Peri-implantitis with iatrogenic implant corrosion: A clinical report of titanium particles remaining in local tissues for up to nine years.

The release of titanium particles is a common yet often overlooked complication of implant therapy. Most research has focused on nanoscale or submicrometer titanium particles and their immunological effects, with limited data on the long-term tissue response to larger particles. This report presents a patient with a mechanical implant complication accompanied by peri-implantitis. The improper removal of a fractured abutment screw resulted in severe implant damage and the release of numerous 20- to 200-µm titanium particles, which remained in the surrounding tissue for 9 years. After implant removal, scanning electron microscopy, energy-dispersive X-ray spectroscopy, histopathology, and immunohistochemistry were used to evaluate the tissue response. The findings showed that long-standing micrometer-sized titanium particles were primarily encapsulated by fibrous tissue rather than eliciting an inflammatory reaction. This report provides clinical evidence that the prolonged presence of micrometer-sized titanium particles in tissues does not necessarily trigger a significant immune or inflammatory response.