FIXING THE MANDIBLE IN OTHER WAYS

ANAESTHESIA (1) Mandibular block (A 6-3). (2) Ketamine (A 8.1). (3) Diazepam (A 8.6). Atropinize the patient to dry his saliva.

USING ACRYLIC TO FIX AN ARCH BAR

MATERIALS Ordinary cold cure acrylic (’Simplex’), as used by dental technicians to repair broken dentures. This is supplied as a liquid monomer and a powdered polymer.

Put some of the powdered polymer into a small pot. Drop the liquid monomer onto it and stir it with a spatula until it is the consistency of putty.

METHOD Sit the patient up in a chair. Make an arch bar from several strands of thick (2 mm) stainless steel wire, and fashion it to fit the arch of his mandible, lingually, or buccally, or both.

To stop the resin sticking, lightly spread vaseline on the patient’s lips, mucous membrane and tongue-but not his teeth.

Hold the arch bar in place with blobs or a continuous wad of cold cure acrylic. Lightly spread vaseline on your fingers (to stop the acrylic sticking) and press the acrylic into place over the arch bar. Press it firmly between the bases of the patient’s teeth. If the arch bar is going to stay in place, the resin must go between the overhanging parts of his adjacent teeth. If he is older, and his gingival papillae have resorbed, or he has missing teeth, the resin will be able to pass between them and stick more firmly.

Hold the arch bar in place until the resin has set (in about 10 minutes).

USING COMPOUND FILLING MATERIAL TO STICK HOOKS ON

INDICATIONS (1) Conscious and cooperative patients. (2) This method is particularly suited to unilateral fractures. (3) Recent fractures that will be fairly easy to reduce.

CONTRAINDICATIONS Much bleeding which makes cleaning and drying the surfaces of a patient’s teeth impractical.

MATERIALS Compound filling material, such as ’Adaptic’ or ’Isopaste’ and their special bonding compounds, or their generic equivalents. 50% phosphoric acid, 2 mm stainless steel wire. Rubber bands.

METHOD The patient will probably need about six hooks depending on the site of his fracture.

Sit him up in a chair. Clean the surfaces of his teeth at each fixation point carefully, and dry them free of saliva. Use spirit on a pledget of cotton wool, or a dental engine brush.

While his teeth are still dry, apply phosphoric acid on a paint brush for 60 seconds.

Wash his tooth for 30 seconds, and then dry it again.

Keep his teeth dry with suction, rolls of paper tissue, or cotton wool in his buccal sulcus.

Apply the bonding material to the dry, etched surface with a small brush or a wisp of cotton wool.

Mix a little of the the compound material and the catalyst with a spatula on a small paper pad, and immediately press it into place with lightly vaselined fingers over the prepared surfaces of his upper and lower teeth. While it is still soft, press a hook into it.
Join up the hooks with rubber bands or wire. Rubber will place less strain on the hooks. If you join them with wire, take care not to exert too much force, or you may displace them. After 6 weeks you can chip composite away quite easily. The last remaining pieces may have to be removed with a dental drill.

ALTERNATIVE NOT USING HOOKS Hold the patient’s jaws together with bridges of filling material passing from one jaw to another. You will probably only need about 4 bridges. As they set, keep his jaws aligned and his teeth in occlusion.