Titanium Allergy in Dental Implants Patients

Summary:

Ti allergy can be detected in dental implants patients, even though its estimated prevalence is low (0.6%).

Detailed Abstract:

BACKGROUND: In dentistry, allergic reactions to Ti dental implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to non-specific immune suppression.

OBJECTIVE: Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material.

MATERIAL AND METHODS: Thirty-five subjects out of 1500 implant patients treated and/or examined (2002-2004) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out.

RESULTS: Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)(P=0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight).

CONCLUSIONS: Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing post-op allergy compatible response (ACRG), in which cases allergy tests could be recommended.

Authors:

Sicilia A, Cuesta S, Coma G, Arregui I, Guisasola C, Ruiz E, Maestro A.

Source:

Clin Oral Implants Res. 2008 Aug;19(8):823-35.

Comments

Comment on the frequency of titanium allergy

Tue, 10/14/2008 - 15:47 — MELISA_Foundation

First of all, I would like to add that titanium allergy has been discussed previously on this forum at
www.osseonews.com/melisa-test-for-hypersensitivity-to-metals/
, specifically why patients rarely have a positive reaction to titanium in patch testing.

I would also like to comment on the wide range of frequency of immunologic responses to titanium in the MELISA test as reported by Valentine-Thon and Schiwara, 2003. This was caused by large amount of referrals for titanium allergy testing by a dermatologist with a special interest in titanium, and therefore the frequency is unnaturally high.

In a study published 1997, 650 Swedish patients with clinically verified or suspected metal hypersensitivity, 3% were positive to titanium dioxide in MELISA testing (Stejskal V, Human Hapten-Specific Lymphocytes: Biomarkers of Allergy in Man, Drug Information Journal, Vol. 31, pp. 1379-1382, 1997). In larger study of 3 162 German and Swedish patients with local and systemic reactions attributed to dental restorations, the frequency of positive responses to titanium dioxide was 7 % (Stejskal, V, et al. Metal-specific lymphocytes: biomarkers of sensitivity in man. Neuro Endocrinol Lett 1999;20:289-298. In a subgroup of 111 patients suffering from chronic fatigue-like syndrome, the titanium-specific reactivity was 5% which can be compared to 2% in 116 healthy subjects. Valentine-Thon and colleagues, found the frequency of 4.2 % of positive responses to titanium dioxide among 700 patients in northern Germany (Valentine-Thon E, et al. LTT-MELISA® is clinically relevant for detecting and monitoring metal sensitivity, Neuro Endocrinol Lett 2006; 27(Suppl 1): 17-2487). The same group reported in 2006 the study on 56 patients who developed health problems after receiving titanium-based implants. In the MELISA test, more than half of patients responded with increased proliferation to titanium dioxide, although they were all patch test negative. In patients who did not respond to titanium in vitro, a majority responded to other metals. Clinical symptoms disappeared or improved dramatically after implant replacement, thus emphasizing the clinical relevance of in vitro lymphocyte transformation tests (Müller et al. Hypersensitivity to titanium: Clinical and laboratory evidence. Neuro Endocrinol Lett 2006; 27(Suppl 1): 31-35). In conclusion, these studies indicate that the use of in vitro methods might be a suitable complement for detection of systemic titanium allergy.

Vera Stejskal

Associated Professor of Immunology
University of Stockholm, Sweden and
1st Medical Faculty, Charles University,
Prague, Czech Republic