Reduction is done digitally or with a periosteal elevator used as a lever. The fracture reduction is maintained with digital compression.
Either a figure-of-8 or a twisted wire is placed between the maxillary canine teeth. The canine teeth are acid-etched for 20-30 seconds. The acid-etch is rinsed and the teeth dried.
A thin ring of flowable composite is put on the maxillary canine teeth to help keep the wire from slipping coronally.
A figure-of-8 or twisted wire is placed so that the palatal fracture/separation is reduced. Appropriate occlusion is verified.
Application of the composite splint
The addition of a composite splint may be required for additional stability.
The teeth to be included in the splint are acid-etched for 20-30 seconds.
The teeth are thoroughly irrigated and dried. A composite temporization material is placed and contoured to avoid sharp edges or projections.
The dog should be kept on soft food for one or two weeks after surgery.
Intraoperative intravenous administration and then oral antibiotics for one to two weeks is recommended. Antibiotics used should have an excellent oral cavity penetration and spectrum. Example: ampicillin at 20 mg/kg intravenous antibiotics followed by oral antibiotics amoxicillin/clavulanic acid at 15-20 mg/kg orally twice daily.
Pain medication, such as opioids and non-steroidal anti-inflammatory medications, are used for 7-14 days.
If the fracture involved the oral cavity, oral rinse with 0.05-0.12% chlorhexidine gluconate solution is recommended (not for maxillomandibular fixation).
Recheck is recommended in 10-14 days and at three and six months post-surgery.
If there are any signs of complications (i.e. purulent nasal discharge), CT and rhinoscopy are indicated.
The splint should be cleaned twice daily using 0.05-0.12% chlorhexidine gluconate solution. Another option is to use a water-flossing device.
The composite and the wires are kept in place for six to eight weeks. They are removed under general anesthesia using debonding pliers.
The teeth involved in the fixation should receive periodontal cleaning. Moderate to severe gingivitis is commonly seen with the presence of an intraoral splint.