As discovered by Malvern Mastersizer and DLS, the sizes of G4 and G5 implant particles released as result of implantoplasty are in the range of nano (NPs) and fine particles (FPs) (125.4 ± 10.9 nm–77.4 ± 9.1 μm and 57.74 ± 2.66 nm–48.4 ± 6.4 μm for G4 and G5 implant particles, respectively). NPs and FPs can enter cells via a number of routes such as phagocytosis, endocytosis and macropinocytosis as well as passive diffusion. Exposure to nanomaterials and nanoparticles can potentially result in biological responses at molecular level such as DNA methylation, histone post-translational modifications and noncoding RNAs in mammalian cells.

In the field of Orthopaedics, titanium (oxide) wear particles from implants were reported to enter bone-forming cells and stem cells via endocytosis and cause adverse biological response including osteolysis. It has also been proposed that titanium particles induce secretion of pro-inflammatory cytokines by fibroblasts, which are involved in the chemotactic migration and recruitment of monocytes/macrophage and subsequently the pathogenesis of aseptic loosening of implants.  Therefore, although no short-term effect of G4 particles on HGFs was observed in the present study, further, long-term investigations are also of crucial importance.