Is Rigid Fixation Using Titanium Plates in the Mandible as Successful as We Think?

Introduction: Since the introduction of the titanium plating system it has become the gold standard. Titanium is considered biocompatible, corrosion resistant with an elasticity modulus closest to bone than any other metal. Nonetheless, titanium plates are not always as inherent as we hope.

Objectives: Investigated the morbidity associated with titanium plates used for rigid fixation following mandibular fractures

Methods: Retrospective study of patients suffering from mandibular fractures and treated in our institute between the years 2000-2018 using open reduction internal fixation with titanium plates. Data acquired included age, gender, complications and location. Predictor variable was location of titanium fixation plates in different mandibular fractures. Outcome variable was plate removal.

Results: 571 patients were included, 107 resulted in plate removal; 18.7%. Body was the most prevalent location of fracture with 29.3%. Symphysis/para symphysis area showed the highest percentage of plate removal with 24.1%, followed by body and angle with 21.3 and 19.8% respectively. Cases with double plating showed 23.4% of complication rates resulting in plate removal, upper border plating in 15% and lower border plating in 8.8%, all reconstruction plates. Pain was the most frequent complication in all fracture sites. Plate exposure was the second most common complication in body and angle fractures.

Conclusion: Although titanium plates for rigid fixation of mandibular fractures show good results in the literature, when investigating complications resulting in titanium plate removal almost every fifth patient returned for plate removal. Age distribution emphasized the age group of 41-50 years old with a decrease towards young and elderly which may imply better healing at younger age and soft tissue elasticity and less complaints in the elderly population. Double plating resulted in significant more complications compared to lower border plates, suggesting proximity to the oral cavity is a major risk factor for plate removal. Complications rates and patterns resulting in plate removal are not at all negligible and perhaps should encourage us clinicians to consider using biodegradable systems when appropriate in the adult patient.