Clinical and Radiological Analysis of Arch Bars Over-Retained for 14 years Post Maxillo-Mandibular Fixation

Abstract

Maxillo-mandibular fixation (MMF) is common technique used in mandibular fractures to stabilize the fragments and maintain the patient in normal dental occlusion during the healing process. Arch bars with elastics are one of the most frequently used methods of MMF and are temporary, and designed to be removed after the healing process is completed. There is controversy as to what impact the hardware has on dental hygiene and oral health. No reports of long-term retention of the hardware exist. This report details the case of arch bars retained for 14 years. The patient underwent MMF and internal fixation at age 16 for a complex mandibular fracture and failed to follow-up for timely removal of the arch bars due to loss of insurance. He presented at age 30 with dental pain and returned to the treating center for removal. He was in normal occlusion, but general indices of dental and periodontal health were extremely poor with multiple non-restorable teeth despite reporting good oral hygiene in the intervening period. A decline in overall dental health was evident at 1 year following removal of arch bars. Due to the presence of smooth surface dental caries, it was concluded that the presence of the arch-bars had exacerbated already poor oral hygiene and contributed to the extensive dental pathology seen. This case highlights the need for timely follow-up and hardware removal. Understanding each patient’s individual social and financial circumstances is essential to this process and a formalized office recall process may have prevented this complication.