Britbh 0
loumol
of Oral and .Wa.ri/lofacia/
1990 The British
Association
Surgery
(19yo) 28, 136-137
of Oral and Maxillofacial
Surgeons
@266-4356X@O/0026-0136/110.00
TECHNICAL NOTE Modification of orthodontic brackets for use in intermaxillary
fixation
P. Magennis, P. Craven Maxillofacial Surgery Department,
A method of SUMMARY. traction/fixation is illustrated.
Chester Royal Infirmary, Chester CHl2AZ
modifying
orthodontic
brackets
to facilitate
their
use
in
intermaxillary
INTRODUCTION
Attaching wires or elastics around cleats on the arch-wires of fixed orthodontic appliances during orthognathic procedures is now an accepted practice. Where intermaxillary fixation is needed for the treatment of acute injuries, it is only very rarely such convenient devices are in situ. None the less, there are occasions when the use of acid-etched brackets bonded to teeth, as a base for intermaxillary fixation or traction, would be preferable to more conventional methods. Placing orthodontic brackets level to allow the immediate placement of a rigid arch-bar with cleats is difficult even for an experienced orthodontist. Used individually the shape of orthodontic brackets does not permit more than one elastic band (or wire) to be looped around them, and this requires considerable manual dexterity. If ordinary brackets are modified as illustrated below, placement of one or more elastics is made so simple that even the patient can manage it.
METHOD To make the loop, first choose a stainless steel wire of a diameter which fits snugly into the bracket’s slot. Make the first bend at a distance just less than the width of the slot. The second makes the side of the loop approximately 3 to 4 mm in length. The third bend completes the loop. The bracket will then self-retain within the loop (Fig. 1A). The long end of the wire is used to hold the assembly whilst at least four spot welds are placed. The wire is then cut off flush with the bracket and any sharp edges burnished (Fig. 1B). Placing brackets on the premolars and canines is usually adequate. It is important that care is taken to ensure that they do not prop open the bite. Elastics may be used to reduce the fracture and provide fixation so long as the teeth are opposed and the adjacent arch complete. Should it prove necessary to bracket a tooth which is unopposed or
Fig. IA - Wire loop engaging the slot in the orthodontic bracket.
Fig. IB - Modified bracket ready for use.
lacks the buttressing of adjacent teeth, wires rather than elastics should be used for fixation after reduction has taken place. This precaution avoids the complication of inadvertant orthodontic tooth movement. Brackets may be quickly placed with the patient in the dental chair using an acid etch technique without need for any anaesthetic and is well tolerated by the patient. They are reliable, easy to remove, and may be reused. 136
Orthodontic brackets for use in intermaxillarv tixation
137
He subsequently attended his own dental surgeon for initial treatment to his damaged teeth, his dentist being able to remove and replace the elastics before and after treatment. After 2 weeks the IMF was removed and on follow up a satisfactory clinical result was obtained. DISCUSSION The use of elastics attached
Fig. 2 - Modified brackets in use.
Case reports Case I A 23-year-old man attended the Accident Unit having sustained a fracture of the left angle of his mandible in an alleged assault. His dental arches were complete, the occlusion was deranged and his medical history included an intravenous drug abuse habit of 4 years duration. At the end of the afternoon clinic taking appropriate precautions, brackets were bonded to his premolars and elastics used to reduce his fracture. Four weeks IMF achieved a satisfactory clinical result.
to individual teeth for the reduction and/or fixation of mandibular fractures is not a new idea, Rowe and Williams (1985) illustrate a method using eyelets. The placement of eyelets or the wiring of an archbar-under local or general anaesthetic-is unpleasant and can even be dangerous for the patient. Nor are these procedures without risk to the operator, especially where patient’s medical or social history may make self-injury with a wire a significant hazard. Using the modified brackets traction may be applied to reduce a displaced fracture, or achieve occlusion when the condylar neck is fractured. The size of the force and the length of time (a few hours) required to do this are much less than would be necessary for extrusion to occur. Once the arches are together movement of a tooth is prevented by occlusion with the opposing tooth. There have been no problems in this respect with any of the seven patients treated by this method. Although not used as a routine, this technique has proved a useful adjunct to other methods available for treating fractured mandibles. Where intermaxillary traction or fixation alone is indicated, where the patient does not need an anaesthetic for any other reason, or where he has a medical condition which would make surgery hazardous for him or the surgeon, this technique is particularly indicated.
Cuse 2
Acknowledgements
A 17-year-old boy fractured the left angle of his mandible in a sports accident. His arches were complete, the occlusion deviated to the side of the fracture, and his bite was open 2 mm anteriorly. In&al wear suggested the open bite was as a result of the fracture. Brackets were bonded to the premolars and canines and elastics placed. His normal occlusion was soon restored. After five weeks the IMF was released, the following week the brackets were removed and the patient discharged after an uneventful review period.
To Mr J. I. Cawood (Chester Royal Infirmary) and Mr A. E. Green (Bury General Hospital) for the permission to use their patients in this paper.
Reference Rowe, N. L. & Williams, J. LI. (1985). In: MuxillofuciulInjuries. p. 238. Edinburgh: Churchill Livingstone.
The Authors P. Magennis BDS, FFDRCS, FDSRCS
Medical Student 17 Deramore Drive Belfast BT9 5JR
Case 3
P. Craven
A 37-year-old man received bilateral fractures of his mandibular condyles in a road traffic accident. In addition to an anterior open bite his teeth, which were heavily restored, sustained a number of Class II and three Class III fractures. The brackets were placed as illustrated in Fig. 2.
Chief Maxillofacial Technician Maxillofacial Surgery Department Chester Royal Infirmary Correspondence
and requests for offprints to P. Magennis
Paper received 13 January 1989 Accepted 29 June 1989
loumol
of Oral and .Wa.ri/lofacia/
1990 The British
Association
Surgery
(19yo) 28, 136-137
of Oral and Maxillofacial
Surgeons
@266-4356X@O/0026-0136/110.00
TECHNICAL NOTE Modification of orthodontic brackets for use in intermaxillary
fixation
P. Magennis, P. Craven Maxillofacial Surgery Department,
A method of SUMMARY. traction/fixation is illustrated.
Chester Royal Infirmary, Chester CHl2AZ
modifying
orthodontic
brackets
to facilitate
their
use
in
intermaxillary
INTRODUCTION
Attaching wires or elastics around cleats on the arch-wires of fixed orthodontic appliances during orthognathic procedures is now an accepted practice. Where intermaxillary fixation is needed for the treatment of acute injuries, it is only very rarely such convenient devices are in situ. None the less, there are occasions when the use of acid-etched brackets bonded to teeth, as a base for intermaxillary fixation or traction, would be preferable to more conventional methods. Placing orthodontic brackets level to allow the immediate placement of a rigid arch-bar with cleats is difficult even for an experienced orthodontist. Used individually the shape of orthodontic brackets does not permit more than one elastic band (or wire) to be looped around them, and this requires considerable manual dexterity. If ordinary brackets are modified as illustrated below, placement of one or more elastics is made so simple that even the patient can manage it.
METHOD To make the loop, first choose a stainless steel wire of a diameter which fits snugly into the bracket’s slot. Make the first bend at a distance just less than the width of the slot. The second makes the side of the loop approximately 3 to 4 mm in length. The third bend completes the loop. The bracket will then self-retain within the loop (Fig. 1A). The long end of the wire is used to hold the assembly whilst at least four spot welds are placed. The wire is then cut off flush with the bracket and any sharp edges burnished (Fig. 1B). Placing brackets on the premolars and canines is usually adequate. It is important that care is taken to ensure that they do not prop open the bite. Elastics may be used to reduce the fracture and provide fixation so long as the teeth are opposed and the adjacent arch complete. Should it prove necessary to bracket a tooth which is unopposed or
Fig. IA - Wire loop engaging the slot in the orthodontic bracket.
Fig. IB - Modified bracket ready for use.
lacks the buttressing of adjacent teeth, wires rather than elastics should be used for fixation after reduction has taken place. This precaution avoids the complication of inadvertant orthodontic tooth movement. Brackets may be quickly placed with the patient in the dental chair using an acid etch technique without need for any anaesthetic and is well tolerated by the patient. They are reliable, easy to remove, and may be reused. 136
Orthodontic brackets for use in intermaxillarv tixation
137
He subsequently attended his own dental surgeon for initial treatment to his damaged teeth, his dentist being able to remove and replace the elastics before and after treatment. After 2 weeks the IMF was removed and on follow up a satisfactory clinical result was obtained. DISCUSSION The use of elastics attached
Fig. 2 - Modified brackets in use.
Case reports Case I A 23-year-old man attended the Accident Unit having sustained a fracture of the left angle of his mandible in an alleged assault. His dental arches were complete, the occlusion was deranged and his medical history included an intravenous drug abuse habit of 4 years duration. At the end of the afternoon clinic taking appropriate precautions, brackets were bonded to his premolars and elastics used to reduce his fracture. Four weeks IMF achieved a satisfactory clinical result.
to individual teeth for the reduction and/or fixation of mandibular fractures is not a new idea, Rowe and Williams (1985) illustrate a method using eyelets. The placement of eyelets or the wiring of an archbar-under local or general anaesthetic-is unpleasant and can even be dangerous for the patient. Nor are these procedures without risk to the operator, especially where patient’s medical or social history may make self-injury with a wire a significant hazard. Using the modified brackets traction may be applied to reduce a displaced fracture, or achieve occlusion when the condylar neck is fractured. The size of the force and the length of time (a few hours) required to do this are much less than would be necessary for extrusion to occur. Once the arches are together movement of a tooth is prevented by occlusion with the opposing tooth. There have been no problems in this respect with any of the seven patients treated by this method. Although not used as a routine, this technique has proved a useful adjunct to other methods available for treating fractured mandibles. Where intermaxillary traction or fixation alone is indicated, where the patient does not need an anaesthetic for any other reason, or where he has a medical condition which would make surgery hazardous for him or the surgeon, this technique is particularly indicated.
Cuse 2
Acknowledgements
A 17-year-old boy fractured the left angle of his mandible in a sports accident. His arches were complete, the occlusion deviated to the side of the fracture, and his bite was open 2 mm anteriorly. In&al wear suggested the open bite was as a result of the fracture. Brackets were bonded to the premolars and canines and elastics placed. His normal occlusion was soon restored. After five weeks the IMF was released, the following week the brackets were removed and the patient discharged after an uneventful review period.
To Mr J. I. Cawood (Chester Royal Infirmary) and Mr A. E. Green (Bury General Hospital) for the permission to use their patients in this paper.
Reference Rowe, N. L. & Williams, J. LI. (1985). In: MuxillofuciulInjuries. p. 238. Edinburgh: Churchill Livingstone.
The Authors P. Magennis BDS, FFDRCS, FDSRCS
Medical Student 17 Deramore Drive Belfast BT9 5JR
Case 3
P. Craven
A 37-year-old man received bilateral fractures of his mandibular condyles in a road traffic accident. In addition to an anterior open bite his teeth, which were heavily restored, sustained a number of Class II and three Class III fractures. The brackets were placed as illustrated in Fig. 2.
Chief Maxillofacial Technician Maxillofacial Surgery Department Chester Royal Infirmary Correspondence
and requests for offprints to P. Magennis
Paper received 13 January 1989 Accepted 29 June 1989
