Metal allergy patient treated by titanium implant denture: A case report with at least 4‐year follow‐up
Clin Case Rep. 2018 Oct; 6(10): 1972–1977.
Published online 2018 Aug 28. doi: 10.1002/ccr3.1753
Huijiao Yan, 1 Shaista Afroz, 1 Junhel Dalanon, 1 Nami Goto, 1 Maki Hosoki, 1 and Yoshizo Matsukacorresponding author 1
Key Clinical Message
Patch testing with metal reagents was positive on female patient with history of metal hypersensitivity after dental treatment. All of the dental restorations with metal components were removed, and subsequent oral rehabilitation utilizing dental implants and metal‐free prostheses was carried out. The treatments alleviate the presenting signs and symptoms.
Keywords: case study, metal allergy, patch test, titanium implant
1. INTRODUCTION
With the rapid development of technology and material science, more nonmetal materials are used in dental clinical treatment. However, we still need to use metal materials for the treatment. To increase the stability and corrosion resistance of materials, most of the metals are used in the form of alloys.1 The oral cavity has a complex environment; metal materials exist in the mouth for a long time. Daily life's acidic diet, food residue decomposition, and bacterial metabolism, such as acid production, reduce the pH value of the oral environment resulting in the chemical corrosion of the metal restorations.2
These metal ions may precipitate and are distributed throughout the body or absorbed by the local tissue. In vitro experiments also confirmed that nickel‐chromium alloy metal in the acidic artificial saliva environment would cause electrochemical corrosion and precipitation of the metal ions.3 It is not only possible to detect elevated metal ions in saliva, but some studies have shown that elevated levels of nickel and chromium are also detected in urine and blood of patients with nickel‐chromium alloy restorations.4, 5It will lead to adverse reactions such as hypersensitivity or tissue damage. Metal allergic reactions are manifested not only in the oral mucosa but also in the extremities, limbs, and even on the skin. The clinical symptoms may not only be the subjective feelings such as the burning of oral mucosa, but also some objective damage such as moss‐like reaction, stomatitis, lip inflammation, and implant nail loosening may also occur. On the skin surface, the allergic manifestations may be in the form of eczema, contact dermatitis, plantar palm rash, etc.6, 7
According to our study of 212 suspected patients with metal allergy, the result of patch test showed the highest positive reaction toward Nickel (Ni) 25%, followed by Palladium (Pd) 24.4%, Chromium (Cr) 16.7%, Cobalt (Co) 15.9%.8 Also, Frigerio et al9 who performed patch tests on 100 patients who underwent first joint arthroplasty showed that the allergic rate was positive toward Ni 21%, Co 8%, Pd 3%, and Co–Pd was often accompanied by metal‐nickel cross‐allergy. Thyssen et al10 published on the analysis of contact allergic literature found that Ni allergy rate of 8.6% (0.7%‐27.8%) in North America and Western Europe is one of the most susceptible components causing contact allergy.
A case of a 54‐year‐old female patient with an allergy to metal jewelry is reported here. She presented with the allergic symptoms after the dental treatment. Clinical manifestations were mainly hyperemia in the oral mucosa and hand‐foot eczema. The results of the patch test showed that the patient had a positive reaction to a plurality of metallic metals mainly based on nickel and we treated by Ti implant dentures.
PMCID: PMC6186882 PMID: 30349710
