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Arch Bar use in Primary and Mixed Dentition: Feasibility, Safety, and Outcomes
Sanjay Naran, Paul Afrooz, MD, Michael Bykowski, MS, BPhil, Darren Smith, MD, Alex Rottgers, MD, Lisa Vecchione, DMD, MDS, Joseph Losee, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
BACKGROUND - Arch bars provide accurate reduction and stabilization either solitarily, or to augment internal fixation. Some argue arch bars cannot be used in primary and mixed dentition given the anatomy of primary teeth, risk of tooth avulsion, and potential disruption of developing permanent dentition; however, it has been our practice to do so. Current literature does not provide outcome data in instances when arch bars are used in primary and mixed dentition.
METHODS - Patients up to the age of thirteen presenting to our Pediatric Plastic Surgery Service with mandible fractures treated with arch bars from 2000-2010 were reviewed. Elements collected included; demographics, surgical and medical history, fracture management, adverse outcomes, and dental health.
RESULTS - 154 mandible fractures in 79 patients were captured, with 21 patients representing 34 fractures meeting our inclusion criteria. Average age at injury was 7.7 years (range: 2.6-13.5), and average follow-up was 23.3 months. Fracture types included; condylar head (n=10), condylar neck (n=10), angle (n=3), body (n=3), and parasymphysis (n=8). 44.2% had no adverse outcomes, while 8.8% had Type 1, 23.5% Type 2, and 23.5% Type 3 adverse outcomes. At follow-up, panorex scans were obtained and a pediatric dentist examined all patients. Preliminary data show no adverse effects on permanent dentition growth.
CONCLUSION - While our use of arch bars has so far yielded uncompromised dental health at early follow-up, long-term data is required before definitive recommendations can be made. However, recommendations can be offered based on our early data. Arch bars appear safe to use in the primary and mixed dentition population. Their use does not guarantee the avoidance of internal fixation complications. If internal fixation is required, the least invasive approach is favored with special care to avoid maturing tooth buds. Treatment with arch bars requires comprehensive evaluation including annual follow-up augmented by dental examinations and dedicated dental films.
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