bandage before wearing the gloves.

TWISTING DENTAL WIRE

WIRES IN MMF  

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' gauge,./mm soft stainless steel0 wire has been found effective. This wire re1uire stretching,about 230 before use.

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' inch,2/ cm0 length wire is commonly used.

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Twisted portion should be parallel,in the long axis0 to wire loop.if not wire will brea(.

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"are should be ta(en to hold the free end to avoid the eyeball injury during wire cutting.

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4ver tightening may cause avulsion of tooth.

PRECAUTION IN WIRING  

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5ecogni$e the pre-existing occlusal abnormality li(e open bite % cross bite. 6ire should be tugged inter dentally7towards occlusion.

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8t should not impinge gingival soft tissue& it should not interfere occlusion.

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Finger should be run around patient9s mouth to ensure loose end & sharp end-they might ulcerate the mucosa. :lways ensure tongue is not trapped between teeth.

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TYPES OF WIRING TECHNIQUES 

!ssig9s wiring

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ilmer9s wiring

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8vy eyelet wiring

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5isdon9s wiring

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:rch bar !rich9s arch bar ;elen(o archbar Two german silver bar

ESSIG’S WIRING

GILMER’S WIRING

RISDON’S WIRING

IVY EYELET WIRING

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6henever re1uired without distrubing the main wire joining wire can be removed

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6hen there is brea(age only the eyelet can be removed and replace

STEPS IN IVY EYELET FIXATION

ERICH’S ARCH BAR 

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8t is effective%1uic(&inexpensive method of fixation.

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refabricated%custom made%acraylated arch bar%erich9s%jelan(o%german two silver bar are types of arch bar.

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refabricated flat malleable ss metal strip.

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8n upper jaw hoo( towards upward %in lower jaw hoo(s towards downward direction.

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8t should not cross the fracture line.

STEPS IN ARCH BAR FIXATION

SEMI CIRCLE ARCH BAR 

BONDED ARCH BAR 

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:rchbar 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 

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Advana!" 2.oral hygeine .safty to operator,from serotransmission of blood born virus *<=->3%*"=-2.?/%*8=.>30

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.injury to periodontium is reduced

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D#$advana!" :ttainment of moisture free enamel surface is difficult. @tability is lesser than conventional archbar.

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COMPARISON OF FREQUENTLY USED WIRING TECHNIQUE

BUTTONS AS EYELET IN MMF

SCREW RETAINED IMF

SCREW RETAINED MMF

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:lternative to conventional ++F. Titanum screw fixed with maxilla or mandible. @afe time-sparing%patient comfortable%%no occlusal disturbance%oral hygeine maintenance are advantage. @crew loosening%root fracture%loosened wire%screw shear%malocclusion&ingested hardware are disadvantage.

COMPARISION BETWEEN SCREW V%S ERICH’S ARCHBAR 

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@elf tapping screws are used faster than erich9s arch bar. @crew need ?./-22. minutes to fix 8+F.

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!rich9s arch bar need 2 minutes to fix 8+F.

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4ral hygiene status is good in A3 of patient%fair in 23 of patient.

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8atrogenic injury to root fracture is a disadvantage .

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IMF USING THERMOFORMING PLATE  

8n plaster model thermoforming ,inner soft sheet-ethylene vinyl acetate%outer hard sheet-polycarbonate @"*!B-C!NT:D."o0 adapted,li(e night guard%soft occlusal splint0.

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8n articulater after model surgery desiarable occlusion achieved,indirect method-in lab0.

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T is then transferred to patient mouth to do 8+F.

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T strength is appropriate in all case.

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eriod range-2 days%next E days day7night alternatively imf is used.

ROHTA DENTAL COLLEGE 'RDC(TECHNIQUE

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8t is a simple%1uic(%economical &mininally invasive techni1ue.

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Desser periodontal problem%no speciali$ed instrument or lab wor( is re1uired for this techni1ue.

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8ndicated in minimally displaced #%orthognathic surgery & in tumor resection surgery.

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"ould be used in mass casualties such as war injury or natural calamities.

MATRIXWAVE MMF  

<4N!-<45N ++F system consist wave shaped plate attached to maxilla & mandible with selfdrilling loc(ing screws give additional anchorage.

MATRIXWAVE MMF SYSTEM

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late can be stretched in plane.

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4cclusion is brought by wiring around the hoo(s & accessible screw heads.

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Bsed in age2 or higher,in whom permanent teeth have erupted0.

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Cesigned to help avoid tooth loosening%for patient comfort.

SMART LOC HYBRID MMF

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: revolutionary system combines both :5"* <:5 and ++F @"5!6.

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@trength & rigidity of arch bar with safety & efficiency of ++F screw.

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This omit the need of securing wire placement % thereby reduce the chance of wire stic( injuries.

ADVANTAGE OF SMART LOC HYBRID MMF

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8t can be removed under D:.

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@afety to patient protect the gingival soft tissue & tooth roots.

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lacement doesn9t contingent on existing dentition thereby reduce the ris( of tooth avulsion.

PREVELANCE OF MMF

COMPARISON OF COMPLICATION BETWEEN OPEN REDUCTION & CLOSED REDUCTION 'MMF(

PERIOD OF IMMOBILI)ATION  

oung adult with # of angle G > wee(s.

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Tooth retained in fracture line G add 2 wee(.

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Fracture at the symphysis G add 2 wee(.

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:ge  years and over G add 2 or  wee(s.

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"hildren and adolescents G subtract 2 wee(.

CALCULATING THE DURATION OF MMF egG   : -year old patient % symphysis fracture% where tooth in fracture line ,base > wee(sH2 wee( for less favorable siteH2 wee( allowed for ageH2 wee( for tooth retained in fracture line0 re1uire ' wee(s immobili$ation.

ADVANTAGE OF MMF  

+ore conservative.

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8n presence of sufficient teeth%a simple fracture is expected for clinical union within  wee(s

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Bseful in medically compromised patient.

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"omplication of surgery is not present. reat s(ill,surgical s(ill0 not re1uired.

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PITFALLS OF MMF  

 "an not be abtain absolute stability.

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Cecreased nutritional status-weight loss. 4ral hygiene maintenance is difficult.

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Thinning &necrosis of articular cartillage.T+; se1uelae ,+C@0.

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4steoporosis%adhesion in joints.

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:trophy & wea(ening of muscles.

CONCLUSION  

8nspite of growing ethusiasm for 458F% ++F remain a relevent techni1ue in maxillofacial surgery.

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8n some case are more cost effective than rigid fixation.

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