The occlusal wafer: simple technique for construction and its use in maxillofacial surgery

The acrylic occlusal wafer is a thin piece of plastic which fits between and indexes the occlusal surfaces of the maxillary and mandibular teeth. This appliance has three functions: it positions the jaws relative to one another; it prevents sliding movement during intermaxillary fixation; and it prevents unwanted orthodontic movement during intermaxillary fixation from the pressure of intermaxillary wires or rubber bands on unsupported teeth. The role of the occlusal wafer is well established in orthognathic surgery where it is used as a key for setting the jaws when osteotomies are performed. It has been underutilized in trauma due to the time and technical expertise required for fabrication. This paper describes a technique which can result in occlusal wafers of surgical quality in about 20 minutes, requires minimal laboratory equipment, and can be mastered by clinical personnel. Four cases are presented which illustrate the use of occlusal wafers and the indications for the device are discussed.