Erich arch bars are thin, malleable strips of stainless steel wired to the teeth and used to hold a broken jaw in the correct bite position while bone heals. They have been the standard tool for this job, known as maxillomandibular fixation (MMF), for roughly a century and remain the technique against which every newer alternative is measured.1PubMed. Maxillomandibular Fixation: Understanding the Risks and Benefits of Contemporary Techniques in Adults Despite that long track record, Erich arch bars come with real drawbacks in operating-room time, infection risk, and comfort, which has pushed surgeons toward several competing devices over the past two decades.
What an Erich Arch Bar Actually Is
An Erich arch bar is a prefabricated metal strip, usually made of surgical-grade stainless steel (AISI 316), with small hooks or lugs stamped along its length at regular intervals. The bar is contoured to follow the curve of the dental arch and then secured to the teeth with thin stainless steel ligature wires, typically 24- or 26-gauge. Once a bar is wired onto both the upper and lower teeth, rubber bands or additional wires stretched between the hooks on the two bars pull the jaws together, locking the patient’s bite in the correct position. That locked position lets a fractured mandible or midface bone heal without shifting.
The concept dates to the First World War, when surgeons needed a reliable way to stabilize the devastating jaw injuries caused by shrapnel and gunfire. Early versions, developed independently by Sauer in Germany and Gilmer in the United States, were simply round bars flattened on one side and tied to teeth with brass wire. Blair and Ivy later refined the design to a bar about 2 mm wide that conformed better to tooth surfaces and improved stability.2PubMed Central. Intermaxillary fixation screws versus Erich arch bars in mandibular fractures: A comparative study and review of literature The modern Erich arch bar is recognizably the same device, just manufactured to tighter tolerances.
When Surgeons Reach for Arch Bars
The primary indication is mandibular fractures, where getting the bite right is everything. If upper and lower teeth do not meet precisely after the bone heals, the patient faces chronic problems with chewing, jaw pain, and joint strain. Arch bars give the surgeon a way to wire the jaws into the patient’s pre-injury bite before plating the fracture, and sometimes to keep them wired shut for weeks afterward if the fracture is managed without plates (so-called closed reduction). They are also used in midface fractures that affect the dental occlusion, in orthognathic (jaw-realignment) surgery, and occasionally as temporary stabilization for loose teeth after alveolar trauma. A case report even documents their use in a 12-year-old child with a symphysis fracture of the mandible, where the bar was applied to reduce mobility at the fracture site.3Journal of Dentomaxillofacial Science. Early treatment of symphysis mandibular fracture in 12 years old children using erich arch bar: a case report
How Placement Works
Placing Erich arch bars is tedious, hands-on work. The surgeon trims the bar to span the full dental arch, bends it to match the curvature of the teeth, and positions it against the outer surfaces of the teeth at the gum line. Then, one tooth at a time, a length of ligature wire is threaded around the tooth and through the gap between the bar and the tooth, twisted tight, and trimmed. Doing this for every tooth in both arches means manipulating sharp wire ends in a confined, bloody surgical field for a significant stretch of time.
Getting wire tension right matters. A laboratory study found that for a 24-gauge wire held at a 5 mm working length, only about 2.6 to 2.8 twists were needed to reach tightness, with wire failure occurring after roughly 1.7 to 1.9 additional twists past that point. Holding the wire at a longer working length (10 mm) allowed more twists before tightness and more margin before breakage. Twisting at a 45-degree angle rather than perpendicular gave a tighter result with more resistance to snapping.4PubMed. Tight Placement of Erich Arch Bar While Avoiding Wire Fatigue Failure In practice, that margin of error is thin, and an over-twisted wire breaks and has to be redone, adding time and frustration.
Time in the Operating Room
One of the biggest complaints about Erich arch bars is how long they take to place. A clinical comparison published in JAMA Otolaryngology found a mean operative time of about 99 minutes for Erich arch bar placement, compared with roughly 49 minutes for four-point fixation screws and about 56 minutes for bone-supported (hybrid) arch bars.5JAMA Otolaryngology–Head & Neck Surgery. A Clinical Comparison and Economic Evaluation of Erich Arch Bars, 4-Point Fixation, and Bone-Supported Arch Bars for Maxillomandibular Fixation A randomized trial comparing hybrid and Erich bars reported even starker numbers, with the hybrid group averaging about 18 minutes versus about 41 minutes for Erich bars.6PubMed Central. Comparative Analysis of Hybrid Arch Bars Versus Erich Arch Bars for Maxillomandibular Fixation in the Management of Mandibular Fractures—A Prospective Randomized Clinical Trial Every extra minute under general anesthesia adds cost and risk, so this is not a minor concern.
Time differences show up at removal, too. Because every ligature wire has to be unwound and cut, taking Erich bars out is itself a procedure. A meta-analysis found that removal time was roughly 23 minutes longer for Erich arch bars than for IMF screws, which simply unscrew in seconds.7PubMed. Comparison between Erich arch bars and intermaxillary screws in maxillofacial fractures involving the dental occlusion: a meta-analysis
Cost Considerations
You might assume that a simple metal strip costs less than a purpose-built screw system, and in terms of raw hardware price that is often true. But the longer operating time flips the math. The same JAMA study found that total operative charges for Erich arch bar placement averaged about $7,919, compared with roughly $5,290 for four-point fixation and about $6,751 for bone-supported arch bars. When the charges for a second procedure to remove the hardware were added in, Erich bars climbed to roughly $9,585, still the most expensive option by a margin of over $2,000.8JAMA Otolaryngology–Head & Neck Surgery. A Clinical Comparison and Economic Evaluation of Erich Arch Bars, 4-Point Fixation, and Bone-Supported Arch Bars for Maxillomandibular Fixation In resource-limited settings, though, the low unit cost of an Erich arch bar can still make it the only realistic choice when the expense of proprietary screw kits is prohibitive.
Risks to the Surgical Team
The sharp wire ends involved in arch bar placement create a real occupational hazard. A prospective study tracking 172 fixation procedures recorded 40 needlestick injuries, a rate of 23%. All injuries hit the non-dominant hand, and almost all were caused by wire rather than a needle. Night-time procedures had a dramatically higher injury rate of 45%, compared with 18% during the day.9PubMed. Incidence and patterns of needlestick injuries during intermaxillary fixation Because many jaw fracture patients arrive in emergency settings where hepatitis B, hepatitis C, and HIV status may be unknown, every puncture carries the worry of bloodborne virus exposure.
Glove perforation tells a similar story. A randomized trial found that Erich arch bar placement averaged 0.56 glove tears per case, significantly more than the 0.11 tears per case seen with hybrid arch bars.10PubMed. Hybrid Arch Bars Reduce Placement Time and Glove Perforations Compared With Erich Arch Bars During the Application of Intermaxillary Fixation: A Randomized Controlled Trial A study of a modified Erich arch bar design that bolts to bone rather than wiring around teeth found wire-prick injuries dropped from about 56% of cases with the conventional bar to about 19% with the modified version.11PubMed Central. A Comparative Randomized Prospective Clinical Study on Modified Erich Arch Bar with Conventional Erich Arch Bar for Maxillomandibular Fixation Embrasure wires, a simpler alternative, also reduce needlestick injuries to both the operating surgeon and the assistant compared with Erich arch bars.12PubMed. Comparison of Erich arch bar versus embrasure wires for intraoperative intermaxillary fixation in mandibular fractures
What Arch Bars Do to the Gums and Teeth
Wire ligatures sit right at the gum line and trap food and plaque, making thorough brushing almost impossible while the bars are in place. This predictably hammers periodontal health. A comparative study found that patients with Erich arch bars had significantly worse plaque scores, gum inflammation, and deeper probing depths at four, six, and eight weeks after placement compared with patients whose fractures were managed without bars. At four weeks, every patient in the arch bar group had bleeding on probing.13Trauma Monthly. Comparison of Periodontium Reaction to Fixation of Mandibular Fractures with and Without Erich Arch Bars A randomized trial comparing Erich bars to IMF screws found higher biofilm accumulation and worse patient-reported quality of life in the arch bar group during the first two weeks after surgery.14PubMed. Erich arch bars vs intermaxillary fixation screws for mandibular fracture reduction during ORIF: a randomized clinical trial
The problems are usually reversible once the hardware comes out, but there are cautionary extremes. Erich arch bars are harder to place on teeth that are decayed, crowded, or already compromised by gum disease, and the wires can worsen existing periodontal problems.15PubMed Central. Erich arch bar versus hanger plate technique for intermaxillary fixation in fracture mandible: A prospective comparative study There is also a published case of an arch bar left in a child for 11 years, resulting in severe periodontitis and extensive root-surface decay, a dramatic reminder that these devices must be removed in a timely fashion.
Patient Experience and Quality of Life
Living with wired-shut jaws is miserable in ways that go beyond the obvious liquid-only diet. A randomized study comparing arch bars to IMF screws found that arch bar patients had significantly more difficulty maintaining a normal diet and were more likely to say they would not want to go through the same treatment again.16PubMed Central. Use of Arch Bars versus IMF-Screws in Maxillomandibular Fixation of Mandibular Fractures: A Randomised Prospective Study The protruding wire ends scratch the inside of the cheeks and lips, and the inability to open the mouth creates anxiety about choking or vomiting. Patients are typically given wire cutters to carry at all times in case of an airway emergency.
Removal itself is uncomfortable. A study comparing arch bar removal with and without local anesthesia found that the overwhelming majority of patients, about 97%, preferred having anesthetic injected before the wires were unwound. The most common dose was 2 mL of lidocaine with epinephrine.17Journal of Contemporary Issues in Business and Government. Comparison of arch bar removal with and without the usage of local anaesthesia
How the Alternatives Compare
Several devices now compete with the traditional Erich arch bar. The most important are IMF screws and hybrid (bone-supported) arch bars, though bonded brackets and embrasure wires also have niches.
IMF Screws
These are small self-tapping screws driven directly into the jawbone between tooth roots. Rubber bands or wires stretched between upper and lower screws pull the jaws together, the same principle as arch bars but without wiring to each tooth. A meta-analysis found that IMF screws are substantially faster to place and remove, and produce far fewer glove perforations (roughly one-quarter the risk). Interestingly, the same analysis found that screws carry a higher rate of iatrogenic injuries to the patient, meaning the screw itself can damage a tooth root during placement. No significant difference in plaque buildup was observed between the two methods across pooled studies.18PubMed. Comparison between Erich arch bars and intermaxillary screws in maxillofacial fractures involving the dental occlusion: a meta-analysis Screw loosening is also a known limitation: if a screw backs out partway through healing, fixation is compromised.
Hybrid Arch Bars
These combine a pre-shaped metal bar with bone screws rather than ligature wires, so the bar is screwed into bone between tooth roots instead of being wired around the teeth. Placement is dramatically faster, and the surgeon handles far fewer sharp wire ends. One trial found placement averaged about 23 minutes for the hybrid bar versus about 86 minutes for a conventional Erich bar, but the hybrid group had three times the rate of mucosal overgrowth, where gum tissue grows over the screw heads and must be cleared at removal.19PubMed Central. Comparison of hybrid arch bar versus conventional arch bar for temporary maxillomandibular fixation during treatment of jaw fractures: a prospective comparative study A second randomized trial reported similar time savings and no glove punctures in the hybrid group, but two instances of root injury from screw placement and soft tissue overgrowth affecting over half of placed screws. The conventional Erich bar cost considerably less in raw materials.20PubMed Central. Comparison of Efficacy and Safety of Hybrid Arch Bar with Erich Arch Bar in the Management of Mandibular Fractures: A Randomized Clinical Trial
Bonded Arch Bars
Instead of wiring, these are glued directly to the tooth enamel with dental resin, eliminating wire-related injuries entirely. A comparative evaluation found that resin-bonded arch bars were easier to apply, caused less periodontal damage, and minimized puncture risk to the surgeon.21PubMed Central. Comparative evaluation of the resin bonded arch bar versus conventional erich arch bar for intermaxillary fixation Their limitation is bond strength: in a patient who clenches hard or has wet, contaminated tooth surfaces, the resin may not hold as securely as wire. They see more use in cooperative patients with intact enamel than in complex trauma settings.
Use in Children
Traditional teaching held that Erich arch bars should be avoided in children because deciduous (baby) teeth have short roots that could be pulled out by the wire tension, and the developing permanent tooth buds underneath could be harmed. A study examining arch bar use in children with primary and mixed dentition challenged that assumption, reporting no periodontal defects, tooth avulsions, or disturbances to permanent teeth. The authors concluded that arch bars can be used safely in pediatric patients when the clinical situation calls for it.22PubMed. The safe and efficacious use of arch bars in patients during primary and mixed dentition: a challenge to conventional teaching That said, most pediatric oral and maxillofacial surgeons still exercise caution and may prefer bonded splints or other less invasive approaches when feasible.
What the Metal Releases Into Your Mouth
Erich arch bars sit in the wet, acidic environment of the mouth for weeks, and like any metal implant they corrode slowly and release trace ions. The standard bar is AISI 316 stainless steel, which contains iron, chromium, nickel, and manganese. A laboratory study soaking arch bars in simulated body fluids found that the overall release of metal ions was low, but that nickel and chromium were the primary corrosion products. Bars that had been previously used (reused after sterilization, a practice in some resource-limited settings) released significantly more nickel than fresh bars, and acidic or high-chloride conditions accelerated the release.23Bulletin of the Chemical Society of Ethiopia. DETERMINATION OF METAL IONS RELEASED BY STAINLESS STEEL ARCH BAR INTO BIO-FLUIDS
Bar construction also matters. An earlier in-vitro study compared solid stainless steel arch bars to silver-brazed bars (which have solder joints) and found that the brazed type released 140 to 600 times more metal than the solid type over 28 days.24PubMed. Metal release from arch bars used in maxillofacial surgery. An in vitro study For patients with known nickel allergy, the low-level nickel release from even a solid bar is worth discussing with the surgeon, though allergic reactions severe enough to require early removal are uncommon in practice.
The Modified Arch Bar Approach
Some surgeons have tried to keep the arch bar concept while sidestepping its worst traits. A modified Erich arch bar design adapts the bar to the outer surface of the jawbone rather than wrapping wires around each tooth’s neck. Perforations are placed in the bone between tooth roots, avoiding the gum-line contact that drives periodontal damage. A randomized study comparing this modified bar to the conventional version found that the modified design cut wire-prick injuries by roughly two-thirds, reduced operative time, lowered patient-reported pain during the procedure, and produced cleaner teeth afterward.25PubMed Central. A Comparative Randomized Prospective Clinical Study on Modified Erich Arch Bar with Conventional Erich Arch Bar for Maxillomandibular Fixation Modifications like these blur the line between the traditional Erich bar and the newer hybrid systems, and reflect a broader trend of moving fixation hardware off the teeth and onto bone wherever possible.
Why Erich Arch Bars Persist
Given all the drawbacks, it is fair to wonder why any surgeon still uses the original design. The answer comes down to a few persistent advantages. Erich arch bars provide fixation across the entire dental arch, distributing force broadly rather than concentrating it at a few screw points. That makes them more resistant to losing grip if a single point fails. They work in patients with virtually any dental anatomy, including partially edentulous patients (people missing some but not all teeth), where there may not be enough bone between roots to seat screws safely. They require no power drill and no proprietary kit, just a bar, wire, and a wire twister. And generations of oral surgeons have trained on them, which means the learning curve for a new resident is cushioned by wide institutional expertise. For complex fractures where precise occlusal control over weeks of healing is critical, many experienced surgeons still consider the conventional arch bar the most reliable option, accepting the longer operative time as a reasonable trade-off for biomechanical security.