Incidence of bracket failure during orthognathic surgery: a comparison of two techniques to establish interim maxillomandibular fixation

Purpose: The purpose of this study is to review the frequency of bracket failure using two different techniques for establishing interim fixation during orthognathic surgery. Methods and material: The first group (standard technique) had a maxillomandibular fixation (MMF) established during surgery by ligating splints to orthodontic appliances. The second group of patients had an interim fixation established using maxillomandibular screws (alternative technique). Preoperative and immediate postoperative panoramic radiographs were examined for loose and or missing brackets in both groups. Intraoperative observations were also recorded in the second group. The type of surgery (one- or two-jaw) and whether or not cemented bands on the molars were present were noted. A Pearson’s chi-square analysis was done comparing the two groups. Results: There were 210 patients in the first group and 104 in the second. The overall incidence of missing or loose brackets following surgery in the standard technique group was 16 %; 172 of them had a cemented band on either the first or on the first and second molars. There was a higher incident of lost or loose bonded brackets when the patients had no cemented brackets or underwent a two-jaw surgery. In the second group of 104 patients, there was one loose or missing brackets caused by the application of MMF (Pearson’s chi-square value = 15.84, p < 0.0001). Conclusions: When using orthodontic brackets to establish interim fixation, the incidence of missing or loose brackets during orthognathic surgery was dramatically higher in two-jaw cases and in cases where only bonded brackets were placed by the orthodontist. When using maxillomandibular screws to establish interim fixation, the problem has been greatly diminished.