Jaw wiring is a medical procedure to keep the

jaw The jaws are a pair of opposable articulated structures at the entrance of the mouth, typically used for grasping and manipulating food. The term ''jaws'' is also broadly applied to the whole of the structures constituting the vault of the mouth ...

closed for a period of time. Originally, it was used as the mandibular equivalent of a

cast Cast may refer to: Music * Cast (band), an English alternative rock band * Cast (Mexican band), a progressive Mexican rock band * The Cast, a Scottish musical duo: Mairi Campbell and Dave Francis * ''Cast'', a 2012 album by Trespassers William ...

, to fix the jaw in place while a

fracture Fracture is the appearance of a crack or complete separation of an object or material into two or more pieces under the action of stress (mechanics), stress. The fracture of a solid usually occurs due to the development of certain displacemen ...

healed. Jaw wiring is also used for weight-loss purposes, to prevent the ingestion of solid food.

Mechanism

Jaw wiring is performed by attaching orthodontic brackets to the teeth, and wrapping pliable wire either around or through the brackets or with the use of arch bars or loops affixed with wires around the teeth, or with metal splints bonded to the teeth. The wiring may be configured to immobilise the jaw in the case of fracture or surgery or to place the patient’s

lower jaw In jawed vertebrates, the mandible (from the Latin ''mandibula'', 'for chewing'), lower jaw, or jawbone is a bone that makes up the lowerand typically more mobilecomponent of the mouth (the upper jaw being known as the maxilla). The jawbone i ...

in a semi-closed resting position. This permits a moderate amount of jaw movement and relatively clear speech, but inhibits the ingestion of solid foods, forcing patients to adhere to a

liquid diet A liquid diet is a diet that mostly consists of liquids, or soft foods that melt at room temperature (such as ice cream). A liquid diet usually helps provide sufficient hydration, helps maintain electrolyte balance, and is often prescribed for pe ...

Types

Inter-maxillary fixation

This type of jaw wiring, also known as maxillo-mandibular fixation (MMF), is used in patients with mandibular fractures or those who need

orthognathic surgery Orthognathic surgery (), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusio ...

to correct deformed jaws. It is performed by an

oral surgeon Oral and maxillofacial surgery (OMFS) is a surgical specialty focusing on reconstructive surgery of the face, facial trauma surgery, the mouth, head and neck, and jaws, as well as facial plastic surgery including cleft lip and cleft palate s ...

, who attaches an "arch bar" to the upper jaw and another to the lower jaw with thin wires that are threaded between and around the teeth. The arch bars completely enwrap the

dental arch The dental arches are the two arches (crescent arrangements) of teeth, one on each jaw, that together constitute the dentition. In humans and many other species, the superior (maxillary or upper) dental arch is a little larger than the inferi ...

. The upper and lower arch bars are connected to each other with wires or elastics, compressing the upper teeth against the lower teeth and preventing jaw movement. IMF is an invasive procedure performed under

general anesthesia General anaesthesia (UK) or general anesthesia (US) is medically induced loss of consciousness that renders a patient unarousable even by painful stimuli. It is achieved through medications, which can be injected or inhaled, often with an analgesi ...

. Once the bones have set (usually after 4–6 weeks, sometimes two or three months), the wiring is removed under

local anesthesia Local anesthesia is any technique to induce the absence of sense, sensation in a specific part of the body, generally for the aim of inducing local analgesia, i.e. local insensitivity to pain, although other local senses may be affected as well. ...

or nitrous oxide sedation. There are other methods for wiring teeth together. Ivy loops are a method by which wires are passed between the teeth and gums and then fastened with a loop at the front, and wires are then secured to these loops. Cap splints are metal splints which cover the entire surface of the teeth. Fixation can also be achieved by passing wires through the brackets of braces, which are commonly used before surgery. IMF is also used to aid weight loss; various studies from the 1970s and early 1980s used ivy loops and cap splints to wire the jaws together to enforce a liquid diet until such time as sufficient weight loss had been achieved; this was typically around nine months but in one study could be as long as 17 months. It was found that patients typically put much of the weight they had lost back on, and in 1980 a study concluded that it was "a safe but ineffective means of controlling weight". However, a study published in the ''British Medical Journal'' in 1981 found that jaw wiring could be effective if aftercare were provided, in this case a nylon cord passed around the patient's waist after weight loss had been achieved, which would remind them if they started to put weight back on. John Garrow, the co-author of that study, defended the practice in a 1999 letter, calling it "a safer and less expensive alternative to gastroplasty" and pointing to his positive results when accompanied with the waist cord. Conventional jaw wiring for weight loss remains in use in Nigeria and South Africa, though in the latter, dentists are said to perform the procedure reluctantly, as they know it is ineffective but patients say they will find someone else to do it. Contrary to earlier practice, wiring is retained at most for six weeks. The same pattern of weight replenishment after unwiring is observed in Nigeria, although the Nwoga et al (2019) study noted that the reasons for desiring weight loss may have been temporary, e.g. marriage or fitting into a wedding gown.

Orthodontic jaw wiring

The second type of jaw wiring is called orthodontic jaw wiring (OJW) or dental jaw wiring, and can be used as a treatment for

obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...

and

compulsive overeating A food addiction or eating addiction is any behavioral addiction characterized primarily by the compulsive consumption of palatable and hyperpalatable food items, and potentially also sugar-sweetened beverages (SSBs). Such foods often have hi ...

. In this procedure, a

dentist A dentist, also known as a dental doctor, dental physician, dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in provi ...

orthodontist Orthodontics (also referred to as orthodontia) is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns. It may also address the modificati ...

attaches braces to certain teeth (typically the canines and

premolars The premolars, also called premolar teeth, or bicuspids, are transitional teeth located between the canine and molar teeth. In humans, there are two premolars per quadrant in the permanent set of teeth, making eight premolars total in the mout ...

) and inserts wiring, but not elastics, between the upper and lower teeth in a figure-8 pattern. The wiring is removed periodically to allow the jaw joints to move freely, especially in the vertical direction. The procedure is not invasive and does not require anesthesia. OJW does not keep the upper and lower teeth in contact. The sole purpose of the wiring is to limit the extent to which the jaws may open. In the resting position, the teeth are parted 2–4 millimeters, with the lips lightly touching. (The ivy loop method used in the study in Nigeria also allows limited jaw movement.) Orthodontic jaw wiring is removed when the patient has achieved their weight loss goals.

References

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External links

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Jaw surgery Surgical wire