Arch bar removal is a routine but often anxiety-inducing procedure that follows the healing of a jaw fracture. It typically happens in a clinic or office setting, takes anywhere from about ten to thirty minutes depending on the type of bar, and involves cutting and unwinding the wires or unscrewing the hardware that held your jaws in alignment while the bone healed. The experience is uncomfortable but manageable for most people, and the relief afterward is significant. What happens during removal, how much it hurts, and what recovery looks like depend heavily on which type of arch bar you have and how long it has been in place.
What Arch Bars Are and Why They Need to Come Out
Arch bars are metal devices wired or screwed along the upper and lower dental arches to hold the jaws together during healing of a fracture. The traditional version, known as the Erich arch bar, is a thin metal strip with small hooks that gets secured to individual teeth using fine wire ligatures. Newer alternatives include hybrid arch bars, which combine a bar with bone screws driven into the jawbone between tooth roots, and standalone intermaxillary fixation (IMF) screws, which skip the bar entirely and anchor directly into bone.
Regardless of type, the hardware needs to come out once healing is confirmed, usually around four to six weeks after surgery. Leaving arch bars in place indefinitely is not an option. A case report documented what happens when removal is neglected: a patient whose arch bars stayed in for 14 years developed severe dental decay, including cavities on smooth tooth surfaces that are rarely affected under normal circumstances, along with extensive periodontal disease and multiple teeth that could not be saved.1FACE. Clinical and Radiological Analysis of Arch Bars Over-Retained for 14 years Post Maxillo-Mandibular Fixation That extreme case aside, even standard-duration use takes a toll on gum health and plaque accumulation, so timely removal matters.
Where Removal Takes Place
Whether you go back to an operating room or sit in a clinic chair depends largely on the type of arch bar. A study comparing Erich arch bars, four-point fixation, and bone-supported (screw-retained) arch bars found a dramatic difference: roughly two-thirds of patients with traditional Erich arch bars needed to return to the operating room for removal, compared with only about 7 percent of those with bone-supported bars.2JAMA Network. A Clinical Comparison and Economic Evaluation of Erich Arch Bars, 4-Point Fixation, and Bone-Supported Arch Bars for Maxillomandibular Fixation The reason is straightforward: traditional bars involve many individual wire ligatures threaded around teeth, and cutting and pulling those wires can be painful enough to warrant sedation or general anesthesia. Bone-anchored systems, by contrast, use screws that can often be backed out chairside with little drama. One study of screw-retained bars reported successful removal in an outpatient setting without any local anesthesia at all.3Journal of Oral Biology and Craniofacial Research. The use of Synthes MatrixWAVE bone anchored arch bars for closed treatment of multiple concurrent mandibular fractures
If your surgeon tells you that removal will happen in the office, that is a good sign: it means the hardware type and your healing trajectory support a simpler procedure. If a return to the OR is planned, it usually reflects the complexity of the wiring rather than any problem with your fracture healing.
How Much It Hurts
Pain during removal is one of the biggest concerns patients have, and it varies by hardware type. For traditional Erich arch bars, the process involves clipping each wire ligature and pulling it free from around the tooth. The gums are often tender and somewhat inflamed after weeks of wiring, so this tugging and unwinding is felt. In a study comparing removal experiences, patients with Erich arch bars reported an average pain score of about 5.7 on a ten-point scale, while those with IMF screws averaged around 3.7.4PubMed Central. Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience That gap is meaningful: it is the difference between moderate and mild discomfort.
Hybrid arch bars, which combine wires with screws, tend to fall somewhere in between. One trial recorded average pain scores during the fixation period of about 2.5 for hybrid bars versus 3.4 for traditional Erich bars, suggesting the hybrid design causes less ongoing irritation even before removal day.5PubMed Central. Comparative Evaluation of Erich Arch Bars with Hybrid Arch Bars for Maxillomandibular Fixation in the Treatment of Mandibular Fractures: A Prospective Clinical Study Less irritation during the fixation period generally translates to less sensitivity at removal.
Topical anesthetic applied inside the mouth before the procedure can help. A review of alternative anesthesia techniques noted that intra-oral topical anesthetics can produce meaningful pain relief for arch bar removal.6Journal of Dental Anesthesia and Pain Medicine. Alternative practices of achieving anaesthesia for dental procedures: a review If you are nervous about the pain, it is worth asking your surgeon ahead of time what they plan to use for numbing. Some clinicians apply a gel and give it a few minutes to take effect; others may offer local anesthetic injections or mild sedation for patients with traditional wiring.
How Long the Procedure Takes
Removal time is surprisingly variable depending on the hardware system, and the published numbers across studies do not always agree, partly because different institutions use different techniques and definitions of “removal.” For traditional Erich arch bars, reported removal times in clinical trials range from roughly 11 minutes on the faster end to over 23 minutes on the slower end.7PubMed Central. The Use of Screw Retained Hybrid Arch Bar for Maxillomandibular Fixation in the Treatment of Mandibular Fractures: A Comparative Study For hybrid arch bars, one trial found an average removal time of about 30 minutes, while another found it closer to 9 minutes.8PubMed Central. Comparison of hybrid arch bar versus conventional arch bar for temporary maxillomandibular fixation during treatment of jaw fractures: a prospective comparative study9PubMed 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
The practical takeaway is that you should expect the removal appointment to block out roughly 20 to 45 minutes, accounting for setup, anesthesia application, the actual removal, and a quick check of your bite and gums afterward. It is not a long procedure, but it is not instantaneous either, especially if you have traditional wire-based fixation with many individual ligatures to cut and extract.
IMF Screws and Why Removal Is Different
If your jaw was fixed using IMF screws rather than arch bars, removal is a distinctly simpler experience. These small bone screws are backed out with a screwdriver, and because they sit in bone rather than wrapping around teeth, there is no wire to cut, no ligature to unwrap, and far less soft tissue disturbance. A randomized trial found that the entire process of placing and removing IMF screws took a fraction of the time compared with arch bars, and wire-prick injuries to the surgical team dropped from about 57 percent of arch bar cases to nearly zero with screws.10PubMed Central. Use of Arch Bars versus IMF-Screws in Maxillomandibular Fixation of Mandibular Fractures: A Randomised Prospective Study
Comfort during the fixation period also favors screws. In one comparison, about 85 percent of patients with IMF screws described their pain as tolerable while the fixation was in place, compared with 45 percent of arch bar patients.11PubMed Central. Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience The screws are not appropriate for every fracture pattern, so the choice is ultimately your surgeon’s, but if you are given the option, the removal experience alone is a real advantage.
What Happens to Your Gums and Teeth
Weeks of having metal hardware wired around your teeth leaves a mark on your oral health. Plaque builds up heavily around the wires because flossing is impossible and even brushing is awkward. Studies consistently show that plaque scores are much worse with arch bars than with screw-based alternatives. In one comparison, the average plaque index was about 3.1 in the arch bar group versus 0.95 in the screw group, a huge gap on that scale.12Journal of the International Clinical Dental Research Organization. To Compare the Efficiency of Maxillomandibular Fixation Screws Over Erich Arch Bar in Achieving Intermaxillary Fixation in Maxillofacial Trauma: A Clinical Study Another trial tracked plaque levels over 45 days and found that the screw group’s hygiene scores improved steadily, while the arch bar group’s scores stayed essentially flat, meaning the hardware blocked any meaningful oral hygiene improvement during that entire period.13PubMed Central. Evaluation of efficacy of intermaxillary fixation screws versus modified arch bar for intermaxillary fixation
The encouraging news is that the damage from standard-duration fixation is largely reversible. A follow-up study that examined teeth and gums a full year after wiring removal found that periodontal health was clinically and radiologically restored, with only one tooth showing temporary increased mobility.14PubMed. Interdental wiring in jaw fractures: effects on teeth and surrounding tissues after a one-year follow-up In the short term, though, expect your gums to look swollen and bleed easily after the bars come off. Some tooth mobility is normal in the first weeks and gradually resolves as the periodontal ligament tightens back up.
Wire ligatures can also cause mechanical injury to tooth roots. The tight wire around the neck of each tooth creates forces similar to orthodontic movement, and those forces can damage the protective cell layer on the root surface, potentially triggering external root resorption in some cases.15Biomedical and Pharmacology Journal. Comparison of Arch Bar, Eyelets and Transmucosal Screws for Maxillo Mandibular Fixation in Jaw Fratcure – Section: Discussion This is generally mild and self-limiting, but it is one more reason surgeons prefer to remove arch bars as soon as fracture healing allows rather than leaving them in “just in case.”
Mucosal Overgrowth Around Screws
If you have a hybrid arch bar with bone screws, there is a specific complication worth knowing about: the gum tissue can grow over the screw heads during the weeks of fixation, making removal trickier. One study reported mucosal overgrowth around about 31 percent of hybrid arch bar screws, along with screw loosening in about 12.5 percent.16PubMed Central. The Use of Screw Retained Hybrid Arch Bar for Maxillomandibular Fixation in the Treatment of Mandibular Fractures: A Comparative Study A different study using a bone-anchored arch bar system specifically designed to resist this problem reported no overgrowth issues at all and straightforward outpatient removal.17Journal of Oral Biology and Craniofacial Research. The use of Synthes MatrixWAVE bone anchored arch bars for closed treatment of multiple concurrent mandibular fractures
When overgrowth does happen, your surgeon typically uses a small instrument or scalpel to free the tissue before backing the screw out. It adds a couple of minutes and a brief sting but is not a major ordeal. If you notice that one of your screw heads has disappeared under the gum before your removal appointment, mention it ahead of time so the team can prepare.
Sharps Injuries and Why Surgeons Care About Hardware Type
Arch bar removal is not only a patient experience issue; it is an occupational hazard for the surgical team. Traditional wire-based arch bars produce sharp ends that regularly puncture gloves and skin. A prospective study logged needlestick injuries during intermaxillary fixation procedures and found that 23 percent of all procedures resulted in at least one wire-prick injury to the surgeon, with virtually all injuries caused by a wire rather than a needle.18PubMed. Incidence and patterns of needlestick injuries during intermaxillary fixation The risk was even higher during nighttime procedures, reaching about 45 percent. Since jaw fractures frequently involve trauma patients whose bloodborne virus status may be unknown, these injuries are a genuine concern.
This is one of the driving forces behind the shift toward screw-based systems. In a randomized trial comparing hybrid arch bars to traditional Erich bars, glove perforation occurred in 25 percent of hybrid cases versus 100 percent of Erich cases.19PubMed 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 That reduction matters for both the placement and removal phases. From your perspective as a patient, the practical implication is that newer fixation systems tend to make the removal process smoother for everyone involved.
Getting Your Jaw Moving Again After Removal
Once the bars and wires come off, your jaw will feel stiff. Weeks of enforced immobility cause the muscles and joint to tighten, and your opening will be limited at first. Many patients can only open about half as wide as normal immediately after release from fixation. The temptation is to wait for things to loosen up on their own, but active exercise appears to speed up the process considerably.
A randomized trial of early jaw exercises after fixation release found that patients who performed structured opening exercises ten times daily recovered much faster than those who relied on basic finger-assisted stretching alone. About four weeks out, the exercise group had recovered roughly 56 to 68 percent of their normal opening range, compared with 18 to 39 percent in the control group. Pain scores were also lower in the active exercise group.20British Journal of Oral and Maxillofacial Surgery. Effectiveness of early active mandibular exercise in early recovery of mandibular movement and quality of life after orthognathic surgery: a single-centre randomised clinical trial The exercises are simple: controlled opening and closing, side-to-side movements, and forward protrusion of the lower jaw, repeated frequently throughout the day. Tongue depressors stacked between the front teeth can serve as a rough measuring tool to track progress.
Expect the return to full function to take several weeks to a few months. Chewing will feel awkward at first, and you may find yourself favoring one side. Starting with soft foods and gradually reintroducing firmer textures is standard advice. If your bite feels off after the bars come out, report it to your surgeon promptly rather than waiting, as a malocclusion caught early is far easier to address than one that has been compensated for over time.
Oral Hygiene in the Days and Weeks After Removal
The day your arch bars come off, your mouth will not look or feel its best. Expect puffy, red gums that bleed when you brush, a coating of hardened plaque or calcite around the teeth where the wires sat, and possibly some sore spots where wire ends pressed into the cheek lining. A professional dental cleaning soon after removal makes a significant difference. The calculus that built up under and around the wiring is difficult to remove with a toothbrush alone, and getting it cleaned off early helps the gums recover faster.
During the fixation period, oral hygiene is severely compromised by the hardware itself. At the six-week mark, one trial found that nearly 70 percent of arch bar patients had poor oral hygiene, compared with about a third of patients using IMF screws.21PubMed Central. Use of Arch Bars versus IMF-Screws in Maxillomandibular Fixation of Mandibular Fractures: A Randomised Prospective Study Once the bars are off, the physical barriers to cleaning disappear, and the mouth begins to heal. Most gingival inflammation resolves within a few weeks of diligent brushing and flossing. If you had significant plaque buildup, your dentist may recommend chlorhexidine rinses for the first week or two to help knock down bacterial counts while the gums are still recovering.
When Removal Gets Complicated
Straightforward removal is the norm, but a few situations can make it harder. If a wire ligature breaks during removal and a fragment stays embedded in the gum tissue, your surgeon may need to probe for it or take a quick X-ray to locate it. Retained wire fragments are uncommon but can cause chronic irritation or infection if left behind.
Loose or partially backed-out screws in hybrid systems sometimes strip the bone around them, making the final turns difficult to catch. If a screw will not come out with normal torque, a small incision in the gum tissue may be needed to get a better grip. This is more of an annoyance than a complication and adds only a few minutes to the visit.
The most problematic scenario is the patient who delays or skips the removal appointment altogether, as in the 14-year case described earlier. Extended retention allows chronic plaque accumulation, progressive demineralization of tooth enamel, and irreversible periodontal damage. That patient ultimately developed smooth-surface cavities, a type strongly associated with long-term plaque stagnation, and lost multiple teeth. The lesson is simple: keep the removal appointment even if your jaw feels fine and you are tired of medical visits.
What to Ask Your Surgeon Before the Appointment
Walking into the removal appointment informed helps manage anxiety and ensures the procedure goes smoothly. A few questions are worth raising at the visit before removal or over the phone ahead of time:
- What type of arch bar do I have? This determines whether removal will be a quick screw-backing or a longer wire-cutting process, which in turn affects how much numbing you may want.
- Will this be done in the office or the OR? If an OR visit is required, you will need to plan for anesthesia protocols, fasting, and a ride home.
- What pain control will be used? Options range from topical gel to local anesthetic injections to conscious sedation, depending on the hardware and your comfort level.
- Should I schedule a dental cleaning soon after? Most surgeons recommend seeing your dentist within a week or two of removal for a thorough cleaning.
- What jaw exercises should I start? Getting instructions before the bars come off means you can begin exercising as soon as you leave the appointment rather than waiting for a follow-up.
If you have had bloodwork done recently showing any clotting concerns, or if you started or stopped any medications during the fixation period, bring that up as well. The removal itself does not typically cause significant bleeding, but inflamed gums can ooze, and your surgeon should know your current medication list.