J. Maxillofac. Oral Surg.
https://doi.org/10.1007/s12663-020-01466-0
TECHNICAL NOTE
Double Loop Interdental Wiring: A Neoteric Technique
for Maxillo-mandibular Fixation
Ramakrishna Shenoi1 • Jignesh Rajguru1 • Pranav Ingole1 • Jui Karmarkar1 •
Jignesh Rajguru1
Received: 13 August 2020 / Accepted: 6 October 2020
Ó The Association of Oral and Maxillofacial Surgeons of India 2020
Introduction Technique
The objective of establishing intra-operative occlusion by A pre-stretched 24G wire of appropriate length is used in
temporary inter-maxillary fixation remains constant even the following technique. A single loop is incorporated in
with evolving principles for treatment for facial fractures. the centre of the wire. One end of this wire is passed along
The techniques used during the intra-operative temporary the buccal interdental embrasure on the distal aspect of first
inter-maxillary fixation (IMF) consist of Erich arch bars, molar, and the same end is passed from the palatal inter-
Ivy interdental eyelet wiring, resin-bonded arch bars, dental embrasure mesial to first premolar and brought out
bonded brackets, inter-maxillary fixation screws, cast metal buccally with the help of wire forceps. The other end of the
splints, embrasure wires and pearl steel wires [1]. wire is passed along the buccal interdental embrasure on
Erich arch bar along with circumdental wiring for inter- the mesial aspect of first molar in a manner where the loop
maxillary fixation is one of the most widely accepted lies between the second premolar and first molar, and the
technique for facial fractures [2]. However, the procedure wire is encircled around the neck of second premolar and
can be time consuming and cumbersome at times. It also passed along the palatal interdental embrasure and brought
affects the marginal part of periodontal complex. out buccally. Another loop is made at this point, and the
In view of fracture realignment and immobilisation, wire is then adapted along the buccal aspect. Both the ends
Maxillo-mandibular fixation (MMF) screws are inserted of the wire are twisted to form a rosette. Thus, both the
into the bony base. However, MMF screws may pose a loops lie mesial and distal to second premolar as shown in
constant risk to damage the radicular structure if the Figs. 1, 2, 3, 4 and 5.
technique has not been mastered. It also lacks the versa- The maxillo-mandibular fixation is achieved using 24G
tility beyond its pure maintenance of occlusion [3]. or 26G wire after appropriate reduction. The above-stated
We have devised a technique that overcomes the relative technique reduces the number of wires incorporated to
bulky and rigid arch bars which may not be well tolerated achieve MMF. Hence, the marginal complex of periodontal
by the patients and the damage to the radicular structures tissues is less traumatised as compared to arch bar. The
during the placement of IMF screws. possible drawback of the proposed technique would be
difficulty in achieving MMF in cases with multiple avulsed
teeth. Therefore, appropriate case selection is of paramount
significance. The authors advocate this technique for
appropriate cases where fractures require a lesser degree of
immobilisation for shorter duration.
& Jignesh Rajguru
jignesh.rajguru19@gmail.com
1
Department of Oral and Maxillofacial Surgery, VSPM Dental
College and Research Centre, Nagpur, Maharashtra, India
123
J. Maxillofac. Oral Surg.
References
1. Qureshi AA, Reddy UK, Warad NM, Badal S, Jamadar AA,
Qurishi N (2016) Intermaxillary fixation screws versus Erich arch
bars in mandibular fractures: a comparative study and review of
literature. Ann Maxillofac Surg 6(1):25–30
2. Chandan S, Ramanojam S (2010) Comparative evaluation of the
resin bonded arch bar versus conventional Erich arch bar for
Fig. 1 Initial step of Double Loop Interdental Wiring technique intermaxillary fixation. J Maxillofac Oral Surg 9(3):231–235
3. Cornelius CP, Ehrenfeld M (2010) The use of MMF screws:
surgical technique, indications, contraindications, and common
problems in review of the literature. Craniomaxillofac Trauma
Reconstr 3(2):55–80
Publisher’s Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
Fig. 2 The second step in sequence
Fig. 3 The second Loop is the penultimate step of the technique
Fig. 4 The Double Loop Interdental Wiring technique in situ
Fig. 5 Maxillo-mandibular fixation achieved using the Double Loop
Interdental Wiring technique
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