DIAGNOSIS AND CLINICAL MANAGEMENT IN THE TREATMENT OF FOREIGN BODY REACTION TO TITANIUM IN IMPLANTOLOGY

Abstract

Titanium is widely used in implantology and various other surgical specialties (cardiovascular surgery, orthopedics, neurosurgery, and general surgery) due to its exceptional biocompatibility and ability to promote osseointegration. However, growing evidence indicates that it can induce complex biological reactions in susceptible individuals, such as hypersensitivity and delayed Foreign Body Response (FBR), which represent significant diagnostic challenges due to vague and nonspecific symptoms. This study, a narrative literature review, synthesized recent literature on the pathogenesis and clinical management of these reactions. The results indicate that the release of titanium particles and ions, resulting from biocorrosion and mechanical stress, acts as a cytotoxic factor, altering the local immune balance and modulating macrophages, which contributes to marginal bone loss and the progression of peri-implantitis. The diagnosis of hypersensitivity is clinical and by exclusion, with a history of metal intolerance being a risk factor to be considered in selective preoperative evaluation. Current clinical management emphasizes that removal of the implanted material results in significant improvement or complete resolution of symptoms. It is concluded that there is an urgent need for standardization of diagnostic protocols and clarification of pathophysiological mechanisms to guide decision-making, reduce unnecessary investigations, and improve patients' quality of life.