Exfoliative cytology and titanium dental implants: a pilot study

J Periodontol. 2013 Jan;84(1):78-83. doi: 10.1902/jop.2012.110757. Epub 2012 Mar 13.


Background: Oral exfoliative cytology is a diagnostic method that involves the study of cells exfoliated from the oral mucosa. Ions/particles released from metallic implants can remain in the peri-implant milieu. The aim of the present study is to assess the presence of metal particles in cells exfoliated from peri-implant oral mucosa around titanium dental implants.

Methods: The study comprised 30 patients carrying titanium dental implants, who had neither a metallic prosthesis nor metal restorations in neighboring teeth. Individuals undergoing orthodontic therapy and those who had oral piercing were also excluded from the study. The study sample included patients with and without peri-implantitis. Cytologic samples of the peri-implant area were collected. Samples of the marginal gingiva on the contralateral side of the implant were taken from the same individuals to serve as control. Cytologic analysis was performed using light microscopy. Titanium concentration was determined using inductively coupled plasma-mass spectrophotometry.

Results: Metal-like particles were observed inside and outside epithelial cells and macrophages in cytologic smears of peri-implant mucosa of both patients with and without peri-implantitis. No particles were found in the control cytologic samples. The concentration of titanium was higher in the peri-implantitis group compared with the group without peri-implantitis; no traces of titanium were observed in controls.

Conclusions: Regardless of an inflammatory response, ions/particles are released from the surface of the implant into the biologic milieu. Exfoliative cytology is a simple technique that may be used to detect metal particles in cells exfoliated from the peri-implant mucosa.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acrylic Resins / chemistry
  • Adult
  • Biocompatible Materials / analysis*
  • Biocompatible Materials / chemistry
  • Coloring Agents
  • Crowns
  • Cytodiagnosis / instrumentation
  • Cytodiagnosis / methods*
  • Dental Implants*
  • Dental Materials / chemistry
  • Dental Porcelain / chemistry
  • Dental Prosthesis, Implant-Supported
  • Epithelial Cells / pathology
  • Female
  • Gingiva / cytology
  • Humans
  • Macrophages / pathology
  • Male
  • Middle Aged
  • Mouth Mucosa / pathology*
  • Peri-Implantitis / pathology
  • Pilot Projects
  • Spectrophotometry, Atomic
  • Titanium / analysis*
  • Titanium / chemistry


  • Acrylic Resins
  • Biocompatible Materials
  • Coloring Agents
  • Dental Implants
  • Dental Materials
  • Dental Porcelain
  • Titanium