The cytotoxicity of hydroxyapatite (HA), tricalcium phosphate (TCP), and two types of apatite-containing glass-ceramics designated A.W-GC and A.W.CP-GC was evaluated by the direct contact method using V79 cells. Compatibility of the cells was assessed as a function of cellular attachment and subsequent growth using scanning electron microscopy. Although all of the tested materials have surfaces available for cellular attachment, cell growth was markedly inhibited by HA sintered at 600 degrees C and 900 degrees C, and slightly inhibited by HA sintered at 1200 degrees C, TCP and the glass-ceramics. In attempts to clarify the cause of this toxicity, the interactions of the ceramics with culture medium was assessed by measurement of calcium (Ca), inorganic phosphate (P), magnesium (Mg), pH and albumin content in the medium. The grade of toxicity corresponded to the degree of reduction of Ca, P, and albumin in the medium. Furthermore, surface reactions of the ceramics were demonstrated to vary in both mode and degree depending on their chemical structure and level of microporosity. Thus, the surface reactivity of ceramic materials should be always taken into account in discussing their biocompatibility in vivo.