Tissue changes adjacent to titanium plates in patients

INTRODUCTION: Titanium miniplates are widely used for osteosynthesis in maxillofacial surgery. Titanium is considered to be well tolerated but the long-term effects of titanium retained within human tissues are unclear. AIMS: This study was designed to evaluate histomorphologically the soft tissues adjacent to titanium maxillofacial miniplates and screws in patients, and to determine the nature of pigmented, particulate debris found in the tissues. Materials: Thirty-five soft tissue specimens were excised from the tissues adjacent to titanium miniplates which had been in situ for between 1 month and 13 years. METHODS: All of the soft tissue specimens were prepared for examination under the light microscope. Four specimens were examined under the scanning electron microscope and the transmission electron microscope. Energy dispersive X-ray analysis (EDX) was used to confirm the elemental composition of the particles under investigation. RESULTS: All of the soft tissues showed fibrosis. Pigmented debris was present in 70% of the specimens and titanium was identified by EDX analysis. The debris was predominantly extra-cellular and was not associated with any inflammatory response or giant cell reaction. Fibroblasts were the predominant cell with small aggregates of lymphocytes and scattered macrophages. CONCLUSION: Titanium is apparently well tolerated for up to 13 years.