Abstract
The aim of this study was to evaluate the microscopic structure of soft tissue covering titanium plates and screws used in jaw surgery (mandible fracture and orthognathic surgery), after a minimum period of 12 months from insertion, and to quantify the presence of any metallic particles. Periosteum covering the osteosynthesis plates was removed from 20 patients and examined by light microscopy in order to assess the cell morphological changes and the possibility of metal particles presence in the soft tissue. Local signs of tissue toxicity or inflammation were taken into consideration when evaluating the routine removal of titanium maxillofacial miniplates. No signs of screw loosening or acute inflammation were detected on the osteosynthesis site, but de-coloration of the periosteum was seen, and metallic particles were observed to have migrated into the soft tissues. Even if the titanium is well-tolerated by the human body in time, without severe local or general complications, our findings suggest that plate removal should be considered after bone healing has occurred.
Highlights
Pure titanium (CpTi) and its alloys are the first-choice material for bone internal fixation in trauma or orthognathic surgery due to their biological and mechanical properties, including their excellent biocompatibility, corrosion resistance, and high mechanical strength [1]
70 Commercially pure titanium (CpTi) miniplates with 2.0 diameter screws made by Stryker Leibinger (GmbH & Co.KG Freiburg, Germany) were removed, and 20 samples of soft tissue overlying the titanium plates were harvested and analyzed by optic microscopy
In order to measure the dimensions of the metallic particles present in the soft tissue, ImageJ software used
Summary
Pure titanium (CpTi) and its alloys are the first-choice material for bone internal fixation in trauma or orthognathic surgery due to their biological and mechanical properties, including their excellent biocompatibility, corrosion resistance, and high mechanical strength [1]. Even if they are well-tolerated, the long-term side effects within human tissues are still unclear and controversial [2]. Plate removal is another debatable issue that has different approaches. Some papers have presented discolored gray tissues over the miniplates [9,10], and others have reported Ti toxicity due to oxidative stress [11]
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