engleski

Is titanium allergy a myth or reality?

A worldwide use of titanium implants in medicine and dentistry has grown exponentially in the last three decades. Titanium alloys are being widely used for dental implants, endoprostheses, pacemakers, stents and orthodontic brackets. A good corrosion behaviour and high biocompatibility are primarily gained by an immediately formed oxide film on the surface. However, sporadic cases of titanium incompatibility that deserve attention have been reported. The clinical manifestation included urticaria, eczema, oedema, redness and pruritus of the skin and mucosa or rarely depression and neurological disturbances. The forementioned symptoms can be grouped into the I and IV type of hypersensitivity. Patients that are affected by metal allergens are generally diagnosed using the epicutaneous (patch) test which has not yet been standardized for titanium and therefore cannot be clinically reliable. Aim of the presented case was evaluation of two avaliable diagnostic methods in exclusion or confirmation of suspected titanium allergy. After placement of two Astra Tech dental implants in the right mandible, a 44-year-old patient complained of subjective sensations associated with potential titanium allergy. There was no clinical sign nor symptom related to allergic etiology. On the patient's request, explantation of the inserted dental implants was done followed by epicutaneous testing and scanning electon microscopy (SEM) (Field Emission Scanning Electron Microscope, JSM-7000F, Jeol Ltd, Japan) of the explanted implant surfaces. Based on the SEM technique, mapping of the tissue chemical elements found on the implant surface using Cameo software (CAMEO Chemicals, CAMEO Software Suite, USA) was also performed. Suspected titanium allergy was not confirmed neither by epicutaneous testing nor after scanning electron microscopy and consequent chemical elements analysis of the found tissue on the impant surface. On SEM images there were no implant surface irregularities. Chemical analysis of the tissue found on the explanted implant surface has confirmed normal bone tissue between implant threads on low magnification and on higher magnification some organic material which can respond to osteoblast on the titanium implant surface. These results may sustain normal osseointagration process. Epicutaneous testing and current method of chemical elements mapping based on SEM technology are efficient and reliable diagnostic method in potential exclusion or confirmation of suspected titanium allergy.

dental implantology ; allergy ; SEM ; diagnostics ; physics

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