Metal allergy patient treated by titanium implant denture: A case report with at least 4‐year follow‐up

Yan, Huijiao; Afroz, Shaista; Dalanon, Junhel; Goto, Nami; Hosoki, Maki; Matsuka, Yoshizo

doi:10.1002/ccr3.1753

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…Our analysis found the value of post device implantation patch testing to be less clear, which aligns with previous reports that clinical findings alone may not be predictive of relevant metal allergy 1,2 . Nonetheless, there are multiple reports documenting the association between MHR and adverse events post‐implantation 11‐15 . The ACDS and other international groups have published recommendations for the evaluation of patients with MHR concerns 6,16 .…”

Section: Discussionsupporting

confidence: 73%

“…1,2 Nonetheless, there are multiple reports documenting the association between MHR and adverse events post-implantation. [11][12][13][14][15] The ACDS and other international groups have published recommendations for the evaluation of patients with MHR concerns. 6,16 Evaluation to rule out MHR may be warranted after exclusion of other causes.…”

Section: Diagnostic Performance Of Clinical Findingsmentioning

confidence: 99%

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Clinical factors before or after device implantation in predicting metal hypersensitivity reactions: A retrospective study

Tam

et al. 2020

Contact Dermatitis

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Background: Metal hypersensitivity reactions (MHR) as a cause of implant-related complications are highly debated and recommendations regarding pre-procedural allergy evaluation vary dramatically. Objective: To examine patients referred before or after device implantation and identify factors that could be useful to guide the value of patch testing. Methods: Patients who underwent patch testing pre-or post-device implantation between July 2006 and September 2016 were analyzed retrospectively. Results: A series of 127 patients underwent patch testing: pre-implantation (n = 40) and post-implantation (n = 87). In the pre-implant group, a history of metal allergy demonstrated high sensitivity (0.94; 95% CI: 0.83-1.00) and negative likelihood ratio (0.17; 95% CI:0.02-1.29) for diagnosing MHR. No predictive value could be ascribed to any of the clinical symptoms (eg dermatitis, pain, swelling, implant failure, and/or other symptoms) for patients referred following orthopaedic and dental post device implantation. Eight patients in the orthopaedic group and six patients in dental group with relevant patch test reactions underwent implant revisions, and seven and five patients improved, respectively. Conclusions: Pre-implant patch testing for selected individuals with a history of metal allergy can help guide implant choice. Post-implant patch testing may be helpful in some patients if other causes have been excluded, as patients with confirmed MHR benefited from revisions. K E Y W O R D S allergic contact dermatitis, metal hypersensitivity, patch testing, pre-implant testing, prostheses implant complications 1 | INTRODUCTION Metal hypersensitivity reactions (MHR) to implanted devices are a growing concern. The significance and frequency of MHR are subject to debate and recommendations regarding pre-procedural metal hypersensitivity evaluation via patch testing differ. Amongst orthopaedic surgeons in the United Kingdom, MHR in the setting of orthopaedic implantation are considered inconsequential or non-existent. 1,2 German experts recommend the use of titanium implants in patients with concerns about metal reactions. 3 In Sweden, "virtually no one is tested" before procedures, 4 whereas the American Contact Dermatitis Society (ACDS) in the United States recommends metal patch testing for individuals with a history of metal reactions prior to implantation and for those with concern about metal allergy after the implant. 5,6 Few retrospective and prospective studies have been conducted on the association between implant complications and hypersensitivity.

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Section: Discussionsupporting

confidence: 73%

Section: Diagnostic Performance Of Clinical Findingsmentioning

confidence: 99%

Clinical factors before or after device implantation in predicting metal hypersensitivity reactions: A retrospective study

Tam

et al. 2020

Contact Dermatitis

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“…32 The question remains that if titanium is not a sensitizer, what could explain the adverse localized "allergic" reactions in titanium implant patients? In the literature the relationship between postoperative complaints in implant patients and titanium allergy is highlighted, 15,[47][48][49] suggesting that true allergy to titanium may exist.…”

Section: Discussionmentioning

confidence: 99%

“…The question remains that if titanium is not a sensitizer, what could explain the adverse localized “allergic” reactions in titanium implant patients? In the literature the relationship between postoperative complaints in implant patients and titanium allergy is highlighted, 15,47‐49 suggesting that true allergy to titanium may exist. However, our retrospective study on titanium hypersensitivity with 468 patients who underwent titanium salt patch testing could not identify titanium‐specific risk factors, nor could a clinical picture after patch testing be identified.…”

Section: Discussionmentioning

confidence: 99%

Titanium salts tested in reconstructed human skin with integrated MUTZ‐3‐derived Langerhans cells show an irritant rather than a sensitizing potential

et al. 2020

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Background: The nature of clinically related adverse reactions to titanium is still unknown. Objective: To determine whether titanium salts have irritant or sensitizing potential in a reconstructed human skin (RHS) model with integrated Langerhans cells (LCs). Methods: RHS-LCs (ie, reconstructed epidermis) containing primary differentiated keratinocytes and CFSE + CD1a +-LCs generated from the MUTZ-3 cell line on a primary fibroblast-populated collagen hydrogel (dermis) were topically exposed to titanium(IV) bis(ammonium lactato)dihydroxide (TiALH). LC migration and plasticity were determined. Results: TiALH resulted in CFSE + CD1a +-LC migration out of the epidermis. Neutralizing antibodies to CCL5 and CXCL12 showed that LC migration was CCL5 and not CXCL12 mediated. LCs accumulating within the dermis after TiALH exposure were CFSE + Lang + CD68 + which is characteristic of a phenotypic switch of MUTZ-LC to a macrophage-like cell. Furthermore, TiALH did not result in increased interleukin (IL)-1β or CCR7 messenger RNA (mRNA) in the dermis, but did result in increased IL-10 mRNA. In addition, monocultures of MUTZ-LCs failed to increase LC maturation biomarkers CD83, CD86, and CXCL-8 when exposed to noncytotoxic concentrations of four different titanium salts. Conclusion: These results classify titanium salts as irritants rather than sensitizers and indicate that titanium implant-related complaints could be due to localized irritant-mediated inflammation arising from leachable agents rather than a titanium metal allergy.

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“…Although the implantation success of titanium dental implants is high, complications still occur. There is an increasing number of papers regarding titanium hypersensitivity, skin allergies such as contact dermatitis, eczema, and immune reactions appearing after implant fixation [4][5][6][7]. It is also known that osseointegration problems in patients suffering from osteoporosis or other bone-related problems are one of reasons for unsuccessful implantation of dental implants [8].…”

Section: Introductionmentioning

confidence: 99%

Bioactive Coating on Titanium Dental Implants for Improved Anticorrosion Protection: A Combined Experimental and Theoretical Study

et al. 2019

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In recent years, extensive studies have been continuously undertaken on the design of bioactive and biomimetic dental implant surfaces due to the need for improvement of the implant–bone interface properties. In this paper, the titanium dental implant surface was modified by bioactive vitamin D3 molecules by a self-assembly process in order to form an improved anticorrosion coating. Surface characterization of the modified implant was performed by field emission scanning electron microscopy (FE-SEM), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), and contact angle measurements (CA). The implant’s electrochemical stability during exposure to an artificial saliva solution was monitored in situ by electrochemical impedance spectroscopy (EIS). The experimental results obtained were corroborated by means of quantum chemical calculations at the density functional theory level (DFT). The formation mechanism of the coating onto the titanium implant surface was proposed. During a prolonged immersion period, the bioactive coating effectively prevented a corrosive attack on the underlying titanium (polarization resistance in order of 107 Ω cm2) with ~95% protection effectiveness.

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Metal allergy patient treated by titanium implant denture: A case report with at least 4‐year follow‐up

Cited by 11 publications

References 16 publications

Clinical factors before or after device implantation in predicting metal hypersensitivity reactions: A retrospective study

Clinical factors before or after device implantation in predicting metal hypersensitivity reactions: A retrospective study

Titanium salts tested in reconstructed human skin with integrated MUTZ‐3‐derived Langerhans cells show an irritant rather than a sensitizing potential

Bioactive Coating on Titanium Dental Implants for Improved Anticorrosion Protection: A Combined Experimental and Theoretical Study

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