title: Tissue changes adjacent to titanium plates in patients.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Titanium is apparently well tolerated for up to 13 years.
authors.affiliation: University Hospital Birmingham NHS Trust, Birmingham, UK. langfordnorton@hotmail.com
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Langford
authors.forename: John W
authors.initials: JW
authors.lastname: Frame
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D001863:Bone Screws / Q000009:adverse effects; D020878:Device Removal; D004577:Electron Probe Microanalysis; D005145:Face; D005260:Female; D005355:Fibrosis / Q000209:etiology; D006097:Granulation Tissue; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000209:etiology; D018461:Soft Tissue Infections / Q000209:etiology; D014025:Titanium / Q000009:adverse effects*
chemical_list: D014025:Titanium