37. MANDIBULAR FRACTURES. ORTHOPAEDIC TREATMENT

what are the indications for orthopaedic treatment of mandibular fractures?

there should be teeth available for fixation and immobilisation

there should be small/no dislocation between mobile fragments

what are the contraindications for orthopaedic treatment of mandibular fractures?

old fractures

significant dislocation between fragments

grade 3 mobility of teeth

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)

loop the wire around most distal mandibular tooth

both ends are twisted together to form a solid buccal base

connect the twisted wires from the left to the right side to make 1 structure in the midline

tie the ligatures in the cervical region of each tooth

how is Chavdrov's wiring splint made?

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

same as Risdon's wiring but use 1 piece of wire to create a buccal base via longer wire

what are the standard dental splints?

these are commercially available arch bars

what are standard dental splints used for?

intermaxillary fixation and immobilisation

explain the dimac ligature

Dimac Ligature

- 0.5mm thick, 5-6cm long

the wire has a plastic head with an opening on one end and a screw thread on the other

threaded end goes between the teeth and exits buccally

tighten the ligature by screwing the plastic head with a wrench

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

What are some lab made splints?

Gunning port

Weber

Schuchardt

Gunning Port splints are used for what and how?

edentulous patients

impression taken and construction secured with anchor screws

Weber splints are used for what and how?

primary/mixed dentition and edentulous pts

acrylic construction made in lab after inital impression lies on alveolar ridge and around secured via self curing polymer

Weber splint disadavantge

unreliable fixation

Schuchardt splint design

thick piece of wire make base

seats soldered on wire

seatsa are 3-4mm with 2 ends one occlusal surface teeth other intermaxillary fixation

self curing polymer