Leading clinical paper: Orthognathic surgery/trauma/TMJ disorders

It has been shown that titanium (Ti) has had dramatic success in many surgical procedures as a result of its excellent mechanical properties and resistance to corrosion. There is still concern, however, about the release of metal and controversy surrounding whether or not the plates should be removed after bone healing. This study has been conducted to investigate whether or not there is a relationship between duration of plating and metal release from Ti miniplates in maxillofacial surgery. A prospective cohort study design was used. The concentration of Ti, in the soft tissues covering the plates, was examined in all patients who underwent removal of Ti miniplates from January 1998 to April 1999 (51 cases). Inductively Coupled Plasma-Optical Emission Spectrometry was used to measure Ti. Total Ti and soluble Ti levels were compared to duration of plating (ranged from 15 days to 3 years, mean=8 months). Correlation coefficients and two-way ANOVA were data processed. The average amount of total Ti in the soft tissues surrounding the plates was 1306 g/g dry tissue. The mean of soluble Ti was 0.53 g/g dry tissue. The results of this study do not support the existence of a relationship between duration of plating and total Ti (correlation coefficient=0.093 (P>0.1) nor soluble Ti (correlation coefficient=0.009 (P>0.1) in the soft tissue surrounding the plates. Moreover, the only independent factor of Ti release found was associated with mechanical constraints during surgery. Almost 100% of Ti is released during the osteosynthesis. Then Ti levels remain constant in the surrounding tissues. Most of the time, Ti seems to be clinically inert. Compared to the possible risks of a second operation, removal of Ti miniplates should not be a routine procedure except in the case of complaints from patients, particularly in the case of infection, hypersensitivity, dehiscence or screw loosening.