The behaviour of titanium as a biomaterial: microscopy study of plates and surrounding tissues in facial osteosynthesis

https://doi.org/10.1016/S1010-5182(99)80025-0Get rights and content

Summary

Titanium has become the biomaterial of choice for facial osteosynthesis. Titanium is considered a highly biocompatible and corrosion resistant material, although the ultrastructural behaviour of titanium in human tissues after bone fixation is not well documented.

A prospective scanning electron microscopy study was carried out on 37 commercially pure titanïum miniplates which were removed from 23 patients who had undergone surgery for maxillofacial trauma or deformity. Twenty two cases were used as a control group. Implant-bone specimens were excised using tungsten burs and studied with a scanning electron microscope (Jeol JSM-T-300). Findings at the bone-titanium interface were analyzed, as well as the presence of contaminating bodies on the specimen surface. Biopsies were also obtained from the soft tissues adjacent to 20 miniplates, then sectioned and stained with Haematoxilin-Eosin for histological evaluation by light microscopy.

The results showed good ultrastructural osseointegration of the osteosynthesis material in most cases (81.8%). Mobility was found upon removal in 80% of plates which showed clinical complications. A significant correlation was found between the degree of microscopical osseointegration and macroscopic fixation of the plate. Microscopical contamination was found in 100% of the nine plates with intraoral exposure, while only 36% of the 22 miniplates of the control group had contaminating elements (P<0.001). Thirty-five point one percent of the plates showed hole-like substance loss images, whose size ranged from 10–25μ. Light microscopy showed granular deposits in soft tissues surrounding the plates in 80% of the 20 specimens investigated. Our findings suggest a higher development of corrosion in titanium than previously reported. These findings are not correlated, however with the clinical complications.

References (29)

  • NishiokaG.J. et al.

    The role of bacterial laden biofilms in infections of maxillofacial biomaterials

    J. Oral Maxillofac Surg

    (1988)
  • RavehY. et al.

    New concepts in the reconstruction of mandibular defects following tumor resection

    J. Oral Maxillofac. Surg.

    (1983)
  • BlackJ. et al.

    Metallosis associated with a stable titanium-alloy femoral component in total hip replacement

    J. Bone Joint Surg.

    (1990)
  • BosR. et al.

    Bioresorbable osteosynthesis in maxillofacial surgery. Present and future

    Oral Maxillofac. Surg. Clinics North Am.

    (1990)
  • Cited by (68)

    • Analysis using the finite element method of a novel modular system of additively manufactured osteofixation plates for mandibular fractures - A preclinical study

      2021, Biomedical Signal Processing and Control
      Citation Excerpt :

      Thus, the only treatment option to hinder the inflammation process is to remove the fixation plate. At the same time, it is worth mentioning that plate exposure is not the absolute factor for surface bacterial contamination, as literature data report that plates entirely covered by soft tissue are also prone to biofilm formation [39]. The modular fixation plate system allows clinicians to remove only the infected or corroded parts and replace them during the same surgical procedure or create a bypass securing the bone fracture against hypermobility and subsequent soft tissue ingrowth.

    • Biomedical applications of hybrid polymer composite materials

      2017, Hybrid Polymer Composite Materials: Applications
    View all citing articles on Scopus
    View full text