62.11 Fixing mandibular fractures with resins

You can use two types of synthetic resin to fix a patient’s broken mandible, as an alternative to wiring it. The method is quick, easy, and non–traumatic. Fixing hooks with composite is easier than wiring them directly to his teeth, less traumatic, and more comfortable for him because there are no wire ends to scratch his mouth.

Cold curing quick setting acrylic resin is weaker than the composite material described below, but is cheap and widely available from dental supply houses or dental technicians. It will allow you to fix an arch bar to a mandible, but it is not strong enough to let you stick hooks to it.

Composite filling materials of the ’Adaptic’ or ’Isopaste’ type, together with a bonding agent are more expensive and less readily available than quick curing acrylic resin. A composite is supplied as two pastes which you mix together and which then set solid. It is usually used for filling cavities, but you can use it to make bridges between the teeth of a patient’s upper and lower jaw, or you can use it to stick hooks to his teeth, and then pass rubber bands or wire over them as with interdental wiring (D, Fig. 62-17). To allow the composite to stick you will have to clean the surfaces of his teeth at each fixation point, wash them, etch them with phosphoric acid, wash them again, dry them, coat them with a special bonding agent, and then press the composite onto them. This is not difficult, but it needs care. Be sure you follow the instructions exactly. If you use bridges of composite between a patient’s jaws, one difficulty will be getting them into the right position and getting the composite into place simultaneously. Using hooks avoids this difficulty.

At present, proprietary dental resins are unnecessarily expensive, for example, proprietary compound filling material costs $75 for 100 g, whereas it only costs $6 to manufacture. Fortunately, cheaper ’generic’ dental materials are now being made, and when they became available this method of fixing mandibular fractures will become more economically feasible.

Figure 62.21: ANOTHER WAY OF FIXING THE MANDIBLE. A, using bridges of filling material. B, using hooks. Kindly contributed by W.J. Bailey.