Dental occlusion ties: A rapid, safe, and non-invasive maxillo-mandibular fixation technology.

OBJECTIVES: For decades, Erich arch bars have been a standard in establishing maxillo-mandibular fixation (MMF). While reliable, the approach risks sharps injury, consumes operating room time, and inflicts gingival trauma. Newer technologies including screw-based techniques and "hybrid" techniques have improved MMF by reducing sharps injuries and operating room time, but risk injury to tooth roots, nerves, and gingiva. This study aims to establish the application, strengths, and limitations of dental occlusion ties as a novel alternative in maxillo-mandibular fixation.

STUDY DESIGN: Prospective, non-blinded, human feasibility clinical trial.

MATERIALS AND METHODS: An iterative prototyping process was used to invent dental occlusion ties (brand name: Minne Ties). Development included 3D printing, cadaver prototype testing, human apical embrasure measurement, and ultimately non-significant risk human clinical trial testing. In the IRB-approved feasibility clinical trial, the devices were applied to mandible and maxilla fracture candidates with fractures amenable to intra-operative MMF with open reduction with internal fixation. The ties were removed prior to extubation. Pre-teens, comminuted fracture patients, and patients requiring post-operative MMF were excluded.

RESULTS: Manufactured, sterile prototypes secured MMF successfully in management of unilateral and bilateral mandible and maxilla fractures. All patients reported correction of pre-operative malocclusion. Application times were typically 12-15 minutes for a single surgeon to achieve MMF. Patients incurred negligible gingival trauma from the technology as the ties require no tissue penetration for application.

CONCLUSIONS: Dental occlusion ties offer a non-invasive solution featuring operating room efficiency, minimized sharps risk, and less bony and soft tissue trauma than current commercialized solutions.

LEVEL OF EVIDENCE: Therapeutic, IV.