Resources for Patient Selection & Application
Use the Largest Size (Green) Possible
Use 3-4 Ties per Side
Pull Through Gingival Tissue and Fully Tighten
Use the largest size Minne Ties whenever possible, which minimizes the chance of "flossing out" (i.e. the Ties can pull through the contact point). Only drop down to a smaller size if the largest size won't fit in the embrasure. In this image, the circled Minne Tie would have ideally been the larger size.
It is recommended to use 6-8 ties total for the best strength of construct; Minne Ties are designed to work as a system. Ideally place the ties in sequential embrasures, which creates a buttressing effect. This reinforces the overall strength of construct.
First, tighten each of the Minne Ties finger tight. If the tissue is pierced during insertion, be sure to pull the suture through that tissue by using a rocking motion (see image). Lastly, while holding the clasp against the teeth, pull straight out on the suture with a needle driver. Make sure the Minne Ties are fully seated at the contact points.
Do Not "Twist" Tighten the Suture with a Needle Driver
Once the Minne Ties have been looped and pulled through the patient's gingival tissue using a back and forth rocking motion, it is crucial to use proper tightening techniques to achieve secure and durable MMF.
It’s best to use your gloved hand, rather than a needle driver, to pull on the suture while simultaneously pushing the clasp down against the teeth (see image below). This provides better control and minimizes the risk of compromising the integrity of the coating on the suture. Pull straight out on the tail of the suture (while sliding the clasp toward the teeth) for a secure fit. Do not twist the suture using a needle driver, hemostat, or any other surgical instrument as pictured above.
Pull Outwards on the Tail of the Suture and Push the Clasp Head Towards the Teeth
Keep in mind that Minne Ties are made of suture material, not wire, so a gentle, straight tightening approach ensures the suture stays intact and your patients receive the optimal fixation you’re looking for.
To ensure the Minne Ties are sufficiently tight, many surgeons pull down on the patient’s mandible/chin while visualizing occlusion rather than continuing to manipulate each Minne Tie individually. Minne Ties were designed to work as a system, and this approach helps assess the rigidity of the MMF and the overall strength of construct. If the occlusion is not tight enough, continue to tighten each Tie by pulling straight out while pushing the clasp against the teeth.
Animated Tutorial Video (2:04)
Clinical Demonstration (32s)
Standard Application Tips
Make a plan – assess embrasure alignment
Always try the 1.0 mm size first. If it will not fit use the .7 mm size
Begin posteriorly, moving anteriorly as you place ties
Insert introducer into the maxillary embrasure, from buccal to lingual
Insert introducer back out of the mandibular embrasure from lingual to buccal
Place the introducer into the green side of the clasp head
Pull on the suture to tighten, not on the metal introducer
Tighten all sutures 'finger tight'. Double check occlusion
Tighten again to remove any "slack" by holding clasp against teeth with a pickle fork or needle driver and pulling perpendicularly out on the suture
Leave the tie loose until all sutures have been placed
Apply 4 per side, using adjacent embrasures when possible
Make sure Ties are fully seated at the contact points (pulled through any tissue)
Use suture scissors or scalpel to cut the tail of the suture
Cut suture to remove in the OR, ED, or clinic
Initial Patient Selection
Alternative Application Techniques
It is sometimes beneficial to place Minne Ties in a figure 8 formation for temporary MMF. This can be done by inserting the introducer into the maxillary embrasure and leaving a half inch tail at the clasp end to secure during the last step. Loop horizontally and exit the lingual embrasure, then cross diagonally to reinsert into the mandible buccal embrasure. Loop horizontally again and insert the introducer into the clasp head.
Physicians can reduce a mandible fracture prior to plating by applying Minne Ties horizontally around a few adjacent teeth, straddling the fracture. The best practice is to use the Minne Ties bridle wire style application in conjunction with vertical Minne Ties applied sequentially, as the strength of Minne Ties comes from their use as a system. This technique is comparable to applying a bridle wire for fracture reduction.
Two Minne Ties can share an embrasure when the standard application isn't possible due to inadequate dentition. Best practice is to form a "triangle" by applying Minne Ties in two separate embrasures on the maxilla or mandible and by sharing one embrasure on the opposite site.