Comparison between Erich arch bars and intermaxillary screws in maxillofacial fractures involving the dental occlusion: a meta-analysis

uma meta-análise

Abstract

Introduction: Maxillofacial fractures involving dental occlusion are treated based on intermaxillary fixation (IMF), aiming to restore occlusal functions. The two most commonly used methods are Erich arch bars and IMF screws. However, a broad comparison between the use of Erich arch bars and IMF screws, considering trans- or postoperative parameters, is still unclear in the literature.
Objective: The objective of this systematic review and meta-analysis was to evaluate the quality of IMF achieved by Erich arch bars when compared to IMF screws, considering parameters such as occlusal stability, operative time, safety in performing the technique, quality of life and maintenance of oral hygiene.
Methodology: The present systematic review and meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A PICO question was developed, where P were patients with maxillofacial fractures involving dental occlusion. I the use of screws for IMF, C the use of Erich arch bars for IMF and O the outcomes analyzed. The inclusion criteria comprised clinical trials comparing the two IMF methods, evaluating at least one of the outcomes: occlusal stability, oral hygiene, quality of life, time for application and removal of the IMF appliances and complications. For this purpose, four electronic databases were searched: MedLine (Pubmed), Web of Science, VHL and Cochrane Library.

Results: Fifteen articles were included in the qualitative analysis and 12 of them in the meta-analysis. The use of Erich arch bars took longer to apply and remove when compared to IMF screws. IMF screws have a higher probability of causing iatrogenic injuries and a lower rate of sleeve perforations when compared to Erich arch bars. For the plaque index outcome, there was no significant difference between the IMF methods.
Conclusion: It is not possible to evaluate the quality of trans- and postoperative occlusion and the quality of life of patients, due to the lack of scientific evidence comparing the Erich arch bars and IMF screws for these outcomes. The present results should be interpreted with caution due to the questionable quality of the included studies and the level of evidence presented by the studies through the GRADE tool assessment. It is suggested that new randomized clinical trials be carried out with adequate validity and quality to adequately compare the IMF with Erich arch bars and IMF screws.

Descriptors: maxillomandibular fixation; intermaxillary fixation screws; Erich arch bar; Maxillofacial Surgery.