The Employment of Orthodontic Bracket System as Method of Intermaxillary Fixation in Cases of Traumatic Mandibular Fractures: Retrospective Literary Review and Own Experience

Introduction. Intermaxillary fixation is an important and inseparable constituent part of treatment of trauma patients which provides an adequate interocclusal relationship. It can be employed as a solely conservative moda lity for fracture treatment as well as obligatory assistance of jaw osteosynthesis in case of its traumatic injury. The essential drawbacks of the existing methods of intermaxillary fixation, particularly dental arch bars and ligatures, are negative infl uence on periodontium, complicated hygiene, non-balanced muscular loading, pain and psychological discomfort to the patient etc, which requires a search for alternative methods. A stream development and inculcation to the clinical practice of various orthodontic systems in recent decades allow extrapolating the indications for their employment from orthodontics to other dental directions, especially maxillofacial traumatology. The purpose of the study is a retrospective analysis with clarification of historical aspects and generalization of own experience of employment of non-removable orthodontic technique (bracket system) for fixation of bone fragments in cases of traumatic mandibular fractures. Materials and research methods. Since 2012 in the Department of Surgical Dentistry and Maxillofacial Surgery of The Danylo Galytsky LNMU 57 patients (men – 45, women – 12; age 18 – 45) with traumatic mandibular fractures were examined and treated surgically (control group, 35 patients) and conservatively (main group, 22 patients). In all patients of the main group the intermaxillary fixation was carried out using the elements of non-removable orthodontic technique – brackets VictoryÒ with hooks (specification 0° TQ, 0° ANG, 022) (3М Unitek, USA), which were fixed on teeth according to standard protocol, including acid enamel etching, employment of adhesive, fixation of brackets with light-curing composite). Later the hooks of opposite brackets were joined together by elastic rubber rings in proper occlusal relationship. Control inspection of patients was carried out on 1, 3, 7, 14, 21, 30, 60 and 90 days post-operatively. Results. The obtained results of employment of non-removable orthodontic elements (brackets) for bone fragments fixation in 22 patients with traumatic mandibular fractures were evaluated by us as satisfactory. The mean period of intermaxillary fixation was 19 ± 2 days. On that time clinical and roentgenological signs of fracture consolidation were observed in all patients and there were no occlusal disturbances in any case as well as other complications except of unglue of brackets from the teeth surface. There were no patients' complaints regarding laboured oral hygiene and service of orthodontic appliance. Positive results of investigation are confirmed by the demonstration and description of a clinical case. Conclusions. Summarizing the results of a brief retrospective literary analysis as well as our own clinical experience it could be asserted that employment of elements of non-removable orthodontic technique (bracket system) for fixation of bone fragments in cases of traumatic mandibular fractures creates a serious alternative to the existing methods of an intermaxillary fixation. The proposed method allows to reestablish an adequate anatomical and functional status of the mandible in short terms, facilitates oral hygienic maintenance, requires no local anaesthesia and is suitable for both balanced occlusal loading distribution and, oppositely, correction of occlusal relationship by means of directed elastic pull.