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Björkman L. Adverse reactions to dental biomaterials: Experiences from a specialty clinic. Dent Mater 2024; 40:563-572. [PMID: 38336526 DOI: 10.1016/j.dental.2024.01.004] [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: 12/06/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The Dental Biomaterials Adverse Reaction Unit was initiated by the Norwegian health authorities in 1992 as a response to the public concern regarding the safety of dental amalgam and other dental materials. In this paper, experiences from the Unit are briefly summarized. METHODS The Norwegian health authorities' strategy included four main topics: (i) development of a manufacturer-independent system for monitoring adverse reactions related to dental materials, (ii) funding of a specialty unit for clinical examinations of referred patients, (iii) development of official guidelines for examination and treatment of patients with health complaints attributed to dental materials, and (iv) funding of an experimental treatment project for patients with health complaints attributed to dental amalgam. RESULTS From the start, more than 2700 adverse reaction reports were received. In the initial years, amalgam was the most frequent material mentioned in the reports. Reports about polymer-based composite materials have not increased after the prohibition of amalgam in Norway. Clinical examination of referred patients is complex and time consuming, and it is important to consider differential diagnoses. There are methodological challenges associated with the design of experimental treatments used on patients with adverse reactions attributed to dental materials. However, the results from the treatment project indicate lower symptom load after replacement of amalgam with other dental restorative materials. SIGNIFICANCE Producer independent adverse reaction reporting can provide valuable information about the safety of these materials and could serve as a complement to the mandatory reporting system described in the European medical device regulations (MDR).
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Affiliation(s)
- Lars Björkman
- Dental Biomaterials Adverse Reaction Unit /NORCE, Årstadveien 19, 4th floor, NO-5009 Bergen, Norway.
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2
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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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Grosgogeat B, Vaicelyte A, Gauthier R, Janssen C, Le Borgne M. Toxicological Risks of the Cobalt-Chromium Alloys in Dentistry: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2022; 15:ma15175801. [PMID: 36079183 PMCID: PMC9457507 DOI: 10.3390/ma15175801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 05/27/2023]
Abstract
Background: The toxicological risk of Co-Cr dental alloys is actually a sensitive subject with the European regulatory changes, namely regulation (EU) 2017/745 and annex VI to the CLP regulation (EC) 1972/2008. Objectives: The objective of this review is to conduct a rigorous analysis of the cytocompatibility of cobalt-chromium (Co-Cr) dental alloys. Considering various parameters such as cytotoxicity, type IV hypersensitivity reaction, sensitization, and irritation, we investigated evidence of toxicity of Co-Cr in human dental applications. Data sources: Specific search strategies were performed in three electronic databases, namely Medline, Embase, and Web of Science, using a main restriction in the search regarding the publication date (1995-2022). Study selection: Out of a total of 836 articles, only 21 studies were selected and analyzed according to PRISMA methodology. Results: Among them, 10 in vitro studies using human samples and 11 in vivo studies on human patients were distinguished. Most of the in vitro studies confirmed that Co-Cr alloys have a good cytocompatibility compared to Ni alloys. Regarding the in vivo studies, it appeared that Co-Cr could rarely cause sensitization, irritation, and allergic reactions. Reactions were mainly observed for people allergic to Co or Cr. Nevertheless, titanium-based materials showed better results. Conclusions: This study proposes a new state of the art on Co-Cr dental alloys and will thus be very useful for carrying out additional studies. Relevance: This review will help practitioners in their daily clinical choice.
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Affiliation(s)
- Brigitte Grosgogeat
- Laboratoire des Multimatériaux et des Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Univ Lyon, 69008 Lyon, France
- Hospices Civils de Lyon, Service d′Odontologie, 69007 Lyon, France
- Faculté d′Odontologie, Université Claude Bernard Lyon 1, Univ Lyon, 69008 Lyon, France
| | - Alina Vaicelyte
- Laboratoire des Multimatériaux et des Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Univ Lyon, 69008 Lyon, France
| | - Rémy Gauthier
- CNRS, INSA de Lyon, UCBL, MATEIS UMR CNRS 5510, Lyon, Bât. Saint Exupéry, 23 Av. Jean Capelle, 69621 Villeurbanne, France
| | - Christine Janssen
- Institut de Formation en Masso-Kinésithérapie pour Déficients de la Vue (IFMK DV), 69373 Lyon, France
| | - Marc Le Borgne
- Small Molecules for Biological Targets Team, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, CNRS 5286, INSERM 1052, Université Claude Bernard Lyon 1, Univ Lyon, 69373 Lyon, France
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Roach K, Roberts J. A comprehensive summary of disease variants implicated in metal allergy. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:279-341. [PMID: 35975293 PMCID: PMC9968405 DOI: 10.1080/10937404.2022.2104981] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Allergic disease represents one of the most prominent global public health crises of the 21st century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described.Abbreviations: ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.
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Affiliation(s)
- Ka Roach
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
| | - Jr Roberts
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
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Semaphorin 3A: A potential target for prevention and treatment of nickel allergy. Commun Biol 2022; 5:671. [PMID: 35798870 PMCID: PMC9262932 DOI: 10.1038/s42003-022-03641-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Metal allergy is one of the typical immune disorders encountered during the application of dental/medical materials and has a highly complex pathogenic mechanism. Semaphorin 3A (Sema3A), a member of the semaphorin family, is reported to be involved in various immune disorders. However, its role in metal allergy has not been clarified yet. Herein, we show that Sema3A expression was upregulated in nickel (Ni) allergy-induced mouse ear tissue and in NiCl2-stimulated mouse keratinocytes. Moreover, Sema3A regulated tumor necrosis factor-alpha production and mitogen-activated protein kinase activation in keratinocytes. The specific deletion of Sema3A in keratinocytes did not affect immune cell infiltration but reduced edema and ear swelling; it also impeded Th1 responses to cause a slight alleviation in Ni allergy in mice. Our results demonstrate that Sema3A promotes the development of metal allergy and should be explored as a potential target for the prevention and treatment of metal allergy. Semaphorin 3A is upregulated in keratinocytes upon nickel exposure, subsequently promoting Th1 cytokine responses and driving nickel allergic reactions.
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Takaoka Y, Akiba Y, Nagasawa M, Ito A, Masui Y, Akiba N, Eguchi K, Miyazawa H, Tabeta K, Uoshima K. The relationship between dental metal allergy, periodontitis, and palmoplantar pustulosis: An observational study. J Prosthodont Res 2021; 66:438-444. [PMID: 34588402 DOI: 10.2186/jpr.jpr_d_20_00307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to investigate the relationship between dental metal allergy, periodontitis, and palmoplantar pustulosis among patients from a dental metal allergy clinic over a period of 8 years. METHODS This study included 436 patients who visited our dental metal allergy clinic between April 1, 2009 and March 31, 2016. Diagnoses of skin diseases, periodontal records, dental metal series patch test results, and electron probe microanalysis (EPMA) data were obtained from medical records. Relative risk (RR) values were estimated from these data. RESULTS Of the 359 patients who underwent the patch test, 241 showed a positive reaction. Of the 187 patients who underwent EPMA, 113 had allergenic metals in their dental prostheses. These patients were suspected to have a dental metal allergy. Furthermore, 150 of the 436 patients were diagnosed with palmoplantar pustulosis (PPP). The RR of metal allergy between patients with PPP and healthy subjects was 3.88. The RR of periodontal disease between patients with PPP and PPP-negative patients in the national average was 2.54. CONCLUSIONS In this study, both dental metal allergy and periodontitis showed a high RR for PPP.
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Affiliation(s)
- Yurina Takaoka
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Yosuke Akiba
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Masako Nagasawa
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Akiko Ito
- Department of Dermatology, Nagata Clinic, Niigata, Japan.,Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yukiko Masui
- Department of Dermatology, Nagata Clinic, Niigata, Japan.,Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nami Akiba
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Kaori Eguchi
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Haruna Miyazawa
- Division of Periodontology, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan.,Clinical and Translational Research Center, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koichi Tabeta
- Division of Periodontology, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
| | - Katsumi Uoshima
- Division of Bio-Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental sciences, Niigata University, Niigata, Japan
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SnapshotDx Quiz: May 2021. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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8
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Cobalt–Chromium Dental Alloys: Metal Exposures, Toxicological Risks, CMR Classification, and EU Regulatory Framework. CRYSTALS 2020. [DOI: 10.3390/cryst10121151] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
During the 20th century, metal alloys have assumed an important role as restorative materials. Among existing examples, cobalt–chromium (Co–Cr) alloys increasingly began to be used in medicine and especially in dentistry. Their success is mainly due to their mechanical properties such as stiffness, strength and corrosion resistance, thus allowing a high biocompatibility. There are quite meaningful data on the corrosion and toxicity of Co–Cr alloys for their use in restorative materials such as dental prostheses. Toxicological studies following Co and Cr exposures in the oral cavity are more difficult to conduct because there are many different situations leading to the release of metal ions and wear particles. Furthermore, the links between exposure and the appearance of local or systemic toxicity are not automatic. Since 2017, the European Union (EU) regulatory framework for Co–Cr alloys has been undergoing profound changes. A new EU Medical Devices Regulation (MDR) (2017/745) will be applied in May 2021 with the need to consider that Co metal is a new carcinogenic, mutagenic and toxic to reproduction (CMR) substance. On 18 February 2020, the 14th Adaptation to Technical Progress (ATP14) to the Classification, Labelling and Packaging (CLP) regulation was published, including the harmonised classification for Co metal as a CMR 1B substance. In this context, the use of Co might be forbidden if the medical devices are invasive and as soon as they include more than 0.1% (m/m) Co. This review provides a specific overview on Co–Cr dental alloys in terms of metal ions and wear particles release, toxicological risks, and the actual and new EU regulatory framework.
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Kassapidou M, Hjalmarsson L, Johansson CB, Hammarström Johansson P, Morisbak E, Wennerberg A, Franke Stenport V. Cobalt-chromium alloys fabricated with four different techniques: Ion release, toxicity of released elements and surface roughness. Dent Mater 2020; 36:e352-e363. [PMID: 32943232 DOI: 10.1016/j.dental.2020.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the metal ion release, surface roughness and cytoxicity for Co-Cr alloys produced by different manufacturing techniques before and after heat treatment. In addition, to evaluate if the combination of materials affects the ion release. METHODS Five Co-Cr alloys were included, based on four manufacturing techniques. Commercially pure titanium, CpTi grade 4 and a titanium alloy were included for comparison. The ion release tests involved both Inductive Coupled Plasma Optical Emission Spectrometry and Inductive Coupled Plasma Mass Spectrometry analyses. The surface analysis was conducted with optical interferometry. Cells were indirectly exposed to the materials and cell viability was evaluated with the MTT (3-(4.5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide) method. RESULTS All alloys showed a decrease of the total ion release when CpTi grade 4 was present. The total ion release decreased over time for all specimens and the highest ion release was observed from the cast and milled Co-Cr alloy in acidic conditions. The cast and laser-melted Co-Cr alloy and the titanium alloy became rougher after heat treatment. All materials were within the limits of cell viability according to standards. SIGNIFICANCE The ion release from Co-Cr alloys is influenced by the combination of materials, pH and time. Surface roughness is influenced by heat treatment. Furthermore, both ion release and surface roughness are influenced by the manufacturing technique and the alloy type. The clinical implication needs to be further investigated.
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Affiliation(s)
- Maria Kassapidou
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden; Department of Prosthetic Dentistry, Institute for Postgraduate Dental Education, Box 1030, SE-551 11 Jönköping, Sweden.
| | - Lars Hjalmarsson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden; Specialist Dental Clinic, Folktandvården Sörmland AB, The Mälar Hospital, SE-631 88 Eskilstuna, Sweden; Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden.
| | - Carina B Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden.
| | - Petra Hammarström Johansson
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden.
| | - Else Morisbak
- NIOM, Nordic Institute of Dental Materials, Sognsveien 70 A, 0855 Oslo, Norway.
| | - Ann Wennerberg
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden.
| | - Victoria Franke Stenport
- Department of Prosthodontics/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden.
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Oktem A, Uysal PI, Akdoğan N, Tokmak A, Yalcin B. Clinical characteristics and associations of palmoplantar pustulosis: an observational study. An Bras Dermatol 2019; 95:15-19. [PMID: 31899067 PMCID: PMC7058866 DOI: 10.1016/j.abd.2019.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Palmoplantar pustulosis is a chronic and relapsing disease of the palms and soles, which is characterized by scattered clusters of pinhead-sized, sterile pustules. Objective The aim of the present study was to determine demographic features, co-morbidities, and relation of palmoplantar pustulosis with psoriasis. Methods A total of 48 patients (M/F: 15/33) were enrolled in the present study. A detailed history regarding age of onset, palmoplantar pustulosis duration, number of recurrences, personal and family history of psoriasis, accompanying arthritis, sternoclavicular tenderness, dental fillings, smoking status, and autoimmune disease was obtained; thorough dermatological examination was carried out. Patch testing results and laboratory investigations for thyroid autoimmunity were recorded. Results Thirty-five of 48 patients (72.9%) were current smokers. Twenty of the 48 patients (41.7%) had dental fillings. There was not any significant correlation between palmoplantar pustulosis duration and dental filling duration (p = 0.170). Psoriasis was not detected in any patients either in history or in dermatological examination. Nail involvement and joint complaints were observed in seven of 48 patients (14%) and in nine of 48 patients (18%), respectively. Autoimmune thyroiditis was observed in four of 48 patients (12%). Patients with patch testing positivity (12.5% of patients, M/F: 1/5) had no considerable association for history of external contact with these materials. Study limitations Retrospective analysis. Conclusion Palmoplantar pustulosis appears to be a distinct entity from psoriasis. Routine thyroid functions test could be analyzed, but patch testing is not required in patients with palmoplantar pustulosis. Also, patients with palmoplantar pustulosis must be evaluated for musculoskeletal symptoms and signs.
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Affiliation(s)
- Ayse Oktem
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Pınar Incel Uysal
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Neslihan Akdoğan
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Aslı Tokmak
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Basak Yalcin
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Xiaoling Y, Dan S, Hongzhong J. Lack of association between mutation in IL36RN and palmoplantar pustular psoriasis in Chinese patients. An Bras Dermatol 2019; 94:658-663. [PMID: 31789248 PMCID: PMC6939190 DOI: 10.1016/j.abd.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022] Open
Abstract
Background Palmoplantar pustulosis is considered to be a localized pustular psoriasis confined to the palms and soles. Mutation of the IL36RN gene, encoding interleukin-36 receptor antagonist (IL-36Ra), is associated with generalized pustular psoriasis, but IL36RN mutations in Chinese palmoplantar pustulosis patients have not previously been investigated. Objective The aim of this study was to evaluate the mutation of IL36RN in Chinese patients with palmoplantar pustulosis. Methods Fifty-one Han Chinese patients with palmoplantar pustulosis were recruited. All exons and exon-intron boundary sequences of IL36RN were amplified in polymerase chain reactions, and Sanger sequencing of the amplicons was performed. Results Among the 51 palmoplantar pustulosis patients, four different single-base substitutions were identified in nine patients. The mutations were c.140A>G/p.Asn47Ser in five patients, c.258G>A/p.Met86IIe in two patients, and c.115+6T>C and c.169G>A/p.Val57IIe in one patient each. All mutations were heterozygous. Comparison with the human genome database and reported literature suggested that these variants may not be pathogenic mutations causing palmoplantar pustulosis. Furthermore, there was no difference in disease severity, onset age, or disease duration between patients with these heterozygous IL36RN variants and those without (p > 0.1). Study limitation Lack of the further evaluation of IL36Ra protein in palmoplantar pustulosis lesions. Conclusions The four variants of IL36RN identified did not appear to be associated with the specific phenotypes of palmoplantar pustulosis.
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Affiliation(s)
- Yu Xiaoling
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shu Dan
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jin Hongzhong
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Brunasso Vernetti AMG, Puntoni M, Massone C. Palmoplantar Pustulosis and Allergies: A Systematic Review. Dermatol Pract Concept 2019; 9:105-110. [PMID: 31106012 PMCID: PMC6502300 DOI: 10.5826/dpc.0902a05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In 2007 the International Psoriasis Council considered palmoplantar pustulosis (PPP) a condition separate from psoriasis, and several authors maintain that PPP is a reactive process to metal contact allergies independent from psoriasis. OBJECTIVES To evaluate the frequency of allergies and psoriasis in patients with PPP and to determine the role of allergens in PPP. METHODS A systematic search of the English databases (PubMed and Web of Science) from January 1964 to August 2018 to identify all patients affected by PPP and allergies and/or psoriasis. RESULTS In total, 16 publications describing a total of 519 patients with PPP were evaluated and 122 cases of concomitant PPP and metal allergy were found. The frequency of allergies among patients with PPP was 22.7%; between the identified allergens, 84.3% of cases correspond to metal allergies. In 65.1% of metal allergies, an improvement in PPP was seen after withdrawal of contact. The concomitant presence of psoriasis was recorded in 18% of the cases. CONCLUSION There is some evidence to support the association of PPP with metal allergies but also with psoriasis, suggesting the role of metal allergens as a trigger factor in patients with PPP.
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Affiliation(s)
| | - Matteo Puntoni
- Unit of Biostatistics, Scientific Directorate, Galliera Hospital, Genoa, Italy
| | - Cesare Massone
- Department of Dermatology, Galliera Hospital, Genoa, Italy
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Masui Y, Ito A, Akiba Y, Uoshima K, Abe R. Dental metal allergy is not the main cause of palmoplantar pustulosis. J Eur Acad Dermatol Venereol 2019; 33:e180-e181. [PMID: 30653749 DOI: 10.1111/jdv.15434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Y Masui
- Department of Dermatology, Nagata Clinic, Niigata, Japan.,Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - A Ito
- Department of Dermatology, Nagata Clinic, Niigata, Japan.,Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Y Akiba
- Division of Bio-Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Uoshima
- Division of Bio-Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - R Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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14
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Kitagawa M, Murakami S, Akashi Y, Oka H, Shintani T, Ogawa I, Inoue T, Kurihara H. Current status of dental metal allergy in Japan. J Prosthodont Res 2019; 63:309-312. [PMID: 30738702 DOI: 10.1016/j.jpor.2019.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the current status of patients with dental metal allergies in Japan. METHODS This study analyzed dental metal allergy in 1225 patients (1:3 male to female ratio; average age 53.0 ±16.5 years), including 300 who were scheduled to undergo dental implant surgery, between 2006 and 2016. For diagnosis of metal allergy, patch tests using metal allergens were performed. Additionally, when necessary, metal element analysis of dental alloys was performed in the mouths of some patients using an X-ray fluorescence analyzer for those who exhibited positive reactions. RESULTS Among 925 patients (i.e., excluding those scheduled to undergo dental implant surgery [n=300]), nearly one-half (44.0%) exhibited a positive response to any metal element in the patch test. The positivity rates were as follows: nickel (22.5%); palladium (14.8%); and zinc (11.5%). Almost one-half (42.3%) of the patients had diseases associated with metal allergy. Among patients who exhibited a positive reaction to any metal element in the patch test, more than two-thirds (67.9%) had dental alloys containing the positive metal element(s). One-half (55.6%) of the patients who underwent treatment to remove the metal experienced improvement in symptoms. In patients who underwent patch testing as an implant preoperative examination, several (2.7%) exhibited a positive reaction to titanium. CONCLUSIONS Dental metals, including nickel, palladium and zinc, which are indispensable to dental treatment in Japan, had high positivity rates in patch testing, and one-half of the patients improved following removal of the metal. Additionally, there were several patients with allergy to titanium.
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Affiliation(s)
- Masae Kitagawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan.
| | - Satoshi Murakami
- Department of Clinical Pathophysiology, Tokyo Dental College, Tokyo, Japan
| | - Yoshihiko Akashi
- Department of Clinical Pathophysiology, Tokyo Dental College, Tokyo, Japan
| | - Hiroko Oka
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan; Department of Global Dental Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoaki Shintani
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - Ikuko Ogawa
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - Takashi Inoue
- Department of Clinical Pathophysiology, Tokyo Dental College, Tokyo, Japan
| | - Hidemi Kurihara
- Center of Oral Clinical Examination, Hiroshima University Hospital, Hiroshima, Japan; Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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15
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Kouno M, Nishiyama A, Minabe M, Iguchi N, Ukichi K, Nomura T, Katakura A, Takahashi S. Retrospective analysis of the clinical response of palmoplantar pustulosis after dental infection control and dental metal removal. J Dermatol 2017; 44:695-698. [PMID: 28150339 DOI: 10.1111/1346-8138.13751] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/25/2016] [Indexed: 01/07/2023]
Abstract
Both metal allergy and dental focal infection have been considered as causative factors for palmoplantar pustulosis, and several case reports described that the skin lesions were ameliorated after dental metal removal or dental infection control. However, limited data are available to evaluate the association of these factors with disease severity of palmoplantar pustulosis. This study is designed to analyze the clinical outcome of 85 palmoplantar pustulosis patients after dental infection control (n = 70), tonsillectomy (n = 6) and dental metal removal (n = 9). More than half of the patients (63%, 44/70) showed positive clinical outcome after dental infection control. The skin lesions of all patients with tonsillitis were improved after tonsillectomy (100%, 6/6). On the other hand, one-third of patients (33%, 3/9) showed positive response after dental metal removal. These results suggest that focal infection is more closely associated with palmoplantar pustulosis than dental metal allergy. According to our findings, palmoplantar pustulosis patients should be preferentially examined for focal infections.
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Affiliation(s)
- Michiyoshi Kouno
- Department of Dermatology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Akihiro Nishiyama
- Department of Oral Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.,Department of Oral Pathological Science and Surgery, Tokyo Dental College, Tokyo, Japan
| | - Masaki Minabe
- Department of Oral Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Naohiko Iguchi
- Department of Oral Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Kenichiro Ukichi
- Department of Oral Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Takeshi Nomura
- Department of Oral Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Akira Katakura
- Department of Oral Pathological Science and Surgery, Tokyo Dental College, Tokyo, Japan
| | - Shinichi Takahashi
- Department of Dermatology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
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16
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Al-Imam H, Benetti AR, Özhayat EB, Pedersen AML, Johansen JD, Thyssen JP, Jellesen MS, Gotfredsen K. Cobalt release and complications resulting from the use of dental prostheses. Contact Dermatitis 2016; 75:377-383. [PMID: 27385620 DOI: 10.1111/cod.12649] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cobalt release from dental prostheses has been shown to elicit allergic reactions in cobalt-allergic patients. It is therefore important to investigate whether these prostheses are possible sources of sensitization. OBJECTIVES To assess (i) cobalt release from dental prostheses and (ii) allergic reactions to components of dental prostheses, and (iii) to investigate the oral mucosa for inflammation 1-5 years after insertion of the prostheses. METHOD Clinical oral examination was conducted in 66 patients with 84 dental prostheses. Cobalt release from 84 functional (used) and 32 non-functional (new) prostheses was investigated with the cobalt spot test. Contact allergy was assessed by patch testing. Smear tests for Candida spp. were performed in patients showing signs of inflammation of the oral mucosa. The prostheses were assessed for biological and technical complications. RESULTS None of the functional prostheses released cobalt, whereas this was observed in 24 of 32 non-functional prostheses. None of the patients had contact allergy to cobalt. Of the 66 patients, 11 showed signs of inflammation of the oral mucosa, 2 had oral candidiasis, 16 had ill-fitting prostheses, and all had insufficient oral hygiene. CONCLUSIONS Dental prostheses released cobalt during the fabrication stages, but not 1-5 years after insertion. No allergic reactions were observed. Signs of inflammation were related to candidiasis, insufficient oral hygiene, and ill-fitting prostheses.
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Affiliation(s)
- Hiba Al-Imam
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Ana R Benetti
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Esben B Özhayat
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Anne M L Pedersen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Jeanne D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital, Herlev-Gentofte, 2900, Denmark
| | - Jacob P Thyssen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital, Herlev-Gentofte, 2900, Denmark
| | - Morten S Jellesen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, 2800, Denmark
| | - Klaus Gotfredsen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 2200, Denmark
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17
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Molecular Mechanisms of Nickel Allergy. Int J Mol Sci 2016; 17:ijms17020202. [PMID: 26848658 PMCID: PMC4783936 DOI: 10.3390/ijms17020202] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 12/28/2022] Open
Abstract
Allergic contact hypersensitivity to metals is a delayed-type allergy. Although various metals are known to produce an allergic reaction, nickel is the most frequent cause of metal allergy. Researchers have attempted to elucidate the mechanisms of metal allergy using animal models and human patients. Here, the immunological and molecular mechanisms of metal allergy are described based on the findings of previous studies, including those that were recently published. In addition, the adsorption and excretion of various metals, in particular nickel, is discussed to further understand the pathogenesis of metal allergy.
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Liu F, Zhang M, Lou Y, Liu H, Sang H. The spontaneous regression of palmoplantar pustulosis following removal of dental amalgams: A report of two cases. Australas J Dermatol 2015; 57:e93-6. [PMID: 26081174 DOI: 10.1111/ajd.12366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
Abstract
Metal allergens are occasionally reported to be associated with palmoplantar pustulosis. We describe two severe, therapy-resistant, chronic cases of palmoplantar pustulosis induced by metal dental fillings. Both patients' clinical findings and symptoms regressed following the removal of their metal teeth. A patch test examination revealed positive reactions to metal allergens in both cases (in Case 1 the positive reactions were to cobalt chloride hexahydrate and nickel sulfate and in Case 2 the positive reaction was to nickel sulphate). Our studies suggest that metal allergens may play an important role in the pathogenesis of palmoplantar pustulosis.
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Affiliation(s)
- Fang Liu
- Department of Dermatology, Jinling Hospital affiliated to Nanjing University School of Medicine, Nanjing, China
| | - Min Zhang
- Department of Dermatology, Jinling Hospital affiliated to Nanjing University School of Medicine, Nanjing, China
| | - Yanfeng Lou
- Department of Dermatology, Jinling Hospital affiliated to Nanjing University School of Medicine, Nanjing, China
| | - Haibo Liu
- Department of Dermatology, Jinling Hospital affiliated to Nanjing University School of Medicine, Nanjing, China
| | - Hong Sang
- Department of Dermatology, Jinling Hospital affiliated to Nanjing University School of Medicine, Nanjing, China
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Une éruption dentesque. Rev Med Interne 2013; 34:181-3. [DOI: 10.1016/j.revmed.2012.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022]
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Song H, Ma Q, Wen Y. Cobalt-based dental alloy, allergy to cobalt, and palmoplantar pustulosis—reply. Oral Surg Oral Med Oral Pathol Oral Radiol 2012. [DOI: 10.1016/j.tripleo.2011.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Cobalt-based dental alloy, allergy to cobalt, and palmoplantar pustulosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:153-4; author reply 154. [DOI: 10.1016/j.tripleo.2011.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 05/14/2011] [Indexed: 11/20/2022]
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