Abstract
Background
Management of maxilla and mandibular fractures are based on the principles of reduction, fixation and immobilization of the fracture segments.
Purpose
One of the processes of reduction is to apply continuous and gradual elastic traction by placing elastics from the upper and lower arch bars in a definite manner and direction as per the fracture line. Orthodontic elastic separators are versatile, and the major advantage is the higher traction forces as compared to conventional elastics.
Methods
Prestretched separator elastics were guided over the arch bar or fixed orthodontic appliances to provide desired traction.
Results
Orthodontic elastic separators are therefore versatile, and the major advantage is the higher traction forces as compared to conventional elastics. They provide an edge over the use of wires as they tend to break off by work hardening.
Conclusion
Therefore, we have adapted orthodontic separators and have used them in place of conventional elastics for the last 10 years with appreciable results after taking informed consent from the patients.
Keywords: Elastomeric separators, Fracture, Immobilization, Intermaxillary fixation
Management of maxilla and mandibular fractures is based on the principles of reduction, fixation and immobilization of the fracture segments. One of the processes of reduction is to apply continuous and gradual elastic traction by placing elastics from the upper and lower arch bars in a definite manner and direction as per the fracture line [1]. The discretion of choice lies with the operator and as per the case.
The main challenge that arises is achieving the optimal occlusion of the patient before advancing to intermaxillary fixation. This technique overcomes the reflex muscle contraction resulting from the post-traumatic stress or post-intervention stress on musculature. Conventional elastics that are red, white and blue in color have been used for this purpose since long. However, conventional elastic traction force is not adequate in grossly displaced fractures. Therefore, we have adapted orthodontic separators and have used them in place of conventional elastics for the last 10 years with appreciable results after taking informed consent from the patients (Fig. 1).
Fig. 1.
Prestretched elastomeric separator
Elastomeric separators are radio-opaque and are readily available in various dimensions and colors. The blue elastic separators used in our study are of type 854-250A with an inner diameter of 0.060 in /1.52 mm. These reportedly underwent 31% and 39% force decay after 24 h and 2 weeks, respectively, post-stretching in simulated oral environment [2, 3]. Comparisons of elastics from the same manufacturer with the same force level (tested under equal conditions in other studies) continue to show differences in force levels [4].
These blue elastics can readily be applied to any form of arch bar through ball cleat or hook attachments or fixed orthodontic appliances, IMF screws or eyelet loops bent to form hooks, etc. Most manufacturers recommend extending the elastics three times their lumen when examining force extension characteristics. Some studies used extensions of 20–50 mm, proposing it was the normal range for clinical use [5]. The elastics can be guided to the desired position using small/medium mosquito or artery forceps. Any tendency of displacement of the occlusion can be identified and intervened by quick removal and replacement of the elastics, which gives it an edge over use of wires as they tend to break off by work hardening tendency [6]. The placement and removal are easy and less time-consuming (Fig. 2).
Fig. 2.
Use of elastomeric separators in IMF
Orthodontic elastic separators are therefore versatile, and the major advantage is the higher traction forces as compared to conventional elastics. Elastic traction is thereby a reliable technique in providing reduction of jaw fracture and the temporary fixation of the bone fragments before rigid internal fixation.
Funding
No funding was received for this study.
Compliance with Ethical Standards
Conflicts of interest
The authors have no conflicts of interest.
Footnotes
Publisher's Note
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Contributor Information
Rajat Mohanty, Email: rajatmohanty007@gmail.com.
Chhaya Jha, Email: jchhaya50@gmail.com.
References
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