Effects of education and experience on detection of proximal caries on digital radiographs

Objectives

Early detection of proximal caries can result in less-invasive treatments. This study aimed to assess the effects of education and experience on accurate detection of proximal caries on digital radiographs.

Methods

Third-year and sixth-year dental students, maxillofacial radiology postgraduate students, and general dentists comprised the study population (total, 28). Standard digital bitewing radiographs were obtained for 50 extracted teeth, and evaluated for proximal caries on a monitor. All assessments were performed under ambient light (<50 lux). The teeth were subsequently sectioned into 1-mm-thick slices. After reaching the lesion, it was visually inspected, and then determined for its depth in each slice using a caries detector solution. A four-scale grading system for assessment of lesion depth. These results were considered to be the gold standard, and compared with the opinions of the observers. Data were analyzed using SPSS16 software for kappa, sensitivity, specificity, false-negative, false-positive, negative predictive value, and positive predictive value statistics. The kappa coefficients were used to compare the accuracy of diagnoses of the observers and the extents of involvement of tooth structures.

Results

The diagnostic accuracy for grade I caries was 21.9 % among third-year dental students, 17.4 % among sixth-year dental students, 34.5 % among maxillofacial radiology postgraduate students, and 14.3 % among general dentists. The respective diagnostic accuracies were 16.2, 15.2, 5.7, and 7.6 % for grade II caries and 3.5, 32.1, 25, and 14.2 % for grade III caries.

Conclusions

Although education played a great role in improving caries detection skill, it failed to raise it to an acceptable range.

     

A nationwide survey of undergraduate training in oral and maxillofacial surgery

Purpose

To investigate the current status of undergraduate training in oral and maxillofacial (OMF) surgery in Germany using a nationwide survey and hence contribute to an educational improvement in the field.

Methods

A 39-item questionnaire was sent to all university clinics with an OMF surgery chair in Germany (n?=?34).

Results

Ninety-two percent of OMF clinics are involved in the curricular training in medicine and 100% in dentistry. Eighty-one percent of OMF clinics perform curricular examinations and, respectively, 86% in dentistry. Examinations are mainly performed written with multiple-choice tests (62% medicine, 76% dentistry) and using non-structured oral examinations (57% medicine, 86% dentistry). Objective structured clinical examinations (OSCEs) are only used in 19% of all faculties.

Conclusion

OMF surgery with its involvement both in medical and dental education has a special position as a surgical discipline. Our results show that OMF as a specialty is underrepresented in dental and especially in medical education considering the numerical and health economic importance of OMF consultations. Enhancing curricular integration and developing more structured examination forms is necessary to guarantee a high quality of OMF education.

     

Long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton: a retrospective study

Objectives

The reconstruction of oral function in irradiated patients with craniofacial tumors is a significant challenge. The aim of this study was to detect long-term success of dental implant-supported dentures in postirradiated patients treated for neoplasms of the maxillofacial skeleton.

Materials and methods

From 2004 to 2011, 36 irradiated patients underwent oral function reconstruction using implant-supported prostheses. Bone augmentation was completed using vascularized bone grafts in 22 patients. Fourteen patients were treated by hyperbaric oxygen therapy (HBO). A total of 198 dental implants were used in jaw rehabilitation. After loading, implant success rates, biological and prosthetic complications, patient satisfaction, and psychological changes were recorded.

Results

Bone augmentation of the jaw was successful and vascularized grafts provided an additional vascular supply in compromised irradiated tissue. Rehabilitation was successful in all of the patients after loading. Thirty-eight dental implants failed, and 35 implants were removed. The success rate of the implants was 93.6 % for 10 years after loading. It was not a significant difference in implant success rate between the HBO group and the other groups. The prosthodontic maintenance results and complication rates showed that patients required intervention 0.19 times per year. All patients were satisfied with the oral restoration results.

Conclusion

The restoration of oral function in radiotherapy patients with tumor resection using implant-supported prostheses is a viable treatment option.

Clinical relevance

Either alone or in combination with HBO, dental implant-supported prostheses can be used an effective therapeutic approach for irradiated patients with oral function reconstruction.

     

The Jugaad Technique for Jaw Reconstruction: Denture Based Inverse Planning

Aim

The aim of this clinical paper is to introduce a technique to plan for functional maxillofacial reconstructions.

Materials and Methods

Preoperative dental casts were made of the patient and mock surgery performed on the casts. A fibula analogue was then placed in an ideal functional reconstruction position. New dentures were fabricated on the fibula analogue and drill holes for the placement of implants were placed through the denture. This denture formed as a guide to position the fibula transplant during surgery.

Results

This technique was useful in producing functional and rehabilitative outcomes in cases of both maxillary and mandibular reconstructive surgeries.

Conclusion

The Jugaad technique—denture based inverse planning—is a cost effective method for planning and executing maxillofacial reconstructions using mock surgery on casts and interim dentures.

     

What Surgical Education the Speciality Offers? Perception of Role of Oral and Maxillofacial Surgery by 1200 Healthcare Professionals,Students and the General Public in Hyderabad,India

Aim

To investigate the perception of Oral and maxillofacial surgery by healthcare professionals, students and general public.

Materials and Methods

A questionnaire form was created that listed ten clinical situations, and given by hand to 1200 individuals, divided into six groups: group 1, medical professionals; group 2, Specialties of dentistry; group 3, general dentists; group 4, medical students; group 5, dental students; and group 6, general public, each comprising 200 individuals. Respondents were asked to indicate who they would expect to treat them if they had one of the specified conditions listed in the questionnaire. We present the results and current awareness levels of this simple questionnaire. The present study addresses the common issue raised by many authors, ‘What surgical education the speciality offers?’ especially to medical professionals, medical students and general public to enhance an appropriate referral.

Results

Most of the respondents in groups 2, 3 and 5 agreed that specific conditions listed in the questionnaire were within the domain of oral and maxillofacial surgery, but such response was not seen in groups 1, 4 and 6 (p < 0.001). An overall awareness level of oral and maxillofacial surgery was found to be 50.2%.

Conclusion

The onus of creating and improving the awareness and perception of our specialty lies on oral and maxillofacial surgeon. Unified efforts at individual as well as global level will help achieve this goal.

     

Challenging issues in teaching oral radiology to undergraduate students

Introduction

When teaching dental radiology to undergraduate dental students, we should ideally cover all of the contemporary radiological fields evenly. However, it has become challenging to provide sufficient instruction within the curriculum compared with past times, because new radiological techniques quickly become popular. In the present study, we classified the questions received from sixth-grade students in Osaka Dental University for the purpose of better understanding the elements of effective teaching.

Materials and methods

We classified the questions received from sixth-grade students in Osaka Dental University using e-mail and the LINE mobile messaging app, from October 2011 to October 2014. The classification was based on the table of contents of Oral and Maxillofacial Radiology, Fifth Edition. In addition, we itemized the questions related to dental radiology set in national dental examinations performed from 2012 to 2015. We then compared the students’ concerns with the contents of the national examinations.

Results

Many questions were related to intraoral radiographic imaging, X-ray generation and projection geometry, radiographic interpretation, radiological protection, contrast-enhanced X-ray examination, panoramic imaging, and side effects of radiotherapy.

Conclusions

The reasons why students had difficulty in understanding specific areas were considered to be the compressed ratio of lecture time and contents, difficulty in giving full scope to the imagination, and lack of chances to observe equipment in clinical use.

     

A Protocol for Management of the Hairs Problem in Oral Cavity Reconstruction by Submental Flap

Background

Submental flap is a useful aid in maxillofacial reconstruction. For intraoral usage the hairs in male patients will create some problems.

Materials and Methods

In a retrospective study, patients in whom submental flap had been used for reconstruction of orofacial region between 2007 and 2013, in the Mashhad University, Ghaem Hospital, were included. The ways in which the problem of hairs was solved in male patients were evaluated.

Results

There were 42 patients in whom submental flap was used for orofacial reconstruction. Sixty percent were males. Three ways had been used for management of intraoral hairs: radiotherapy (9 patients), second surgery (2 patients) and flap de-epithelialization (13 patients).

Conclusion

Deepithelialized variant of submental flap is the best option when submental flap is used for oral cavity reconstruction in male patients. Flap thickness, age, race and postoperative radiotherapy can have strong influence on this strategy.

     

Arch Wire: A Novel Technique for Intra-Maxillary Fixation

Introduction

Arch bars are regularly used in the management of dentoalveolar and minimally displaced fractures of the maxilla or mandible and luxation or avulsion of teeth by maxillofacial surgeons. The procedure for arch bar placement has remained unchanged over the period of years, and this coupled with the difficulty in maintenance of oral hygiene is a problem that begs attention.

Technique

We have devised a technique to overcome these hurdles and achieve adequate intramaxillary splinting. The technique uses an arch wire and ligature wire assembly instead of the conventional arch bar.

Conclusion

This technique is easy to learn and can thus be used as a rapid yet robust alternative to the conventional arch bar for dentoalveolar and minimally displaced fractures.

     

Socioeconomic and psychosocial predictors of dental healthcare use among Brazilian preschool children

Background

Disparities in utilization of oral healthcare services have been attributed to socioeconomic and individual behavioral factors. Parents’ socioeconomic status, demographics, schooling, and perceptions of oral health may influence their children’s use of dental services. This cross-sectional study assessed the relationships between socioeconomic and psychosocial factors and the utilization of dental health services by children aged 1–5 years.

Methods

Data were collected through clinical exams and a structured questionnaire administered during the National Day of Children’s Vaccination. A Poisson regression model was used to estimate prevalence ratios and 95% confidence intervals.

Results

Data were collected from a total of 478 children. Only 112 (23.68%) were found to have visited a dentist; 67.77% of those had seen the dentist for preventive care. Most (63.11%) used public rather than private services. The use of dental services varied according to parental socioeconomic status; children from low socioeconomic backgrounds and those whose parents rated their oral health as “poor” used dental services less frequently. The reason for visiting the dentist also varied with socioeconomic status, in that children of parents with poor socioeconomic status and who reported their child’s oral health as “fair/poor” were less likely to have visited the dentist for preventive care.

Conclusion

This study demonstrated that psychosocial and socioeconomic factors are important predictors of the utilization of dental care services.

     

A preliminary study on plasma concentration achieved following intrapterygomandibular space injection of dexamethasone as a route of drug delivery with lignocaine inferior alveolar nerve block–correlation of clinical effects

Purpose

To determine the quantity of dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone when co-administered with inferior alveolar nerve block correlating with the clinical effects in the postoperative phase.

Objective

A preliminary prospective study to evaluate the dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone with 2% lignocaine inferior alveolar nerve block to achieve hemi-mandibular anesthesia for minor oral surgical procedures and derive clinical correlations.

Background

Dexamethasone is a glucocorticoid, chiefly used for the management of postsurgical sequelae like trismus and swelling in maxillofacial surgical practice. Conventionally, parenteral dexamethasone is administered via intravenous or intramuscular route. Intrapterygomandibular space injection is a novel route of steroid delivery described in literature. For minor oral surgical procedures in maxillofacial surgical practice requiring inferior alveolar nerve block, dexamethasone can be administered along with local anesthetic through a single injection as a mixture (twin mix).

Methods

Prospective double-blind randomized clinical trial was designed to evaluative plasma concentration of dexamethasone achieved following injection of a freshly prepared mixture of 1.8 ml of 2% lignocaine with adrenaline (1:200000) and 1 ml (4 mg) dexamethasone [2.8 ml solution of twin mix] in the pterygomandibular space. The 30 candidates included for the trial were randomly split into three study groups (ten each)—(1) control group (C); (2) intramuscular group (IM); (3) intraspace group (IS).

Results

The mean plasma dexamethasone concentration at 30 min postinjection in group IM was 226.41?±?48.67 ng/ml and for IS group it was 209.67?±?88.13 ng/ml. Post hoc (Bonferroni-Holm test) intergroup comparison for plasma dexamethasone concentration (IM and IS) was found statistically insignificant (P?=?0.605).

Conclusion

Intraspace route of drug administration can be utilized to deliver dexamethasonized local anesthetics safely with predictable clinical effects in the patients requiring mandibular minor oral surgery under local anesthesia.

     

Solitary Extramedullary Plasmacytoma of the Maxillary Sinus,Progressing to Smoldering Multiple Myeloma with Multifocal Skeletal Involvement,which Resolved Completely Following Chemotherapy Alone

Background

The world wide pattern of oral and maxillofacial surgical conditions has rarely been reported despite its significance in ensuring quality of care. A large number of patients are managed surgically in Oral and Maxillofacial Surgery department of Dhaka Dental College Hospital but there has been no surgical audit to identify the potential problems in patient care.

Objectives

The aim of this study was to identify the pattern of oral and maxillofacial conditions in patients of maxillofacial surgery of Dhaka Dental College Hospital, which would provide valuable information to build up the focus of attention, to develop a future strategy plan, to improve its clinical care and extend the academic and research field.

Patients and Methods

A retrospective survey of oral and maxillofacial surgical cases managed at the inpatient Department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital. All admitted patients from 1st January, 2012 to 31st December, 2012 were included in this study. The patients’ data were retrieved from the wards registers and patient records. The data were recorded as age, sex, occupation, geographic distribution, diagnosis, treatment done and operation name. These were studied to assess the prevalence of age, sex, diseases and the name of the treatment offered. Analysis of major groups of diagnosis on the basis of age and sex was also studied. Mortality was also recorded.

Results

Between 1st January, 2012 and 31st December, 2012 a total of 768 patients were treated. Among them 494 patients were male while 274 were female, male female ratio was 1.80:1. The majority of the patients were from Dhaka division. The mean age of the patients was 33.20 years; peak age group was 15–30 years. The most common diagnosis was maxillofacial injuries (35 %), followed by oral squamous cell carcinoma (22 %) and odontogenic tumours and hamartomas (11 %). Maxillo-mandibular fixation or wiring was the main modality of treatment. The mortality rate was 0.26 % of total patients.

Conclusions

The department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital is a busy centre for specialized maxillofacial services in Bangladesh. A good number of patients with a wide range of oral and maxillofacial surgical conditions are managed here. Maxillofacial injury and oral cancer are the two most common conditions encountered here.

     

Dental care use in Ontario: the Canadian community health survey (CCHS)

Background

Oral health is a significant measure of overall health, and regular dental visits are recommended for the maintenance of oral health. The purpose of this study is to determine the pattern (amount and type) of, and factors associated with dental care use among Ontarians.

Methods

Data from the 2014 cycle of the Canadian Community Health Survey was used and analysis was restricted to individuals aged 12 and above residing in Ontario. Dental care use was defined by two distinct outcomes: not visiting a dentist within the past year and visiting a dentist only for emergencies. Multivariable logistic regression was performed to examine the association between socio-demographic, health behavior, oral health, and other health-related factors and the two outcomes.

Results

More than a quarter of participants reported not visiting the dentist in the last year, and 19% reported usually visiting a dentist only for emergencies. Multivariable logistic regression analysis suggested that males, individuals of Aboriginal status, those with low educational attainment, low household income, no dental insurance, who smoked, less frequent teeth brushing, poor health of teeth and mouth, or had diabetes were at a significant increased likelihood of not visiting the dentist within the past year, and only visiting a dentist for emergency care.

Conclusions

Socioeconomic status, self-reported oral health, and general health behaviors were associated with dental care use. These findings highlight the need for focusing efforts toward improving dental care use among Ontarians.

     

Mechanical and microstructural properties of fixation systems used in oral and maxillofacial surgery

Objectives

This paper aims to evaluate in vitro the mechanical and microstructural properties of internal fixation systems used in oral and maxillofacial surgeries.

Materials and methods

Four brands of internal fixation systems (screws and 4-hole straight plates) were selected and assigned to four groups: G1 Leibinger®, G2 Tóride®, G3 Engimplan®, and G4 Medartis®. The systems were submitted to Vickers hardness testing, metallographic and interstitial elements chemical composition analyses. Data were submitted to ANOVA and Tukey’s test for statistical analysis.

Results

Plates in groups 1, 2, and 3 showed similar microstructure and mechanical properties, different from those in G4 revealing larger grains. In all groups, the screws showed similar microstructure, with uniform arrangement and size of grains; the screws showed higher hardness values than those observed for the plates.

Conclusions

The results indicate that all materials tested are adequate for use in oral maxillofacial surgeries.

     

Knowledge and practice regarding safety standards of oral radiology among dental practitioners in western Maharashtra,India

Objective

To evaluate the knowledge and practice regarding safety standards of oral radiology among dental practitioners in Mumbai, India.

Methods

A cross-sectional study was conducted among 200 dental practitioners. Data related to methods of radiation protection were collected by a predesigned, pretested, self-administered questionnaire. The data were analyzed and the results expressed in percentages.

Results

The bisecting angle technique was preferred by 69.2 % of the practitioners. Most of the X-ray machines had a pointed cone (60.6 %) type of position-indicating device. Both conventional films and digital sensors were used as image receptors with slight preference for the latter (44.8 vs. 55.1 %, respectively). Approximately three-fourths of the dental practitioners (75.4 %) used E-speed films, and in 48.0 % of cases, either dentists or assistants held the X-ray film with their fingers while taking radiographs. Most of the practitioners used a lead apron for patient protection either regularly (23.6 %) or occasionally (48.0 %). A total of 40.9 % of the dentists stood near the patient without wearing a lead apron during exposure. Only 14.7 % were aware of the position-and-distance rule, which is used when no protective barrier is present. Nearly half of the dentists changed the exposure time according to the patient and region to be radiographed.

Conclusion

The results of this study indicate that more work must be done to increase the knowledge of radiation protection among practicing dentists.

     

Methodological quality assessment of paper-based systematic reviews published in oral health

Objectives

This study aimed to conduct a methodological assessment of paper-based systematic reviews (SR) published in oral health using a validated checklist. A secondary objective was to explore temporal trends on methodological quality.

Material and methods

Two electronic databases (OVID Medline and OVID EMBASE) were searched for paper-based SR of interventions published in oral health from inception to October 2014. Manual searches of the reference lists of paper-based SR were also conducted. Methodological quality of included paper-based SR was assessed using an 11-item questionnaire, Assessment of Multiple Systematic Reviews (AMSTAR) checklist. Methodological quality was summarized using the median and inter-quartile range (IQR) of the AMSTAR score over different categories and time periods.

Results

A total of 643 paper-based SR were included. The overall median AMSTAR score was 4 (IQR 2–6). The highest median score (5) was found in the pain dentistry and periodontology fields, while the lowest median score (3) was found in implant dentistry, restorative dentistry, oral medicine, and prosthodontics. The number of paper-based SR per year and the median AMSTAR score increased over time (median score in 1990s was 2 (IQR 2–3), 2000s was 4 (IQR 2–5), and 2010 onwards was 5 (IQR 3–6)).

Conclusion

Although the methodological quality of paper-based SR published in oral health has improved in the last few years, there is still scope for improving quality in most evaluated dental specialties.

Clinical relevance

Large-scale assessment of methodological quality of dental SR highlights areas of methodological strengths and weaknesses that can be targeted in future publications to encourage better quality review methodology.

     

Diffusion-weighted magnetic resonance imaging in oral and maxillofacial lesions: preliminary study on diagnostic ability of apparent diffusion coefficient maps

Objectives

The aim of this study was to investigate the usefulness of diffusion-weighted magnetic resonance imaging (DWI) in oral and maxillofacial lesions, especially the utility of apparent diffusion coefficient (ADC) maps for differential diagnosis of these lesions.

Methods

Fifty-seven patients who underwent magnetic resonance imaging for diagnosis of oral and maxillofacial lesions were included in this prospective study. DWI was performed on a 1.5 T unit with b-factors of 0 and 800 s/mm², and ADC maps were generated. ADC values were measured for all 57 oral and maxillofacial lesions (19 squamous cell carcinoma, 10 medication-related osteonecrosis of the jaw, 6 odontogenic abscess, 4 ranula, 4 osteoradionecrosis, 4 hemangioma, 3 pleomorphic adenoma, 3 odontogenic keratocyst, 2 nasopalatine duct cyst, 1 malignant melanoma, and 1 basal cell carcinoma).

Results

The mean ADC values for ranula (2.69 ± 0.59 × 10^?3 mm²/s) and nasopalatine duct cyst (2.34 ± 0.12 × 10^?3 mm²/s) were significantly higher than those for the other oral and maxillofacial lesions (p = 0.000). In contrast, the mean ADC value for odontogenic abscess (0.67 ± 0.36 × 10^?3 mm²/s) was significantly lower than those for the other oral and maxillofacial lesions (p = 0.000).

Conclusions

The present study suggests the usefulness of DWI in oral and maxillofacial lesions, especially the utility of ADC maps for differential diagnosis of these lesions.

     

Patients’ perceptions of oral cancer screening in dental practice: a cross-sectional study

Background

Oral cancer is increasing in incidence in the UK and indeed worldwide. Delay in diagnosis is common; up to half of patients are diagnosed with advanced lesions. Thus it is essential to develop methods to aid early detection. This study aimed to assess dental patients’ experiences and awareness of oral cancer and screening within general dental practice.

Methods

A cross-sectional questionnaire survey of 184 English-speaking adults, with no previous history of oral cancer was conducted. The questionnaire collected data on participant’s knowledge of oral cancer, experience of ‘screening’, attitudes and feelings towards having a screening, anticipated help-seeking behaviours, health-related behaviours (particularly risk factors) and sociodemographics.

Results

Twenty percent of respondents had never heard of oral cancer; 77% knew little or nothing about it and 72% did not know that their Dentist routinely screens for oral cancer. Overall, attitudes to screening were positive. Ninety two percent of respondents would like their Dentist to tell them if they were being screened for signs of oral cancer and 97% would like help from their Dentists to reduce their risk.

Conclusion

Patients seem generally unaware of oral cancer screening by their dentist but are happy to take part in screening, would like to be informed, and welcome the support of their Dentist to reduce their risk of developing oral cancer.

     

Association between gingival bleeding and gingival enlargement and oral health-related quality of life (OHRQoL) of subjects under fixed orthodontic treatment: a cross-sectional study

Background

There are scarce evidences that evaluated the impact of periodontal disease on oral health-related quality of life (OHRQoL) taking marginal gingival alterations into consideration. Thus, this study aimed to verify the association between OHRQoL and gingival enlargement and gingival bleeding in subjects under fixed orthodontic treatment (FOT).

Methods

330 participants under FOT for at least 6 months were examined by a single, calibrated examiner for periodontal variables and dental aesthetic index. Socio-economic background, body mass index, time with orthodontic appliances, and use of dental floss were assessed by oral interviews. OHRQoL was evaluated using the oral health impact profile (OHIP-14) questionnaire. The assessment of associations used unadjusted and adjusted Poisson regression models.

Results

Higher impacts on the OHIP-14 overall were observed in subjects who presented higher levels of anterior gingival enlargement (RR 2.83; 95% CI 2.60-3.09), were non-whites (RR 1.29; 95% CI 1.15-1.45), had household income lower than five national minimum wages (RR 1.85; 95% CI 1.30-2.61), presented body mass index?>?25 (RR 1.14; 95% CI 1.01-1.29), and showed a dental aesthetic index?>?30 (RR 1.32; 95% CI 1.20-1.46).

Conclusions

Anterior gingival enlargement seems to influence the OHRQoL in subjects receiving orthodontic treatment.

     

End Stage Renal Disease: Not a Contraindication for Minor Oral Surgery—Protocol for the Management of Oral Surgery patients with ESRD on Hemodialysis

Objective

To describe a safe and effective protocol for the management of patients with end stage renal disease (ESRD) undergoing minor oral surgery.

Subjects and Methods

A prospective cohort study was conducted on all patients with ESRD who were referred for dental consultation. A definite protocol was designed in consultation with the nephrologist to minimize the risk of bleeding and wound healing complications during and after the minor surgical procedures. 36 patients consented for the protocol to be followed while 4 patients did not comply with the protocol and in 2 cases the protocol could be followed. The intra operative, post operative bleeding, and the wound healing were assessed in these patients.

Results

36 patients had uneventful extractions as the blood pressure was brought down to pre hypertensive stage following the protocol. 4 patients who did not comply with the protocol had episodes of bleeding in the post operative period. There were two special scenarios where additional precautions had to be taken have been discussed. The wound healing was satisfactory in all these patients.

Conclusion

The protocol discussed in this article helps us provide safe minor oral surgical treatment in patients with ESRD.

     

Comparison of Efficacy of Transalveolar Screws and Conventional Dental Wiring Using Erich Arch Bar for Maxillomandibular Fixation in Mandibular Fractures

Introduction

Maxillomandibular fixation is required in nearly all cases of facial fractures which can be achieved by conventional dental wiring techniques or newer methods using transalveolar screws.

Material and Methods

A prospective randomized clinical study divided into two groups with thirty adult patients each with mandibular fractures was undertaken comparing the Maxillomandibular fixation technique using transalveolar screws and Erichs arch bar. Total time taken, rate of glove perforation, intraoperative and postoperative complications were noted in both the groups.

Results

The time taken for maxillomandibular fixation in minutes and rate of glove perforation was found to be statistically significantly less for transalveolar group compared to arch bar group (p < 0.05). However, there was no significant difference found in the oral hygiene and gingival status using the Glass index and Gingival index. The rate of screw breakage (04.67%), wire breakage (05.12%), non-vitality due to iatrogenic dental damage (01.66%), soft tissue injury and tooth loss were some of the noted complications during the study.

Conclusion

We found that transalveolar group offered advantages like less time taken with a definite decreased risk of percutaneous injury, while the iatrogenic complications like dental damage can be reduced by taking adequate precautions.