Note: last updated before 2013

INDICATIONS

1. Maxillofacial Fractures Requiring Occlusal Control
   1. Maxillomandibular fixation (MMF)
   2. Temporary occlusal orientation for placement of rigid internal fixation

ADVANTAGES

1. Simple and quick to apply
2. Clean (oral hygiene improved)
3. Will not tend to obstruct mandibular reduction
4. Good with multiple missing teeth or edentulous spans

DISADVANTAGES

1. Does not lend to elastic therapy
2. No continuous occlusal level (superior tension band) control
3. Not useful to stabilize teeth

NURSING CONSIDERATIONS

1. See Erich Arch Bars protocol

SURGICAL TECHNIQUE

1. Place Ivy loop through embrasure and pull both wires through to the lingual until most of the slack is removed
2. Separate wires and pass one around one tooth anterior and one around one tooth posterior to original embrasure
3. Pass the posterior wire through the preformed loop
4. Clamp wire twister on to each wire and cross hands and pull, relieving any slack
5. On anterior teeth, secure wire on lingual surfaces of teeth BELOW height of contour (cingulum) while twisting.
   1. When passing wires in mandibular anterior region, pass Ivy loop through embrasure between central incisors; instead of wrapping around one tooth posterior on either side, wrap around two teeth (mandibular incisors are small and have less stability than other teeth)
6. Twist the wire while maintaining apical pull (towards the root end), aiming toward the mesial line angle.
7. Cut the wire and rosette, maintaining low profile of wire
8. Place a minimum of five Ivy loops per full arch

MAXILLOMANDIBULAR FIXATION

1. Remove throat pack if present
2. Apply 0.018 in (25-gauge) wires between appropriate interarch loops to secure MMF
3. Avoid tongue (occlusal impingement)