Hybrid arch bars reduce placement time and glove perforations compared to Erich arch bars during the application of maxillomandibular fixation: a randomized controlled trial

Purpose The use of a bone-fixated hybrid arch bar system provides an alternative method to Erich arch bars to apply maxillomandibular fixation (MMF) during the treatment for mandibular fractures. The purpose of the study is to compare the time for placement and removal, effect on the gingiva, and operator safety. Methods The authors designed a parallel-group, randomized controlled trial to compare the 2 types of arch bars. Patients with mandibular fractures presenting to the authors’ institution were enrolled in the study and randomized into 2 groups: (1) the Erich arch bar group secured with circumdental stainless steel wires and (2) the Hybrid arch bar group secured with bone-borne self-drilling locking screws. 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 by using the Student t test. Results A total of 90 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 Â ± 9.3 minutes and 6.9 Â ± 3.1 for the Hybrid arch bars ( P P  = .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 Â ± 5.1 minutes) than for the Erich arch bar group (17.9 Â ± 10.7 minutes) ( P  = .0007). Conclusions Hybrid arch bars with bone-borne locking screws offer a number of advantages, including faster placement, shorter removal time, and a greater margin of safety for the operating surgeons, as demonstrated by significantly fewer glove tears and penetrations.