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Arch bars retained for 16 years do not appear to significantly lead to orthodontic pathology
Jack E. Brooker
Wendy Chen
Joshua M. Barnett
Jesse A. Goldstein
Joseph E. Losee
Lindsay Schuster
University of Pittsburgh
2018-01-30
Presenter: Jack E. Brooker
Affidavit:
This work has neither been presented nor published. Jack E. Brooker was instrumental in the conception and undertaking of this study as well as the abstract preparation
Director Name: Vu Nguyen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Erich arch bars are widely used for mandibulomaxilliary fixation (MMF) but are associated with worsened dental hygiene. A 30-year-old male presented with right-sided dental pain and was advised to seek removal of his arch bars. Aged 14 he underwent internal fixation & MMF for a right-sided ramus and left parasymphyseal fracture. The patient lost insurance and did not return for arch bar removal.
Methods: Patient records were assessed as were panoramic radiographs by an attending orthodontist. Periapical radiographs were taken to document dental and periodontal health.
Results: Upon inspection at the original treating center, the arch bars were ingrown into the gingiva. Dental decay was extensive, requiring multiple extractions. Arch bars were removed and the patient discharged, to return a year later. At follow-up, dental health had worsened with multiple non-restorable teeth and a greater decay, missing and filling rate (DMFR). Alveolar bone height was within normal limits. He was advised to seek adult dental providers.
Conclusion: No reports describe arch bars in situ for many years. This patient showed very poor dental hygiene and decay but this worsened significantly after archbar removal suggesting they were not the primary cause. Maxillofacial surgery relies upon hardware or behavioral modification techniques which lack consequences immediately obvious to the patient; compliance cannot be relied upon. Counselling tailored to the patient's circumstances is necessary to impress the need for follow-up. Maintaining a list at the treating center of patients with non-permanent hardware in-situ may also have helped to avoid this complication.
