Orofacial trauma can result from a variety of mishaps, such as motor vehicle accident, fall from a height, kicking injury or bite wounds. Initial assessment of orofacial injuries should be done gently and preferably under sedation, proceeding from least invasive to most invasive. Evaluation should focus on asymmetry, swelling, discharge and injuries to adjacent structures.
Intraoral radiography is essential for accurate and complete evaluation of oral fractures, especially in relation to the teeth and the intricate bone of the mandibles and the maxilla. Radiography of the skull and CT scanning may also be valuable for imaging the location and extent of injuries. Occlusion, tooth mobility, tooth fracture, TMJ function and soft tissue defects/injuries must all be assessed.
The main objectives in the repair of oral fractures are the maintenance of proper occlusion and the return to full function of the jaws. For this reason and because there are so many sensitive and vital structures in and around the mouth, minimally invasive repair techniques are preferred whenever possible. Interdental wiring techniques in combination with acrylic or composite splinting represent very effective means of repairing oral fractures.
Using the teeth as anchors for rigid intraoral stabilization not only eliminates the need for additional external hardware or large amounts of buried implant material in a contaminated/infected situation, but it also aids in the preservation of proper occlusion. The anchoring teeth on either side of the fracture line can be wired together to anatomically reduce the fracture fragments and in so doing can reestablish the proper occlusal relationship between the maxilla and the mandible.
The main goal of this wiring is fracture fragment reduction, not to provide the sole stability for bone healing. Once the interdental wiring is applied and tightened properly, an intraoral splint is applied over the wire. The wire in this case acts somewhat like rebar in concrete and allows for the combination of the wire and splint material to complement each other synergistically. Acrylic has been used quite effectively for many years as an intraoral splint material that may be laid down over the wiring to provide the necessary stability for healing.
Self-cure composite is a high-tech alternative to acrylic that is now available. Unlike the acrylic, composite has no noxious fumes with which to contend. The composite material can be applied directly to the teeth and attached interdental wiring, bonding securely to each. The material is smoothly shaped when it has set completely to help prevent serious periodontal insult and soft tissue trauma. Care is also taken to avoid interference of the occluding teeth with the splint.
The patient is fed a softened diet and is not permitted to have chew toys while the appliance is in the mouth. The combined wiring and splinting is left in place for about four to six weeks, until a bony union has occurred. Then the appliance is carefully removed to avoid damage to the teeth or soft tissues of the mouth. The teeth are thoroughly scaled and polished to eliminate plaque build-up from the healing phase.