37. MANDIBULAR FRACTURES. ORTHOPAEDIC TREATMENT

what is closed reduction and what are the 2 types?

= reduction of the fragments without surgical exposure

- manual.= directly reducing fragment

- elastic traction = gradually reducing over time via elastics (useful for more displaced + mobile fragments)

what are the indications of closed reduction?

recent fracture

mobile fragments

minimal displacement

what are the indications of open reduction?

- failed closed reduction

- when closed reduction is contraindicated (surgical tx needed e.g.

cyst in fracture line

osteomyelitis

edentulous/ severe malocclusion {no teeth/occlusion for fixation})

- old, immobile fracture

what are the indications for orthopaedic treatment of mandibular fractures?

stable teeth

minimal/no displacement

mobile fragments

fracture in which closed reduction is indicated

what are the contraindications for orthopaedic treatment of mandibular fractures?

- old fractures

- significant dislocation between fragments

- grade 3 mobility of teeth (advanced periodontitis)

what are the most common orthopaedic methods for mandibular fractures?

Dental ligatures

Arch bars

Splints

what are the types of orthodontic splints?

According to Material:

Aluminum

Steel

Acrylic

Reinforced acrylic

According to Support

Tooth-borne

Attached to teeth.

Ridge-borne

Attached to edentulous alveolar ridges.

IMF Splints

Contain hooks that receive elastics for IMF.

what are types of temporary immobilisation methods used in the dental office?

Gilmer's Ligature: temporary wire fixation.

Ivy Loop: Loop wiring for IMF.

Ernst Wiring: Emergency stabilization technique.

when can splints be used?

when there are enough stable teeth

when there is minimal dislocation

when we can use inter maxillary fixation

when there are maxillary and mandibular teeth which are stable

what are the types of custom splints we can use?

1. risdon's wiring

2. chavdarov's wiring

3. roy-stout wiring

4. baronov's wiring

5. atanasov's wiring

how is Risdon's wiring splint made?

0.4mm thick, 25cm long wire (2 wires)

- 2 wires twisted around distal molars on each side

- ends of each wire twisted buccally

- both wires connected at midline = buccal base wire

tie the ligatures in the cervical region of each tooth to anchor each tooth to buccal base

- hooks at lengths of 6-8mm can be placed for IMF

how is Chavdrov's wiring splint made?

0.4mm thick, 45-50cm long wire (1 wire)

modified risdon technique in which 1 wire is used instead of 2 (simpler)

how is Roy Stout wiring splint made?

0.4mm thick, 70-80cm long wire

- loop wire around most distal mandibular tooth

- short part of wire used to form buccal base

- place a small rubber tube along the base

- he long part of the wire is passed lingually to bucally through the interdental spaces

- bring the wire back from the lingual side and make loops

- remove the rubber tube and twist the loops to anchor the wire to the teeth

- twisted loops form rigid hooks - can be used for IMF

how is Baranov's wiring splint made?

0.4mm thick, 70-80cm long wire

- form separate loops and hooks, drive them between the teeth from lingual to buccal direction

- adjacent hooks are twisted together in pairs on the buccal side

- The enlarged hooks serve as attachment points for:

elastics

ligature wires

to achieve intermaxillary fixation (IMF).

why might baranovs wiring be preferred over roy-stout wiring?

better oral hygiene

less plaque accumulation (dt no horizontal buccal base wire)

how is Atanasov's wiring splint made?

create 12-14 loops of wire 8-10mm apart

smooth part of the wire should be left to curve around the last molar

loops insert interdentally and tightened

smooth part of the wire passes through all the loops creating a continuous buccal base

can be reduced to 3-4 loops for improved hygiene

what are the standard dental splints?

these are commercially available arch bars

give an example of a standard dental splint

Dimac Ligature

- 0.5mm thick, 5-6cm long

- wire has threaded end + plastic head (hexagonal shape)

- threaded end past through interdental spaces

- plastic head tightened with special wrench

- elastics are attached to these plastic anchor points

what are the advantages of the Dimac ligature?

easy to fit

good for oral hygiene

what are the disadvantages of the Dimac ligature?

only suitable for fractures with minimal fragmentation

schuchardt's splint (laboratory-made splint)

- consists of a buccal base and perpendicular seats

- buccal ends form IMF

- occlusal ends remain on teeth and are removed after ligation

- self-curing acrylic is used to fixate splint to teeth

gunning-port-limberg splint (laboratory-made splint)

- maxillary and mandibular splints fabricated after impression of edentulous jaws

- joined together via self-curing acrylic

- anchored to jaws via special screws + grooves