Journal of Maxillofacial and Oral Surgery

, Volume 17, Issue 2, pp 211–217 | Cite as

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

  • Yashmeet Kaur Sandhu
  • Sarfaraz Padda
  • Tejinder Kaur
  • Amit Dhawan
  • Sarika Kapila
  • Jasmine Kaur
Comparative Study



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.


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.


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.


Transalveolar screws Maxillomandibular fixation Mandibular Fractures 


Compliance with Ethical Standards

Conflict of interest

The author declares that they have no conflict of interest.

Ethical Approval

Study has been approved by the institutional ethic committee.

Informed consent

All patients in the study have given informed consent to participate in the study.


  1. 1.
    Arthur G, Berardo N (1989) Asimplified technique of maxillomandibular fixation. J Oral Maxillofac Surg 47:1234CrossRefPubMedGoogle Scholar
  2. 2.
    European Committee for Standarization. Medical gloves for single use Part 1: requirements for testing for freedom from holes. EN455-1:1993EGoogle Scholar
  3. 3.
    Peter S (2000) Essentials of preventive and community dentistry, 1st edn. Arya Publishing House, New Delhi, pp 478–479Google Scholar
  4. 4.
    Peter S  (2000) Essentials of preventive and community dentistry, 1st edn. Arya Publishing House, New Delhi, pp 472–474Google Scholar
  5. 5.
    Karlis V, Glickman R (1997) An alternative to arch bar maxillomandibular fixation. Plast Reconstr Surg 99:1758–1759CrossRefPubMedGoogle Scholar
  6. 6.
    Sahoo NK, Mohan R (2010) INF screw: an ideal intermaxillary fixation device during open reduction of mandibular fractures. J Maxillofac Oral Surg 9(2):170–172CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rowe NL, Williams JL (1994) Maxillofaccial injuries, 2nd edn. Churchill Livingstone, LondonGoogle Scholar
  8. 8.
    Schneider AM, David LR, De Franzo AJ, Marks MW, Molnar JA, Aegenta LC (2000) Use of specialized bone screws for intermaxillary fixation. Ann Plast Surg 44:154–157CrossRefPubMedGoogle Scholar
  9. 9.
    Avery CM, Taylor J, Johnson PA (1999) Double gloving and a system for identifying glove perforations in maxillofacial trauma surgery. Br J Oral Maxillofac Surg 37:316–319CrossRefPubMedGoogle Scholar
  10. 10.
    Gaujac C, Ceccheti MM, Yonezaki F, Garcia IR, Peres MP (2007) Comparative analysis of 2 techniques of double—gloving protection during arch bar placement for intermaxillary fixation. J Oral Maxillofac Surg 65:1922–1925CrossRefPubMedGoogle Scholar
  11. 11.
    Avery CM, Johnson PA (1992) Surgical glove perforation and maxillofacial trauma: to plate or wire? Br J Oral Maxillofac Surg 30:31–35CrossRefPubMedGoogle Scholar
  12. 12.
    Gordon KF, Reed JM, Anand VK (1995) Results of intracortical bone screws fixation technique for mandibular fractures. Otolaryngol Head Neck Surg 113:248–252CrossRefPubMedGoogle Scholar
  13. 13.
    Imazawa T, Komuro Y, Inove M et al (2003) Mandibular fractures treated with MMFS method. J Craniofac Surg 17:544; 3:159–161Google Scholar
  14. 14.
    Bali R, Sharma P, Garg A (2011) Incidence and patterns of needle stick injuries during intermaxillary fixation. Br J Oral Maxillfac Surg 49:221–224CrossRefGoogle Scholar
  15. 15.
    Anshul R (2014) A simplified method of preventing needle stick type injury to the operators finger while performing intermaxillary fixation. J Maxillofac Oral Surg 13(2):215–216CrossRefGoogle Scholar
  16. 16.
    Anshul R, Datarkar A, Boorle R (2009) Customised screw for IMF for maxillofacial injuries. Br J Oral Maxillofac Surg 47:325–326CrossRefGoogle Scholar
  17. 17.
    Fabbroni G, Aabed S, Mizen K, Starr DG (2004) Transalveolar screws and the incrdence of dental damage: a prospective study. Int J Oral Maxillofac Surg 33:442–446CrossRefPubMedGoogle Scholar
  18. 18.
    Widar Fredrik, Kashani Hossein, Kanaraja Sanjiv, Dahlin Chister, Ramusson Lars (2012) A retroseptive evaluation of iatrogenic dental root damage with predrilled vs drill free bone anchor screws for IMF. Dent Traumatol 28:127–131CrossRefPubMedGoogle Scholar
  19. 19.
    Hartwig S, Andreas B, Christian D, Voss JO, Moritz H, Saskia P, Raguse JD (2016) Drill related root injury caused by intraoperative intramaxillary fixation: an analysis of, 1067 screw applications. Dent Traumatol. doi: 10.1111/edt.12305 Google Scholar
  20. 20.
    Bins A, Oomens MAE, Boffano P, Forouzanfar T (2015) Is there enough evidence to regularly apply bone screws for intermaxillary fixation in mandibular fractures. J Oral Maxillofac Surg 73:1963–1969CrossRefPubMedGoogle Scholar
  21. 21.
    Alves M Jr, Baratieri C, Araeyo MTS, Souza MMG, Mania LC (2012) Root damage associated with intermaxillary screws: a systemic review. Int J Oral Maxillofac Surg 41:1445–1450CrossRefPubMedGoogle Scholar
  22. 22.
    Florence VA, Kofod T, Pinhott EM (2016) Intermaxillary fixation screw morbidity in treatment of mandibular fractures-a retrospective study. J Oral Maxillofac Surg 74:1800–1806Google Scholar
  23. 23.
    Bai Z, Gao Z, Xiao X, Zhang W, Fan X, Wang Z (2015) Application of IMF screws to assist rigid fixation of jaw fractures: our experience of 168 cases. Int J Clin Exp Pathol 8(9):11565–11568PubMedPubMedCentralGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2017

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgerySri Guru Ram Das Institute of Dental Sciences and ResearchAmritsarIndia
  2. 2.Department of Oral Medicine and RadiologyIbn Sina National College for Medical SciencesJeddahKingdom of Saudi Arabia

Personalised recommendations