Hines Ward nearly coughed it away but his gritty quarterback saved his best for last.
Ben Roethlisbeger threw an uncharacteristic 43 passes but completed 33 of them for 363 yards with a touchdown and two interceptions.
His counterpart, Kerry Collins, was equally efficient, throwing for 244 yards with one touchdown and an interception.
The story of the game, however, was the play of both defenses who came out of 2008 ranked first and second in every major statistical category.
Even without star defensive tackle Albert Haynesworth, the Titans' defensive line did its job in getting good pressure on Roethlisberger with four sacks and grabbing two interceptions, one of which was almost taken back for a touchdown before halftime by Pro Bowl cornerback Cortland Finnegan.
The Steelers came out strong especially with the play of star safety Troy Polamalu, who came out like a house of fire with five tackles and an incredible one-handed interception in the first quarter alone.
However, his night ended on a blocked field goal by James Farrior and it is speculated that the injury could be an MCL sprain; his loss was felt immediately as the Titans took only two plays to tie the score at seven in the second quarter capped off by Justin Gage's 14-yard touchdown reception.
Pittsburgh's running game, somewhat of a weakness last season, was again exposed as they were held to 36 total yards on 23 carries.
The Titans had their opportunities to score and take control of the game but dropped passes and missed field goals doomed their chances to begin 2009 on a winning note.
Tied at 10 late in the fourth quarter, Roethlisberger's 30-yard completion to Hines Ward would have set up Pittsburgh with plenty of time to run out the clock for a game-winning field goal but Ward fumbled the ball at the five-yard line giving the ball to Tennessee.
After winning the coin toss, Roethlisberger again led the Steelers down the field highlighted by rookie Mike Wallace's 22-yard reception allowing Jeff Reed to kick the winning field goal.
Passing: Roethlisberger (PIT): 33/43, 363 yards, 1 TD, 2 INT
Rushing: Johnson (TEN): 15 att., 57 yards, O TD
Receiving: Holmes (PIT): 9 rec, 131 yards, 1 TD