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Huang C, Chiang SYV, Gawkrodger DJ. The contribution of metal allergy to the failure of metal alloy implants, with special reference to titanium: Current knowledge and controversies. Contact Dermatitis 2024; 90:201-210. [PMID: 38148670 DOI: 10.1111/cod.14481] [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: 09/25/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
After almost three-quarters of a century during which contact dermatologists have often struggled to comprehend the relationship between metal allergy and failure of metal-alloy containing implant, it is possible to say that a relationship does exist, particularly for cobalt and chromium, but also for nickel. There is still debate as to whether allergy develops as a consequent of failure but thenceforth contributes to it, or whether sensitisation starts first and induces failure secondarily-opinion probably favours the first. Metal-on-polypropylene articulations were associated with few metal allergic problems but now are less favoured by orthopaedists due to plastic wear products causing osteolysis and pseudotumour formation through local inflammation. New metal alloys are regularly being introduced such that interested dermatologists need to stay on top of the situation. The jury is still out as to whether the recent favouring of titanium-containing alloys will confirm them to be more inert allergenically. Case reports do show some clinical reactions to titanium-containing implants and patch test series have inferred sometimes quite a high background rate of allergy, but interpretation must be tempered by the awareness that titanium salts on patch testing have a tendency to cause irritant reactions. Blood monitoring of metal ion values is now recommended in certain situations after joint replacement and increasing levels may be an indication that allergy with joint failure can develop, in which case patch testing is indicated, and suggested series are available. Predictive patch testing, whilst generally not recommended in the past, has been introduced into some protocols often by non-dermatologists, such that it is now needed for temporo-mandibular joint and Nuss bar insertion, and it can be anticipated that this may become more commonplace in the future. One of the major current deficits for patch testers is standardised guidance on which preparation or preparations to use for suspected titanium allergy. One suggestion is 0.5% titanium sulphate in petrolatum, though experience in at least one centre suggests the use of a battery of titanium salts might be desirable.
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Affiliation(s)
- Chenghao Huang
- Calderdale Royal Hospital, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK
| | - Shu Yu Vanessa Chiang
- Calderdale Royal Hospital, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK
| | - David J Gawkrodger
- Department of Dermatology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
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Qiu P, Wang P, Liu M, Dai T, Zheng M, Feng L. Biocompatibility and osteoinductive ability of casein phosphopeptide modified polyetheretherketone. Front Bioeng Biotechnol 2023; 11:1100238. [PMID: 36860888 PMCID: PMC9969344 DOI: 10.3389/fbioe.2023.1100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Polyetheretherketone (PEEK) is a potential implant material for dental application due to its excellent mechanical properties. However, its biological inertness and poor osteoinductive ability limited its clinical application. Based on a lay-by-layer self-assembly technique, here we incorporated casein phosphopeptide (CPP) onto PEEK surface by a simple two-step strategy to address the poor osteoinductive ability of PEEK implants. In this study, the PEEK specimens were positively charged by 3-ammoniumpropyltriethoxysilane (APTES) modification, then the CPP was adsorbed onto the positively charged PEEK surface electrostatically to obtain CPP-modified PEEK (PEEK-CPP) specimens. The surface characterization, layer degradation, biocompatibility and osteoinductive ability of the PEEK-CPP specimens were studied in vitro. After CPP modification, the PEEK-CPP specimens had a porous and hydrophilic surface and presented enhanced cell adhesion, proliferation, and osteogenic differentiation of MC3T3-E1 cells. These findings indicated that CPP modification could significantly improve the biocompatibility and osteoinductive ability of PEEK-CPP implants in vitro. In a word, CPP modification is a promising strategy for the PEEK implants to achieve osseointegration.
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Affiliation(s)
- Peng Qiu
- The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China,Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Luzhou, Sichuan, China,Institute of Stomatology, Southwest Medical University, Luzhou, Sichuan, China,*Correspondence: Peng Qiu, ; Pin Wang,
| | - Pin Wang
- The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China,Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Luzhou, Sichuan, China,Institute of Stomatology, Southwest Medical University, Luzhou, Sichuan, China,*Correspondence: Peng Qiu, ; Pin Wang,
| | - Min Liu
- The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China,Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Luzhou, Sichuan, China,Institute of Stomatology, Southwest Medical University, Luzhou, Sichuan, China
| | - Tao Dai
- The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China,Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Luzhou, Sichuan, China,Institute of Stomatology, Southwest Medical University, Luzhou, Sichuan, China
| | - Min Zheng
- The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China,Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Luzhou, Sichuan, China,Institute of Stomatology, Southwest Medical University, Luzhou, Sichuan, China
| | - Le Feng
- The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, Sichuan, China,Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Luzhou, Sichuan, China,Institute of Stomatology, Southwest Medical University, Luzhou, Sichuan, China
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Metal Allergy: State-of-the-Art Mechanisms, Biomarkers, Hypersensitivity to Implants. J Clin Med 2022; 11:jcm11236971. [PMID: 36498546 PMCID: PMC9739320 DOI: 10.3390/jcm11236971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Metal allergy is mainly an environmental disorder which can cause allergic contact dermatitis. Environmental metal exposures include jewelry, everyday metal items, mobile phones, leather, metal-rich food and implants, including stents or anchors. While consumer exposure is liable for the majority of metal hypersensitivity cases, the significance of occupational exposure to metals remains relevant. Although the most common metal allergens are nickel, chromium, and cobalt; however, lately, gold, palladium, titanium, and some others have also attracted attention. This review highlights advances in metal allergy mechanisms, biomarkers for potential patients' stratification as well as biological treatments. The most recent evidence of human exposure to metal for risk assessment is discussed, as well as the relationship between the occurrence of metal hypersensitivity and implanted devices, including non-characteristic symptoms. The latest data on the diagnosis of metal hypersensitivity are also reported.
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