ABSTRACT
Introduction:
Maxillofacial trauma treatment involves maxillomandibular fixation. Despite reduced need for post-operative MMF with plating devices, temporary intraoperative MMF is still necessary for proper tooth positioning. The aim of this research is to evaluate the cost-effectiveness, impact on patient gingival health, glove perforation, and time required for utilizing the Ultra Lock Ezy Bar compared to Erich’s Arch Bar.
Methods:
Ten patients with mandibular fractures were randomly split into two groups for treatment: Group A (study) and Group B (control). Group A received treatment with an Ultra Lock Ezy Bar and screws, while Group B received treatment using an Erich’s Arch Bar and wires. Follow-ups were done for suture removal, wound healing, and evaluations on gingival index, glove perforations, and treatment times.
Results:
In application time, group A had mean of 44.00 ± 3.391 and group B had 90 ± 9.354, with no significant difference. Neither group showed significant mean differences in removal time. Group B had statistically significant glove perforation (4.80 ± 0.837) compared to 0 in group A. Pre-operative gingival index comparison showed significance. After four weeks, group B’s mean index was 1.720 ± 0.2387 and group A’s was 1.120 ± 0.2049 with no statistical distinctions.
Conclusion:
To sum up, the randomized control experiment produced convincing results when comparing Erich’s Arch Bar with Ultra Lock Ezy Bar for mandibular fixation in ten patients. With notably quicker application and removal times, no glove perforations, and comparable gingival health immediately following surgery, Ultra Lock Ezy Bar showed clear benefits.
KEYWORDS: Erich’s arch bar, IMF, mandibular fractures, MMF, ultra lock Ezy bar
INTRODUCTION
One common element of therapy for mandibular fractures is intermaxillary fixation. However, these methods can be time-consuming, potentially causing mucosal, dental, and injury from sharp wires. They are also restricted in cases of inadequate dentition or partial edentulism.[1] Bone supported devices like IMF screws have been reported, although they may only be used for favourable and mildly displaced fractures.[2]
Mandibular fractures are common due to its architecture and location.[3] There are two types of therapies for mandibular fractures: Open reduction and closed reduction. Techniques such as Erich arch bars, bridle wires, ivy loops, and IMF screws can be used for IMF.[4]
To examine the clinical efficacy of IMF, our study compared the placement of an Ultra Lock Ezy Bar using screw fixation with an Erich’s Arch Bar secured with circumdental wires to maxilla and mandible in cases of mandibular fractures.
MATERIALS AND METHODS
This randomized control experiment was conducted in the SBDCH, Chennai, OMFS department. Ten patients with mandibular fractures were randomly assigned to two groups: Group A (study group) and Group B (control group). Group A received treatment with an Ultra Lock Ezy Bar and 2 × 6/8mm IMF screws, while Group B received treatment using an Erich’s Arch Bar with straight, 24 gauge stainless steel wires.
Ortho Max Mfg Co. Pvt. Ltd. in India provided the supplies for both groups. Patients were allocated to the groups randomly. Before any surgical treatments, each patient’s informed, written consent was obtained according to the protocol. The study was approved by Institutional ethical committee (SBDCH/IEC/12B/2021/15). General anesthesia was induced in both groups and the same operator and helper handled each case. Weekly follow-ups were scheduled to monitor the stability, wire loosening, postoperative complications, wound healing, occlusion, and any other difficulties. The arch bar was removed after three to four weeks based on the degree of occlusal stability and occlusion.
Outcome measures
Primary outcome
To compare intermaxillary fixation using Ultra Lock Ezy Bar to Erich’s Arch Bar secured with circumdental wires in the treatment of mandibular fractures.
Secondary outcome
Evaluate the application and removal time of Arch Bars Compare glove perforation rates during the application and removal Assess the effects of Arch Bar on gingival health Subjects who consent to participate in the study, aged between 20 and 65 and reporting to a casualty with fractures in mandibular symphysis, angle, body, and condyle area are included in the study. Exclusion criteria for the study include patients with severe systemic disorders, osseous pathology, radiation or chemotherapy, panfacial fractures, and patients receiving treatment under general anesthesia.
Small eyelets on each tooth arch in Ultra Lock Ezy Bar are oriented towards the gingiva. After positioning the bar on one half of the arch and calculating the number of eyelets required to cover the entire arch, the bar is cut to the proper size. The posterior portion of the arch bar is curved inward to avoid unnecessary damage to the mucosa. Both jaws can be treated with arch bar application. First, a 702-carbide bur is used to drill a hole in the center eyelet between two central incisors to fix the arch bar. To secure the arch bar to the arch, a 2*6/8mm IMF screw is inserted into the hole. Subsequently, additional interradicular eyelets are drilled on either side of the central eyelet to avoid injuring the root of the teeth [Figure 1].
Figure 1.
Ultra lock Ezy bar
Erich’s Arch Bar has small hooks on each dental arch facing the gums. After placing the bar on half of the arch and determining the number of hooks needed to cover the entire arch, the bar was cut to the correct size. The back of the arch bar was curved inward to prevent unnecessary damage to the mucosa. The stainless-steel wire was initially used to attach the arch bar to the first molar by passing through the interdental space from the outer side to the inner side behind the first molar. Then, the wire was brought back to the outer side through the space between the first and second premolars below the arch bar. The ends of the wire were twisted in a clockwise direction. Next, it was secured to the opposing side of first molar and left in place among the teeth of the arch [Figure 2].
Figure 2.
Erich’s arch bar
Statistical analysis
Statistical analyses were conducted using the SPSS for Windows Version 22.0. The Kolmogorov-Smirnov test was used to examine the normality of data, and the results indicated that data was normally distributed. For continuous variables, mean and standard deviation were used to do a descriptive analysis of all the explanatory parameters. Categorical variables were reported as percentages and frequencies. To compare the differences between groups, the unpaired T-test was employed. A significance threshold of P < 0.05 was applied.
| Group | n | Mean | Std. Deviation | P | |
|---|---|---|---|---|---|
| Application Time | A | 5 | 44.00 | 3.391 | 0.313 |
| B | 5 | 90.00 | 9.354 | ||
| Removal Time | A | 5 | 25.40 | 4.506 | 0.660 |
| B | 5 | 49.80 | 3.421 | ||
| Glove perforation on application | A | 5 | 0.00 | 0.000 | 0.011 |
| B | 5 | 4.80 | 0.837 | ||
| Glove perforation on removal | A | 5 | 0.00 | 0.000 | 0.011 |
| B | 5 | 3.80 | 0.837 |
RESULTS AND DISCUSSION
IMF screws were introduced to address the limitations of arch bars. According to a study conducted by Chao and Hulsen in 2015, the time required to apply the Ultra Lock Ezy Bar in this investigation was significantly shorter than that required to apply Erich’s Arch Bar.[5] Another study by King et al.[6] found a significant difference in glove penetration during application between Ultra Lock Ezy and Erich’s Arch Bar group.
Before surgery, the gingival index was assessed in groups A and B. There was no noticeable difference in gingival index between the two groups during the first, second, third, and fourth postoperative evaluations.
A study by Xavier S. A. in 2022 examined the effectiveness of combining a hybrid arch bar with an Erich arch bar for maxillomandibular fixation.[7] The findings indicated that applying the Hybrid arch bar took less time and was easier to remove. However, when applying Erich’s arch bar, there were more instances of glove rips or penetrations compared to the Hybrid arch bar.
CONCLUSION
According to the study results, the Ultra Lock Ezy Bar is a viable substitute for the traditional Erich arch bar. It offers better gingival health, a lower incidence of glove perforation, and ease of use. However, the hardware costs of the Ultra Lock Ezy Bar are higher than those of the Erich arch bar.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
- 1.Ingole PD, Garg A, Shenoi SR, Badjate SJ, Budhraja N. Comparison of intermaxillary fixation screw versus eyelet interdental wiring for intermaxillary fixation in minimally displaced mandibular fracture: A randomized clinical study. J Oral Maxillofac Surg. 2014;72:958.e1–7. doi: 10.1016/j.joms.2014.01.005. [DOI] [PubMed] [Google Scholar]
- 2.Rai A, Datarkar A, Borle RM. Are maxillomandibular fixation screws a better option than Erich arch bars in achieving maxillomandibular fixation?A randomized clinical study. J Oral Maxillofac Surg. 2011;69:3015–8. doi: 10.1016/j.joms.2010.12.015. [DOI] [PubMed] [Google Scholar]
- 3.Murray JM. Mandible fractures and dental trauma. Emerg Med Clin North Am. 2013;31:553–73. doi: 10.1016/j.emc.2013.02.002. [DOI] [PubMed] [Google Scholar]
- 4.Shatat H, Kamel H, Elbokle N. Evaluation of bone supported Smart Lock Hybrid arch bar versus Erich arch bar for the treatment of mandibular fractures: A randomized clinical trial. Egypt Dent J. 2021;67:2091–100. [Google Scholar]
- 5.Chao AH, Hulsen J. Bone-supported arch bars are associated with comparable outcomes to Erich arch bars in the treatment of mandibular fractures with intermaxillary fixation. J Oral Maxillofac Surg. 2015;73:306–13. doi: 10.1016/j.joms.2014.08.025. [DOI] [PubMed] [Google Scholar]
- 6.King BJ, Christensen BJ. Hybrid arch bars reduce placement time and glove perforations compared with erich arch bars during the application of intermaxillary fixation: A randomized controlled trial. J Oral Maxillofac Surg. 2019;77:1228.e1–8. doi: 10.1016/j.joms.2019.01.030. [DOI] [PubMed] [Google Scholar]
- 7.Xavier SA, Wahab A. Evaluating the effectiveness of Hybrid arch bar with Erich arch bar during maxillomandibular fixation: A prospective, randomized, single-blinded study. Int J Health Sci. 2022;6(Suppl 4):3622–7. [Google Scholar]