1.

What are the different Interdental Wiring Techniques that may be done
to reduce and fixate alveolar fractures in a Closed Reduction
Technique? Enumerate the armamentarium needed & steps on how
each is done.

A. Erich Type Arch Bar

-There are many types of prefabricated arch bars like Jelenko
krupps, Erich, Hamilton but the most popular one and commonly
used is the Erich’s Arch Bar
-It is a refabricated arch bar with hooks incorporated on the outer
surface with flat malleable stainless metal strip
-It provides an effective, quick and inexpensive method of fixation

Armamentarium:
 Dentistry Basic Instrument Tray
 Erich arch bars
 Stainless Steel (26-gauge) wire
 Lips: shearer
 Tongue: Weeder or Minnesota
 Towels around mouth
 Split sheet
 Anesthesia
 Hemostat
 Wire Twister
 Wire Cutter
Procedure:
 The bar is available in spool form
 The bar should be cut accurately to the length of the dental arch
 Accuracy on this regard will prevent injury to the adjacent soft
tissues by protruding ends
 Each arch bar is to be fixed to the upper and lower dental arches

 On the upper jaw; the hooks are arranged in an upward

direction
 The bar is attached to the lower jaw with the hooks in a
downward direction
 The arch bar should be adapted to the buccal surface of
each arch by bending it. Bending of the arch bar should
start at the buccal side of the last tooth progressing past
the midline and finishing at the other end.
 The arch bar is fixed to each tooth, with 26 gauge stainless
steel wire, which is passed from the mesial surface of a
tooth to the lingual side and back on the buccal side from
the distal surface of the tooth.
 On the end of the wire is above the bar and the other
below.
 Securing the Arch Bar
 By twisting the two ends of wire together; the bar is
attached securely and firmly to the necks of the
teeth on the buccal surface of the arch. The twisting
of the wires should be always done in clockwise
manner, so that later on removal of wires can be
done in counterclockwise.
Video Link: https://www.youtube.com/watch?v=RGp46yHoVag

B. Custom Splints
-These are the custom made appliances that are fabricated for
individual patient.
-The splints can be constructed using acrylic material or cast metal.
-It is used when the wiring of the teeth will not provide adequate
fixation.
-Also used when horizontal splinting across the fracture zone is
required without closing the patient’s mouth.
-Indicated when both the jaws are edentulous and in case of
growing children, where mixed dentition is present and number of
firm teeth for anchorage are not adequate.

B.1. Cast Metal Splint

-These splints are fabricated in various metals in the
laboratories.
-It requires impressions of both arches.
-The lower cast is saved through the line of fracture.

Procedure:
  The cast is reassembled in proper occlusion and fixed in
position by pouring a base for the cast.
 The splint is formed till the gingival margins in 28 gauge
sheet wax.
 Occlusal relations are established in the wax up by
checking the centric relation with opposite cast, while the
wax is soft.
 Then the wax-up is sent for casting procedure and the
finished cast splint is obtained.
B.2. Acrylic Splint
*Lateral Compression Splint
 It is made for the stabilization of mandibular
arch
 Mainly used in cases of children in mixed
dentition and presence of developing buds.
 It can be used in adult mandibular body
fracture, where the stability cannot be
obtained by means of other type of horizontal
wiring methods
*Gunning Splint
 In edentulous jaws, suitably modified can be
used or specially constructed Gunning splint
 Circumferential wiring is used to fix the splint
to the mandibular bone and or splint is fixed to
the maxilla by means of peralveolar wiring
**Peralveolar Wiring

Armamentarium:
 26 gauge wire
 Kelsey-Fry Bone Awl
 Mouth Retractors
 Wire Cutter

Procedure:
 Two peralveolar wires are placed in the canine region on
either side for fitting patien’s own denture to alveolar ridge
 The splint is formly attached in the position in the upper
jaw: A Kelsey-Fry bone awl introducer is pushed from
buccal to palatal aspect
 A gauge 26 wire is threaded through the eye and the wire
is withdrawn with on the buccal surface
 Same procedure is repeated on opposite side and then the
splint is replaced in the mouth and wires adjusted over it
and twisted over the grooves and the ends ticked inwards.

**
Wiring
 -> Obwegeser’s Procedure
 It is used for fixation of lateral compression splint to the
mandibular bone
 Lower border of mandible is palpated in the canine
region and the skin is pierced beneath the lower border
of the mandible by Kelsey-Fry Bone Awl and it emerges
through the floor of the mouth

Armamentarium:
 a26 or 28 gauge wire
 Kelsey-Fry Bone Awl
 Retractors
 Wire Cutter
Procedure:
 A gauge wire 26 or 28 is inserted through the eye of
the awl and the awl is withdrawn till the lower border
and directed upward along the buccal surface of
mandible to pierce through the buccal sulcus
 The two ends of the wire are adjusted and the splint
is adjusted and the lingual and buccal wires are held
together and twisted in the region of canine grooves,
cut and finished forward.

C.

Direct Interdental Wiring (Gilmer’s)

- This technique provides a simple and rapid method of
immobilisation of jaws.
- This technique should only be considered as a first aid method
for achieving temporary immobilization of fractured fragments.

Armamentarium
 15cm of prestretched 0.35mm ss wire
 Retractors
 Wire cutter
Procedure
 A 15 cm length of prestreched 0.35 mm diameter soft
stainless steel wire passed around teeth emerging
through interdental spaces.
 With the wire placed around the neck of the two ends are
twisted to tooth produce 3 cm tail.
 Intermaxillary fixation is effected after reduction of
fracture by twisting separate tails together obtaining
crisscross bracing.
 Cut ends should be bent to avoid soft tissue trauma.
 Video Link: https://youtu.be/gJ0VNN0rgqM

D. Indirect Interdental Wiring (Eyelet or Ivy Loop)

- Eyelet wiring is a simple and effective method of reduction
provided that teeth of a fractured segment are of suitable
number,shape and quality.

Armamentarium
 0.35 mm diameter soft stainless steel wire is used.
 26 gauge ss wire
 Retractors
 Wire cutter
Procedure
 Wire should be stretched by 10% of original length so as
to prevent the loosening of wires after insertion.
 Eyelet wires are made by twisting the middle of each
length of wire around the shaft of a rod of 3mm
diameter which is held in a vice.
 Three or four twists enough.
 Ends of the eyelet wires are cut off obliquely to equalize
their length so as to produce a sharp point which will
readily pass through interdental space.
  Technique: The shafts of the preformed eyelet wire are
curved parallel to the contour of the palate to facilitate
their passage through interdental space.
 Both the ends have been passed through the respective
interdental spaces.
 Distal end is passed through the eyelet and passed
beneath the mesial shaft.
 End of the tie wire is formed in to a small hook which is
inserted through eyelet and then passed through
selected eyelet in lower jaw.
 Clockwise twist is given.
 Twisted ends are cut short , formed in to loops and
tucked away into interdental spaces.
 Tie wires form a V pattern so as to minimize any lateral
movements

Video Link https://youtu.be/TwO4rXPU4T8

D.11 HALLAM’S & WILLIAM’S MODIFICATION
Removal of eyelet wires:
 Normal period of immobilization is 6 weeks.
 Eyelets are removed after loosening the wire twist by
anticlockwise rotation so that labio buccal wire can be
cut.
 Distal portion can be sectioned by elevating the labio
buccal wire.
 Eyelet is then gripped by strong forceps with continuous
firm traction applied at right angle to labiobuccal surface
of tooth, wire will usually be delivered.

D.2. Clove hitch method

 One shaft of the eyelet wire is formed into a clove hitch.
 after placing the clovehitch over isolated tooth ,loops
are tightened and wire is pushed down beneath the
 neck of the tooth, the ends being twisted in clockwise
direction.
 A tie wire is passed through the eyelet in the ususal
manner and the end crossed close to the eyelet around
the upper distal pair of teeth

D.3. Button Wiring

 Considers that eyelet wires have several drawbacks.
 described the use of titanium buttons of 8mm diameter,
inclusive of a 1mm rim, and 2mm deep.
 Each button has two 1mm diameter holes with 1mm
apart.
 The ends of the wire are passed through holes and
twisted twice.
 Similar to eyelet fixation, buttons are fixed and distal
wire is passed through twist at the deeper aspect of
button.

E. Continous Wiring or Multiple Loop Wiring

- Stout described a technique which permits blocks of teeth in
either jaw to be wired in such a manner that elastic traction can
be used to reduce the fracture.

Armamentarium
  26 gauge 30 cm lenghth of ss wire
 Solder wire
 Wire cutter
Procedure
 A 30 cm length of wire is taken and one end is laid along
the buccal surface of teeth while the other is passed
around the most posterior teeth below its contact point to
emerge through anterior space.
 Wire is back through same interdental space passing
around the buccal wire.
 A pliable rod of 5 cm length and 3 mm diameter passed
through wire loop and laid along the buccal surface of
segment parallel to wire.
 Until the quadrant is enclosed, the wire on the lingual
aspect is passed in sequence through interdental space.
 The ends of the wires lie on buccal aspect and they are
clipped.
 The rod is now withdrawn by forward pull.
 Loop is twisted by artery clip.
 Each loop is finally bent towards sulcus if elastic traction
is used or towards occlusal surface if tie wire is used.
 The same procedure is followed in all the quadrants and
IMF is done.