Wiring Techniques Ppt

WIRINGTECHNIQUES 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 . artery forceps.tweezer. 26 gauge wire. shepherds hook probe… . wire cutter.ARNAMENTORIUM USED FOR MMF  Needle holder. arch bar. .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 . 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. 6 inch(15 cm) length wire is commonly used. .45mm soft stainless steel) wire has been found effective. This wire require stretching(about 10%) before use.WIRES IN MMF       26 gauge(0. Twisted portion should be parallel(in the long axis) to wire loop. PRECAUTION IN WIRING      Recognize the pre-existing occlusal abnormality like open bite . Finger should be run around patient’s mouth to ensure loose end & sharp end-they might ulcerate the mucosa. cross bite. . It should not impinge gingival soft tissue& it should not interfere occlusion. Wire should be tugged inter dentally/towards occlusion. Always ensure tongue is not trapped between teeth. TYPES OF WIRING TECHNIQUES Essig’s wiring  Gilmer’s wiring  Ivy eyelet wiring  Risdon’s wiring  Arch bar Erich’s arch bar Jelenko archbar Two german silver bar  . ESSIG’S WIRING . GILMER’S WIRING . RISDON’S 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 . Prefabricated.german two silver bar are types of arch bar.erich’s.quick&inexpensive method of fixation. .in lower jaw hooks towards downward direction.acraylated arch bar. In upper jaw hook towards upward .ERICH’S ARCH BAR      It is effective.jelanko. It should not cross the fracture line.custom made. Prefabricated flat malleable ss metal strip. 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 1.85.safty to operator(from serotransmission of blood born virus HBV-30%.32%) 4.injury to periodontium is reduced Disadvantage Attainment of moisture free enamel surface is difficult.HIV0.HCV-1. Stability is lesser than conventional archbar.oral hygeine 2. COMPARISON OF FREQUENTLY USED WIRING TECHNIQUE . BUTTONS AS EYELET IN MMF . SCREW RETAINED IMF . malocclusion&ingested hardware are disadvantage. .loosened wire..root fracture. Titanum screw fixed with maxilla or mandible.screw shear. Safe time-sparing.oral hygeine maintenance are advantage. Screw loosening.no occlusal disturbance.patient comfortable.SCREW RETAINED MMF     Alternative to conventional MMF. COMPARISION BETWEEN SCREW V/S ERICH’S ARCHBAR      Self tapping screws are used faster than erich’s arch bar. Iatrogenic injury to root fracture is a disadvantage . Screw need 8.52-11. Oral hygiene status is good in 90% of patient. .2 minutes to fix IMF. Erich’s arch bar need 100 minutes to fix IMF.fair in 10% of patient. . Period range-12 days.IMF USING THERMOFORMING PLATE      In plaster model thermoforming (inner soft sheet-ethylene vinyl acetate.next 7 days day/night alternatively imf is used. TP strength is appropriate in all case.soft occlusal splint). TP is then transferred to patient mouth to do IMF.outer hard sheet-polycarbonate SCHEU-DENTAL. In articulater after model surgery desiarable occlusion achieved(indirect method-in lab).Co) adapted(like night guard. quick.ROHTAK DENTAL COLLEGE (RDC)TECHNIQUE     It is a simple. .economical &mininally invasive technique.orthognathic surgery & in tumor resection surgery. Lesser periodontal problem. Could be used in mass casualties such as war injury or natural calamities.no specialized instrument or lab work is required for this technique. Indicated in minimally displaced #. .MATRIXWAVE MMF  BONE-BORN MMF system consist wave shaped plate attached to maxilla & mandible with selfdrilling locking screws give additional anchorage. for patient comfort. Designed to help avoid tooth loosening. . Used in age12 or higher(in whom permanent teeth have erupted).MATRIXWAVE MMF SYSTEM     Plate can be stretched in plane. Occlusion is brought by wiring around the hooks & accessible screw heads. This omit the need of securing wire placement . . Strength & rigidity of arch bar with safety & efficiency of MMF screw.SMART LOCK HYBRID MMF    A revolutionary system combines both ARCH BAR and MMF SCREW. thereby reduce the chance of wire stick injuries. .ADVANTAGE OF SMART LOCK HYBRID MMF    It can be removed under LA. Placement doesn’t contingent on existing dentition thereby reduce the risk of tooth avulsion. Safety to patient protect the gingival soft tissue & tooth roots. PREVELANCE OF MMF . COMPARISON OF COMPLICATION BETWEEN OPEN REDUCTION & CLOSED REDUCTION (MMF) . . Age 40 years and over : add 1 or 2 weeks. Fracture at the symphysis : add 1 week. Children and adolescents : subtract 1 week. Tooth retained in fracture line : add 1 week.PERIOD OF IMMOBILIZATION      Young adult with # of angle : 3 weeks. symphysis fracture.CALCULATING THE DURATION OF MMF eg: A 40-year old patient . 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. . . Great skill(surgical skill) not required. Complication of surgery is not present. In presence of sufficient teeth.ADVANTAGE OF MMF      More conservative.a simple fracture is expected for clinical union within 4 weeks Useful in medically compromised patient. adhesion in joints.TMJ sequelae (MPDS). Thinning &necrosis of articular cartillage. Atrophy & weakening of muscles.PITFALLS OF MMF       Can not be abtain absolute stability. . Oral hygiene maintenance is difficult. Osteoporosis. Decreased nutritional status-weight loss. MMF remain a relevent technique in maxillofacial surgery. By using recent advancement technique in MMF we can get a faster. better stable fixation with patient comfortable & good oral hygeine. safety. In some case are more cost effective than rigid fixation. .CONCLUSION    Inspite of growing ethusiasm for ORIF. Thank you .