Orthodontic Screw–Assisted Intermaxillary Fixation for Mandibular Fracture Fragments: A Narrative Review and Technical Rationale for a Minimally Invasive Intraoral Method

Background/Objectives: Mandibular fractures frequently require restoration of occlusion, stabilization of bone fragments, and maintenance of intermaxillary relationships during healing. Conventional Erich arch bars remain a widely used method of maxillomandibular fixation (MMF), but are associated with prolonged operative time, mucosal trauma, plaque accumulation, needle-stick risk, and reduced comfort. Bone-supported intermaxillary fixation (IMF) screws have been introduced as an alternative, yet screw-related complications continue to limit their universal adoption. This narrative review synthesizes the clinical, morphological, biomechanical, technical, and practical rationale for a proposed method of mandibular fracture stabilization using self-tapping titanium orthodontic screws, with heads placed intraorally in the alveolar process of the maxilla and mandible, connected by elastic intermaxillary traction. Methods: A narrative literature review was undertaken across five thematic domains: mandibular fracture management, Erich arch bars, intermaxillary fixation screws, orthodontic miniscrews, and the biomechanics of elastic maxillomandibular fixation. The proposed technique was appraised against these existing fixation concepts and their documented clinical limitations. Results: Screw-based intermaxillary fixation can shorten operative time and avoid extensive circumdental wiring relative to conventional arch bars, with a potential but meta-analytically mixed hygiene benefit. Elastic traction between screws near a fracture line is not new: it was first described as "Elastic Internal Traction" in 2004, and a more recent precedent combines IMF screws with orthodontic elastic chains; the present proposal extends this lineage using orthodontic titanium screws with a provisional, not yet anatomically validated interradicular placement scheme (approximately 8 mm from the gingival margin, at least one tooth from the fracture edge), connected by elastic rings. Biomechanically, elastic intermaxillary traction is proposed to distribute force between the maxilla and mandible, but this has not been tested for this specific combination. Conclusions: Orthodontic screw-assisted intermaxillary fixation represents a promising, minimally invasive intraoral strategy for selected mandibular fractures, with potential advantages including reduced intraoral bulk, improved hygiene access, and controlled fragment stabilization. Prospective clinical trials, CBCT-based anatomical safety studies, and dedicated biomechanical analyses are required before broad clinical use.