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Watanabe M, Liu L, Ichikawa T. Are Allergy-Induced Implant Failures Actually Hypersensitivity Reactions to Titanium? A Literature Review. Dent J (Basel) 2023; 11:263. [PMID: 37999027 PMCID: PMC10670842 DOI: 10.3390/dj11110263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE This literature review was performed to assess whether implant failures are associated with titanium allergy. MATERIALS AND METHODS An electronic search of the MEDLINE/PubMed, Cochrane Library, and Scopus databases up to April 2021 was conducted, and the obtained articles were independently assessed by two reviewers. Articles describing cases of implant failure in which the cause of implant failure was only identified as allergy were included. RESULTS Twelve studies were included. Eight studies identified Ti allergy by clinical examinations, of which four used patch tests, three used the lymphocyte transformation test (LTT)/memory lymphocyte immunostimulation assay (MELISA), and one used both tests. Nine studies reported cases of titanium hypersensitivity in combination with other systemic allergy-related disorders, with eight cases also showing positive results for Ni, Hg, Cr, and Co hypersensitivity. Ten papers reported the improvement of symptoms after the removal of the Ti implants and their replacement with zirconia implants, and two of these papers showed good results. CONCLUSION Cases of probable titanium allergy included those with true titanium allergies and those with a potentially different cause. However, the differentiation of these cases is difficult. Since no definitive method has been established for diagnosing titanium allergy, a comprehensive diagnosis based on the clinical course and clinical examination using a patch test/LTT/MELISA is necessary. Implant treatment should be performed with caution in patients with any preoperative allergies.
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Affiliation(s)
- Megumi Watanabe
- Department of Prosthodontics & Oral Rehabilitation, Tokushima University, Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima 770-8504, Japan; (L.L.); (T.I.)
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Tatezawa R, Sugiyama T, Gotoh S, Shindo T, Ikeda H, Hokari M, Takizawa K, Nakayama N, Fujimura M. Possible Delayed Foreign Body Reactions against Titanium Clips and Coating Materials after Unruptured Cerebral Aneurysm Surgery. Neurol Med Chir (Tokyo) 2023; 63:482-489. [PMID: 37648536 PMCID: PMC10687670 DOI: 10.2176/jns-nmc.2023-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/28/2023] [Indexed: 09/01/2023] Open
Abstract
Delayed foreign body reactions to either or both clipping and coating materials have been reported in several small series; however, studies in the titanium clip era are scarce. This study aims to survey the contemporary status of such reactions to titanium clips and coating materials. Among patients who received a total of 2327 unruptured cerebral aneurysmal surgeries, 12 developed delayed intraparenchymal reactions during outpatient magnetic resonance imaging (MRI) follow-up. A retrospective investigation was conducted. The patients' average age was 58.6 (45-73) years, and 11 were women. The aneurysms were located in the middle cerebral artery (n = 7), internal carotid artery (n = 4), or anterior communicating artery (AComA, n = 1). In 10 patients, additional coating with tiny cotton fragments was applied to the residual neck after clipping with titanium clips; however, only the clipping with titanium clips was performed in the remaining two. The median time from surgery to diagnosis was 4.5 (0.3-60) months. Seven (58.3%) patients were asymptomatic, and three developed neurological deficits. MRI findings were characterized by a solid- or rim-enhancing lobulated mass adjacent to the clip with surrounding parenchymal edema. In 11 patients, the lesions reduced in size or disappeared; however, in one patient, an AComA aneurysm was exacerbated, necessitating its removal along with optic nerve decompression. In conclusion, cotton material is a strongly suspected cause of delayed foreign body reactions, and although extremely rare, titanium clips alone may also induce such a reaction. The prognosis is relatively good with steroid therapy; however, caution is required when the aneurysm is close to the optic nerve, as in AComA aneurysms.
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Affiliation(s)
- Ryota Tatezawa
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Taku Sugiyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Shuho Gotoh
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | | | - Hiroshi Ikeda
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Masaaki Hokari
- Department of Neurosurgery, Teine Keijinkai Medical Center
| | | | - Naoki Nakayama
- Department of Neurosurgery, Kashiwaba Neurosurgical Hospital
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
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Mizukoshi K, Okazawa Y, Amemiya K, Tsuchiya Y, Motegi S, Tsukamoto R, Honjo K, Takahashi R, Yoshihara N, Kawano S, Kawai M, Munakata S, Ishiyama S, Sugimoto K, Takahashi M, Kojima Y, Ikeda S, Sakamoto K. Examination of colorectal cancer cases with metal allergy. Surg Today 2023:10.1007/s00595-023-02643-7. [PMID: 36757618 DOI: 10.1007/s00595-023-02643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 09/30/2022] [Indexed: 02/10/2023]
Abstract
PURPOSE To report our initiatives and treatment results for patients with colorectal cancer with metal allergy. METHODS A total of 27 patients (2.6%) with a history of metal contact dermatitis were identified among 1027 patients who underwent curative resection of colorectal cancer from 2014 to 2020. The results of the patch test, perioperative results, and postoperative colonoscopy findings were also investigated. RESULTS The patch test for metal allergens and staples was performed in 21 patients (77.8%), and 13 of them (61.9%) tested positive for at least one metal allergen. Ni (38.1%), Co (28.6%), and Pd (19.0%) showed higher positive rates than other metals, and 1 patient (4.8%) tested positive for staples. Stapled anastomosis/suturing was performed as planned in 15 of 27 patients. In 10 patients, the anastomosis method was changed from stapled to hand-sewn according to the no-patch test results (60%), positivity for multiple metals (20%), positivity for staples (10%), and surgeon's judgment (10%). No complications and abnormal colonoscopy findings were found to be associated with stapled anastomosis/suturing. CONCLUSION The patch test is useful for selecting an optimal anastomosis method for patients with suspected metal allergy.
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Affiliation(s)
- Kosuke Mizukoshi
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan. .,Department of Surgery, Kuwana City Medical Center, 3-11 Kotobuki-cho, Kuwana-shi, Mie, 511-0061, Japan.
| | - Yu Okazawa
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kota Amemiya
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yuki Tsuchiya
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Shunsuke Motegi
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Ryoichi Tsukamoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kumpei Honjo
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Rina Takahashi
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Nagisa Yoshihara
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Shingo Kawano
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Masaya Kawai
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Shinya Munakata
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Shun Ishiyama
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yutaka Kojima
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Shigaku Ikeda
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Clinical report of six-month follow-up after cementing PEEK crown on molars. Sci Rep 2022; 12:19070. [PMID: 36351981 PMCID: PMC9646781 DOI: 10.1038/s41598-022-23458-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
We conducted a six-month clinical follow-up on computer-aided design/computer-aided manufacturing-fabricated molar polyetheretherketone PEEK crowns to investigate their therapeutic effect. Only the PEEK crowns were examined as our study focused on short-term clinical evaluation of the new PEEK material. Twenty-three cases of PEEK crowns placed on the molars of 20 subjects (7 males and 13 females, mean age: 60.6 ± 14.2 years) were included in the study. The evaluation items were the condition of the crowns at the time of cementation and after six months, patient satisfaction, masticatory ability, and occlusal force. Mann-Whitney U tests with a significance level of 5% were used to examine the difference in glucose concentration by masticatory ability, occlusal pressure, and occlusal force, with and without PEEK crowns. The occlusion, margin fit, and contact of all 23 cases at the time of cementing were good. Six months after cementation, there was no crown desorption, fracture or crack, and prosthodontics was not needed in the 22 cases (one patient dropped out). No wear of the dental antagonist was observed. Patient satisfaction was generally high. There was no significant difference in masticatory ability between the groups with and without PEEK crowns. The subject's occlusal force was within the normal range. PEEK crowns used on molars can replace metal crowns and hold promise for an appropriate and effective treatment.
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Müller-Heupt LK, Schiegnitz E, Kaya S, Jacobi-Gresser E, Kämmerer PW, Al-Nawas B. The German S3 guideline on titanium hypersensitivity in implant dentistry: consensus statements and recommendations. Int J Implant Dent 2022; 8:51. [PMID: 36329297 PMCID: PMC9633908 DOI: 10.1186/s40729-022-00451-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is currently a lack of guidelines for clinicians regarding titanium hypersensitivity in implant dentistry. Diagnostic tests such as the epicutaneous test or the lymphocyte transformation test showed inconsistent results regarding reliability and validity and thus, evidence-based consensus recommendations regarding diagnostic and therapeutic options may be helpful in clinical decision-making. Therefore, the German S3 guideline on titanium hypersensitivity in implant dentistry was developed. FINDINGS In the objectives, procedure, voting method and venue were defined and the consensus participants were invited. A systematic literature research was performed, and the overall quality of the evidence was rated according to the GRADE working group. Eight recommendations were formulated within the framework of a structured consensus conference under independent moderation and could be voted on with strong consensus (> 95% agreement). The formulated statements and recommendations were developed in small groups according to the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) and were discussed and agreed upon in the plenum. CONCLUSIONS For reasonable decision-making, a patient's clinical symptoms should be regarded as leading parameters, which are usually expressed by a local inflammatory reaction with subsequent disturbed osseous integration. Allergy tests, such as the epicutaneous test or the lymphocyte transformation test are not helpful in titanium intolerance assessments, since these tests indicate T cell-mediated allergies, which are not observed in titanium intolerance reactions. Other metals and impurities that might be present in superstructures or alloys also need to be considered as the cause of an intolerance reaction and a trigger for contact sensitization. In the case of a suspected titanium particle-related, local immunologically induced inflammatory reaction with subsequent impaired osseous integration, dental ceramic implants can be considered as a therapeutic option.
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Affiliation(s)
- Lena Katharina Müller-Heupt
- Department of Oral- and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Eik Schiegnitz
- grid.410607.4Department of Oral- and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Sebahat Kaya
- grid.410607.4Department of Oral- and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | | | - Peer Wolfgang Kämmerer
- grid.410607.4Department of Oral- and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Bilal Al-Nawas
- grid.410607.4Department of Oral- and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131 Mainz, Germany
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Bio-Tribocorrosion of Titanium Dental Implants and Its Toxicological Implications: A Scoping Review. ScientificWorldJournal 2022; 2022:4498613. [PMID: 36312451 PMCID: PMC9616655 DOI: 10.1155/2022/4498613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Abstract
Bio-tribocorrosion is a phenomenon that combines the essentials of tribology (friction, wear, and lubrication) and corrosion with microbiological processes. Lately, it has gained attention in implant dentistry because dental implants are exposed to wear, friction, and biofilm formation in the corrosive oral environment. They may degrade upon exposure to various microbial, biochemical, and electrochemical factors in the oral cavity. The mechanical movement of the implant components produces friction and wear that facilitates the release of metal ions, promoting adverse oro-systemic reactions. This review describes the bio-tribocorrosion of the titanium (Ti) dental implants in the oral cavity and its toxicological implications. The original research related to the bio-tribo or tribocorrosion of the dental implants was searched in electronic databases like Medline (Pubmed), Embase, Scopus, and Web of Science. About 34 studies included in the review showed that factors like the type of Ti, oral biofilm, acidic pH, fluorides, and micromovements during mastication promote bio-tribocorrosion of the Ti dental implants. Among the various grades of Ti, grade V, i.e., Ti6Al4V alloy, is most susceptible to tribocorrosion. Oral pathogens like Streptococcus mutans and Porphyromonas gingivalis produce acids and lipopolysaccharides (LPS) that cause pitting corrosion and degrade the TiO2. The low pH and high fluoride concentration in saliva hinder passive film formation and promote metal corrosion. The released metal ions promote inflammatory reactions and bone destruction in the surrounding tissues resulting in peri-implantitis, allergies, and hyper-sensitivity reactions. However, further validation of the role of bio-tribocorrosion on the durability of the Ti dental implants and Ti toxicity is warranted through clinical trials.
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Zigante M, Špalj S. Clinical predictors of metal allergic sensitization in orthodontic patients. Cent Eur J Public Health 2022; 30:173-178. [DOI: 10.21101/cejph.a7122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 08/13/2022] [Indexed: 11/15/2022]
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Wang X, Liu W, Yu X, Wang B, Xu Y, Yan X, Zhang X. Advances in surface modification of tantalum and porous tantalum for rapid osseointegration: A thematic review. Front Bioeng Biotechnol 2022; 10:983695. [PMID: 36177183 PMCID: PMC9513364 DOI: 10.3389/fbioe.2022.983695] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
After bone defects reach a certain size, the body can no longer repair them. Tantalum, including its porous form, has attracted increasing attention due to good bioactivity, biocompatibility, and biomechanical properties. After a metal material is implanted into the body as a medical intervention, a series of interactions occurs between the material’s surface and the microenvironment. The interaction between cells and the surface of the implant mainly depends on the surface morphology and chemical composition of the implant’s surface. In this context, appropriate modification of the surface of tantalum can guide the biological behavior of cells, promote the potential of materials, and facilitate bone integration. Substantial progress has been made in tantalum surface modification technologies, especially nano-modification technology. This paper systematically reviews the progress in research on tantalum surface modification for the first time, including physicochemical properties, biological performance, and surface modification technologies of tantalum and porous tantalum.
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Affiliation(s)
- Xi Wang
- Department of Emergency and Oral Medicine, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Wentao Liu
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Xinding Yu
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Biyao Wang
- The VIP Department, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Yan Xu
- The Comprehensive Department of Shenyang Stomatological Hospital, Shenyang, China
| | - Xu Yan
- The VIP Department, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
- *Correspondence: Xu Yan, ; Xinwen Zhang,
| | - Xinwen Zhang
- Center of Implant Dentistry, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
- *Correspondence: Xu Yan, ; Xinwen Zhang,
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Diagnostic tests for titanium hypersensitivity in implant dentistry: a systematic review of the literature. Int J Implant Dent 2022; 8:29. [PMID: 35819566 PMCID: PMC9276909 DOI: 10.1186/s40729-022-00428-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/30/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE There are rising concerns about titanium hypersensitivity reaction regarding dental endosseous implants. This review aims to summarize and compare the validity and reliability of the available dermatological and laboratory diagnostic tests regarding titanium hypersensitivity. The following PICO design was used: In Patients with titanium dental implants (P) does epicutaneous testing (ECT) (I), compared to lymphocyte transformation test (LTT) or Memory Lymphocyte Immunostimulation Assay (MELISA) (C) detect hypersensitivity reactions (O)? A literature search was performed including all studies dealing with this topic. Studies regarding orthopedic implants were excluded. METHODS Three databases (MEDLINE PubMed, Cochrane Library, SciELO) were screened for suitable studies and an additional manual search was also performed. Literature regarding hypersensitivity reactions in orthopedic implants, hypersensitivity reactions regarding implants not related to dental or maxillofacial surgery, animal studies and in vitro studies were excluded. A quality assessment of all selected full-text articles was performed. Randomized, controlled trials were evaluated with the Cochrane Risk of Bias Tool I. Cohort studies were assessed according to the New Castle-Ottawa Scale and case series according to Moga et al. (Development of a quality appraisal tool for case series studies using a modified Delphi technique. 2012). RESULTS 10 studies were included in the quantitative synthesis and available for the endpoint diagnostics of intolerance reactions to titanium dental implants: 2 clinical studies, 7 cohort studies and 1 case series. The potential for bias (internal validity) for these studies was overall rated as high. CONCLUSIONS The study of the available literature regarding ECT and MELISA or LTT in patients with suspected titanium hypersensitivity showed inconsistent results in terms of reliability and validity and thus, those tests should be regarded cautiously. There is strong evidence that titanium hypersensitivity in dental implants is associated with innate immunity: unspecific pro-inflammatory responses due to particle induced hyperreactivity of macrophages or toxicological responses especially towards nanoparticles rather than activation of the adaptive immune system. Therefore, tests detecting allergies do not seem expedient and inflammatory clinical signs should be regarded as leading parameters.
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Ion Release and Surface Changes of Nickel-Titanium Archwires Induced by Changes in the pH Value of the Saliva-Significance for Human Health Risk Assessment. MATERIALS 2022; 15:ma15061994. [PMID: 35329446 PMCID: PMC8954586 DOI: 10.3390/ma15061994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/27/2023]
Abstract
The aim of this study was to explore whether changes in the salivary pH influence mechanical properties, surface roughness, and ion release from NiTi archwires with various surface coatings, and discuss the clinical significance of the findings. The uncoated, rhodium-coated, and nitrified NiTi wires were immersed into artificial saliva of different pH values (4.8, 5.1, 5.5, and 6.6). Released nickel and titanium ions were measured with inductively coupled plasma-optical emission spectroscopy at the end of 28 days. Atomic force microscopy was used to measure the arithmetic average surface roughness Ra, the root-mean-square roughness Rq, and the maximum height of the asperities RZ. The nanoindentation hardness (HIT) and Young's modulus (EIT) measurements were performed. The change in the pH of artificial saliva is inversely proportional to the release of titanium from both coated and uncoated wires, and the release of nickel from uncoated wires. The surface roughness parameters of both coated and uncoated wires are unaffected by the change in the pH of artificial saliva. The change in the pH of saliva has minor influence on the hardness and Young's modulus of elasticity of both coated and uncoated wires. The concentration of released metal ions measured was below the recommended upper limit for daily intake; nevertheless, hypersensitivity effects cannot be excluded, even at lower concentrations and at low pH.
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Poli PP, de Miranda FV, Polo TOB, Santiago Júnior JF, Lima Neto TJ, Rios BR, Assunção WG, Ervolino E, Maiorana C, Faverani LP. Titanium Allergy Caused by Dental Implants: A Systematic Literature Review and Case Report. MATERIALS 2021; 14:ma14185239. [PMID: 34576463 PMCID: PMC8465040 DOI: 10.3390/ma14185239] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022]
Abstract
(1) Background: Hypersensitivity reactions to metals may arise in predisposed patients chronically exposed to metallic materials, including dental implants made of titanium alloys. The purpose of this article was to systematically review titanium allergy manifestations in patients treated with dental implants and report a clinical case; (2) Methods: A systematic electronic search was performed for articles published in the English language until July 2021. The following eligibility criteria were adopted: (1) Population: individuals undergoing titanium and/or titanium alloy implant-supported rehabilitations; (2) Exposure: peri-implant soft tissue reactions attributable to implant insertion; (3) Outcome: evidence of titanium allergy, diagnostic methods, and forms of resolution; (3) Results: The included studies, in summary, presented evidence that titanium should not be considered an inert material, being able to trigger allergic reactions, and may be responsible for implant failure. A 55-year-old male patient received 3 implants in the posterior region of the left mandible and presented an epulis-like lesion developed from the peri-implant mucosa. The immunohistochemical analysis of the biopsy specimen confirmed the initial diagnosis of allergic reaction to titanium; (4) Conclusions: Although the evidence is weak, and titanium allergy has a low incidence, hypersensitivity reactions should not be underestimated. A rapid and conclusive diagnosis is mandatory to prevent further complications.
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Affiliation(s)
- Pier Paolo Poli
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy
| | - Fábio Vieira de Miranda
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery and Implantology, School of Dentistry, São Paulo State University-UNESP, Araçatuba 16015-050, SP, Brazil
| | - Tárik Ocon Braga Polo
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery and Implantology, School of Dentistry, São Paulo State University-UNESP, Araçatuba 16015-050, SP, Brazil
| | | | - Tiburtino José Lima Neto
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery and Implantology, School of Dentistry, São Paulo State University-UNESP, Araçatuba 16015-050, SP, Brazil
| | - Bárbara Ribeiro Rios
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery and Implantology, School of Dentistry, São Paulo State University-UNESP, Araçatuba 16015-050, SP, Brazil
| | - Wirley Gonçalves Assunção
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University-UNESP, Araçatuba 16015-050, SP, Brazil
| | - Edilson Ervolino
- Department of Basic Sciences, School of Dentistry, São Paulo State University-UNESP, Araçatuba 16015-050, SP, Brazil
| | - Carlo Maiorana
- Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy
| | - Leonardo Perez Faverani
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery and Implantology, School of Dentistry, São Paulo State University-UNESP, Araçatuba 16015-050, SP, Brazil
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Titanium and Other Metal Hypersensitivity Diagnosed by MELISA® Test: Follow-Up Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5512091. [PMID: 34124241 PMCID: PMC8192180 DOI: 10.1155/2021/5512091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022]
Abstract
This study is aimed at proving the clinical benefit of the MELISA® test in the minimization or complete elimination of health problems in patients with confirmed hypersensitivity to metals used for tissue replacements. A group of 305 patients aged 20-75 years with previously proven metal hypersensitivity (initial MELISA® test), mainly to titanium and then to another fifteen metals, was chosen from the database at the Institute of Dental Medicine. From these patients, a final group of 42 patients agreed to participate in the study, 35 of which were female and 7 were male. The patients completed a special questionnaire aimed at information regarding change of health status from their last visit and determining whether the results of the initial MELISA® test and recommendations based on it were beneficial for patients or not. They were clinically examined, and peripheral blood samples were taken to perform follow-up MELISA® tests. Questionnaire data was processed, and the follow-up MELISA® test results were compared with the results of the initial MELISA® tests. For statistical analysis, the Fisher's exact test and paired T-test were used. Thirty-two patients reported that they followed the recommendations based on the results of the initial MELISA® tests, and of these, 30 patients (94%) confirmed significant health improvement. Six patients did not follow the recommendation, and from these, only one patient reported an improvement in his health problems. By comparison of the initial and follow-up MELISA® test results, it can be stated that the hypersensitivity to the given metal decreased or disappeared after the therapeutic interventions performed based on the initial MELISA® test results. The evaluation of the data obtained from patients in this study confirmed a significant clinical benefit of MELISA® test.
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Dordunoo D, Anaman-Torgbor J, Smith C, Shaik A, Hass M, Gordon C, An M, Aviles-G ML, Weinzierl M. Hypersensitivity in patients receiving metal implants: a scoping review protocol. JBI Evid Synth 2021; 19:1404-1411. [PMID: 33278266 DOI: 10.11124/jbies-20-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to gather the available evidence on metal hypersensitivity to determine the extent of the problem and identify gaps in the evidence about screening practices. INTRODUCTION Hypersensitivity to metal was first reported in 1966. Since this time, the use of metal in prosthetic devices has increased with an associated rise in reported hypersensitivity reaction to other metals. Symptoms of metal hypersensitivity can be subtle, and it is unclear whether clinicians are aware of or routinely ask patients about metal hypersensitivity when documenting allergies. This can lead to a delay in diagnosis, which puts patients at risk of poor outcomes. Hence, there is a need to map the available evidence on hypersensitivity reaction in people who receive metallic device implantation. INCLUSION CRITERIA The review will consider studies that include patients who undergo procedures involving metal implantation. The concept to be explored is hypersensitivity following a procedure that involves the implementation of a device with metal components. Implementation is defined as permanent integration of a foreign (non-biological) object into the human body to restore function. METHODS The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. Searches will be generated in multiple databases and updated as needed. Gray literature and organizational websites will also be searched. Titles, abstracts, and full articles will be screened according to the inclusion criteria. Studies published in English from 1960 to the present will be included. Data will be extracted and findings will be presented in tabular form with a narrative summary.
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Affiliation(s)
- Dzifa Dordunoo
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Judith Anaman-Torgbor
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Catherine Smith
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, BC, Canada
| | - Ajijoon Shaik
- School of Nursing, Camosun College, Victoria, BC, Canada
| | | | - Carol Gordon
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Minjeong An
- College of Nursing, Chonnam National University, Chonnam, South Korea
| | - Martha L Aviles-G
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Miriam Weinzierl
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
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14
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Delayed Titanium Hypersensitivity and Retained Foreign Body Causing Late Abdominal Complications. Case Rep Surg 2021; 2021:5515401. [PMID: 33763279 PMCID: PMC7946486 DOI: 10.1155/2021/5515401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022] Open
Abstract
Titanium is a known metal used widely in the medical field and can cause allergic reactions with complications. Our case is about a 28-year-old female presenting with a spectrum of abdominal symptoms with a complicated medical history. The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. This patient is concurrently found to have a retained pigtail catheter in the cecum discovered incidentally through radiology. We discuss the presentation, investigations, and treatment of this unusual case. The case also unfolds rare differential diagnoses to keep in mind when encountering a patient with abdominal pain and associated nonspecific symptoms.
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Metal allergy after the Nuss procedure for pectus excavatum: a review. Postepy Dermatol Alergol 2021; 37:848-852. [PMID: 33603601 PMCID: PMC7874881 DOI: 10.5114/ada.2020.102094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
Abstract
Minimally invasive repair of pectus excavatum (MIRPE) technique (the Nuss procedure) is a minimally-invasive method that is commonly used in the treatment of pectus excavatum. An allergic reaction to the metal alloy bar that is implanted in the thorax during the procedure is a reported complication. We briefly review current literature concerning epidemiology, mechanisms and research results of allergic reactions after Nuss bar implantation. This allergic reaction occurs in approximately 2.7% of patients and is caused by metals used in the medical implant. The most common symptoms include fever and skin lesions such as allergic dermatitis. Elevated levels of C-reactive protein is a frequent finding in laboratory tests. In order to minimize the risk of such complications, taking a detailed allergy-based medical history and conducting allergy tests, i.e. patch test are required. Allergic reactions can be managed with conservative treatment such as general or topical glucocorticosteroid therapy and antihistamine agents. Severe allergic reactions can be addressed by implant revision, replacement of the steel bar with a titanium substitute or removal of the stabilization at all. Although the risk of an allergic reaction to titanium is smaller it still exists, the titanium substitute is not routinely used due to its higher cost and lesser plasticity which has a negative impact on matching a stabilizing bar during the surgery. Surgeons treating pectus excavatum should remember about the possible allergic reactions after implantation of the metal bar and be familiar with methods of diagnosis and treatment of those complications.
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16
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de Lima-Souza RA, Vallarelli AFA, Viviane Mariano F, Cintra ML. Multiple cutaneous fistula after titanium dental implant: A case report. Clin Implant Dent Relat Res 2021; 23:270-274. [PMID: 33393197 DOI: 10.1111/cid.12972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dental implants allow functional and aesthetic reestablishment. Titanium (Ti) implants emerge as the preferred choice because Ti is considered an inert material, highly resistant to corrosion. However, virtually no material can be considered universally biocompatible and this includes titanium. PURPOSE To report an unusual presentation of inflammatory reaction after a Ti dental implant. MATERIALS AND METHODS The patient presented to a dermatology clinic to evaluate lesions on her face. She reported the placement of dental implants 2 years earlier, one of which evolved with inflammatory signs and instability a few days after the procedure. As anti-inflammatory and antibiotic therapy were fruitless, after 3 months the implant was removed, but the inflammation persisted. On physical examination, painful erythematous-papule-nodular lesions were found on the left mandibular and submandibular region. RESULTS Culture tests for microorganisms were negative and histopathological examination revealed a chronic fistula with a foreign body reaction. Using X-ray fluorescence, Ti particles were found along the fistula wall. CONCLUSIONS Professionals should be aware of complications arising from dental implants, including Ti implants. Detailed anamnesis and laboratory investigation can assure diagnosis for specific therapeutic approaches.
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Affiliation(s)
| | | | - Fernanda Viviane Mariano
- Department of Pathology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Maria Letícia Cintra
- Department of Pathology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
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Dordunoo D, Hass M, Smith C, Aviles-Granados ML, Weinzierl M, Anaman-Torgbor JA, Shaik A, Mallidou A, Adib F. Metal hypersensitivity screening among frontline healthcare workers-A descriptive study. J Clin Nurs 2020; 30:541-549. [PMID: 33237599 DOI: 10.1111/jocn.15571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metal hypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metal hypersensitivity screening into clinical practice. BACKGROUND Adverse device-related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T-cell-mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metal hypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metal hypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment. DESIGN Following the STROBE checklist, a cross-sectional, descriptive study was conducted. METHODS Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation. RESULTS Three hundred forty-five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metal hypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metal hypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were 'Standards of Practice', 'Knowledge' and 'Futility of Screening'. CONCLUSION The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment.
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Affiliation(s)
- Dzifa Dordunoo
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Michelle Hass
- Center for Learning and Innovation, Scripps Health, San Diego, California, USA
| | - Catherine Smith
- Faculty of Health Studies, University of the Fraser Valley, Abbotsford, British Columbia, Canada
| | | | - Miriam Weinzierl
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | | | - Ajijoon Shaik
- Nursing Department, School of Health and Human Services, Camosun College, Victoria, British Columbia, Canada
| | - Anastasia Mallidou
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Farzad Adib
- Department of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Comino-Garayoa R, Cortés-Bretón Brinkmann J, Peláez J, López-Suárez C, Martínez-González JM, Suárez MJ. Allergies to Titanium Dental Implants: What Do We Really Know about Them? A Scoping Review. BIOLOGY 2020; 9:biology9110404. [PMID: 33217944 PMCID: PMC7698636 DOI: 10.3390/biology9110404] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
Simple Summary The scientific literature repeatedly insists on the success of titanium implants. Nevertheless, the so-called tribocorrosion process releases titanium ions into the surrounding tissues, which can trigger a cascade of reactions, localized or at a distance, or even systemic reactions. Consequently, guidelines should be drawn up before starting treatment; when a hypersensitivity reaction following titanium dental implant placement occurs, a range of treatment alternatives should be clearly established and made available. Abstract The purpose of this scoping review was to describe the current state of knowledge and understanding of allergies to titanium dental implants. A scoping review was conducted following the Prisma Extension for Scoping Reviews checklist. An electronic search was performed in five databases complemented by manual and grey literature searches. Fifty-two relevant papers were included for final review. Titanium particles can be released from the surfaces of dental implants in a process called tribocorrosion, which may contribute to bone loss due to inflammatory reaction. Diverse mechanisms have been described that may trigger allergy to titanium, as well as the clinical signs that manifest as the allergy develops. Allergies to titanium are uncommon but represent a real possibility that should not be overlooked in patients requiring prosthodontic rehabilitation with dental implants. Allergy can trigger a range of symptoms. Patients who have already been diagnosed with allergies to other metals will be more predisposed to suffering an allergy to titanium. Further investigation is needed in order to measure the true scope of these allergies.
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Affiliation(s)
- Rubén Comino-Garayoa
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28001 Madrid, Spain; (R.C.-G.); (J.P.); (C.L.-S.); (M.J.S.)
| | - Jorge Cortés-Bretón Brinkmann
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28001 Madrid, Spain;
- Correspondence:
| | - Jesús Peláez
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28001 Madrid, Spain; (R.C.-G.); (J.P.); (C.L.-S.); (M.J.S.)
| | - Carlos López-Suárez
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28001 Madrid, Spain; (R.C.-G.); (J.P.); (C.L.-S.); (M.J.S.)
| | - Jose María Martínez-González
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28001 Madrid, Spain;
| | - María Jesús Suárez
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28001 Madrid, Spain; (R.C.-G.); (J.P.); (C.L.-S.); (M.J.S.)
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Hamza HM, Deen KM, Haider W. Microstructural examination and corrosion behavior of selective laser melted and conventionally manufactured Ti6Al4V for dental applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 113:110980. [DOI: 10.1016/j.msec.2020.110980] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 01/05/2023]
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Munro T, Miller CM, Antunes E, Sharma D. Interactions of Osteoprogenitor Cells with a Novel Zirconia Implant Surface. J Funct Biomater 2020; 11:E50. [PMID: 32708701 PMCID: PMC7565437 DOI: 10.3390/jfb11030050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 02/03/2023] Open
Abstract
Background: This study compared the in vitro response of a mouse pre-osteoblast cell line on a novel sandblasted zirconia surface with that of titanium. Material and Methods: The MC3T3-E1 subclone 4 osteoblast precursor cell line was cultured on either sandblasted titanium (SBCpTi) or sandblasted zirconia (SBY-TZP). The surface topography was analysed by three-dimensional laser microscopy and scanning electron microscope. The wettability of the discs was also assessed. The cellular response was quantified by assessing the morphology (day 1), proliferation (day 1, 3, 5, 7, 9), viability (day 1, 9), and migration (0, 6, 24 h) assays. Results: The sandblasting surface treatment in both titanium and zirconia increased the surface roughness by rendering a defined surface topography with titanium showing more apparent nano-topography. The wettability of the two surfaces showed no significant difference. The zirconia surface resulted in improved cellular spreading and a significantly increased rate of migration compared to titanium. However, the cellular proliferation and viability noted in our experiments were not significantly different on the zirconia and titanium surfaces. Conclusions: The novel, roughened zirconia surface elicited cellular responses comparable to, or exceeding that, of titanium. Therefore, this novel zirconia surface may be an acceptable substitute for titanium as a dental implant material.
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Affiliation(s)
- Thomas Munro
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield 4878, QLD, Australia;
| | - Catherine M. Miller
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 14-88 McGregor Road, Smithfield 4878, QLD, Australia;
- The Australian Institute of Tropical Health and Medicine (AITHM) James Cook University, 14-88 McGregor Road, Smithfield 4878, QLD, Australia
| | - Elsa Antunes
- College of Science & Engineering, James Cook University, 1 James Cook Drive, Douglas, Townsville 4814, QLD, Australia;
| | - Dileep Sharma
- College of Medicine and Dentistry, James Cook University, 14-88 McGregor Road, Smithfield 4878, QLD, Australia;
- The Australian Institute of Tropical Health and Medicine (AITHM) James Cook University, 14-88 McGregor Road, Smithfield 4878, QLD, Australia
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21
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Ulriksdotter J, Svedman C, Bruze M, Glimsjö J, Källberg K, Sukakul T, Mowitz M. Contact dermatitis caused by glucose sensors-15 adult patients tested with a medical device patch test series. Contact Dermatitis 2020; 83:301-309. [PMID: 32608015 DOI: 10.1111/cod.13649] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several cases of allergic contact dermatitis (ACD) to the glucose sensor FreeStyle Libre have been reported. Isobornyl acrylate (IBOA) and N,N-dimethylacrylamide (DMAA) are known culprit allergens. OBJECTIVES To evaluate patients with suspected ACD to FreeStyle Libre in a standardized manner, present causative allergens, and assess patient-reported implications. METHODS A total of 15 patients with suspected ACD to FreeStyle Libre were patch tested with the Swedish baseline series and a new medical device series. IBOA and DMAA were tested at 0.1% and 0.3% in petrolatum (pet.). Readings were performed on day (D) 3 and D7. Background data, details on skin reactions, and associated implications were assessed using a questionnaire. RESULTS Thirteen patients were sensitized to IBOA and four to DMAA. Two positive reactions to IBOA and one to DMAA were seen only at 0.3% concentration on D7. Median duration of sensor use before dermatitis onset was 6 months. Half the number of the patients took precautions in everyday life due to sensor-related skin reactions. Six patients discontinued sensor usage. CONCLUSIONS Patients with suspected ACD to glucose sensors should be evaluated with a relevant patch test series containing IBOA and DMAA. Adding the 0.3% pet. concentration is recommended. The reading on D7 is necessary.
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Affiliation(s)
- Josefin Ulriksdotter
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jenny Glimsjö
- Department of Medicine, Blekinge Hospital, Karlskrona, Sweden
| | - Kajsa Källberg
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Magrone T, Russo MA, Jirillo E. Impact of Heavy Metals on Host Cells: Special Focus on Nickel-Mediated Pathologies and Novel Interventional Approaches. Endocr Metab Immune Disord Drug Targets 2019; 20:1041-1058. [PMID: 31782370 DOI: 10.2174/1871530319666191129120253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Heavy metals [arsenic, aluminium, cadmium, chromium, cobalt, lead, nickel (Ni), palladium and titanium] are environmental contaminants able to impact with host human cells, thus, leading to severe damage. OBJECTIVE In this review, the detrimental effects of several heavy metals on human organs will be discussed and special emphasis will be placed on Ni. In particular, Ni is able to interact with Toll-like receptor-4 on immune and non-immune cells, thus, triggering the cascade of pro-inflammatory cytokines. Then, inflammatory and allergic reactions mediated by Ni will be illustrated within different organs, even including the central nervous system, airways and the gastrointestinal system. DISCUSSION Different therapeutic strategies have been adopted to mitigate Ni-induced inflammatoryallergic reactions. In this context, the ability of polyphenols to counteract the inflammatory pathway induced by Ni on peripheral blood leukocytes from Ni-sensitized patients will be outlined. In particular, polyphenols are able to decrease serum levels of interleukin (IL)-17, while increasing levels of IL- 10. These data suggest that the equilibrium between T regulatory cells and T helper 17 cells is recovered with IL-10 acting as an anti-inflammatory cytokine. In the same context, polyphenols reduced elevated serum levels of nitric oxide, thus, expressing their anti-oxidant potential. Finally, the carcinogenic potential of heavy metals, even including Ni, will be highlighted. CONCLUSION Heavy metals, particularly Ni, are spread in the environment. Nutritional approaches seem to represent a novel option in the treatment of Ni-induced damage and, among them, polyphenols should be taken into consideration for their anti-oxidant and anti-inflammatory activities.
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Affiliation(s)
- Thea Magrone
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, School of Medicine, University of Bari, Bari, Italy
| | - Matteo A Russo
- MEBIC Consortium, San Raffaele Open University of Rome and IRCCS San Raffaele Pisana of Rome, Rome, Italy
| | - Emilio Jirillo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, School of Medicine, University of Bari, Bari, Italy
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Cagna DR, Donovan TE, McKee JR, Eichmiller F, Metz JE, Albouy JP, Marzola R, Murphy KR, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2019; 122:198-269. [PMID: 31405523 DOI: 10.1016/j.prosdent.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022]
Abstract
This comprehensive review of the 2018 dental literature is provided to inform busy dentists about progress in the profession. Developed by the Committee on Scientific Investigation of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to one of the 8 sections of the report including (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information that will likely influence day-to-day treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source materials if greater detail is desired. As the profession continues its march toward evidence-based clinical decision-making, an already voluminous library of potentially valuable dental literature continues to grow. It is the intention of this review and its authors to provide assistance in navigating the extensive dental literature published in 2018. It is our hope that readers find this work useful in the clinical management of patients moving forward.
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Affiliation(s)
- David R Cagna
- Professor, Associate Dean, and Residency Director, Department of Prosthodontics, University of Tennessee Health Sciences Center, College of Dentistry, Memphis, Tenn.
| | - Terence E Donovan
- Professor and Head of Biomaterials, Department of Restorative Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC
| | - James R McKee
- Private practice, Restorative Dentistry, Downers Grove, Ill
| | | | - James E Metz
- Private practice, Restorative Dentistry, Columbus, Ohio
| | - Jean-Pierre Albouy
- Assistant Professor, Department of Restorative Sciences, University of North Carolina School of Dentistry, Chapel Hill, NC
| | | | - Kevin R Murphy
- Associate Clinical Professor, Department of Periodontics, University of Maryland College of Dentistry, Baltimore, MD; Private practice, Periodontics and Prosthodontics, Baltimore, MD
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