Double Loop Interdental Wiring: A Neoteric Technique for Maxillo-mandibular Fixation
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TECHNICAL NOTE
Double Loop Interdental Wiring: A Neoteric Technique for Maxillo-mandibular Fixation Ramakrishna Shenoi1 • Jignesh Rajguru1 Jignesh Rajguru1
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Pranav Ingole1 • Jui Karmarkar1
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Received: 13 August 2020 / Accepted: 6 October 2020 Ó The Association of Oral and Maxillofacial Surgeons of India 2020
Introduction
Technique
The objective of establishing intra-operative occlusion by temporary inter-maxillary fixation remains constant even with evolving principles for treatment for facial fractures. The techniques used during the intra-operative temporary inter-maxillary fixation (IMF) consist of Erich arch bars, Ivy interdental eyelet wiring, resin-bonded arch bars, bonded brackets, inter-maxillary fixation screws, cast metal splints, embrasure wires and pearl steel wires [1]. Erich arch bar along with circumdental wiring for intermaxillary fixation is one of the most widely accepted technique for facial fractures [2]. However, the procedure can be time consuming and cumbersome at times. It also affects the marginal part of periodontal complex. In view of fracture realignment and immobilisation, Maxillo-mandibular fixation (MMF) screws are inserted into the bony base. However, MMF screws may pose a constant risk to damage the radicular structure if the technique has not been mastered. It also lacks the versatility beyond its pure maintenance of occlusion [3]. We have devised a technique that overcomes the relative bulky and rigid arch bars which may not be well tolerated by the patients and the damage to the radicular structures during the placement of IMF screws.
A pre-stretched 24G wire of appropriate length is used in the following technique. A single loop is incorporated in the centre of the wire. One end of this wire is passed along the buccal interdental embrasure on the distal aspect of first molar, and the same end is passed from the palatal interdental embrasure mesial to first premolar and brought out buccally with the help of wire forceps. The other end of the wire is passed along the buccal interdental embrasure on the mesial aspect of first molar in a manner where the loop lies between the second premolar and first molar, and the wire is encircled around the neck of second premolar and passed along the palatal interdental embrasure and brought out buccally. Another loop is made at this point, and the wire is then adapted along the buccal aspect. Both the ends of the wire are twisted to form a rosette. Thus, both the loops lie mesial and distal to second premolar as shown in Figs. 1, 2, 3, 4 and 5. The maxillo-mandibular fixation is achieved using 24G or 26G wire after appropriate reduction. The above-stated technique reduces the number of wires incorporated to achieve MMF. Hence, the marginal complex of periodontal tissues is less traumatised as compared to arch bar. The possible drawback of the proposed technique would be difficulty in achieving MMF in cases with multiple avulsed teeth. Therefore, appropriate case selection is of paramount significance. The authors advocate this techni
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