Steelers kicker Shaun Suisham missed a 54-yard attempt with under a minute to play in regulation, and on the ensuing drive Titans quarterback Matt Hasselbeck hit tight end Jared Cook for a 25-yard gain to set up the winning 40-yard field goal from kicker Rob Bironas.
With under five minutes remaining in the fourth, Hasselbeck hit receiver Kenny Britt for a 5-yard touchdown to tie the score at 23. The touchdown completed an 11-play, 80-yard Tennessee drive in just under four minutes.
Prior to that, Pittsburgh got a 1-yard touchdown run from running back Baron Batch early in the fourth, capping off a 15-play, 80-yard drive that gave the Steelers a 20-16 lead. Suisham drilled a 52-yard field goal midway through the final frame, his third make of the night, giving Pittsburgh the 23-16 advantage.
In throwing for 363 yards, quarterback Ben Roethlisberger surpassed Steelers legend Terry Bradshaw as the franchise's all-time passing leader. Bradshaw's previous record was 27,989 yards through the air. Roethlisberger finished the night going 24-of-40 with one touchdown, an 82-yard strike to receiver Mike Wallace in the first quarter, and one interception.