2017-18 HSC Section 3 Green Book

Plastic and Reconstructive Surgery • January 2016

Fig. 3. ( Above ) Pantomogram of a patient with right ramus fracture with severe periodontal disease and extensive bone loss around the entire dentition. ( Below ) Pantomogram of the same patient after closed reduction of the right ramus fracture with hybrid maxillo- mandibular fixation. Because of poor dentition, hybrid maxilloman- dibular fixation was used instead of traditional Erich arch bars.

Fig. 4. Clinical photograph demonstrating mucosal overgrowth over the arms and screws of the hybrid maxillomandibular fixation system.

placed were 6-mm screws, and it would be rea- sonable to think that placing 8-mm screws would increase the probability of root damage. Three patients had radiographic root fractures; however, only one patient required further treatment of a tooth because of injury from screw placement. The patient developed asymptomatic discolor- ation of tooth 8 requiring endodontic therapy (Fig. 5). The low incidence of clinically significant

root damage supports the use of the SMARTLock system. It appears the previous studies using max- illomandibular fixation screws showed high rates of root damage. However, this study had a large number of screws placed, with only one tooth requiring further dental treatment. There are no other studies that use cone-beam computed tomo- graphic imaging to evaluate tooth damage from the use of the Stryker SMARTLock system.

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