Complications of self-drilling intermaxillary fixation screws with a focus on dental root damage

Intermaxillary fixation is often used in oral and maxillofacial surgery for temporary jaw stabilization. Self-drilling intermaxillary fixation screws are easy to use but can cause dental damage. This retrospective study was performed to examine the complications associated with self-drilling screws, with a focus on dental root damage. Overall, 274 screws were placed in 43 patients between 2010 and 2023 at University Medical Center Utrecht. Patients with missing postoperative imaging or screws placed in edentulous areas were excluded, leaving 162 screws in 28 patients for evaluation. Complications were documented from the patient records and postoperative imaging (panoramic radiographs and/or (cone-beam) computed tomography scans). Dental roots adjacent to 24 screws (14.8%) showed damage on imaging. Logistic regression analysis showed a significantly lower risk of dental root damage with larger interdental distances (OR (per millimetre increase) 0.379, 95% confidence interval 0.210-0.683, P = 0.001). A higher incidence of dental root damage was observed in the posterior region of the jaw; however, no significant association was found between screw location and root damage. Other complications among the 274 screws placed were irritated mucosa (associated with 6.2% of fixation screws), screw loosening (associated with 5.8%), screw overgrowth by oral mucosa (associated with 5.1%), and screw fracture (associated with 0.7%). The placement of self-drilling screws in regions with wider interdental distances is recommended to avoid dental root damage. Studies with larger sample sizes are required to clarify whether screw location independently influences the risk of root injury.