HIGHLIGHTS
SUMMARY
Intolerance reaction to pure titanium implants (grade 4) is more likely a pro-inflammatory reactivity of tissue macrophages in contact with titanium oxide particles disseminated into the peri-implant tissue by tribocorrosion rather than a systemic allergic reaction. When exposed to oxygen, titanium oxidizes and immediately forms a 1-2 nm thick layer of titanium dioxide (TiO2), which protects the titanium surface from further redox_reactions. A dose dependent mechanism was reported for pulmonary inflammation, fibrosis and epithelial hyperplasia. TiO2 particles may contribute significantly to local immune_responses and are capable of strongly upregulating pro-inflammatory . . .
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