Versatility of Hard Occlusal Splints in Optimizing Outcomes in Patients with Old Pan-facial Fractures

Pan-facial fracture repair is considered one of the most challenging complex reconstructive procedures to perform. It is always better to treat facial fractures as soon as possible. A delay of several days or weeks makes an ideal anatomic reduction difficult, if not impossible. METHODS: Patients presenting late with noncompound pan-facial fractures and interrupting maxillary and mandibular arches who were candidates for ORIF were included. Patients had been divided randomly into two groups: group A was managed by the ordinary sequence of repair, and group B was managed with the aid of occlusal dental splint. RESULTS: In total, 20 patients presented late (3–9 weeks post insult) due to serious injuries that required previous intervention. The time until obtaining optimal occlusion ranged between 80 and 120 minutes in the study group, whereas in the control group, the time ranged between 120 and 180 minutes (P < 0.0001). Postoperative malocclusion was noticed to be less frequent in the splint group than in the control group: only one patient with residual malocclusion in the study group versus two patients in the control group. CONCLUSIONS: Occlusal splints could be a good modality for restoring the pre-morbid occlusion in patients with delayed pan-facial fractures. It is a simple, reliable technique that could be easily integrated into our daily practice, and could help decrease the intraoperative time needed for restoration of optimal occlusion and decrease the postoperative malocclusions.