Allergy to titanium dental implants reality or a myth

Abstract

Background According to the phenomenon of osseointegration, titanium dental implants have been regarded as absolutely biocompatible and indifferent to the host despite the reports of hypersensitivity to titanium from other fields of medicine. For the last decade, this problem has started to appear in the reports concerning allergy reactions to titanium dental implants as a background of complications. Aim/Hypothesis The titanium dental implants are commonly treated as biologically inert. Despite that, they are able to cause inflammation in surrounding and distant tissues. In the shadow of the complications, one of them may stand allergic reaction as a response to the constituent part of the used materials. Material and Methods A systematic review of English articles, which corresponded to inclusion criteria, has been done. Access to the library resources of Goethe University in Frankfurt am Main, the database of MEDLINE PUBMED and also the web page of MELISA FOUNDATION were used. The search terms- implant, allergy, titanium, dental, implants, hypersensitivity, metal, reaction in various combinations and also with Boolean operators- AND, OR and NOT resulted in the highest score of 531 articles. Combination of keywords- dental, titanium, implant, allergy, metal, reaction in a database of PUBMED revealed 8 articles which became the basis for further searchings via bibliography lists. Results Due to including criteria 531 articles were studied. The search resulted in a total of 36 studies. About local (facial eczema, mucositis, rash, swelling, hyperaemia of close soft tissues, pain and unexplained implants exfoliation) and general (muscle, joint and nerve pain, chronic fatigue syndrome, neurological problems) symptoms associated with allergy to titanium dental implants reported 4 case reports and 2 clinical studies. Due to a heavy allergic complication, one clinical study described allergic shock- glottis oedema after implant insertion. In one case report, the patient rejected the proposal of explantation of implants. Survival of titanium dental allergologically complicated implants ranged from 3 weeks up to 2 years (5 studies). Out of the allergological tests were conducted- Prick's test- 1 study, Patch tests 5 studies, LTT MELISA - 3 studies. Histological evaluation of specimens was conducted in 2 studies. Two studies showed no allergic symptoms after insertion of titanium dental implants. One study proved discovered probably the mechanism of tolerance to titanium Conclusion and Clinical Implications Based on the collected material it can be stated that- The possibility of occurrence of allergy to titanium dental implants exists. There is an inadequacy of patch tests for detection of allergy to titanium dental implants. The MELISA tests are the solution to the first choice in suspicious cases of titanium allergy. The periimplantitis = allergy (of IV type due to the classification of Gell and Coombs). Probably exists the cure for chronic inflammatory diseases - titanium in the form of dust.