An audit of mandibular fractures treated by intermaxillary fixation using intraoral cortical bone screws.

Background: During the last 10 years, intermaxillary fixation using intraoral cortical bone screws has been introduced for the treatment of mandibular fractures. The aim of this work was to evaluate the indications and possible complications of this method.

Methods: Sixty-two patients with mandibular fractures, treated by intermaxillary fixation using these screws, were evaluated by preoperative and postoperative panoramic radiographs. Clinical testing was carried out for vitality and abnormal mobility of teeth adjacent to the site of screw insertions. To evaluate the efficacy of this method, different factors were considered such as possible iatrogenic dental injuries, loss, breakage or screw cover by oral mucosa and postoperative occlusion.

Results: The most important complication was iatrogenic damage to dental roots (1.5%), 4.9% of the screws were covered by oral mucosa and 1.9% were lost, while none were broken. Malocclusion was observed in one patient (1.6%) and lack of consolidation of a displaced fracture of the mandibular body in another patient.

Conclusions: Use of intraoral cortical bone screws for intermaxillary fixation is a valid alternative to arch bars in the treatment of mandibular fractures. Iatrogenic injury to dental roots is the most important problem of this procedure, but can be minimized by an experienced surgeon.