Titanium Plates and Screws After Jaw Surgery: What Patients Should Know

Jaw surgery changes the position of the facial bones. Titanium plates and screws help keep those bones steady while the body does the real healing.

In orthognathic surgery, including double jaw surgery, Le Fort I osteotomy, bilateral sagittal split osteotomy, or BSSO, and genioplasty, the surgeon carefully cuts and repositions bone. Once the upper jaw, lower jaw, or chin is in the planned position, the bone segments need stable support. That is where fixation hardware comes in.

This article explains what usually stays inside the face after jaw surgery, why it is used, and when it may need attention. It is general education only and does not replace advice from an oral and maxillofacial surgeon.

Why Are Plates and Screws Used in Jaw Surgery?

When a jaw bone is repositioned, it does not instantly heal in its new location. The surgeon must hold the bone segments in the correct alignment long enough for biological bone healing to occur.

Titanium plates and screws are used for rigid internal fixation. This means the fixation is placed inside the body, directly on the bone, rather than relying only on wires, splints, or the teeth to hold things together.

Rigid internal fixation helps:

• Maintain the planned jaw position after surgery

• Reduce unwanted movement between bone segments

• Support early healing while new bone forms across the surgical cuts

• Help the bite and facial alignment stay stable during recovery

  
  

The key distinction is this: plates and screws do not heal the bone by themselves. They act like a stable frame. The body heals the bone through normal biology, including clot formation, new bone growth, and gradual remodeling.

This is different from saying the hardware “permanently fuses” the jaw. The plates stabilize the repositioned segments while healing takes place.

What Are Orthognathic Plates Made Of?

Most plates and screws used in jaw surgery are made from medical-grade titanium or a titanium alloy.

Titanium is commonly used because it has several helpful properties:

• It is strong for its size

• It is lightweight

• It resists corrosion inside the body

• It is generally well tolerated by bone and soft tissue

• It can stay in place long term when it is not causing symptoms

  
  

Medical-grade titanium is not the same as ordinary metal used in household items. It is manufactured for surgical use and must meet specific standards for biocompatibility, strength, and safety.

Titanium also integrates well with surrounding bone in many surgical settings. In jaw surgery, the purpose is not to make the jaw immobile forever. The purpose is to hold the bone segments in position while the bone heals.

Where Are the Plates Positioned?

The location of fixation hardware depends on the operation, the direction of movement, the thickness of the bone, and the surgeon’s plan.

Upper jaw surgery

In a Le Fort I osteotomy, the upper jaw, or maxilla, is separated and repositioned. Plates are often placed along the stronger bony areas of the midface, commonly near the cheek and nose supports.

Typical locations may include:

• The area beside the nose

• The cheekbone support region

• The front and side portions of the upper jaw

  
  

In double jaw surgery, this upper jaw fixation may be combined with lower jaw fixation during the same procedure.

Lower jaw surgery

In a BSSO, the lower jaw is split on both sides so it can be moved forward, backward, or adjusted for symmetry. Fixation may involve small plates with screws or positional screws placed along the sides of the lower jaw.

The hardware is usually positioned inside the mouth, near the back part of the lower jaw. It is generally covered by gum tissue and facial soft tissue after healing.

Genioplasty

A genioplasty moves the chin bone, not the entire lower jaw. The chin segment may be advanced, shortened, lengthened, centered, or otherwise reshaped.

Fixation is often placed at the front of the lower jaw, below the lower front teeth and along the chin bone. A small plate and screws hold the chin segment in its planned position while it heals.

What Happens After the Bone Heals?

After healing, the bone gradually becomes stable in its new position. The surgical cuts fill in with new bone and remodel over time. As this happens, the plates and screws usually become less important mechanically.

In many patients, asymptomatic titanium plates and screws simply remain in place. They are covered by soft tissue and are not visible from the outside.

The hardware does not usually need to be removed just because the bone has healed. Removal is a separate surgical decision. It depends on symptoms, risks, timing, and the surgeon’s assessment.

A useful way to think about it:

Bone healing	Fixation hardware
A biological process performed by the body	A mechanical support system placed by the surgeon
Creates new bone across the surgical sites	Holds bone segments steady during healing
Continues to remodel over time	May remain in place if it causes no problems

Can You Feel the Plates and Screws?

Many patients cannot feel their plates or screws during normal daily life. The hardware is small and is usually covered by bone, gum tissue, muscle, and skin.

Some people may notice firmness under the tissue in certain areas, especially where soft tissue is thin. This may be more noticeable around the upper jaw near the nose or cheek support areas, or at the chin after genioplasty.

Feeling a firm area does not automatically mean something is wrong. After jaw surgery, swelling, scar tissue, numbness, and changing sensation can also affect how the face feels during recovery.

Hardware should be evaluated if there is pain, swelling, drainage, a sharp sensation, or tissue breakdown over the plate.

Do Titanium Plates Need to Be Removed?

Titanium plates and screws often can remain in place when they are not causing symptoms. Routine removal is not always necessary.

Still, it would not be accurate to say plates never need removal. In selected cases, removal may be considered.

Reasons a surgeon may evaluate hardware removal include:

• Infection around a plate or screw

• Hardware exposure through gum tissue or skin

• Ongoing irritation or tenderness linked to the hardware

• Loose screws or plate movement

• Sinus-related symptoms when upper jaw hardware is involved

• A plate that interferes with another needed surgery

• Patient-specific concerns after careful risk discussion

  
  

Removal, when needed, is usually considered after the bone has healed enough to remain stable without the hardware. The timing varies. Removing hardware too early may risk disturbing the healing bone, so this decision should always be made by the treating surgeon.

Can Titanium Cause Cold Sensitivity?

Titanium is a metal, so some patients wonder whether plates and screws make the face sensitive to cold weather.

For most people, titanium fixation does not cause noticeable cold sensitivity. The plates are small and covered by living tissue, which insulates them. Everyday cold air or cold drinks usually do not create a problem.

A small number of patients may report unusual sensitivity, aching, or awareness in areas where hardware sits, especially in thin tissue areas or during periods of nerve recovery. That does not mean every patient will feel cold sensitivity, and it does not always mean the hardware is the cause.

Cold-related discomfort should be discussed with the surgeon if it is persistent, localized, worsening, or tied to swelling or tenderness.

What About Airport Security?

Titanium plates and screws used in jaw surgery generally do not cause problems with airport security screening. They are small and located inside the face.

That said, no one can guarantee that any implant will never trigger a detector. Security equipment varies, and screening procedures can change. If a scanner or detector raises a question, it is usually handled by routine secondary screening.

Most patients do not need special paperwork for jaw fixation hardware. Some people prefer to carry documentation from their surgeon, especially after recent surgery or when traveling internationally. A card or letter may help explain the presence of facial hardware, but it may not change security procedures.

Can You Have MRI, CT or CBCT With Titanium Plates?

Titanium fixation is usually compatible with common medical and dental imaging, but it should always be disclosed before any scan.

CT and CBCT

CT and cone beam CT, or CBCT, are frequently used in jaw and facial imaging. Titanium plates and screws can appear clearly on these scans. They may create some streaking or scatter artifacts, which can make nearby details harder to see.

For dental implants, jaw joints, sinuses, or surgical planning, the radiology team may adjust scan settings or positioning to improve the image.

MRI

Titanium is generally considered MRI compatible under appropriate conditions, but patients should still tell the imaging center about any plates, screws, implants, or past surgeries before the scan.

The imaging team may ask:

• What type of hardware was placed

• Where it is located

• When the surgery was performed

• Whether there are any other implants or devices

  
  

Titanium usually causes less MRI artifact than many other metals, but it can still affect image quality near the hardware. If the MRI is focused on the face, jaw, sinuses, brain, or neck, the radiologist should know about the fixation.

Standard vs Patient-Specific Fixation

Most orthognathic surgery has traditionally used standard fixation plates. These plates come in common shapes and sizes. During surgery, the surgeon selects, bends, and positions them to fit the patient’s anatomy and the planned bone movement.

Patient-specific fixation systems are different. These are designed from a digital surgical plan and manufactured to fit an individual patient’s bone contours and jaw movements. They may be used with cutting guides, custom plates, or both.

The main differences are practical:

Standard fixation	Patient-specific fixation
Selected and shaped during surgery	Designed before surgery from a digital plan
Widely used in Le Fort I, BSSO, and genioplasty	Used in selected cases based on anatomy and planning
Flexible and familiar to many surgeons	May help transfer a virtual plan into the operating room
Not custom-made for one patient	Made for one patient’s planned movements

Both approaches are meant to stabilize bone segments while healing occurs. One is not automatically better for every case. The choice depends on the surgery, anatomy, surgeon preference, planning method, and clinical goals.

When Should Fixation Hardware Be Evaluated?

After jaw surgery, some soreness, swelling, tightness, and numbness are expected during recovery. These symptoms often improve gradually. Still, certain signs should be checked by the surgical team.

Contact the surgeon if there is:

• New or worsening facial swelling after initial improvement

• Redness, warmth, drainage, or a bad taste from an incision

• A plate or screw visible through gum tissue or skin

• Sharp pain in one specific hardware area

• A feeling that something is loose

• Persistent irritation when chewing or speaking

• Fever or other signs of infection

• Sinus symptoms that seem linked to upper jaw hardware

• New symptoms months or years after surgery

  
  

Evaluation may include an exam and imaging. Treatment might involve observation, antibiotics when infection is present, smoothing or treating irritated tissue, or hardware removal in selected cases after the bone has healed.

Titanium plates and screws are a normal part of many orthognathic procedures. Their job is mechanical and temporary in purpose, even if they stay in the body long term. They hold the repositioned bones still while the body builds new bone.

For most patients, the hardware remains quiet, hidden, and compatible with everyday life. When symptoms develop, the right next step is not to guess. It is to have the area evaluated by the surgeon who understands the procedure, the healing timeline, and the exact position of the fixation.