There are a variety of techniques to repair jaw fractures including orthopedic wire placement, intraoral composite (acrylic) splints, bonding of the canine teeth, bone plates, titanium mesh, soft muzzles, and external fixation pins. All have advantages and disadvantages. Repair technique will be based on the cause of the injury, how recently it occurred, location, severity, cosmetic concerns, and functional concerns.
Ultimately, whichever treatment option(s) is elected, the objectives of oral fracture repair are to achieve the following:
Maintenance or return to a functional bite;
Maintain health of remaining teeth;
Rapid return to function; and
Promotion of bony healing.
As an aid to fracture repair in companion animals, intraoral composite splints used alone or in combination with other fixation techniques can be a valuable tool. Composite splints are relatively inexpensive. They often permit closed reduction without direct exposure of fractured bone ends. Compared to more invasive repair techniques, composite splints frequently result in decreased surgical trauma and allow faster return to function for the patient. In most cases the veterinary patient tolerates them very well. They promote normal occlusion (i.e. a normal bite).
Composite splints do require healthy (or relatively healthy) teeth to work. Patients with missing dentition or progressive periodontal disease make application problematic. Dental composite is hard and brittle making splint fracture a possibility.
Interarcade composite splints
In some cases the upper canines are bonded to the lower canines with composite to reinforce other forms of stabilization. Interarcade splinting also helps ensure normal bite during the healing process. The bonded canines become the equivalent of an intraoral muzzle. The patient should be able drink water and eat gruel consistency food without difficulty.
It is often a good idea to place a feeding tube at the time of splint placement to ensure adequate postoperative caloric intake. To help avoid accumulation of plaque and oral debris around the splint, the oral appliance is rinsed at least twice daily with a chlorhexidine product (e.g. CET Oral Hygiene Rinse); in addition, brushing the appliance with a tooth brush can help. Pets with intraoral composite splints should be prevented from chewing on hard objects. For splints placed caudally or at chewing teeth, a soft diet should be offered until splint removal.
The splint is usually removed after three weeks. Once adequate time for healing has taken place, the patient is re-evaluated and new oral x-rays are obtained to assess the fracture site. Composite is then carefully removed under anesthesia. All teeth are scaled and polished prior to completion.