Release of Titanium Particles After Implantoplasty in the Treatment of Peri-Implantitis: Local and Systemic Implications—An Integrative Systematic Review

<b>Background/Objectives:</b> Implantoplasty is widely applied in the surgical management of peri-implantitis; however, this procedure releases titanium micro- and nanoparticles whose biological relevance remains uncertain. Understanding whether these particles influence peri-implant tissue health or systemic responses is essential for assessing the long-term safety of implantoplasty. To determine whether titanium particles generated during implantoplasty are associated with peri-implantitis, peri-implant tissue changes, or systemic effects. <b>Methods:</b> This systematic review followed PRISMA 2020 guidelines. Electronic searches were performed in PubMed, Scopus, and Cochrane Library for studies published between 2015 and 2025. Eligible in vitro, in vivo, observational, and clinical studies evaluated titanium particle release during or after implantoplasty and its local or systemic effects. Study selection and data extraction were conducted independently, and the risk of bias was assessed using RoB 2, ROBINS-I, and AMSTAR 2. Synthesis was qualitative due to heterogeneity. Certainty of evidence was evaluated with GRADE. <b>Results:</b> Fourteen studies met the inclusion criteria. Titanium particles ranging from 100 nm to 54 µm were consistently detected in peri-implant tissues, with higher levels in peri-implantitis sites, though without consistent clinical association. In vitro data showed dose-dependent inflammatory cytokine release and decreased osteogenic activity, whereas human studies did not confirm a direct relationship between particles and peri-implantitis or marginal bone loss. Certainty of evidence was generally low. <b>Conclusions:</b> Titanium particles generated during implantoplasty are detectable but show no consistent clinical association with peri-implantitis or significant inflammation. Implantoplasty may be applied selectively, although robust long-term clinical studies are still required. No protocol was registered.