Hybrid Arch Bars Reduce Placement Time and Glove Perforations Compared to Erich Arch Bars during the Application of Maxillomandibular Fixation: a Randomized Controlled Trial

Publication date: Available online 30 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Brett J. King, Brian J. Christensen

Purpose

The purpose of the study is to compare the time for placement and removal, the effect on the gingiva, and the operator safety of the Stryker Universal SMARTLock Hybrid MMF system with traditional Erich arch bars.

Methods

The authors designed a parallel group, randomized controlled trial to compare the two types of arch bars. Patients with mandibular fractures presenting to the author's institution were enrolled in the study and randomized into one of two groups: the Erich arch bar group and the hybrid arch bar group. The primary outcome variable was arch bar placement time. Secondary outcomes were glove tears or penetrations during application, gingival appearance score at removal, loose hardware at removal, removal time and glove tears or penetrations at removal. The groups were compared using a t-test.

Results

Ninety patients were enrolled in the study. There were 43 patients randomized to the Erich arch bar group and 47 patients randomized to the hybrid arch bar group. The mean time for application of Erich arch bars was 31.3 ± 9.3 minutes and 6.9 ± 3.1 minutes for the Hybrid arch bars (p<0.0001). There were significantly more glove tears or penetrations during application for the Erich Arch Bar group (0.56 ± 0.91 per application) compared to the Hybrid group (0.11 ± 0.32 per application) (p=0.0025). At removal, there was no difference in overall gingival appearance or amount of loose hardware. The time for removal was significantly less for the Hybrid arch bar group (10.5 ± 5.1 vs 17.9 ± 10.7 minutes) (p=0.0007).

Conclusions

Hybrid arch bars with bone-borne locking screws offer a number of advantages over traditional Erich arch bars and circumdental wires, including placement and removal time and a greater margin of safety for the operating surgeons as demonstrated by significantly fewer glove tears and penetrations.

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