The primary aim of this study was to provide a review of the types and frequency of orthodontic brackets, molar bands and orthodontic auxiliaries used for patients undergoing orthognathic surgery. The secondary aim was to evaluate the risk of failure of these items during orthognathic surgery.

From three Dutch hospitals, 124 adult patients were included in this prospective cohort study. Five independent researchers collected the data during surgery using a specifically created data extraction form. The type of surgery, surgeon, orthodontist and type of orthodontic bracket, molar band or auxiliary were noted for each tooth. To evaluate their failure risk, the following variables were noted: failure and site; and type and cause of failure.

Stainless-steel brackets were the most frequently (75.8%) used bracket type seen in patients undergoing orthognathic surgery. Ceramic brackets were seen in 24.2% of the cases and were only applied in the anterior region. Molar bands were present in 58.9% of the patients and mostly with bands on the first molars in combination with bonded tubes on the second molars. In 32.2% of all cases, one or more failures were noted. One-third of all failures were described as detachment of the molar tube on the most posterior molar. Kobayashi ligatures and powerpins showed the highest risk of failure (odds ratio [OR] 3.70, 95% confidence interval [CI] = 1.91-7.15). No significant difference in failure rate was found between stainless-steel brackets, molar bands (OR 0.34, 95% CI = 0.08-1.43) and ceramic brackets (OR 0.44, 95% CI = 0.14-1.45).

Stainless-steel brackets, ceramic brackets, molar bands and surgical hooks are suitable for orthognathic cases. Kobayashi ligatures and powerpins had a significantly higher risk of failure so are not recommended for temporary intraoperative maxillomandibular fixation (TIO-MMF).

The aim of this study was to compare two techniques for temporary intraoperative maxillomandibular fixation (TIO-MMF) during orthognathic surgery: steel-wire ligatures versus power chains. Patients undergoing orthognathic surgery between October 2019 and March 2020 were included in a prospective cross-sectional study conducted in three participating hospitals. Data were collected using a standardized measurement form. A total of 44 patients were included, in whom TIO-MMF was applied 79 times. A statistically significant difference in intraoperative loss of stability of the segment relationship was found between steel-wire ligatures (11.4%) and power chains (0%). The mean application time of TIO-MMF differed significantly between steel-wire ligatures (99 seconds) and power chains (157 seconds) (P < 0.001). There was no statistical difference in occurrence of adverse events between the two techniques. This study found that the application of TIO-MMF with power chains is more stable compared to steel-wire ligatures. Steel-wire ligatures were significantly faster to apply, although the absolute difference (less than 1 minute) was small. Other possible advantages of the proposed technique are discussed. The results of this study suggest that power chains for the application of TIO-MMF in orthognathic surgery are a valuable alternative to steel-wire ligatures.

Throat packs are commonly used in maxillofacial surgeries. However, the evidence to support the benefits of their use is controversial. The aim of this study was to evaluate the effectiveness of throat packs in preventing postoperative nausea and vomiting, and their influence on the incidence of sore throat and dysphagia in patients undergoing orthognathic surgery. This was a prospective double-blind randomized study with 54 patients, who were randomized to two groups: with throat pack (n=27) and without throat pack (n=27). Fifty patients (25 in each group) were included in the analysis; 66% female and 34% male, mean age 29.44±8.53 years. Postoperative nausea and vomiting (Kortilla scale), sore throat (visual analogue scale), and dysphagia were evaluated. Statistically significant differences in favour of the without-pack group were found for the variables throat pain at 24hours (P=0.002) and dysphagia at 2 hours (P=0.007) and 24 hours (P<0.001). There was no difference between the groups regarding postoperative nausea and vomiting (P=1.00). The results of this study indicate that throat packs as utilized here do not prevent postoperative nausea and vomiting and are associated with worse sore throats and postoperative dysphagia.

There is a potential risk that orthodontic brackets can become dislodged into the aerodigestive tract. This case illustrates the management of an orthodontic bracket, which became embedded in the deep tissues of the oropharynx. We aim to highlight the potential risk misplaced dental instruments and materials pose, including that they may become embedded in the soft tissues of the throat and suggest that that this possibility should be considered when they cannot be localized.

Accidental ingestion or inhalation of foreign bodies has been widely documented, including incidents which occur whilst undertaking dental treatment. Most ingested objects pass through the gastrointestinal tract (GIT) spontaneously, but approximately 10%-20% need to be removed endoscopically and 1% require surgery. This case reports a complication arising from the accidental loss of an archwire fragment during maxillary archwire placement. It describes the immediate and subsequent management, including the use of radiographs to track the passage of the fragment through the gastro-intestinal tract. This case stresses the vigilance that dentists must take to prevent inhalation or ingestion of foreign bodies and the consequences of time-delays when management decisions are needed.

There is a potential risk that orthodontic brackets can become dislodged into the aerodigestive tract. This case illustrates the management of an orthodontic bracket, which became embedded in the deep tissues of the oropharynx. We aim to highlight the potential risk misplaced dental instruments and materials pose, including that they may become embedded in the soft tissues of the throat and suggest that that this possibility should be considered when they cannot be localized.

Although inhalation or ingestion of orthodontic appliances can lead to serious medical problems, the real incidence of these complications is anecdotal. This study had two aims: (1) to define the frequency of accidental inhalation/ingestion of orthodontic objects in Finland and (2) to analyze their further management.

An electronic, semi-structured questionnaire was sent to all members of the Orthodontic Section of Apollonia, the Finnish Dental Society (n=251) and the Finnish Federation of Dental Hygienists (n=437). After one reminder, 55.8% of dentists and 34.8% of dental hygienists responded.

In total, 20.0% of the dentists and 6.9% of the dental hygienists reported having one patient who had ingested or inhaled an orthodontic object. The percentages for two or more cases were 18.6% and 6.9%, respectively. According to dentists' answers, the procedures following these complications were (1) observation for 2-14 days (n=27), (2) radiologic evaluation (n=14), (3) medical emergency (n=6) and (4) dietary instruction (n=4). Dental hygienists reported (1) observation (n=9), (2) dietary instruction (n=3) and (3) medical emergency (n=1). None of the cases had been life-threatening.

Although the risk of inhalation or ingestion of orthodontic objects is small and the consequences rarely serious, it should be taken into consideration. Prospective patients should be informed of this possibility.

The purpose of this study is to review the frequency of bracket failure using two different techniques for establishing interim fixation during orthognathic surgery.

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.

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).

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.

The use of bonded orthodontic molar tubes is becoming more prevalent in orthodontics because they have some advantages over conventional bonding. However, a bonded apparatus can become detached, leading to complications. This article presents the case of a submandibular-space abscess associated with a molar tube that detached during orthognathic surgery and became embedded in the soft tissues. The site became infected, and antibiotics were prescribed. Eventually, the molar tube migrated and could be removed under local anesthesia.

The authors reviewed the literature regarding inhalation and ingestion of orthodontic appliances and suggest ways to manage and prevent these events.

The authors conducted literature searches of free text and Medical Subject Headings terms by using PubMed and Embase databases and selected appropriate studies. They analyzed retrieved articles according to several parameters: inhalation or ingestion event, number of cases, patient's sex and age, type of orthodontic appliance, in-office event or out-of-office event, and medical treatment.

The authors found a total of 2,279 articles in their preliminary search. Eighteen reports of 24 cases from this search met all of the search criteria (that is, clinical studies, case reports or reviews limited to English, Hebrew or Arabic on any form of aspiration or inhalation of orthodontic appliances). Most cases (67 percent) involved ingested objects, and of those cases, the majority (57 percent) occurred in female patients. Most cases (85 percent) occurred outside the orthodontist's office. Seventeen patients (71 percent) had been treated with a fixed orthodontic appliance. In 60 percent of cases, the maxilla was involved. With one exception, no severe complications were reported (only seven patients were examined in a hospital emergency department), and patients were discharged uneventfully from the orthodontic office or emergency department.

Orthodontists and team members should participate in medical emergency management courses that emphasize the use of guidelines in cases of inhalation or ingestion of orthodontic objects. Each orthodontist's office should develop written emergency protocols for out-of-office events and present them to patients and their parents at the start of treatment.