Comparative Analysis of Hybrid Arch Bars Versus Erich Arch Bars for Maxillomandibular Fixation in the Management of Mandibular Fractures—A Prospective Randomized Clinical Trial

Introduction: Mandibular fractures, being the most common facial fractures, involve maxillomandibular fixation (MMF) in both closed and open reduction techniques utilizing techniques like Erich arch bars, which pose risks of injuries to the surgeon and the patient. Recent advancements like Hybrid arch bars (HB), combine the advantages of arch bars and bone-supported devices, offering improved safety. This study compares outcomes between traditional Erich arch bars and SMARTLOCK HAB in MMF, addressing challenges posed by traditional methods and exploring the benefits of the recent advancement. Materials and Methods: This single-center, unblinded randomized clinical trial enrolled 48 patients with mandibular fractures. The primary predictor variable was the device type used. EABs were secured with circumdental wires, while HABs were secured with self-drilling locking bone screws. Outcome variables included duration of device placement, glove perforation, prick injuries, gingival and periodontal health, root perforation, bone loss, pain assessment, and device removal duration. Devices were removed after six weeks under local anesthesia. Results: The mean age was 29.9 ± 8.3 years, and 91.7% were male. Primary outcome, duration of device placement, was significantly shorter for HAB (17.6 ± 14 minutes) than the Erich arch bar (EAB) group (41.4 ± 34.9 minutes), with removal duration also favoring the HAB system. Surgeon-related factors, glove perforation and prick injuries, were significantly lower with the HAB group. Patient-related factors showed lower pain scores and similar complications between groups. Conclusion: The HAB system offers an effective alternative with superior outcomes, with easier placement and removal, reduced risk of injury, and improved patient compliance.