Fixation of jaw fractues

splints

Bone fractures are either simple ( no

open wound) or compound ( open
wound). TTT consists of reduction,
immobilization & rehabilitation

Requirement
It must be rigid & immobile

It must be comfort

It must not harm standing teeth &
surrounding structures

Does not disturb normal function

Not interfere with occlusion

Speed & ease of construction

Advantages
1- allows fixation for long times

2- does not harm the teeth

3-Allows early movement of mandible that
prevent the onset of trismus

Methods of immobilization splints

1- for dentulous pt:

1- wire splints

Direct wiring ,interdental wiring ,arch bar,
circumferential wiring

2- labiolingual splints

3- metal cap splintsd

Labiolingual splint, stout sectional

splint
For dentulous or partialy edentulous pt

for fracture without displacement or with
minimum displacement

Acc to materials

Acrylic labiolingual splint

Cast metal labiolingual splint

Acrylic labiolingual splint

Consists of 3 sections, right & left facial sections hinged to a lingual

section by mean of 2 flexible half round wire
Lower cast is sectioned through the fractured line if present &
realigned into the correct anatomical position guided by opposing
arch.
Wax is applied to buccal & lingual surfaces of teeth, the wax should
extend 3mm below the free gingival margin, & above the height of
contour( leaving occlusal surface free) then forming an anterior
projection in midline in form of button
Wrought wire is bent around the most distal tooth on both sides,
then flasked & processed
The button is sectioned vertically to produce 2 separate buccal
sections. 3 sections are brought together with light wire around 2
halves of buttons

Advantages of labiolingual splint

Securely retained as it grips the teeth in

interproximal surfaces
Cement is not necessary
Occlusal surface is free
Being made of clear acrylic resin
A lthough it contacts free gingival tissues, it is
tolerable
It can be easily removed to test for clinical union
Easy to construct, alter & repair

Cast metal labiolingual splint

Reassembled casts are duplicated in
investment,& splint is waxed up on the
duplicate cast

In cases needed long term immobilization,
immobilization,
strength &rigidity.
&rigidity. It offers superior fit,
rigidity smooth, easier to clean & more
comfortable

Metal cap splint

Efficient for reduction & immobilization

Covers buccal , lingual & occlusal aspect
of teeth on both sides of fracture.

The splint is cemented.

Types

One piece metal cap splint ( no or little displacement)

Two piece metal cap splint or with screw connecting bar(

displacement)

Alginate impression of both arch in shallow impression

trays to obtain stone casts. Sectioned & reassembled
plaster base is made to hold 2 sections together

Interproximal buccal & lingual

undercuts are obliterated& cast
is duplicated then hand
articulated with opposing one
on simple hinge articulator
The splint is waxed up by
using casting wax which is
very thin occlusally & carries
imprints of opposing teeth.
teeth.
To control jaw separation cusp
of posterior teeth project
through splint& excess cement
escape through vents.
in case of 2 piece metal cast
splint the female portion of
screws or under plates may be
waxed into wax pattern or
soldered after casting

Edentulous pt

1- GUNNING SPLINTS

In cases with vertical displacement

only & not with horizontal one.
upper & lower imp are made to obtain
casts that are sectioned &
reassembled guided by ridge contour.
// bet. Ridges is used as guide to
mount the casts at vertical dimension
2layers of modeling wax are adapted
2 mm short than depth of vestibule.
vestibule.
occlusion rims are adapted on
premolars & molars region to create a
space in anterior region to facilitate
feeding & vomiting

v-shaped grooves on occl surface of

rims are done on one arch for
anchorage of guttagutta-percha or self
curing acrylic resin at time of fixation
4 st.steel wire hoks are pepared, &
placed on buccal flange of waxed
splint
Inner layer of wax is removed and wax
is processed in acrylic resin
Soft liner or tissue conditioning mat
acts as cushion.
For intermaxillary fixation the splints
are wired together through hooks

Circumferential wiring is used to fix mandibular

splint in posirtion. Maxillary splint is suspended to
zygomatioc arch
extraoral fixation through the use of elastic chin
bandage reduces mandibular movement &
immobilization . After healing takes place
intermaxilary wiring may be removed, while splint
left for a while

In presence of old denture

Relieving fitting surface of denture to create

space for soft liner
Removing upper & lower anterior teeth to
facilitate feeding & cleaning
Hooks or arch bars are fixed to buccal surface
used self cure acrylic resin for fixation
Poor fit , inadequate base extension, & faulty
occlusion should be corrected by soft liner or by
having pt bites on soft compound placed
between occlusal surfaces which is transferred
into acrylic resin

2-Kingsley splint

Either jaws intraoral tray portion embracing teeth

or edentulous alveolar ridge, to which stout wire
arms are attached
the wires are carried out around the face to
provide attachment for bandage passing under
the chin in mandible or over the head in maxilla.
maxilla.
The tray is filled with impression compound or
cotton wool
It provide ttt for fractures maxilla to prevent its
falling on dorsum of tongue