 | This article possibly contains original research .(July 2016) |
Jaw wiring is a medical procedure to keep the jaw closed for a period of time. Originally, it was used as the mandibular equivalent of a cast, to fix the jaw in place while a fracture healed. Jaw wiring is also used for weight-loss purposes, to prevent the ingestion of solid food. [1] [2]
Jaw wiring is performed by attaching orthodontic brackets to the teeth, and wrapping pliable wire either around or through the brackets [3] or with the use of arch bars or loops affixed with wires around the teeth, or with metal splints bonded to the teeth. The wiring may be configured to immobilise the jaw in the case of fracture or surgery or to place the patient’s lower jaw in a semi-closed resting position. This permits a moderate amount of jaw movement and relatively clear speech, but inhibits the ingestion of solid foods, forcing patients to adhere to a liquid diet. [4]
This type of jaw wiring, also known as maxillo-mandibular fixation (MMF), is used in patients with mandibular fractures or those who need orthognathic surgery to correct deformed jaws. It is performed by an oral surgeon, who attaches an "arch bar" to the upper jaw and another to the lower jaw with thin wires that are threaded between and around the teeth. The arch bars completely enwrap the dental arch. The upper and lower arch bars are connected to each other with wires or elastics, compressing the upper teeth against the lower teeth and preventing jaw movement. IMF is an invasive procedure performed under general anesthesia. Once the bones have set (usually after 4–6 weeks, sometimes two or three months), the wiring is removed under local anesthesia or nitrous oxide sedation.
There are other methods for wiring teeth together. Ivy loops are a method by which wires are passed between the teeth and gums and then fastened with a loop at the front, and wires are then secured to these loops. Cap splints are metal splints which cover the entire surface of the teeth. Fixation can also be achieved by passing wires through the brackets of braces, which are commonly used before surgery.
IMF is also used to aid weight loss; various studies from the 1970s and early 1980s used ivy loops and cap splints to wire the jaws together to enforce a liquid diet until such time as sufficient weight loss had been achieved; this was typically around nine months but in one study could be as long as 17 months. It was found that patients typically put much of the weight they had lost back on, and in 1980 a study concluded that it was "a safe but ineffective means of controlling weight". However, a study published in the British Medical Journal in 1981 found that jaw wiring could be effective if aftercare were provided, in this case a nylon cord passed around the patient's waist after weight loss had been achieved, which would remind them if they started to put weight back on. [5] John Garrow, the co-author of that study, defended the practice in a 1999 letter, calling it "a safer and less expensive alternative to gastroplasty" and pointing to his positive results when accompanied with the waist cord. [6]
Conventional jaw wiring for weight loss remains in use in Nigeria and South Africa, though in the latter, dentists are said to perform the procedure reluctantly, as they know it is ineffective but patients tell they will find someone else to do it. Contrary to earlier practice, wiring is retained at most for six weeks. [7] The same pattern of weight replenishment after unwiring is observed in Nigeria, although the Nwoga et al (2019) study noted that the reasons for desiring weight loss may have been temporary, e.g. marriage or fitting into a wedding gown. [8]
The second type of jaw wiring is called orthodontic jaw wiring (OJW) or dental jaw wiring, [9] and can be used as a treatment for obesity and compulsive overeating. In this procedure, a dentist or orthodontist attaches braces to certain teeth (typically the canines and premolars) and inserts wiring, but not elastics, between the upper and lower teeth in a figure-8 pattern. The wiring is removed periodically to allow the jaw joints to move freely, especially in the vertical direction. The procedure is not invasive and does not require anesthesia.
OJW does not keep the upper and lower teeth in contact. The sole purpose of the wiring is to limit the extent to which the jaws may open. In the resting position, the teeth are parted 2–4 millimeters, with the lips lightly touching. (The ivy loop method used in the study in Nigeria also allows limited jaw movement.) Orthodontic jaw wiring is removed when the patient has achieved their weight loss goals.
Trismus is a condition of restricted opening of the mouth. The term was initially used in the setting of tetanus. Trismus may be caused by spasm of the muscles of mastication or a variety of other causes. Temporary trismus occurs much more frequently than permanent trismus. It is known to interfere with eating, speaking, and maintaining proper oral hygiene. This interference, specifically with an inability to swallow properly, results in an increased risk of aspiration. In some instances, trismus presents with altered facial appearance. The condition may be distressing and painful. Examination and treatments requiring access to the oral cavity can be limited, or in some cases impossible, due to the nature of the condition itself.
Orthodontics is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial orthopedics.
Dental braces are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.
Prognathism, also called Habsburg chin, Habsburg's chin, Habsburg jaw or Habsburg's jaw primarily in the context of its prevalence amongst members of the House of Habsburg, is a positional relationship of the mandible or maxilla to the skeletal base where either of the jaws protrudes beyond a predetermined imaginary line in the coronal plane of the skull. In general dentistry, oral and maxillofacial surgery, and orthodontics, this is assessed clinically or radiographically (cephalometrics). The word prognathism derives from Greek πρό and γνάθος. One or more types of prognathism can result in the common condition of malocclusion, in which an individual's top teeth and lower teeth do not align properly.
Orthognathic surgery, also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, and other orthodontic dental bite problems that cannot be treated easily with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries, and malproportions where correction may be considered to improve facial aesthetics and self-esteem.
In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855–1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.
A palatal expander is a device in the field of orthodontics which is used to widen the upper jaw (maxilla) so that the bottom and upper teeth will fit together better. This is a common orthodontic procedure. The use of an expander is most common in children and adolescents 8–18 years of age. It can also be used in adults, although expansion is more uncomfortable and takes longer in adults. A patient who would rather not wait several months for the end result achieved by a palatal expander may be able to opt for a surgical separation of the maxilla. Use of a palatal expander is most often followed by braces to then straighten the teeth.
A dental emergency is an issue involving the teeth and supporting tissues that are of high importance to be treated by the relevant professional. Dental emergencies do not always involve pain, although this is a common signal that something needs to be looked at. Pain can originate from the tooth, surrounding tissues or can have the sensation of originating in the teeth but be caused by an independent source. Depending on the type of pain experienced an experienced clinician can determine the likely cause and can treat the issue as each tissue type gives different messages in a dental emergency.
Orthodontic technology is a specialty of dental technology that is concerned with the design and fabrication of dental appliances for the treatment of malocclusions, which may be a result of tooth irregularity, disproportionate jaw relationships, or both.
Overjet is the extent of horizontal (anterior-posterior) overlap of the maxillary central incisors over the mandibular central incisors. In class II malocclusion the overjet is increased as the maxillary central incisors are protruded.
Crossbite is a form of malocclusion where a tooth has a more buccal or lingual position than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.
Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:
Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Mandibular fractures occur most commonly among males in their 30s.
Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.
Charles Henry Tweed was an American orthodontist known for many of his contributions to the field of orthodontics. He was a founder of the Charles H. Tweed Foundation for Orthodontic Research. Tweed a student of Edward Angle in Pasadena, California and a classmate of Raymond Begg.
Anchorage in orthodontics is defined as a way of resisting movement of a tooth or number of teeth by using different techniques. Anchorage is an important consideration in the field of orthodontics as this is a concept that is used frequently when correcting malocclusions. Unplanned or unwanted tooth movement can have dire consequences in a treatment plan, and therefore using anchorage stop a certain tooth movement becomes important. Anchorage can be used from many different sources such as teeth, bone, implants or extra-orally.
A lip bumper is a dental appliance used in orthodontics, for various purposes to correct a dentition by preventing the pressure from the soft tissue. Lip bumpers are usually used in orthodontic treatment where the patient has a crowded maxillary or mandibular teeth in an arch.
Frankel appliance or Frankel Functional Regulator is an orthodontic functional appliance which was developed by Rolf Fränkel in 1950s for treatment to patients of all ages. This appliance primarily focused on the modulation of neuromuscular activity in order to produce changes in jaw and teeth. The appliance was opposite to the Bionator appliance and Activator appliance.
The Herbst appliance is an orthodontic appliance used by orthodontists to correct class 2 retrognathic mandible in a growing patient, meaning that the lower jaw is too far back. This is also called bitejumping. Herbst appliance parts include stainless steel surgical frameworks that are secured onto the teeth by bands or acrylic bites. These are connected by sets of telescoping mechanisms that apply gentle upward and backward force on the upper jaw, and forward force on the lower jaw. The original bite-jumping appliance was designed by Dr. Emil Herbst and reintroduced by Dr. Hans Pancherz using maxillary and mandibular first molars and first bicuspids. The bands were connected with heavy wire soldered to each band and carried a tube and piston assembly that allowed mandibular movement but permanently postured the mandible forward. The appliance not only corrected a dental Class II to a dental Class I but also offered a marked improvement of the classic Class II facial profile.
