Arch Bar and

Ernst Ligature
Mohammad Adhitya Latief, drg, spBM
Dept. Bedah Mulut dan Maksilofasial
FKG Univ. Indonesia
2017
 Arch bars are applied to the teeth and MMF
is secured. The patient is monitored using x-
rays for positional changes of the
mandibular ramus.
At 6 weeks MMF is released and fracture
stability determined by manipulation. The
patient is placed on a soft diet and if the
occlusion maintains for a two-week period,
the arch bars may be removed.

Arch bar
 Temporary fragment stabilization in
emergency cases
Tension band in combination with rigid
internal fixation
Long term fixation in conservative
treatment
Fixation of avulsed teeth and alveolar
crest fractures

Indication
Check occlusion
Before inserting the arch bars, check the occlusion. There
should be full interdigitation of the teeth with regular
contacts.
Determine if the patient has a normal occlusion or a
preexisting malocclusion before taking the patient to the
operating room
Adjusting the shape
The prefabricated arch bar must be adjusted in
shape and length according to the individual
situation. The arch bar should not damage the
gingiva.
Trimming the bar
The bar should be trimmed to allow ligation to as many teeth as
possible. The bar should not extend past the most distal tooth or
protrude into the gingiva as this will be an irritation to the patient
Symmetric bar position
To achieve calculable tension forces on both bars, the hooks
must be positioned symmetrically in the upper and lower
jaw. This symmetry is essential for functional training with
elastics
Ligature preparation
To fix the arch bar in place, prepare a ligature in the premolar
region of each side. The wire ends should not damage the
surrounding soft tissues
Attaching the bar
Position the arch bar and fix it using the wire twister.
In the premolar and molar regions one end of the wire is above the
arch bar and the other end below it
Wire end
Cut the wire with the cutter and turn the ends away from the
gingiva to prevent damage
Make sure the wire rosettes do not
protrude away from the arch bar as
this will be an irritation to the patient
Photographs show arch bars applied to
mandible and maxilla
MMF With wires
The wire loop is placed over the maxillary and mandibular lugs of
the arch bar and the wire loop is tightened
MMF completed with wire fixation. At least
three wires, a posterior wire loop in each
side, and an anterior wire loop will provide
stable fixation
Elastics
Some surgeons prefer MMF with elastics for intraoperative
management of the occlusion. Additionally, postoperative
training elastics can be used to manage condylar fractures in
a closed manner
Do Not overtighten !
Ernst ligatures
An Ernst Ligature is applied to two neihboring
teeth, preferably the premolars.
Ligatures are placed in all four sections of the
dental arches in a symmetric position.
Ligature application
General consideration
An Ernst ligature is based on two neighboring teeth in the same
segment of one dental arch. If possible, the premolars are used in the
maxilla and mandible.
Passing the wire through the interdental space
Use a 0.4 mm wire of approximately 15 cm length.
Pass one end of the wire through the interdental
space between molar no. 6 and premolar no. 5.
Thread it back from the lingual to
the buccal side via the interdental
space of premolars 4 and 5
Pass the other end between premolar
no.4 and canine no. 3
Closing the loop
This end also goes through the interdental space of
4 and 5.
One wire end must pass below, the other end must
pass above, the horizontal portion of the wire on
the buccal side
Tighten the wire
Then tighten the wire with the twister
Add ligatures in the same way in the other three
sections of the dental arches to form two symmetrical
pairs.
It is of major importance to preserve wire ends of at
least 4-5 cm length
Combining the wires
After assuring correct occlusion, twist the wire ends of
each pair of ligatures together with the twisters. Take
care at this point not to break the wires; otherwise the
procedure would have to be started again
Cut the wire ends and bend them towards
the teeth to protect the oral mucosa and the
surgeons from accidental injuries
Odu Olo!