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Tanwar N, Prakash C, Chaudhary K, Tewari S, Bhagavatheeswaran S. Titanium Allergy in Dentistry: A New Allergen in Rapidly Evolving Implant Dentistry. Contemp Clin Dent 2021; 12:317-320. [PMID: 34759692 PMCID: PMC8525802 DOI: 10.4103/ccd.ccd_773_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/26/2020] [Accepted: 10/10/2020] [Indexed: 11/10/2022] Open
Abstract
Although titanium is considered as the biocompatible material and widely used in medical and dental fields, the clinical application of this material is still a critical issue due to the possible adverse host response. Very few case reports related with titanium-based hypersensitivity reactions with dental implants proved the existence of titanium allergy. The present case report describes 56-year-old male showing allergic symptoms after 1 week of dental implant placement with no perioral or facial signs, but eczema was shown on the distant body parts, and the complete remission was attained after removing the dental implant.
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Affiliation(s)
- Nishi Tanwar
- Department of Periodontology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Chander Prakash
- Department of Oral and Maxillofacial Surgery, Teerthankar Dental College, Muradabad, Uttar Pradesh, India
| | - Kuldeep Chaudhary
- Consultant Prosthodontist and Private Practitioner, Greater Noida, Uttar Pradesh, India
| | - Shikha Tewari
- Department of Periodontology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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Smith S, Taylor CR, Kanevsky E, Povoski SP, Hawley JR. Long-term safety and efficacy of breast biopsy markers in clinical practice. Expert Rev Med Devices 2020; 18:121-128. [PMID: 33233969 DOI: 10.1080/17434440.2020.1852928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: Percutaneous breast and axillary core biopsy followed by marker placement are integral parts of a breast imager's practice benefiting both patients and clinicians. Marker placement is the standard to facilitate future care. The purpose of this study is to characterize the safety and performance of MammoMARK, CorMARK, and HydroMARK biopsy markers by evaluating device-related adverse events, device deficiencies, and long-term safety.Methods: A retrospective review of three radiology practices identified patients who underwent image-guided breast or axillary biopsies followed by marker placement between 1 January 2012 and 1 January 2017. Medical records were reviewed with adverse events related to marker placement and use recorded.Results: 768 markers were placed with three (0.4%) events recorded. Two device deficiencies and one non-serious adverse event occurred in three patients. Device deficiency events involved user errors deploying the markers, one to inability to locate the marker on post-biopsy imaging, and the second to misplacement relative to biopsy target. One non-serious adverse event involved inability to locate/retain the marker in a surgically resected specimen. No serious adverse events were reported.Conclusion: Placement of breast biopsy markers is safe with minimal associated risks. Issues related to device malfunction, durability, reliability, safety, or performance were not reported.
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Affiliation(s)
- Sharon Smith
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Clayton R Taylor
- Department of Radiology, Division of Women's and Breast Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Stephen P Povoski
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeffrey R Hawley
- Department of Radiology, Division of Women's and Breast Imaging, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Reprint of: Breast tissue markers: Why? What's out there? How do I choose? Clin Imaging 2019; 55:196-212. [DOI: 10.1016/j.clinimag.2019.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/21/2022]
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Breast tissue markers: Why? What's out there? How do I choose? Clin Imaging 2018; 52:123-136. [DOI: 10.1016/j.clinimag.2018.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022]
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Gulati K, Ivanovski S. Dental implants modified with drug releasing titania nanotubes: therapeutic potential and developmental challenges. Expert Opin Drug Deliv 2016; 14:1009-1024. [PMID: 27892717 DOI: 10.1080/17425247.2017.1266332] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The transmucosal nature of dental implants presents a unique therapeutic challenge, requiring not only rapid establishment and subsequent maintenance of osseointegration, but also the formation of resilient soft tissue integration. Key challenges in achieving long-term success are sub-optimal bone integration in compromised bone conditions and impaired trans-mucosal tissue integration in the presence of a persistent oral microbial biofilm. These challenges can be targeted by employing a drug-releasing implant modification such as TiO2 nanotubes (TNTs), engineered on titanium surfaces via electrochemical anodization. Areas covered: This review focuses on applications of TNT-based dental implants towards achieving optimal therapeutic efficacy. Firstly, the functions of TNT implants will be explored in terms of their influence on osseointegration, soft tissue integration and immunomodulation. Secondly, the developmental challenges associated with such implants are reviewed including sterilization, stability and toxicity. Expert opinion: The potential of TNTs is yet to be fully explored in the context of the complex oral environment, including appropriate modulation of alveolar bone healing, immune-inflammatory processes, and soft tissue responses. Besides long-term in vivo assessment under masticatory loading conditions, investigating drug-release profiles in vivo and addressing various technical challenges are required to bridge the gap between research and clinical dentistry.
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Affiliation(s)
- Karan Gulati
- a School of Dentistry and Oral Health , Griffith University , Gold Coast , Australia.,b Tissue Engineering and Regenerative Medicine (TERM) Group, Understanding Chronic Conditions (UCC) Program, Menzies Health Institute Queensland , Griffith University , Gold Coast , Australia
| | - Sašo Ivanovski
- a School of Dentistry and Oral Health , Griffith University , Gold Coast , Australia.,b Tissue Engineering and Regenerative Medicine (TERM) Group, Understanding Chronic Conditions (UCC) Program, Menzies Health Institute Queensland , Griffith University , Gold Coast , Australia
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Revell PA, Matharu GS, Mittal S, Pynsent PB, Buckley CD, Revell MP. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016; 5:52-60. [PMID: 26868893 PMCID: PMC4852791 DOI: 10.1302/2046-3758.52.2000574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES T-cells are considered to play an important role in the inflammatory response causing arthroplasty failure. The study objectives were to investigate the composition and distribution of CD4+ T-cell phenotypes in the peripheral blood (PB) and synovial fluid (SF) of patients undergoing revision surgery for failed metal-on-metal (MoM) and metal-on-polyethylene (MoP) hip arthroplasties, and in patients awaiting total hip arthroplasty. METHODS In this prospective case-control study, PB and SF were obtained from 22 patients (23 hips) undergoing revision of MoM (n = 14) and MoP (n = 9) hip arthroplasties, with eight controls provided from primary hip osteoarthritis cases awaiting arthroplasty. Lymphocyte subtypes in samples were analysed using flow cytometry. RESULTS The percentages of CD4+ T-cell subtypes in PB were not different between groups. The CD4+ T-cells in the SF of MoM hips showed a completely different distribution of phenotypes compared with that found in the PB in the same patients, including significantly decreased CD4+ T-central memory cells (p < 0.05) and increased T-effector memory cells (p < 0.0001) in the SF. Inducible co-stimulator (ICOS) was the only co-stimulatory molecule with different expression on CD4+ CD28+ cells between groups. In PB, ICOS expression was increased in MoM (p < 0.001) and MoP (p < 0.05) cases compared with the controls. In SF, ICOS expression was increased in MoM hips compared with MoP hips (p < 0.05). CONCLUSIONS Increased expression of ICOS on CD4+ T-cells in PB and SF of patients with failed arthroplasties suggests that these cells are activated and involved in generating immune responses. Variations in ICOS expression between MoM and MoP hips may indicate different modes of arthroplasty failure.Cite this article: Professor P. A. Revell. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016;5:52-60. doi: 10.1302/2046-3758.52.2000574.
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Affiliation(s)
- P A Revell
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - G S Matharu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - S Mittal
- University of Birmingham, Edgbaston, Birmingham B15 2WD, UK
| | - P B Pynsent
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - C D Buckley
- University of Birmingham, Edgbaston, Birmingham B15 2WD, UK
| | - M P Revell
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
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Evaluation of Stability After Orthognathic Surgery With Minimal Orthodontic Preparation. J Craniofac Surg 2014; 25:911-5. [DOI: 10.1097/scs.0000000000000609] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Evidence for active antigen presentation by monocyte/macrophages in response to stimulation with particles: the expression of NFκB transcription factors and costimulatory molecules. Inflammopharmacology 2013; 21:279-90. [PMID: 23670535 DOI: 10.1007/s10787-013-0170-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The macrophage and lymphocyte response to wear debris contributes to the failure of some joint replacements. Costimulatory molecule expression by particle-containing macrophages is an evidence for antigen presentation. The NFκB transcription factors are regulators of costimulatory molecules and are present in tissue near failed joint prostheses. The tissue localisation of NFκB and the expression of these factors and costimulatory molecules by U937 cells stimulated with nano- and microparticles are reported, together with the effects of an NFκB inhibitor (sc514). MATERIALS AND METHODS The tissue localisation of RelA, RelB, c-rel, p50, p52 and NF-IL6 was examined by immunohistochemistry in samples from 15 patients with failure of metal against polyethylene total hip replacements. The expression of these NFκB factors by U937 cells stimulated with microparticles (CoCr, diamond) and nanoparticles (diamond) was examined by quantified RT-PCR. Lipopolysaccharide provided positive controls while negative controls had no additions to culture. Inhibition of NFκB activity by sc-514 was studied. The expression of costimulatory molecules (CD80, CD86 and HLA-DR) was evaluated in parallel cell culture studies by tricolour flow cytometry. RESULTS AND DISCUSSION Immunohistochemistry of tissue showed the highest expression for NF-IL6 (32.56 ± 11.61 per cent), RelA (33.66 ± 9.98 per cent) and p52 (32.07 ± 12.90 per cent), then RelB (22.63 ± 7.49 per cent), c-rel (14.07 ± 6.72 per cent) and p50 (13.07 ± 5.99 per cent). NF-IL6 was localised to macrophages, RelB to RFD1+ dendritic cells. U937 cells showed an increased expression of all NFκB factors (p < 0.01) in response to CoCr and diamond microparticles. Only RelA and c-rel (p < 0.01) were increased by one diamond nanoparticle and p52 and c-rel (p < 0.01) by another nanoparticulate diamond. Inhibition by sc-514 of RelA, c-rel and p50 expression occurred with all four particles, p52 was decreased for all diamond particles (but not CoCr) and RelB was not inhibited with any of the particles. CD86 and HLA-DR expression were upregulated by microparticles (CoCr, diamond) (p ≪ 0.01) with lower levels (significant) of these molecules found with diamond nanoparticles. CD80 expression was much less than CD86 and HLA-DR. Costimulatory molecule expression in the bone-implant interface indicates antigen presentation by macrophages. Functional studies with U937 monocytes show the same molecules expressed on exposure to micro- and nanoparticles. Highest values occur with CoCr while the smallest diamond nanoparticles are the least stimulatory. NFκB expression gives an insight into the immunogenic potential of the different particles.
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Moure C, Qassemyar Q, Dunaud O, Neiva C, Testelin S, Devauchelle B. Skeletal stability and morbidity with self-reinforced P (L/DL) LA resorbable osteosynthesis in bimaxillary orthognathic surgery. J Craniomaxillofac Surg 2011; 40:55-60. [PMID: 21514172 DOI: 10.1016/j.jcms.2011.01.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 12/31/2010] [Accepted: 01/13/2011] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION We present a retrospective study of 30 consecutive cases of bimaxillary orthognathic surgery with biodegradable self-reinforced poly-L/DL-lactide plates and tacks, for the same indication of Angle class III malocclusion. We reported the skeletal stability and morbidity at 1 year after surgery. PATIENTS AND METHODS All patients underwent bimaxillary procedure. We used self-reinforced poly-L/DL lactic acid copolymer. Stabilization of Lefort I osteotomy was achieved by four plates L-shaped. Sagittal split osteotomies were fixed by two straight-plates. Lateral cephalograms were taken before (T0), soon after (T1) and more than 1 year after surgery (T2). Eight standard landmarks and four angular measurements were taken into account. All differences of the landmarks and angles were measured at T1 and T2. The regular clinical follow-up was scheduled for a minimum period of 1 year. RESULTS The mean advanced maxillary was 3.33 mm and the mean mandibular setback was 6.13 mm. The mean mandibular relapse was 2.2 mm (non-significant). Horizontal maxilla mean variation was 0.8 mm at 1 year at A-point. Vertical maxilla stability depends on maxillary movements: impaction stability is better as an isolated advancement or associated with pull-down movement. We found six inflammatory reactions and two of them need the removal of the plates. CONCLUSION Bimaxillary orthognathic procedure with bioresorbable osteosynthesis is a reliable and reproducible method. Angle class III malocclusions could be entirely and successfully managed with bioresorbable osteosynthesis. The stability and suites at 1 year are comparable to titanium osteosynthesis.
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Affiliation(s)
- Christophe Moure
- Department of Maxillo-Facial Surgery, Amiens North Hospital, University of Picardie Jules Verne, Place Victor Pauchet, F-80054 Amiens cedex 01, France
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Lésion eczématiforme chronique du sein après mise en place d’un clip chirurgical. ACTA ACUST UNITED AC 2011; 40:174-7. [DOI: 10.1016/j.jgyn.2010.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 07/15/2010] [Accepted: 07/28/2010] [Indexed: 11/19/2022]
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Hailer NP, Blaheta RA, Dahlstrand H, Stark A. Elevation of circulating HLA DR(+) CD8(+) T-cells and correlation with chromium and cobalt concentrations 6 years after metal-on-metal hip arthroplasty. Acta Orthop 2011; 82:6-12. [PMID: 21189110 PMCID: PMC3229991 DOI: 10.3109/17453674.2010.548028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Following metal-on-metal hip arthroplasty (THA), immunological reactions including changes in lymphocyte populations, aseptic loosening, and lymphocytic pseudotumors occur. We hypothesized that changes in lymphocyte subpopulations would be associated with elevated metal ion concentrations. METHODS A randomized trial involving 85 patients matched for age and sex and randomized to receiving metal-on-metal (n = 41) or metal-on-polyethylene total hip arthroplasty (n = 44) was conducted. 36 patients were eligible for follow-up after mean 7 (6-8) years. Concentrations of chromium and cobalt were analyzed by high-resolution inductively coupled plasma mass spectrometry. Leukocyte subpopulations and immunoglobulins in patient blood were measured using standard laboratory methods. RESULTS Patients with a metal-on-metal hip had higher serum concentrations of chromium (1.05 vs. 0.36 μg/L; p < 0.001) and cobalt (0.86 vs. 0.24 μg/L; p < 0.001) than those with metal-on-polyethylene. The percentage of HLA DR(+) CD8(+) T-cells was higher in the metal-on-metal group (10.6 vs. 6.7%; p = 0.03) and correlated positively with chromium and cobalt concentrations in patient blood (Pearson's correlation coefficient: 0.39, p = 0.02; 0.36, p = 0.03, respectively). The percentage of B-cells was lower in the metal-on-metal group (p = 0.01). The two groups were similar with respect to immunoglobulin concentrations and Harris hip scores, and there were no radiographic signs of loosening. INTERPRETATION We conclude that immunological alterations appear to be associated with increased cobalt and chromium concentrations. It is tempting to speculate that HLA DR(+) CD8(+) T-cells are involved in the pathogenesis of allergic reactions, implant loosening, and lymphocytic pseudotumors.
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Affiliation(s)
- Nils P Hailer
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Roman A Blaheta
- Department of Urology, Goethe University, Frankfurt am Main, Germany
| | - Henrik Dahlstrand
- Department of Molecular Medicine and Surgery, Section of Orthopedics, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - André Stark
- Department of Molecular Medicine and Surgery, Section of Orthopedics, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Thyssen JP, Menné T, Schalock PC, Taylor JS, Maibach HI. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery. Br J Dermatol 2011; 164:473-8. [PMID: 21087227 DOI: 10.1111/j.1365-2133.2010.10144.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Allergic complications following insertion of metallic orthopaedic implants include allergic dermatitis reactions but also extracutaneous complications. As metal-allergic patients and/or surgeons may ask dermatologists and allergologists for advice prior to planned orthopaedic implant surgery, and as surgeons may refer patients with complications following total joint arthroplasty for diagnostic work-up, there is a continuous need for updated guidelines. This review presents published evidence for patch testing prior to surgery and proposes tentative diagnostic criteria which clinicians can rely on in the work-up of patients with putative allergic complications following surgery. Few studies have investigated whether subjects with metal contact allergy have increased risk of developing complications following orthopaedic implant insertion. Metal allergy might in a minority increase the risk of complications caused by a delayed-type hypersensitivity reaction. At present, we do not know how to identify the subgroups of metal contact allergic patients with a potentially increased risk of complications following insertion of a metal implant. We recommend that clinicians should refrain from routine patch testing prior to surgery unless the patient has already had implant surgery with complications suspected to be allergic or has a history of clinical metal intolerance of sufficient magnitude to be of concern to the patient or a health provider. The clinical work-up of a patient suspected of having an allergic reaction to a metal implant should include patch testing and possibly in vitro testing. We propose diagnostic criteria for allergic dermatitis reactions as well as noneczematous complications caused by metal implants.
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Affiliation(s)
- J P Thyssen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
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Egusa H, Ko N, Shimazu T, Yatani H. Suspected association of an allergic reaction with titanium dental implants: a clinical report. J Prosthet Dent 2009; 100:344-7. [PMID: 18992567 DOI: 10.1016/s0022-3913(08)60233-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent reports have questioned whether metal sensitivity may occur after exposure to titanium. This clinical report demonstrates the emergence of facial eczema in association with a titanium dental implant placed for a mandibular overdenture supported by 2 implants. Complete remission was achieved by the removal of the titanium material. This clinical report raises the possibility that in rare circumstances, for some patients, the use of titanium dental implants may induce an allergic reaction.
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Affiliation(s)
- Hiroshi Egusa
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
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Revell PA. The combined role of wear particles, macrophages and lymphocytes in the loosening of total joint prostheses. J R Soc Interface 2008; 5:1263-78. [PMID: 18647740 PMCID: PMC2607446 DOI: 10.1098/rsif.2008.0142] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This review considers the causes of loosening of prosthetic joint replacement paying attention to the biological mechanisms rather than other effects that are physical, such as component fracture and other failure related to mechanical problems. Infection accounts for approximately 1.5 per cent of joint loosening and when it occurs it is a cause of serious concern to the surgeon. The loosening of prosthetic joints in the absence of infection is by far the most common reason for revision surgery and is known as aseptic loosening. While this may be multifactorial in terms of causation, and non-biological factors may contribute significantly in a particular individual, a significant part is undoubtedly played by the generation of wear debris, mainly from the bearing surfaces of the joint, and the cellular reaction to this in the implant bed. Phagocytic cells (macrophages and multinucleated giant cells) are the ones that remove foreign material from the tissues, and the ways in which these cells function in the interface between implant and bone are described. Mediators produced locally include numerous cytokines, enzymes and integrins. There is evidence for interactions between macrophages and locally recruited lymphocytes, which may or may not give rise to an immunologically mediated process.Sensitization of individuals having metal implants in place has been shown by positive skin tests or blood lymphocyte transformation tests and in these cases has been accompanied by loosening and failure of the replacement joint. The question remains as to whether this process is also present in a proportion of individuals with aseptic loosening in the absence of clearly defined clinical evidence of sensitization.Numerous studies performed by the author's group and, latterly, by others suggest that the cellular reactions detected in the tissues in cases of aseptic loosening are indeed those of contact sensitization. There is good evidence to show that a type IV cell-mediated immune reaction is taking place, with TH1 cell involvement and active antigen presentation. The extent to which sensitization is present in individual cases of aseptic loosening remains a subject for further work and this needs all the sophisticated molecular methods now available to modern biology to be applied in appropriate prospective clinical studies coupled with experimental models in vitro and in vivo. Immunological processes may play a more important part in joint loosening than previously considered.
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Affiliation(s)
- Peter A Revell
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London, London, UK.
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Nawaz F, Wall BM. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome: suspected association with titanium bioprosthesis. Am J Med Sci 2007; 334:215-8. [PMID: 17873538 DOI: 10.1097/maj.0b013e318141f723] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS), also known as hypersensitivity syndrome, is an idiosyncratic drug reaction presenting with fever, diffuse lymphadenopathy, exfoliative dermatitis, and visceral involvement, which may include hepatitis, pneumonitis, pericarditis, myocarditis, nephritis, and colitis. This report describes a 19-year-old, previously healthy man with manifestations of hypersensitivity (DRESS) syndrome after acquiring a titanium bioprosthesis for a spinal fracture. To our knowledge, there have been no prior reports of DRESS syndrome in association with titanium bioprosthetic implants.
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Affiliation(s)
- Fareha Nawaz
- Veterans Affairs Medical Center and Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Cheung LK, Chow LK, Chiu WK. A randomized controlled trial of resorbable versus titanium fixation for orthognathic surgery. ACTA ACUST UNITED AC 2004; 98:386-97. [PMID: 15472652 DOI: 10.1016/j.tripleo.2004.02.069] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine any differences in the intra- and postoperative morbidities and complications between resorbable and titanium plating systems for fixation in orthognathic surgery. STUDY DESIGN This prospective randomized clinical trial was conducted in the Oral and Maxillofacial Surgery unit of the University of Hong Kong. Patients with dentofacial deformities were randomly assigned into the titanium and resorbable fixation groups. Intraoperative data such as the surgical procedures, time for fixing each plate, and number of broken plates and screws were recorded. Subjective and objective parameters related to clinical morbidities were assessed postoperatively. RESULTS A total of 60 patients with 177 osteotomies were included in this study. Eighty-seven osteotomies fixated with 196 titanium plates and 784 titanium screws were performed in 30 patients, whereas 90 osteotomies fixated with 165 resorbable plates and 658 resorbable screws were done in another 30. The postoperative infection rate was 1.53% (3/196) and 1.82% (3/165) in the titanium and resorbable fixation groups, respectively. These infections were mainly due to loose screws and wound dehiscence. The plate exposure rate was 1.02% (2/196) for the titanium group and 1.21% (2/165) for the resorbable group. The plate removal rate in the titanium and resorbable groups was 1.53% (3/196) and 3.63% (6/165), respectively. Statistically significant difference was shown in the plating time of step (mandibular body) and Hofer (mandibular subapical) osteotomies. There was no significant difference in the subjective clinical parameters such as wound discomfort, clinical stability of the osteotomy segments, palpability of plate, and overall satisfaction of the results between the 2 fixation groups. Similarly, objective parameters including wound dehiscence, rate of infection, plate exposure, occurrence of sinus tract, and palpability assessed by surgeons in both groups also showed no significant difference. CONCLUSION Bioresorbable fixation devices offer similar function as titanium in fixation for orthognathic surgery and do not impose an increase in the clinical morbidities.
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Affiliation(s)
- Lim Kwong Cheung
- Oral & Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
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Maitz MF, Pham MT, Matz W, Reuther H, Steiner G, Richter E. Ion beam treatment of titanium surfaces for enhancing deposition of hydroxyapatite from solution. BIOMOLECULAR ENGINEERING 2002; 19:269-72. [PMID: 12202194 DOI: 10.1016/s1389-0344(02)00039-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surface coating with hydroxyapatite (HA) is a common way to improve the osseointegration of orthopaedic and dental titanium (Ti)-based materials. The main problems with current techniques are changes in composition during heating and poor adhesion to the surface. An alternative method is deposition of HA onto an activated surface out of a solution. The present work studies the surface treatment involving ion implantation of Na into Ti to induce a modification in chemistry and morphology, showing sodium titanate (Na(2)TiO(3)) incorporated within the surface layer with concentration, depth distribution, and morphology depending on the parameters of the ion implantation. Such ion-implanted Ti surfaces actively induce heterogeneous precipitation of HA from a simulated body fluid containing physiological concentrations of calcium and phosphate ions. This is compared with the activation by NaOH etching. The growth of bone forming cells on the pure Na implanted surface is oriented without an increased bone formation. Cell growth on the NaOH etched surface is reduced. After deposition of HA on both surfaces cell the growth pattern was improved.
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Affiliation(s)
- M F Maitz
- FZ-Rossendorf, PO Box 510119, 01314 Dresden, Germany.
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Torgersen S, Moe G, Jonsson R. Immunocompetent cells adjacent to stainless steel and titanium miniplates and screws. Eur J Oral Sci 1995; 103:46-54. [PMID: 7600250 DOI: 10.1111/j.1600-0722.1995.tb00010.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Subepithelial soft tissue and bone obtained from the implant bed in the vicinity of stainless steel and titanium miniplates and screws were evaluated with respect to the presence of immunocompetent cells. The study included tissue specimens from 19 patients, in whom the implants (14 stainless steel and 5 titanium) had been in situ for more than 6 months. The ABC (avidin-biotin-complex) immunoperoxidase staining technique using monoclonal antibodies defining T lymphocytes (CD3+), macrophages (CD11c+) and Class II MHC (HLA-DR) was performed on EDTA demineralized, frozen bone tissue, and on fresh frozen soft tissue specimens. The results showed scattered T lymphocyte clusters, small numbers of macrophages and abundant expression of HLA-DR in the soft tissue adjacent to both stainless steel and titanium implants. There was no substantial difference in tissue reactions between implants of the two materials. The demineralized bone sections disclosed presence of immunocompetent cells in the connective tissue lining the periphery of the screw holes. Metal particles were seen in both the soft tissue and the bone specimens. We conclude that a mild tissue reaction takes place in the vicinity of miniplates and screws of stainless steel and titanium, and that the intensity of the reaction indicates that the implants are well tolerated by the host tissue.
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Affiliation(s)
- S Torgersen
- Department of Dental Biomaterials, School of Dentistry, Haukeland Hospital, Norway
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Carboni GP, Contri P, Pilla G, Vasina PG. Dermatitis associated with orthopaedic prostheses and internal fixations. Contact Dermatitis 1994; 31:197-8. [PMID: 7821025 DOI: 10.1111/j.1600-0536.1994.tb01974.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- G P Carboni
- Department of Dermatology, Ospedale Maggiore, Bologna, Italy
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Motolese A, Truzzi M, Giannini A, Seidenari S. Contact dermatitis and contact sensitization among enamellers and decorators in the ceramics industry. Contact Dermatitis 1993; 28:59-62. [PMID: 8458219 DOI: 10.1111/j.1600-0536.1993.tb03342.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
126 enamellers and 64 decorators from 5 factories underwent dermatological and allergological examination using occupational test series in order to evaluate the prevalence of dermatitis and contact sensitization, and to identify the most important sensitizing substances. 48 workers (corresponding to 25.26% of the study population) were sensitized, with a total of 55 positive patch tests. Dermatitis was present in 22 workers, whereas 44 subjects claimed to have had skin lesions in the past. We found 17 positivities to specific substances: 7 to red iron oxide; 2 to antimony trioxide, manganese dioxide and maleic anhydride; and 1 to red copper oxide, cadmium chloride, vanadium pentoxide and sodium tripolyphosphate.
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Affiliation(s)
- A Motolese
- Department of Dermatology, University of Modena, Italy
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