Uploaded byAlexGeor
PPTX, PDF89 views

chap-3c Wire and Wiring Techniques s.pptx

This seminar covers various wire and wiring techniques used in trauma management, including their applications and principles. Key focuses include closed reduction for fractures, various types of wiring methods such as bridle and essig’s wiring, and the use of suspension wires in midface fractures. The document details the advantages and disadvantages of these techniques as well as practical applications in the treatment of edentulous patients and maxillofacial injuries.

Embed presentation

Download to read offline
11/03/2024 1 Wire and Wiring Techniques Prepared by Dr.Alex Asmamaw( DMD, OCMFS )
11/03/2024 2 outline • Objective • Introduction • Closed reduction • Armamentarium and Principles • Direct ,indirect, multiloop wiring and Arch bare • Internal skeletal suspension wiring • Intraosseous wiring • Summary • Reference
11/03/2024 3 Objective in this seminar we will cover • different types of wire like ss & k wires • Different types of wiring technique • Wiring in edentulous patients • Use of suspension wire in mid face fractures
11/03/2024 4 INTRODUCTION •wiring is one of the oldiest techniques truma mangment • The wire can only provide stability by means of its ability to prevent gap • the wire cannot neutralize torsion or shear forces • wireing technique can be applied for MMF , suspensions or interossious fixation
11/03/2024 5 closed reduction indication of closed reduction • Nondisplaced favorable fractures • Grossly comminuted fractures • Fractures in children involving the developing dentition • Coronoid fractures • treatment of condylar fractures Contraindicated in asthmatic, in parkinsonism, mentally challenged patients
11/03/2024 6 cont... advantage of closed reduction 1. Day-care procedure, not require hospitalization 2. Cost-effective and safe 3. Avoid damage to the vital structure disadvantage 1. Restriction of mouth opening for minimum of 4 weeks 2. Patients can take only liquid diet
11/03/2024 7 cont... 3. Diffcult to maintain oral hygiene 4. Challenging in partially edentulous patients 5. Weight loss 6. Partial trismus for few weeks
11/03/2024 8 Armamentarium and Principles Basic principles to be followed are : 1. Continuous tension on the wire while twisting and tightening. 2. Force should be apically directed while tightening. 3. Utilizing a clock wise direction for all tightening/twisting. 4. Only half a turn to be given at a time at the end.
11/03/2024 9 CONT... 5. Once the tail is cut, it is turned and placed into the inter-proximal embrasures. 6. Once all the wires are in place, move the fnger around the arch bar/wire to check for any sharp edge/margin/ wire ending.
11/03/2024 10 Armamentarium 1. Presterilized 26 gauge stainless steel wires cut into lengths of 20 cm each. • Wires are always cut on a bevel,. • The wires should be prestretched about 10 % to prevent loosening after fixing it to the teeth. 2. Two needle holders or wire holders. 3. Wire cutters 4. Kelsey-Fry bone-awl introducer
11/03/2024 11 Direct ,indirect,multiloop wiring and Arch bare Direct Indirect • BRIDLE WIRE IVY LOOPING • GILMER’S ERNST • ESSIG’S WIRING • RISDON’S WIRING Continuous or Multiloop STOUT’S OBWEGESER
11/03/2024 12 ininterdental wiring fracture Bridle Wire • First advocated by Hippocrates, • bridle wire remains one of the oldest yet a conventional method of treating mandibular fractures. • This technique represents a temporary way of stabilizing the fractured segments, preventing them from flaying apart.
11/03/2024 13 cont... Advantages • include stabilization of the two fractured • segments preventing further damage to the adjacent soft tissues, • maintenance of the airway patency (especially advantageous for the fractures of the anterior mandible), • decrease pain, and reducing damage to the neurovascular bundle from immobilizing the fractured fragments,
11/03/2024 14 Gilmer’s Wiring • This technique represents an easy and fastest method of immobilization. Technique • A 15 cm pre-stretched wire is passed through the interdental embrasureand twisted to achieve a 3 cm tail
11/03/2024 15 cont... • Multiple teeth (at least 5–6) in either jaw are utilized. • the tails from opposite arch are twisted together in a cross arch or zigzag fashion to achieve immobilization • The only drawback of this technique is that, in cases of broken /loose wire,all the cross arch wires will have to be removed and redone post placement of twisted wire
11/03/2024 16 ESSIG’S WIRING Used to stabilize dentoalveolar fracture as well as it can be used as anchoring device for IMF. • The luxated teeth also can be stabilized using this wiring. • There should be sufficient number of teeth on either side of the fracture line. • A 40 cm 26 gauge pre-stretched stainless steel wire is used.
11/03/2024 17 Cont… • The wire is passed interproximally between two teeth present a little away from fracture line.
11/03/2024 18 cont... • The wires are passed around the teeth in a figure of 8 manner until they reach 2 to 3 teeth away from the fracture line. • Now the wires are passed without looping to the other side of the fracture line and 2 to 3 teeth away from the fracture line on the opposite side. • Again the wires are taken around 2 to 3 teeth in a figure of 8 manner. • Now this acts as an arch bar on which the other smaller wires are tightened to stabilize the fracture.
11/03/2024 19 RISDON’S WIRING • It is commonly used method of horizontal wire fixation. • This can be a substitute technique for arch bar. • In this method second molars are usually chosen for anchorage on either side. • A 25 cm long 26 guage wire is passed around the neck of second molar on each side and both the ends are brought in buccal side
11/03/2024 20
11/03/2024 21 Cont… • The ends are twisted for entire length thus forming a strong base wire that comes towards the midline from each second molars. • Two base wires are grasped and twisted at mid line and adapted to the necks of the teeth on the buccal side .  • This base wire is secured to individual teeth by using additional interdental wires.  • This type of horizontal wiring offers strong fixation.
11/03/2024 22 Indirect wireing Eyelet Wiring (Ivy Loop Method • eyelet wiring is a simple and effective method of reduction and immobilization of jaw fracture • Used when fracture lines are favorable and displacement minimal • It is advisable in cases where many teeth are present in pairs in both arches. • May also be used in combination with gunning type splints in an apposing edentulous jaw, and arch bars or partially dentate jaw.
11/03/2024 23 Interdental Eyelet Wiring (Ivy Loop
11/03/2024 24 Hallam modification Button wiring clove hitch technique
11/03/2024 25 MULTI LOOP WIRING STOUT’S • The posterior part of four quadrants are used for wiring. • 4 pieces of 26 gauge 20 cm long wires are required and piece of solder is used for making loops. • The piece of solder wire is adapted to buccal surface of teeth. • The 20 cm long pre stretched wire is folded into two parts, one part acts as the stationary wire and the other end is brought distal to the second molar and taken around it on lingual side.
11/03/2024 26
11/03/2024 27 cont... • This working end is threaded through the mesial side of second molar to the buccal side under the solder wire. • It is then looped around the stationary wire and solder wire and back into the interdental space from buccal to lingual. • The same procedure is repeated for each tooth up to midline.
11/03/2024 28 Cont… • The solder wire is removed after the loops are formed and the loops are twisted to form eyelets. • Finally the stationary and working ends of the wires are twisted together.
11/03/2024 29 Multiple loop wiring (Obwegeser method)
11/03/2024 30 Cont… • This technique utilizes a 30 cm-long wire that is bent into a continuous “W” form • The elevated portion of the arcade acts to form the loop, whereas the depressed portion adapts to the contour of the teeth palatally or lingually. • The distal end of the wire arcade is kept long enough so that it will follow the buccal contour of the arch, when it is passed through the interdental space of the most posterior tooth from lingual/palatal to buccal side. •
11/03/2024 31 Cont… • The elevated ends of the wire are held together and twisted • The loops can be used for both elastic traction and wires for securing MMF. • The disadvantage of this technique is that it is very cumbersome and adequate expertise is needed to carry out this technique.
11/03/2024 32 ARCH BAR FIXATION • The arch bar is a flat, sturdy stainless steel bar on which fleats or hooks are attached. • It is an effective, quick and inexpensive method of fixation. • Commercially available arch bars are usually customized or prefabricated. • In most clinical scenarios, prefabricated arch bars like Erich’s, Jelenko are the need for placement
11/03/2024 33 Jelenko arch Erich’s arch bar
11/03/2024 34 Cont… Indications 1. Partially edentulous patients where placement of eyelets is not an option due to insufficient number of teeth. 2. The teeth present are far apart making MMF impossible. 3. For alignment of avulsed teeth/displaced dentoalveolar fracture into proper arch form. 4. Reduction and immobilization of dentoalveolar component/ fracture.
11/03/2024 35 Cont… • 5. As a part of integrated treatment for suspension for treatment of maxillofacial fractures. • The arch bar is measured to fit from first molar to first molar. • The arch bar is placed in such a way that the fleats or hooks face towards the gingival margin.
11/03/2024 36 Cont… • Now 15 cm of 26 guage wire is taken and starting from the distal tooth, the wire is passed from buccal to lingual side below the arch bar and from lingual to buccal above the arch bar and twisted together. • This is continued for all the teeth and the arch bar is secured. • When placing an arch bar across a displaced fracture segment,it is cut at the fracture site and placed separately.
11/03/2024 37 acrylic splint Lateral compression splint/ open cap acrylic splint • for the stabilization of mandibular arch. • Mainly used in cases of children, where there is mixed dentition and presence of developing teeth buds • It can be also used in adult mandibular body fracture,
11/03/2024 38 GUNNING –TYPE SPLINTS
11/03/2024 39 Cont… Indications: • For the unilateral and bilateral fractures of the edentulous mandible, where the fractures lying proximal to these areas can be controlled by inter maxillary fixation. Contraindications: • Unfavourably displaced fracture lying outside the denture bearing areas.
11/03/2024 40 Cont… • Severe posterior displacement of fractures of the anterior part of the mandible which will probably be inadequately controlled by this method alone and requires additional fixation. • Projectile injuries, involving grossly comminuted soft tissue and bone loss. • Extreme atrophy of the maxilla or mandible.
11/03/2024 41 PER ALVEOLAR WIRING • Two perialveolar wires are placed in the canine region on either side for fitting patient’s own denture to alveolar ridge. • The splint is firmly placed in the position in the upper jaw. • A kelsey-Fry bone awl introducer is pushed from buccal to palatal aspect. • A 26 gauge wire is threaded through the eye and the wire is withdrawn with it the wire on the buccal surface.
11/03/2024 42 • Same procedure is repeated on opposite side and then the splint is placed in the mouth and wires adjusted over it and twisted over the grooves and the ends tucked inwards
11/03/2024 43 CIRCUMMANDIBULAR WIRING OBWEGESER’S PROCEDURE • It is used for fixation of lateral compression splint to the mandibular bone. • Lower border of mandible is palpated in the canine region and the skin is pierced beneath the lower border of the mandible by Kelsey- Fry bone awl and it emerges through the floor of mouth.
11/03/2024 44 Cont… • A 26 or 28 guage wire is inserted through the eye of the awl and the awl is withdrawn till the lower border and directed upward along the buccal surface of mandible to pierce through the buccal sulcus. • The two ends of the wire are adjusted and the splint is adjusted and the lingual and buccal wires are held together and twisted in the region of canine grooves, cut and finished inward
11/03/2024 45
11/03/2024 46 Prolonged use of MMF • IMF are placed in the for 4- 6 weeks • prolonged placement of will cause - ankylosis of TMJ - wight loss - Poor oral hygiene - Malnutrition
11/03/2024 47 Internal Suspension wiring • The principle of internal wire suspension was first described by Adams in 1943 • the wires are passed subcutaneously from stable skeletal points into the oral cavity and are fixed on both sides to the arch bars under traction (craniofacial suspension). • Depending on the type of fracture, the point of fixation may vary. • The wires are always passed from a stable point above the fracture line.
11/03/2024 48
11/03/2024 49 Lateral frontal suspension • le Fort III and II (Mandible stable) • An incision is made in the lateral 3rd of the eyebrow to expose the zygomatic process of the frontal bone • A bur hole is drilled 5mm above the suture line and angulated to emerge on the post of infra-temporal fossa. • A 40cm length of soft stainless steel wire is passed through this and bent backwards and then threaded through the eye of a Rowe zygomatic awl.
11/03/2024 50 • The awl is then passed downwards and forward behind the frontal process of the zygomatic bone to pierce the oral mucosa adjacent to the molar tooth and is secured to a splint or arch bar.
11/03/2024 51 Central frontal wire • leFort III and II (Mandible unstable) • 2cm horizontal incision is done on central forehead • Roger “Anderson pin” inserted about 2cm subcutaneous tissue tunnel. • An awl is then passed upwards through the soft tissues, entering via the vestibule of the mouth in the upper canine region • passing posterolateral to the piriform margin of the nose and in front of the lacrimal
11/03/2024 52 a silicone tube below the pin to allow them to diverge at a lower point over the glabella
11/03/2024 53 Circum zygomatic • Le Fort II and I • The instrument pierces the temporal fascia and keeping the point close to the deep or temporal surface • enter the upper buccal sulcus in the first molar region. • The wire is attached, and the tip of the introducer withdrawn to lie just above the arch without emerging from the skin and movelateral to and down to the arch • emerge through the original point of entry of the wire in the buccal sulcus and fix on arch bar
11/03/2024 54 Obwegeser technique
11/03/2024 55 Zygomatic suspension • This method was advocated by Guerman (1957). • Used in le fort I • A 3 cm incision is made in the upper buccal sulcus above the premolar and molar teeth and the soft tissues are dissected subperiosteally to expose the base of the zygomatic buttress • A bur hole is drilled posteriorly and slightly laterally and a soft stainless-steel wire is passed.
11/03/2024 56 Cont… • The two ends are then attached to a suitable loop on either the arch bar or silver cap splint. • The deep aspect of the periosteum should not be penetrated so as to avoid herniation of the buccal pad of fat.
Infra-orbital suspension • A 3 cm incision is made in the upper buccal sulcus above the canine tooth, • the soft tissues are dissected subperiosteally to expose the inferior orbital margin lateral to the infra-orbital foramen. • A bur hole is drilled upwards and posteriorly and a soft stainless-steel wire is passed. • During the drilling of the bur hole and the threading of the wire the globe of the eye should be protected with the rounded end of a Howarth’s periosteal elevator.
11/03/2024 58 Cont… • The end of the wire is then withdrawn into the mouth and the two ends are attached to a suitable loop or cleat on the arch bar or silver cap splint
Piriform aperture suspension • A transverse 2 cm incision is made in the upper labial sulcus directly above the lateral incisor tooth • the periosteum is reflected to expose the bony piriform aperture of the nose, • The nasal mucosa is then elevated from the medial aspect to a depth of 2 cm
11/03/2024 60 • the periosteal elevator is left in position to act as a guard for this vascular tissue.
Cont… • A bur hole is drilled threading the wires as described above and subsequent fsoft stainless-steel wire is passed. • The two ends are withdrawn into the mouth and attached to a suitable loop or cleat depending on the method of intermaxillary fixation used. • In children, particularly when united to a circum mandibular wire (also repeated on the contralateral side), a very rigid and stable fixation can be achieved in this way
11/03/2024 62 Transosseous or intraosseous wiring Direct bone wiring in the mandible 1. the posterior fragment fractures, 2. the edentulous mandibular fracture, 3. Compound mandibular fracture, and 4. the lower border of the mandible in the presence of multiple fractures where the upper border of the jaw has been secured by one of the conventional methods of fixation,
11/03/2024 63 Cont… • The direct wiring of mid-face fractures which occur at normal suture lines 1.Fronto-nasal; 2. Fronto-maxillary; 3. Fronto-zygomatic 4.Maxillary-zygomatic.
11/03/2024 64 Cont… When the fracture does not occur at a normal suture line the commoner sites for direct wiring are: 1. Inferior and lateral orbital margins; 2. Superior orbital margin; 3. Zygomatic arch; 4. Palatal processes of the maxillae
11/03/2024 65 Transfixation with Kirschner wire • comparison with other techniques the appliances are extremely simple and unobtrusive and • nursing care is, in many respects, less of a problem. • the transfixation wire can be readily removed without recourse to any form of anesthesia • short time of operation
11/03/2024 66 Cont… • it can provide control in only a single plane • A hand drill or Toller type is used for insertion of the wire or, • in the absence of such an instrument, a Kirschner-type hand drill • The standard 1.5 mm diameter Kirschner wire and 2 mm Toller wire
11/03/2024 67 Indication • Le Fort II maxillary fractures without comminution • condyle head fracture • in the treatment of the elderly or ill patient • contraindicated in the management of severely displaced single fractures of the middle third of the facialskeleton
11/03/2024 68 summary • wiring technique is important management of fascial bone fracture • Different wire techniques are used based on the dentition of the patient can be incorporated with plates • used in both dentoalveolar and fascial bone fracture
11/03/2024 69 References • Textbook of Oral and Maxillofacial Surgery neelima milek • Maxillofacial Injuries,Rowe and Williams • Oral and Maxillofacial Surgery for the Clinician

More Related Content

PPTX
Odontogenic tumors ppt
bymadhusudhan reddy
 
PPT
Final impression CD
byDr. Ayesha Zaheer
 
PPTX
Dental composite and shrink free composite
byDrGhadooRa
 
PPT
classification of malocclusion
byshabeel pn
 
PDF
The-principles-of-tooth-preparation-may-be-divided-into-three-broad-categorie...
byMuhammadArif275963
 
PPTX
Class V and VI amalgam cavity preparations
byNadeem Aashiq
 
PPT
Dental amalgam
byDr. Arpit Viradiya
 
PPTX
Recent dental composite resins
byAhmed Mostafa Hussein Mohammed
 
Odontogenic tumors ppt
bymadhusudhan reddy
 
Final impression CD
byDr. Ayesha Zaheer
 
Dental composite and shrink free composite
byDrGhadooRa
 
classification of malocclusion
byshabeel pn
 
The-principles-of-tooth-preparation-may-be-divided-into-three-broad-categorie...
byMuhammadArif275963
 
Class V and VI amalgam cavity preparations
byNadeem Aashiq
 
Dental amalgam
byDr. Arpit Viradiya
 
Recent dental composite resins
byAhmed Mostafa Hussein Mohammed
 

What's hot

PPT
Premalignant lesions
byMoola Reddy
 
PPTX
Pin Retained Restoration
byDrBaljeetSinghHora
 
PDF
radiology-paralleling-technique
byParth Thakkar
 
PPSX
Cysts in orofacial region
byMohammed Rhael
 
PPT
J. class iii,iv, & v direct composite
byEmjei Mendoza
 
PPTX
Viral lesions in children
byDr. Faizan Ansari
 
PPTX
Removable orthodontic appliance
bymrboy
 
PPT
5.retainers, clasp assemblies and indirect retainers
bywww.ffofr.org - Foundation for Oral Facial Rehabilitiation
 
PPTX
Surveying in Removable Prosthodontics
bySuryansh Singh
 
PPT
Resection oral surgery (very simplified)
byKiks Legaspi
 
PPTX
Premalignant lesions and conditions
byDr Bhavik Miyani
 
PPT
5.full metal crown
byLama K Banna
 
PPTX
Principles of cavity preparation 2017
byMarie Claire Ineza
 
PDF
Ellis and davey’s classification of tooth fracture
byDr Faraz Mohammed
 
PPTX
Extraoral examination
byNeelam Kumari
 
PDF
Dental ceramics
byYaman Yousof
 
PPTX
Principles of tooth preparation copy
bydipalmawani91
 
PPTX
2 tissue response exam, preprosthetic
byHoang Hieu
 
PPTX
THE COMPLETE CAST PREPARATION
byMCODS, Manipal University
 
PPTX
Primary spaces of space infection
byAvishek Panda
 
Premalignant lesions
byMoola Reddy
 
Pin Retained Restoration
byDrBaljeetSinghHora
 
radiology-paralleling-technique
byParth Thakkar
 
Cysts in orofacial region
byMohammed Rhael
 
J. class iii,iv, & v direct composite
byEmjei Mendoza
 
Viral lesions in children
byDr. Faizan Ansari
 
Removable orthodontic appliance
bymrboy
 
5.retainers, clasp assemblies and indirect retainers
bywww.ffofr.org - Foundation for Oral Facial Rehabilitiation
 
Surveying in Removable Prosthodontics
bySuryansh Singh
 
Resection oral surgery (very simplified)
byKiks Legaspi
 
Premalignant lesions and conditions
byDr Bhavik Miyani
 
5.full metal crown
byLama K Banna
 
Principles of cavity preparation 2017
byMarie Claire Ineza
 
Ellis and davey’s classification of tooth fracture
byDr Faraz Mohammed
 
Extraoral examination
byNeelam Kumari
 
Dental ceramics
byYaman Yousof
 
Principles of tooth preparation copy
bydipalmawani91
 
2 tissue response exam, preprosthetic
byHoang Hieu
 
THE COMPLETE CAST PREPARATION
byMCODS, Manipal University
 
Primary spaces of space infection
byAvishek Panda
 

Similar to chap-3c Wire and Wiring Techniques s.pptx

PPTX
Various intermaxillary fixation techniques
byDr VenuSameera Panthagada
 
PPTX
Wiring techniques in maxillofacial surgery
bySyed Abuthagir
 
PPTX
Exercise Modules
bySudipta Chandra
 
PPTX
Mandibular-#-2.pptx
byAshishpanda32
 
PPTX
Closed Reduction & Simple Wiring Techniques.pptx
byssuser3690c8
 
PPTX
SUM MANDIBULAR.pptx
byDrsumayyakhan
 
PPTX
Closed Reduction in Mandibular Fractures
byDr. Tshewang Gyeltshen
 
DOCX
Surgical therapy
byPrakash Prakh
 
PPTX
Transosseus wiring circumferential wiring dentoalveolar fracture
byAzis Aimaduddin
 
PPTX
Mandibular fractures and their management
byLinto14
 
PPTX
MANDIBULAR FRACTURE.pptx
byDR DAVIS NADAKKAVUKARAN
 
PPTX
Occlusion and Mmf vv-1.pptx
byShubhanshu Gaurav
 
PPTX
Edgewise appliance
byAstha Patel
 
PPT
Fracture stabilization
byEhab Napih
 
PPTX
mandibular fracture_ chsdft aswiyshs.pptx
byAlsafakKamal1
 
PPT
Beggs satge 1&2
byreshmininan
 
PPTX
MBT wire sequence during orthodontic alignment and leveling
byMaher Fouda
 
PPTX
13. Begg's Philosophy.pptx
byManasa Penumatsa
 
PPTX
Metallurgy & fixation methods
byDr. SHEETAL KAPSE
 
PPTX
MANAGEMENT OF MAXILLOFACIAL FRACTURES
byNagarajan Srini
 
Various intermaxillary fixation techniques
byDr VenuSameera Panthagada
 
Wiring techniques in maxillofacial surgery
bySyed Abuthagir
 
Exercise Modules
bySudipta Chandra
 
Mandibular-#-2.pptx
byAshishpanda32
 
Closed Reduction & Simple Wiring Techniques.pptx
byssuser3690c8
 
SUM MANDIBULAR.pptx
byDrsumayyakhan
 
Closed Reduction in Mandibular Fractures
byDr. Tshewang Gyeltshen
 
Surgical therapy
byPrakash Prakh
 
Transosseus wiring circumferential wiring dentoalveolar fracture
byAzis Aimaduddin
 
Mandibular fractures and their management
byLinto14
 
MANDIBULAR FRACTURE.pptx
byDR DAVIS NADAKKAVUKARAN
 
Occlusion and Mmf vv-1.pptx
byShubhanshu Gaurav
 
Edgewise appliance
byAstha Patel
 
Fracture stabilization
byEhab Napih
 
mandibular fracture_ chsdft aswiyshs.pptx
byAlsafakKamal1
 
Beggs satge 1&2
byreshmininan
 
MBT wire sequence during orthodontic alignment and leveling
byMaher Fouda
 
13. Begg's Philosophy.pptx
byManasa Penumatsa
 
Metallurgy & fixation methods
byDr. SHEETAL KAPSE
 
MANAGEMENT OF MAXILLOFACIAL FRACTURES
byNagarajan Srini
 

More from AlexGeor

PPTX
instrumentation for fixed ortodontics(1).pptx
byAlexGeor
 
PPTX
Anchorage and dentofacial orthopedics.pptx
byAlexGeor
 
PPTX
2b. malignant nasal paranasal sinus ca.pptx
byAlexGeor
 
PPTX
head and neck Sarcoma-of-the-Jaw (1).pptx
byAlexGeor
 
PPTX
3. GIT physiology in oral and maxillofacial surgery ci.pptx
byAlexGeor
 
PPTX
2. salivary gland anatomy oral and maxillofacica.pptx
byAlexGeor
 
PDF
anatomyofperiodontium periodon-180923181101.pdf
byAlexGeor
 
PPTX
01 skin and skin lesions 1 dermatology coursepptx
byAlexGeor
 
PPTX
Epistaxis nasal bleeding undergraduate lecture
byAlexGeor
 
PPTX
disease of inner ear presentation for undergraduate
byAlexGeor
 
PPTX
Applied Anatomy and physiology of Ear.pptx
byAlexGeor
 
PPTX
the Anatomy and physiology of pharynx.pptx
byAlexGeor
 
PPTX
RL 2 CHapter 4. oral radiology lecture pptx
byAlexGeor
 
PPTX
chap-3j firearm injury maxillofacial.pptx
byAlexGeor
 
PPTX
chap-3j firearm injury maxillofacial.pptx
byAlexGeor
 
PPTX
chap-3c Wire and Wiring Techniques .pptx
byAlexGeor
 
PPTX
chap-3e Naso orbito ethmoid bone fracture OE fracture.pptx
byAlexGeor
 
PPTX
Zygomaticomaxillary complex Fracture pptx
byAlexGeor
 
PPTX
The Red Eye conjuctival diseases of the eyepptx
byAlexGeor
 
PPT
HISTORY AND PHYSICAL EXAM OF THE EYE. HO.ppt
byAlexGeor
 
instrumentation for fixed ortodontics(1).pptx
byAlexGeor
 
Anchorage and dentofacial orthopedics.pptx
byAlexGeor
 
2b. malignant nasal paranasal sinus ca.pptx
byAlexGeor
 
head and neck Sarcoma-of-the-Jaw (1).pptx
byAlexGeor
 
3. GIT physiology in oral and maxillofacial surgery ci.pptx
byAlexGeor
 
2. salivary gland anatomy oral and maxillofacica.pptx
byAlexGeor
 
anatomyofperiodontium periodon-180923181101.pdf
byAlexGeor
 
01 skin and skin lesions 1 dermatology coursepptx
byAlexGeor
 
Epistaxis nasal bleeding undergraduate lecture
byAlexGeor
 
disease of inner ear presentation for undergraduate
byAlexGeor
 
Applied Anatomy and physiology of Ear.pptx
byAlexGeor
 
the Anatomy and physiology of pharynx.pptx
byAlexGeor
 
RL 2 CHapter 4. oral radiology lecture pptx
byAlexGeor
 
chap-3j firearm injury maxillofacial.pptx
byAlexGeor
 
chap-3j firearm injury maxillofacial.pptx
byAlexGeor
 
chap-3c Wire and Wiring Techniques .pptx
byAlexGeor
 
chap-3e Naso orbito ethmoid bone fracture OE fracture.pptx
byAlexGeor
 
Zygomaticomaxillary complex Fracture pptx
byAlexGeor
 
The Red Eye conjuctival diseases of the eyepptx
byAlexGeor
 
HISTORY AND PHYSICAL EXAM OF THE EYE. HO.ppt
byAlexGeor
 

Recently uploaded

PPTX
SAPIENT3.0 Medi-trivia Quiz (FINALS) | F.A.Q. 2025
byDr. Anindya
 
PPTX
Pharmacology_Quick_Revision_2ndYear_BDS-1.pptx
bymaddieinfo7
 
PPTX
thyroid neoplasm diagnosis and management
bysauravSLASHmajumdar
 
PPTX
ATA_2025_DTC_MCh_Detailed_Presentation.pptx
byAnbu Arasan
 
PPTX
Recent and update advances in RMNCAH+N.pptx
bypoornimatomar21
 
PPTX
Sliding Filament Theory | Muscle Physiology | KEMU
bymuhammadmoazzin7
 
PPTX
Dental plaque dental plaque periodontology.pptx
bymohdx8884
 
PPTX
Nocardia.-Introduction,Morphology,Classification,Pathogenesis,Epidemiology,Cl...
byAmeenKhan59
 
PPTX
Acute kidney injury and its management.pptx
byrozhnuraddin
 
PDF
The Doctor's Balance Sheet By Dr Kanhu Charan Patro
byKanhu Charan
 
PPTX
Extending Horizons of Progestins in Reproductive Medicine
bySujoy Dasgupta
 
PPTX
BRONCHIAL ASTHMA.pptx by gokulakrishnan
byGOKULAKRISHNAN JANARTHANAN
 
PDF
Key Pharmaceutical Advisory Firms for Early-Stage Biotech Businesses
byk kumar
 
PPTX
LOW DOSE RADIATHERAPY (LDRT) IN OSTEOARTHRITIS
byKanhu Charan
 
PPT
Treating With Precision in CRSwNP: Defining the Role of Targeted Biologic The...
byPVI, PeerView Institute for Medical Education
 
PDF
Rethinking Pulmonary Fibrosis: From Fine-Tuning Diagnosis to Illuminating Nov...
byPVI, PeerView Institute for Medical Education
 
PPTX
Sexual Dysfunction in infertile couples- Lecture
bySujoy Dasgupta
 
PPTX
Sample Acceptance-Rejection-Criteria in lab
byKISMAT ALI
 
PPTX
CATARACT SURGERY... KAL AAJ AUR KAL... THE PAST, THE PRESENT AND THE FUTURE.
byirfanrawal
 
PPTX
Blow-Out Fracture _ M Rinaldi Dahlan - Penang.pptx
byMavisVermilion11
 
SAPIENT3.0 Medi-trivia Quiz (FINALS) | F.A.Q. 2025
byDr. Anindya
 
Pharmacology_Quick_Revision_2ndYear_BDS-1.pptx
bymaddieinfo7
 
thyroid neoplasm diagnosis and management
bysauravSLASHmajumdar
 
ATA_2025_DTC_MCh_Detailed_Presentation.pptx
byAnbu Arasan
 
Recent and update advances in RMNCAH+N.pptx
bypoornimatomar21
 
Sliding Filament Theory | Muscle Physiology | KEMU
bymuhammadmoazzin7
 
Dental plaque dental plaque periodontology.pptx
bymohdx8884
 
Nocardia.-Introduction,Morphology,Classification,Pathogenesis,Epidemiology,Cl...
byAmeenKhan59
 
Acute kidney injury and its management.pptx
byrozhnuraddin
 
The Doctor's Balance Sheet By Dr Kanhu Charan Patro
byKanhu Charan
 
Extending Horizons of Progestins in Reproductive Medicine
bySujoy Dasgupta
 
BRONCHIAL ASTHMA.pptx by gokulakrishnan
byGOKULAKRISHNAN JANARTHANAN
 
Key Pharmaceutical Advisory Firms for Early-Stage Biotech Businesses
byk kumar
 
LOW DOSE RADIATHERAPY (LDRT) IN OSTEOARTHRITIS
byKanhu Charan
 
Treating With Precision in CRSwNP: Defining the Role of Targeted Biologic The...
byPVI, PeerView Institute for Medical Education
 
Rethinking Pulmonary Fibrosis: From Fine-Tuning Diagnosis to Illuminating Nov...
byPVI, PeerView Institute for Medical Education
 
Sexual Dysfunction in infertile couples- Lecture
bySujoy Dasgupta
 
Sample Acceptance-Rejection-Criteria in lab
byKISMAT ALI
 
CATARACT SURGERY... KAL AAJ AUR KAL... THE PAST, THE PRESENT AND THE FUTURE.
byirfanrawal
 
Blow-Out Fracture _ M Rinaldi Dahlan - Penang.pptx
byMavisVermilion11
 

chap-3c Wire and Wiring Techniques s.pptx

  • 1.
    11/03/2024 1 Wire andWiring Techniques Prepared by Dr.Alex Asmamaw( DMD, OCMFS )
  • 2.
    11/03/2024 2 outline • Objective •Introduction • Closed reduction • Armamentarium and Principles • Direct ,indirect, multiloop wiring and Arch bare • Internal skeletal suspension wiring • Intraosseous wiring • Summary • Reference
  • 3.
    11/03/2024 3 Objective in thisseminar we will cover • different types of wire like ss & k wires • Different types of wiring technique • Wiring in edentulous patients • Use of suspension wire in mid face fractures
  • 4.
    11/03/2024 4 INTRODUCTION •wiring isone of the oldiest techniques truma mangment • The wire can only provide stability by means of its ability to prevent gap • the wire cannot neutralize torsion or shear forces • wireing technique can be applied for MMF , suspensions or interossious fixation
  • 5.
    11/03/2024 5 closed reduction indicationof closed reduction • Nondisplaced favorable fractures • Grossly comminuted fractures • Fractures in children involving the developing dentition • Coronoid fractures • treatment of condylar fractures Contraindicated in asthmatic, in parkinsonism, mentally challenged patients
  • 6.
    11/03/2024 6 cont... advantage ofclosed reduction 1. Day-care procedure, not require hospitalization 2. Cost-effective and safe 3. Avoid damage to the vital structure disadvantage 1. Restriction of mouth opening for minimum of 4 weeks 2. Patients can take only liquid diet
  • 7.
    11/03/2024 7 cont... 3. Diffcultto maintain oral hygiene 4. Challenging in partially edentulous patients 5. Weight loss 6. Partial trismus for few weeks
  • 8.
    11/03/2024 8 Armamentarium andPrinciples Basic principles to be followed are : 1. Continuous tension on the wire while twisting and tightening. 2. Force should be apically directed while tightening. 3. Utilizing a clock wise direction for all tightening/twisting. 4. Only half a turn to be given at a time at the end.
  • 9.
    11/03/2024 9 CONT... 5. Oncethe tail is cut, it is turned and placed into the inter-proximal embrasures. 6. Once all the wires are in place, move the fnger around the arch bar/wire to check for any sharp edge/margin/ wire ending.
  • 10.
    11/03/2024 10 Armamentarium 1. Presterilized26 gauge stainless steel wires cut into lengths of 20 cm each. • Wires are always cut on a bevel,. • The wires should be prestretched about 10 % to prevent loosening after fixing it to the teeth. 2. Two needle holders or wire holders. 3. Wire cutters 4. Kelsey-Fry bone-awl introducer
  • 11.
    11/03/2024 11 Direct ,indirect,multiloopwiring and Arch bare Direct Indirect • BRIDLE WIRE IVY LOOPING • GILMER’S ERNST • ESSIG’S WIRING • RISDON’S WIRING Continuous or Multiloop STOUT’S OBWEGESER
  • 12.
    11/03/2024 12 ininterdental wiringfracture Bridle Wire • First advocated by Hippocrates, • bridle wire remains one of the oldest yet a conventional method of treating mandibular fractures. • This technique represents a temporary way of stabilizing the fractured segments, preventing them from flaying apart.
  • 13.
    11/03/2024 13 cont... Advantages • includestabilization of the two fractured • segments preventing further damage to the adjacent soft tissues, • maintenance of the airway patency (especially advantageous for the fractures of the anterior mandible), • decrease pain, and reducing damage to the neurovascular bundle from immobilizing the fractured fragments,
  • 14.
    11/03/2024 14 Gilmer’s Wiring •This technique represents an easy and fastest method of immobilization. Technique • A 15 cm pre-stretched wire is passed through the interdental embrasureand twisted to achieve a 3 cm tail
  • 15.
    11/03/2024 15 cont... • Multipleteeth (at least 5–6) in either jaw are utilized. • the tails from opposite arch are twisted together in a cross arch or zigzag fashion to achieve immobilization • The only drawback of this technique is that, in cases of broken /loose wire,all the cross arch wires will have to be removed and redone post placement of twisted wire
  • 16.
    11/03/2024 16 ESSIG’S WIRING Usedto stabilize dentoalveolar fracture as well as it can be used as anchoring device for IMF. • The luxated teeth also can be stabilized using this wiring. • There should be sufficient number of teeth on either side of the fracture line. • A 40 cm 26 gauge pre-stretched stainless steel wire is used.
  • 17.
    11/03/2024 17 Cont… • Thewire is passed interproximally between two teeth present a little away from fracture line.
  • 18.
    11/03/2024 18 cont... • Thewires are passed around the teeth in a figure of 8 manner until they reach 2 to 3 teeth away from the fracture line. • Now the wires are passed without looping to the other side of the fracture line and 2 to 3 teeth away from the fracture line on the opposite side. • Again the wires are taken around 2 to 3 teeth in a figure of 8 manner. • Now this acts as an arch bar on which the other smaller wires are tightened to stabilize the fracture.
  • 19.
    11/03/2024 19 RISDON’S WIRING •It is commonly used method of horizontal wire fixation. • This can be a substitute technique for arch bar. • In this method second molars are usually chosen for anchorage on either side. • A 25 cm long 26 guage wire is passed around the neck of second molar on each side and both the ends are brought in buccal side
  • 20.
  • 21.
    11/03/2024 21 Cont… • Theends are twisted for entire length thus forming a strong base wire that comes towards the midline from each second molars. • Two base wires are grasped and twisted at mid line and adapted to the necks of the teeth on the buccal side .  • This base wire is secured to individual teeth by using additional interdental wires.  • This type of horizontal wiring offers strong fixation.
  • 22.
    11/03/2024 22 Indirect wireing EyeletWiring (Ivy Loop Method • eyelet wiring is a simple and effective method of reduction and immobilization of jaw fracture • Used when fracture lines are favorable and displacement minimal • It is advisable in cases where many teeth are present in pairs in both arches. • May also be used in combination with gunning type splints in an apposing edentulous jaw, and arch bars or partially dentate jaw.
  • 23.
  • 24.
    11/03/2024 24 Hallam modificationButton wiring clove hitch technique
  • 25.
    11/03/2024 25 MULTI LOOPWIRING STOUT’S • The posterior part of four quadrants are used for wiring. • 4 pieces of 26 gauge 20 cm long wires are required and piece of solder is used for making loops. • The piece of solder wire is adapted to buccal surface of teeth. • The 20 cm long pre stretched wire is folded into two parts, one part acts as the stationary wire and the other end is brought distal to the second molar and taken around it on lingual side.
  • 26.
  • 27.
    11/03/2024 27 cont... • Thisworking end is threaded through the mesial side of second molar to the buccal side under the solder wire. • It is then looped around the stationary wire and solder wire and back into the interdental space from buccal to lingual. • The same procedure is repeated for each tooth up to midline.
  • 28.
    11/03/2024 28 Cont… • Thesolder wire is removed after the loops are formed and the loops are twisted to form eyelets. • Finally the stationary and working ends of the wires are twisted together.
  • 29.
    11/03/2024 29 Multiple loopwiring (Obwegeser method)
  • 30.
    11/03/2024 30 Cont… • Thistechnique utilizes a 30 cm-long wire that is bent into a continuous “W” form • The elevated portion of the arcade acts to form the loop, whereas the depressed portion adapts to the contour of the teeth palatally or lingually. • The distal end of the wire arcade is kept long enough so that it will follow the buccal contour of the arch, when it is passed through the interdental space of the most posterior tooth from lingual/palatal to buccal side. •
  • 31.
    11/03/2024 31 Cont… • Theelevated ends of the wire are held together and twisted • The loops can be used for both elastic traction and wires for securing MMF. • The disadvantage of this technique is that it is very cumbersome and adequate expertise is needed to carry out this technique.
  • 32.
    11/03/2024 32 ARCH BARFIXATION • The arch bar is a flat, sturdy stainless steel bar on which fleats or hooks are attached. • It is an effective, quick and inexpensive method of fixation. • Commercially available arch bars are usually customized or prefabricated. • In most clinical scenarios, prefabricated arch bars like Erich’s, Jelenko are the need for placement
  • 33.
    11/03/2024 33 Jelenko archErich’s arch bar
  • 34.
    11/03/2024 34 Cont… Indications 1. Partiallyedentulous patients where placement of eyelets is not an option due to insufficient number of teeth. 2. The teeth present are far apart making MMF impossible. 3. For alignment of avulsed teeth/displaced dentoalveolar fracture into proper arch form. 4. Reduction and immobilization of dentoalveolar component/ fracture.
  • 35.
    11/03/2024 35 Cont… • 5.As a part of integrated treatment for suspension for treatment of maxillofacial fractures. • The arch bar is measured to fit from first molar to first molar. • The arch bar is placed in such a way that the fleats or hooks face towards the gingival margin.
  • 36.
    11/03/2024 36 Cont… • Now15 cm of 26 guage wire is taken and starting from the distal tooth, the wire is passed from buccal to lingual side below the arch bar and from lingual to buccal above the arch bar and twisted together. • This is continued for all the teeth and the arch bar is secured. • When placing an arch bar across a displaced fracture segment,it is cut at the fracture site and placed separately.
  • 37.
    11/03/2024 37 acrylic splint Lateralcompression splint/ open cap acrylic splint • for the stabilization of mandibular arch. • Mainly used in cases of children, where there is mixed dentition and presence of developing teeth buds • It can be also used in adult mandibular body fracture,
  • 38.
  • 39.
    11/03/2024 39 Cont… Indications: • Forthe unilateral and bilateral fractures of the edentulous mandible, where the fractures lying proximal to these areas can be controlled by inter maxillary fixation. Contraindications: • Unfavourably displaced fracture lying outside the denture bearing areas.
  • 40.
    11/03/2024 40 Cont… • Severeposterior displacement of fractures of the anterior part of the mandible which will probably be inadequately controlled by this method alone and requires additional fixation. • Projectile injuries, involving grossly comminuted soft tissue and bone loss. • Extreme atrophy of the maxilla or mandible.
  • 41.
    11/03/2024 41 PER ALVEOLARWIRING • Two perialveolar wires are placed in the canine region on either side for fitting patient’s own denture to alveolar ridge. • The splint is firmly placed in the position in the upper jaw. • A kelsey-Fry bone awl introducer is pushed from buccal to palatal aspect. • A 26 gauge wire is threaded through the eye and the wire is withdrawn with it the wire on the buccal surface.
  • 42.
    11/03/2024 42 • Sameprocedure is repeated on opposite side and then the splint is placed in the mouth and wires adjusted over it and twisted over the grooves and the ends tucked inwards
  • 43.
    11/03/2024 43 CIRCUMMANDIBULAR WIRING OBWEGESER’SPROCEDURE • It is used for fixation of lateral compression splint to the mandibular bone. • Lower border of mandible is palpated in the canine region and the skin is pierced beneath the lower border of the mandible by Kelsey- Fry bone awl and it emerges through the floor of mouth.
  • 44.
    11/03/2024 44 Cont… • A26 or 28 guage wire is inserted through the eye of the awl and the awl is withdrawn till the lower border and directed upward along the buccal surface of mandible to pierce through the buccal sulcus. • The two ends of the wire are adjusted and the splint is adjusted and the lingual and buccal wires are held together and twisted in the region of canine grooves, cut and finished inward
  • 45.
  • 46.
    11/03/2024 46 Prolonged useof MMF • IMF are placed in the for 4- 6 weeks • prolonged placement of will cause - ankylosis of TMJ - wight loss - Poor oral hygiene - Malnutrition
  • 47.
    11/03/2024 47 Internal Suspensionwiring • The principle of internal wire suspension was first described by Adams in 1943 • the wires are passed subcutaneously from stable skeletal points into the oral cavity and are fixed on both sides to the arch bars under traction (craniofacial suspension). • Depending on the type of fracture, the point of fixation may vary. • The wires are always passed from a stable point above the fracture line.
  • 48.
  • 49.
    11/03/2024 49 Lateral frontalsuspension • le Fort III and II (Mandible stable) • An incision is made in the lateral 3rd of the eyebrow to expose the zygomatic process of the frontal bone • A bur hole is drilled 5mm above the suture line and angulated to emerge on the post of infra-temporal fossa. • A 40cm length of soft stainless steel wire is passed through this and bent backwards and then threaded through the eye of a Rowe zygomatic awl.
  • 50.
    11/03/2024 50 • Theawl is then passed downwards and forward behind the frontal process of the zygomatic bone to pierce the oral mucosa adjacent to the molar tooth and is secured to a splint or arch bar.
  • 51.
    11/03/2024 51 Central frontalwire • leFort III and II (Mandible unstable) • 2cm horizontal incision is done on central forehead • Roger “Anderson pin” inserted about 2cm subcutaneous tissue tunnel. • An awl is then passed upwards through the soft tissues, entering via the vestibule of the mouth in the upper canine region • passing posterolateral to the piriform margin of the nose and in front of the lacrimal
  • 52.
    11/03/2024 52 a siliconetube below the pin to allow them to diverge at a lower point over the glabella
  • 53.
    11/03/2024 53 Circum zygomatic •Le Fort II and I • The instrument pierces the temporal fascia and keeping the point close to the deep or temporal surface • enter the upper buccal sulcus in the first molar region. • The wire is attached, and the tip of the introducer withdrawn to lie just above the arch without emerging from the skin and movelateral to and down to the arch • emerge through the original point of entry of the wire in the buccal sulcus and fix on arch bar
  • 54.
  • 55.
    11/03/2024 55 Zygomatic suspension •This method was advocated by Guerman (1957). • Used in le fort I • A 3 cm incision is made in the upper buccal sulcus above the premolar and molar teeth and the soft tissues are dissected subperiosteally to expose the base of the zygomatic buttress • A bur hole is drilled posteriorly and slightly laterally and a soft stainless-steel wire is passed.
  • 56.
    11/03/2024 56 Cont… • Thetwo ends are then attached to a suitable loop on either the arch bar or silver cap splint. • The deep aspect of the periosteum should not be penetrated so as to avoid herniation of the buccal pad of fat.
  • 57.
    Infra-orbital suspension • A3 cm incision is made in the upper buccal sulcus above the canine tooth, • the soft tissues are dissected subperiosteally to expose the inferior orbital margin lateral to the infra-orbital foramen. • A bur hole is drilled upwards and posteriorly and a soft stainless-steel wire is passed. • During the drilling of the bur hole and the threading of the wire the globe of the eye should be protected with the rounded end of a Howarth’s periosteal elevator.
  • 58.
    11/03/2024 58 Cont… • Theend of the wire is then withdrawn into the mouth and the two ends are attached to a suitable loop or cleat on the arch bar or silver cap splint
  • 59.
    Piriform aperture suspension •A transverse 2 cm incision is made in the upper labial sulcus directly above the lateral incisor tooth • the periosteum is reflected to expose the bony piriform aperture of the nose, • The nasal mucosa is then elevated from the medial aspect to a depth of 2 cm
  • 60.
    11/03/2024 60 • theperiosteal elevator is left in position to act as a guard for this vascular tissue.
  • 61.
    Cont… • A burhole is drilled threading the wires as described above and subsequent fsoft stainless-steel wire is passed. • The two ends are withdrawn into the mouth and attached to a suitable loop or cleat depending on the method of intermaxillary fixation used. • In children, particularly when united to a circum mandibular wire (also repeated on the contralateral side), a very rigid and stable fixation can be achieved in this way
  • 62.
    11/03/2024 62 Transosseous orintraosseous wiring Direct bone wiring in the mandible 1. the posterior fragment fractures, 2. the edentulous mandibular fracture, 3. Compound mandibular fracture, and 4. the lower border of the mandible in the presence of multiple fractures where the upper border of the jaw has been secured by one of the conventional methods of fixation,
  • 63.
    11/03/2024 63 Cont… • Thedirect wiring of mid-face fractures which occur at normal suture lines 1.Fronto-nasal; 2. Fronto-maxillary; 3. Fronto-zygomatic 4.Maxillary-zygomatic.
  • 64.
    11/03/2024 64 Cont… When thefracture does not occur at a normal suture line the commoner sites for direct wiring are: 1. Inferior and lateral orbital margins; 2. Superior orbital margin; 3. Zygomatic arch; 4. Palatal processes of the maxillae
  • 65.
    11/03/2024 65 Transfixation withKirschner wire • comparison with other techniques the appliances are extremely simple and unobtrusive and • nursing care is, in many respects, less of a problem. • the transfixation wire can be readily removed without recourse to any form of anesthesia • short time of operation
  • 66.
    11/03/2024 66 Cont… • itcan provide control in only a single plane • A hand drill or Toller type is used for insertion of the wire or, • in the absence of such an instrument, a Kirschner-type hand drill • The standard 1.5 mm diameter Kirschner wire and 2 mm Toller wire
  • 67.
    11/03/2024 67 Indication • LeFort II maxillary fractures without comminution • condyle head fracture • in the treatment of the elderly or ill patient • contraindicated in the management of severely displaced single fractures of the middle third of the facialskeleton
  • 68.
    11/03/2024 68 summary • wiringtechnique is important management of fascial bone fracture • Different wire techniques are used based on the dentition of the patient can be incorporated with plates • used in both dentoalveolar and fascial bone fracture
  • 69.
    11/03/2024 69 References • Textbookof Oral and Maxillofacial Surgery neelima milek • Maxillofacial Injuries,Rowe and Williams • Oral and Maxillofacial Surgery for the Clinician

Editor's Notes

  • #10 so that the bevel can act as a needle point, to pass through the interdental areas Overstretching beyond this point should be avoided as this will make the wire brittle and susceptible to breakage
  • #13 thereby preventing gross movements and also decreasing muscle cramping.
  • #15 Twisted wire to produce 3 cm tell Use cross brasing when bossible
  • #22  the maxillary arch, loops can be placed between two molars, two premolars, or between lateral incisor and canine or two central incisors. In the mandibular arch, loops are best placed between two molars, two premolars, or between lateral incisor and
  • #27 Elastic and wire can be used, easy to open in case of need for access to oral cavity
  • #37 (open reduction and direct fixation is contraindicsted). where the stability cannot be obtained by means of other type of horizontal wiring methods.
  • #52 and this reduces the possibility of tenting up of the soft tissues in the region of the inner canthus
  • #62  but where this alone may leave the lower border inadequately reduced
  • #67 circumstances, where the zygomatic complexes are intact, cranio-maxillary fixation may be unnecessary