Metal microparticles – what’s the damage?

09 September 2025

It’s no secret that human bodies are currently ingesting and inhaling more microplastics than at any time in human history.[i] Whilst the long-term impacts of this are yet to be fully discovered, it is unlikely to be positive. But microplastics aren’t the only microscopic concern.

Miniscule metal particles can enter the body through respiratory, dermal, gastrointestinal, circulatory, immunological and neurological tracts.[ii] For dental professionals, titanium microparticles are of particular concern due to their role in dental implant treatments and their perceived association with peri-implantitis.

 

Titanium troubles

Discovered in 1791, titanium is the ninth most abundant metal on the planet. Two centuries later, the first titanium dental prostheses were made, revamping the healthcare landscape by offering a strong and safe material that was biocompatible with the human body and compatible with CT and MRI scans.[iii] Titanium has since become the most common material for dental implants, promoting osseointegration when the metallic surface fuses with the jawbone.

However, the relationship between implant material and implant failure must be considered. One of the leading causes of treatment failure is peri-implantitis, with an incidence among implant patients of 20-47%.[iv] Whilst the risk factors for this are many – poor oral hygiene maintenance, lifestyle choices like smoking, diabetes and other health conditions[v] – one area to focus on is the role of titanium micro-particles.

Research on peri-implantitis patients found that a much higher concentration of titanium micro-particles was present at an inflamed site than a healthy implant site.[vi] There are several explanations for the presence of micro-particles:

• The abrasion of the drill bit against the bone tissue can produce metal particles that remain around the implant site
• Metal particles have been detected in the surrounding tissue immediately after implant placement
• Dental trauma
• Implant wear[vii]

The latter is the most likely cause: titanium reacts quickly to oxygen, forming a layer of oxide film that improves corrosion resistance and optimises biocompatibility.[viii] Friction between the bone surface and the implant can destroy the oxide film, exposing the titanium and increasing its vulnerability to corrosion. This process then releases particles into the surrounding tissue, making wear a risk factor that dental professionals should educate their patients on to contain this problem.[ix] This could include wearing mouthguards for sports or at night to prevent bruxism, and attending regular dental appointments.

 

Correlation is not causation

Whilst there is substantial body of research highlighting the prevalence of titanium microparticles in peri-implantitis patients, there is a minimal understanding of whether the metal is a direct cause for the disease. A recent study challenged this notion and emphasised how previous research only focused on inflamed sites. In the research, patients had soft tissue samples taken from both peri-implantitis implant sites and healthy implant sites; each patient was therefore their own control. Titanium microparticles were found at all examined implant sites, suggesting that their presence is not associated with the occurrence of peri-implantitis.[x]

For clinicians, undersized preparation of the implant bed during osteotomy can be a risk factor, leading to increased friction between the bony wall and the screw-shaped implant during installation. Dislodged titanium microparticles are then embedded in the supra-crestal connective tissue.[xi] The tissue samples that contain more titanium particles have an altered gene expression, especially for genes relating to inflammation and wound healing. This suggests that the microparticles may have more of an association with the symptoms of peri-implantitis than being a risk factor for it. The disparities in microparticle densities were also noted, with various implant types producing differing results.[xii]

 

Manage the metal

Despite the presence of microparticles not directly causing peri-implantitis, its impact on gene expression may slow healing for infections. Clinicians can manage this in several ways. First, surface-treating the implant can increase the resistance to friction and therefore delay the corrosion rate of the titanium. Different titanium alloys can also be effective, offering superior corrosion resistance and releasing fewer microparticles.[xiii] Above all, clinicians should stay up to date on the latest research around dental implants, ensuring that any breakthroughs are accounted for when planning and executing future implant treatments.

To support clinicians with this, the Association of Dental Implantology (ADI) runs an excellent programme of Study Clubs throughout the year. Bringing renowned experts and like-minded dental professionals together to discuss the latest advancements in implantology, the CPD-accredited sessions help attendees achieve their educational objectives for the year. Each UK region hosts up to four Study Clubs per year – exclusively for ADI members. Join today to enhance your knowledge and skills in implantology.

 

Eyes open for the future

Titanium is an integral material for clinicians, providing first-class strength and biocompatibility. The presence of metal microparticles in the soft tissue around implants should be reason for concern, but as more research continues to understand the impact of it on the oral cavity, clinicians should continue to master their treatments and stay at the forefront of scientific developments.

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