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INTERDENTAL TENSION BAND WIRING AS A REDUCTION ADJUNCT IN OPEN COMMINUTED MANDIBULAR PARASYMPHYSEAL FRACTURE WITH DENTAL MALALIGNMENT: A CASE REPORT
Abstract
Background: Open comminuted mandibular parasymphyseal fractures present significant challenges due to fragment instability, disrupted occlusion, and increased risk of complications, particularly in cases with dental malalignment where conventional stabilization methods are limited. Objective: To report the application of interdental tension band wiring as a pre-ORIF reduction adjunct in an open comminuted mandibular parasymphyseal fracture.
Case: A 41-year-old male presented with anterior open bite and intraoral bleeding following a motor vehicle accident. Clinical and radiographic findings confirmed an open OCSS CMF Type II left mandibular parasymphyseal fracture with dental malalignment. Conventional adjuncts such as arch bars were considered suboptimal due to the risk of further displacement and periodontal injury. Case Management: Interdental tension band wiring using a 0.4-mm multiple loop configuration was applied as a pre-ORIF reduction aid, followed by definitive fixation with a 2.4-mm reconstruction plate. The technique enabled controlled fragment approximation through dental–periodontal anchorage. At one-month follow-up, satisfactory wound healing, stable occlusion, and normal mandibular function were achieved without complications. Conclusion: Interdental tension band wiring may serve as a practical and cost-effective reduction adjunct in selected cases of open comminuted mandibular parasymphyseal fracture with dental malalignment, offering a clinically adaptable approach when conventional techniques are limited.
Keywords: Bone plates, fracture fixation, malocclusion, mandibular fractures
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Demir U, Asirdizer M, Bingül MB. An evaluation of the demographic features and causes of mandible fractures and the relationships with the side, type, and anatomic location. Medicine. 2025 Mar 28;104(13):e41950. doi:10.1097/MD.0000000000041950
Xu X, Zhu F, Yang C, Xu B, Yuan Z, Zhang W, et al. OCCS Classification and Treatment Algorithm for Comminuted Mandibular Fractures Based on 109 Patients and 11 Years Experiences: A Retrospective Study. JCM. 2022 Oct 26;11(21):6301. doi:10.3390/jcm11216301
Haylaz E, Geduk G, Şeker Ç, İÇen M. Retrospective Evaluation of Maxillofacial Fractures With Cone-Beam Computed Tomography. Cumhuriyet Dental Journal. 2022 Oct 1;25(3):246–51. doi:10.7126/cumudj.1117935
Amran AJ, Rizqiawan A, Mulyawan I, Prasetio O, Subagio EW, Rahman MZ. Quality of Life Evaluation of Postsurgical Mandibular Fracture Patients with Oral Health Impact Profile 14 and General Oral Health Assessment Index Parameters. Eur J Dent. 2023 Oct;17(04):1309–15. doi:10.1055/s-0043-1761450
Kilinç A, Ertaş Ü, Yalçin E, Saruhan N. Mandibula Kırıklarının Retrospektif Analizi. Cumhuriyet Dental Journal. 2017 Apr 30. doi:10.7126/cumudj.306117
Yazdani J, Ghavimi M, Taghizadeh M, Kananizadeh Y, Ghanizadeh M. Effectiveness of placement of second miniplates as tension band unit in mandibular parasymphysis fractures. Dent Res J. 2019;16(3):172. doi:10.4103/1735-3327.255742
Rothe TM, Kumar P, Shah N, Shah R, Mahajan A, Kumar A. Comparative Evaluation of Efficacy of Conventional Arch Bar, Intermaxillary Fixation Screws, and Modified Arch Bar for Intermaxillary Fixation. J Maxillofac Oral Surg. 2019 Sep;18(3):412–8. doi:10.1007/s12663-018-1110-7
Yamamoto K, Matsusue Y, Horita S, Kirita T. Pre-Adapted Arch Bar Revisited for Open Reduction and Internal Fixation in Mandibular Fractures at Tooth-Bearing Sites. Trauma Mon. 2014 Mar 24;19(2). doi:10.5812/traumamon.18169
Johnson AW, Akkina SR, Bevans SE. Maxillomandibular Fixation: Understanding the Risks and Benefits of Contemporary Techniques in Adults. Facial Plastic Surgery & Aesthetic Medicine. 2025 Feb 1;27(1):98–105. doi:10.1089/fpsam.2024.0113
Bell RB, Wilson DM. Is the Use of Arch Bars or Interdental Wire Fixation Necessary for Successful Outcomes in the Open Reduction and Internal Fixation of Mandibular Angle Fractures? Journal of Oral and Maxillofacial Surgery. 2008 Oct;66(10):2116–22. doi:10.1016/j.joms.2008.05.370
Yazdani J, Ghavimi M, Taghizadeh M, Kananizadeh Y, Ghanizadeh M. Effectiveness of placement of second miniplates as tension band unit in mandibular parasymphysis fractures. Dental Research Journal. 2019;16(3):172–8. doi:10.4103/1735-3327.255742 PubMed PMID: 31040873.
Powell PL, Roy RR, Kanim P, Bello MA, Edgerton VR. Predictability of skeletal muscle tension from architectural determinations in guinea pig hindlimbs. Journal of Applied Physiology. 1984 Dec 1;57(6):1715–21. doi:10.1152/jappl.1984.57.6.1715
Buchanan TS, Lloyd DG, Manal K, Besier TF. Neuromusculoskeletal Modeling: Estimation of Muscle Forces and Joint Moments and Movements from Measurements of Neural Command. Journal of Applied Biomechanics. 2004 Nov;20(4):367–95. doi:10.1123/jab.20.4.367
Pearson WG, Langmore SE, Zumwalt AC. Evaluating the Structural Properties of Suprahyoid Muscles and their Potential for Moving the Hyoid. Dysphagia. 2011 Dec;26(4):345–51. doi:10.1007/s00455-010-9315-z
Wheatley BB, Odegard GM, Kaufman KR, Haut Donahue TL. Modeling Skeletal Muscle Stress and Intramuscular Pressure: A Whole Muscle Active–Passive Approach. Journal of Biomechanical Engineering. 2018 Aug 1;140(8):081006. doi:10.1115/1.4040318
Olayemi A. Assessment and determination of human mandibular and dental arch profiles in subjects with lower third molar impaction in Port Harcourt, Nigeria. Ann Maxillofac Surg. 2011;1(2):126. doi:10.4103/2231-0746.92775
Shinde G, Mhaisekar R, Chaube S, Barad A, Bhadange S, Patel H. Assessment of correlation of growth hormone receptor gene with tooth dimensions: A CBCT and genotyping study. J Pharm Bioall Sci. 2019;11(6):457. doi:10.4103/JPBS.JPBS_76_19
Ali Alkhalaf Z, Sghaireen MG, Ganji KK, Alam MK, Issrani R, Mohammed Alsaleh R, et al. Unveiling the Influence of the Curve of Spee on Bite Force and Chewing Ability: A Comparative Study. Lidoriki E, editor. International Journal of Clinical Practice. 2024 Feb 21;2024:1–9. doi:10.1155/2024/6533841
Dougherty KA, Bertolaso C, Schall JI, Smith-Whitley K, Stallings VA. Muscle Strength, Power, and Torque Deficits in Children With Type SS Sickle Cell Disease. Journal of Pediatric Hematology/Oncology. 2018 Jul;40(5):348–54. doi:10.1097/MPH.0000000000001143
Song YL, Yu N, Tan D Ben Poon, Chew MT. A pilot study on three-dimensional printing of stainless steel arch bars for orthognathic segmental jaw surgeries. Annals of 3D Printed Medicine. 2022 Jun;6:100055. doi:10.1016/j.stlm.2022.100055
Wang RC, Keech DR, Elkins TP, Russell P. The Tension Wire Method: A Simple, Effective Means of Mandibular Fixation. Arch Otolaryngol Head Neck Surg. 1998 Apr 1;124(4):448. doi:10.1001/archotol.124.4.448
Shenoi SR, Rao C. Arch Wire: A Novel Technique for Intra-Maxillary Fixation. J Maxillofac Oral Surg. 2016 Dec;15(4):547–8. doi:10.1007/s12663-015-0865-3
Tigraniya D, Dahiya A, Singh V, Bhagol A, Tanwar R, Bagde N. “Comparison among 3 maxillomandibular fixation techniques for management of mandibular fractures – A prospective randomized study.” Journal of Oral Biology and Craniofacial Research. 2025 Sep;15(5):992–1000. doi:10.1016/j.jobcr.2025.06.020
Yadav D, Chaurasia N, Mishra R, Kandel L, Ali S. A comparative clinical study among intermaxillary fixation screw, Erich arch bar and Ivy eyelet in mandibular fracture. JGMC-Nepal. 2024 Dec 31;17(2):144–8. doi:10.3126/jgmc-n.v17i2.68124
Edmunds MC, McKnight TA, Runyan CM, Downs BW, Wallin JL. A Clinical Comparison and Economic Evaluation of Erich Arch Bars, 4-Point Fixation, and Bone-Supported Arch Bars for Maxillomandibular Fixation. JAMA Otolaryngol Head Neck Surg. 2019 Jun 1;145(6):536. doi:10.1001/jamaoto.2019.0183
Kim YG, Yoon SH, Oh JW, Kim DH, Lee KC. Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience. Arch Craniofac Surg. 2022 Feb 20;23(1):23–8. doi:10.7181/acfs.2021.00549
Rastogi S, Ahmed T, Giri K, Dandriyal R, Niranjana Prasad IB, Joshi A, et al. Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable? Craniomaxillofacial Trauma & Reconstruction. 2018 Jun;11(2):118–23. doi:10.1055/s-0037-1603453
Tsolov R, Firkova EI. PERIODONTAL STATUS IN PATIENTS WITH MANDIBULAR FRACTURES. JofIMAB. 2022 Feb 22;28(1):4247–50. doi:10.5272/jimab.2022281.4247
Castejón González AC, Mestrinho LA, Reiter AM. Healing of mandibular body fractures with wire-reinforced interdental bis-acryl composite splints. Journal of Feline Medicine and Surgery. 2025 Mar;27(3):1098612X251314346. doi:10.1177/1098612X251314346
Panesar K, Susarla SM. Mandibular Fractures: Diagnosis and Management. Semin Plast Surg. 2021 Nov;35(04):238–49. doi:10.1055/s-0041-1735818
Vityadewi N, Prawoto AN, Seswandhana RM, Wahdini SI, Ramli RN, Dachlan I. Treatment of extended comminuted mandibular fractures with infected cutaneous fistule Post-ORIF using a reconstruction plate: A case report. Annals of Medicine & Surgery. 2022 Aug;80. doi:10.1016/j.amsu.2022.104319
Daqiq O, Roossien CC, Wubs FW, Van Minnen B. Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing. Sci Rep. 2024 May 23;14(1):11795. doi:10.1038/s41598-024-62011-4
Apriza E, Rahardjo R, Hasan CY. Quality of life patients after treatment of mandibular fractures with ORIF in oral surgery departement of Dr. Sardjito general hospital. Majalah Kedokteran Gigi Indonesia. 2020 Jul 15;6(1):16. doi:10.22146/majkedgiind.41145
Arfeen NU, Azeem SA, Husain ST, Shirazi N, Zaidi HA, Ayub T. Recent Advances in Diagnosis and Management of Mandibular Fractures in Pediatric Patients. Vol. 36. 2025;36:8–13.
DOI: http://dx.doi.org/10.20527/dentino.v11i1.26066
DOI (PDF): http://dx.doi.org/10.20527/dentino.v11i1.26066.g12136
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