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Dental Wiring

Akmal Syakir Bin Kamarulzaman

What is Closed reduction?

Closed Reduction

  • Restoration and alignment of the fractured fragments to their original anatomical position without visualization of the fracture line

Indication :

  • Non displaced favourable fractures
  • Grossly comminuted fractures
  • Mandibular fracture in children
  • coronoid process and condylar fracture

Contraindication :

  • Unfavourable fractures at the angle of mandible
  • unfavourable fractures at the symphysis or body of the mandible
  • medically compromised patient
  • Complex facial fracture

Advantages

  • Inexpensive
  • short procedure
  • conservative
  • no operating room needed in most cases

  • Cannot obtain absolute stability
  • Difficult nutrition
  • atrophy and stiffness
  • Possible temporomandibular joint sequelae

Disadvantages

Direct Interdental Wiring

  • Essig's Wiring
  • Gilmer's Wiring
  • Risdon's Wiring

Indirect Interdental Wiring

Ivy loop/Eyelet Wiring

Arch Bar Fixation

Type Of Wiring Technique

Procedure

Essig's Wiring

  • Essig's wiring can be used to stabilize the dentoalveolar fractures in individual dental arches
  • Can be used as anchoring device for IMF
  • The luxated teeth can be stabilized using essig's wiring

How ??

  • The wire is passed interproximally between two teeth present a little away from fracture line
  • The wire are passed around the teeth in a figure of 8 until they reach 2 to 3 teeth away from the fracture line on the opposite side
  • Again,the wires are taken around 2 to 3 teeth in a figure of 8 manner
  • This act as an archbar which other smaller wires are tightened to stabilize the fracture

Gilmer's Wiring

  • Most common and it is used for IMF
  • Intermaxillary fixation is effected after reduction of fracture
  • Few firm teeth in maxilla and mandible are chosen
  • A pre stretched 26 gauge wire is taken and passed around the neck of chosen tooth
  • Both ends of the wire are brought out on the buccal side and twisted
  • Then the mandibular wires are twisted tightly with the corresponding maxillary wires
  • the ends are cut short and sharp ends are tucked in

Pictures

Intermaxillary fixation is effected after reduction of fracture by twisting seperate tails together obtaining

crisscross bracing

Risdon's Wiring

  • Indication : Fractures of pediatric maxillofacial skeleton

-The primary teeth are shorter and conventional arch bar may slip off intra and post operatively

  • The ends are twisted for entire length thus forming a strong base wire that comes towards the midline from each second molars
  • Two base wires are grasped and twisted at midline
  • The base wire is secured to individual teeth by using additional interdental wires
  • This type of horizontal wiring offers strong fixation

Picture

Indication

Ivy Eyelet

Wiring

  • Minimally displaced fractures
  • Deep bite cases
  • Stabilization of fracture during open reduction and internal fixation
  • Orthognathic surgeries

Disadvantage

  • Associated dentoalveolar fractures and subluxated teeth were not addressed

Pictures

Indication

Arch Bar Fixation

  • Stabilization of multifragments fracture
  • Fixation of IMF

Arch bars are prefered

  • For temporary fragment stabilization in emergency cases before definitive treatment
  • For long term fixation in conservative treatment
  • For fixation of avulsed teeth and dentoalveolar fractures
  • Conservative management of condylar fractures

Advantages &

Disadvantages

  • Rigidly splint the teeth
  • Provides good retention , stability and support
  • provides cross arch stabilization
  • Position closed to alveolar bone

  • Bulk of the arch bar
  • Plaque accumulation

Procedure

  • The arch bar is measured to fit from first molar to first molar
  • The arch bar is placed in such a way that the hooks face towards the gingival margin
  • 26 gauge wire (0.45mm) is taken and starting from the distal tooth
  • The wire is passed from buccal to lingual side below the arch bar and from lingual to buccal above the arch bar and twisted together.
  • This is continued for all the teeth and the arch bar is secured

References

1)Oral and maxillofacial surgery - Neelima Malik 3rd Edition

2)Oral Maxillofacial Surgery - S M Balaji

3)Risdon F. The treatment of fractures of the jaws. Can Med Assoc J. 1929;20:260–262. [PMC free article] [PubMed] [Google Scholar]

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