Restoring and maintaining occlusion is the primary goal of fixation of mandibular fractures. This can be achieved by bonding the maxillary and mandibular canine teeth to each other. The disadvantage of this method is that it does not allow early return to normal function.
Placement of an esophagostomy tube is strongly recommended prior to bonding of the canine teeth.
Example of esophagostomy tube in place.
4. Bonding of the canine teeth
The canine teeth are cleaned, acid-etched for 20-30 seconds and then rinsed with water and completely air dried.
The teeth are placed in normal dental occlusion. The canine teeth are positioned overlapping each other by approximately one half of the length of the crown, allowing enough space for eating, drinking, and movement of the tongue.
A composite temporization material is applied covering the canine teeth forming two pillars.
Note: Care should be taken to avoid sharp edges or points on the dental composite.
Smooth the composite with a Goldie bur (titanium nitride coated) on a straight handpiece or a diamond bur on a high-speed handpiece when the composite solidifies.
The patient should wear an Elizabethan collar until removal of the construct.
Multimodal analgesia is recommended. Non-steroidal medication for 10-14 days and opioids for the first 5 days post-surgery as needed.
The construct should be cleaned at least once daily using 0.12% chlorhexidine gluconate solution. Another option is to use a water-flossing device.
The composite is kept in place for 4-6 weeks and removed with debonding forceps under general anesthesia.
The teeth involved in the fixation should receive periodontal cleaning as moderate to severe gingivitis is seen associated with the fixation wire.
Panting is not possible, therefore exposure to heat is avoided. To prevent damage to the construct, avoid toys and contact with other animals. While rarely seen, if the patient vomits, aspiration pneumonia may occur.