wires are the most frequently applied fixation devices for dental fractures in the rostral mandible and maxilla [2]. They are very versatile and may also be used in conjunction with other implants. Furthermore, they are quite economic.
These devices are mainly used to fix fractures in the rostral half of the mandible. Several wiring techniques are described in the literature and their selection depends on the preferences of the surgeon [1, 2].
Pass the wire between the teeth from inside to outside. If this proves difficult or impossible, drill holes of 2 mm diameter between the teeth at strategic locations facilitate passage (Fig. S4B). A large needle may be sufficient in younger foals [2] (Fig. F4D).
Fig. S4B: With the help of a 2 mm drill bit a hole is drilled between the incisor teeth to facilitate placement of the wires.
Fig. F4D: Cerclage wiring of a fracture of J2 and J3. A 14-gauge needle is inserted between the teeth and a 1.25 mm stainless steel wire threaded into the needle cannula as it is withdrawn.
Cerclage wiring is the most frequently employed technique in the repair of rostral fractures.
The following techniques are available: wiring of the teeth in a figure-8 fashion from left to right, or including at least two teeth on either side of the fracture [1]. Application of overlapping wire loops [2] allows individual tightening of the loops (Fig. F4E) and results in greater stability than with the sinsuoid wire loop technique mentioned above. The Obgeweser technique [1] involves extruding wire loops from the inside to the outside between each of the teeth (Fig. F4F, Fig. S4C). The wire loops may be prepared with special bending pliers. Feed one end of the wire through each wire loop in front of the teeth and unite it with the other end (Fig. S4D). Then tighten each loop by twisting it with a pair of pliers (Fig. S4E). This type of fixation is extremely stable and may be left in place for several months (Fig. X4B).
Wire loops may be applied in a variety of ways.
Fig. S4C: Wire loops are exited from the lingual side between the incisor teeth.
Fig. F4E: The fracture is treated with two cerclage wire loops; one around J1 and J2 and the other in figure-8 fashion around J2 and the adjacent healthy canine tooth.
Fig. F4F: An alternative method involves exiting wire loops from the lingual side to the labial side, followed by feeding of one end of the wire through each loop. After uniting and tightening the two wire ends, each wire loop is tightened as well, resulting in the most stable of all wire fixations. The twisted ends are directed toward the gingivae.
Fig. S4D: One end of the wire is fed through each of the loops in front of the incisor teeth.
Fig. S4E: The wire ends are united and tightened securely. Then each of the wire loops is tightened individually, resulting in superior stability of the fixation.
Fig. X4B: The fracture shown in Fig. S4A and Fig. X4A was reduced and repaired with the Obwegeser technique. Note, a wire loop was placed around each tooth and tightened. The fixation remained in place for 6 months. No teeth had to be removed.
When the rostral part of the incisors or the diastema is fractured, some type of fixation placed further caudally is indicated. Include the canine teeth in male horses (Fig. F4G) or one or two of the premolar teeth. In the latter case, feed the wire around P2 after prior drilling of a 2.5 mm hole between P2 and P3 (Fig. F4H) and unite the ends of the wire further rostrally [2]. Tighten the fixation by twisting the long wire loop at the diastema with one end of a Steinmann pin (Fig. X4B).
Drill holes in the bone of the diastema to allow cerclage fixation of fractures without encircling the teeth.
Drilling small holes into the diastema on either side of the fracture allows application of wire in a figure-8 fashion through the holes [2] (Fig. F4I). In selected cases, cerclage wires may be applied around the ramus and an oblique fracture (Fig. X4C, Fig. X4D). Apply a tension band involving the incisor and premolar teeth to increase stability.
Fig. F4G: Tension band wiring of a fracture to the canine teeth. Note, an indentation (arrow) was created with a rasp in the nuchal aspect of the canine teeth to anchor the wire.
Fig. F4H: The drill guide is used to protect the cheek and gingiva as a drill bit is used to create a hole for passing the wire between P2 and P3 at the gum line. The wire for inclusion of the first cheek tooth in cerclage wire bridging of the interdental space is passed through this hole.
The advantages of wire are that it is easy to use, versatile, and inexpensive, and it confers a secure fixation. Disadvantages include loosening of the fixation and, in certain instances of molar fractures, exposure. Application may involve several stab incisions through the cheek, with its abundant neurovascular network.
Application of cerclage wires to the molar arcades is facilitated by stab incisions through the cheek.
Fig. F4I: Figure-8 wiring of a transverse fracture of the interdental space. The holes are created with a 2.5 mm drill bit or a Steinmann pin.
Fig. X4C: Long oblique fracture through the diastema of one ramus of a Shetland pony.
Fig. X4D: The
