Symptoms of titanium and nickel allergic sensitization in orthodontic treatment

Martina Zigante,Marija Kastelan,Marijana Rincic Mlinaric,Magda Trinajstic Zrinski,Stjepan Spalj,Vjera Perkovic

doi:10.1186/s40510-020-00318-4

Martina Zigante, Marija Kastelan + Show 4 more

Open Access

https://doi.org/10.1186/s40510-020-00318-4

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Abstract

AimThe study aimed to evaluate to which extent self-reported symptomatology, age, and sex are predictors of titanium and nickel allergic sensitization in patients in treatment with fixed orthodontic appliances.MethodsThe study analyzed 228 subjects aged 11–45 years (median 18, interquartile range 16–22); 68% of them were females, and 52% were adolescents. The allergic sensitization testing included epicutaneous patch test to titanium, titanium dioxide, titanium oxalate, titanium nitride, and nickel sulfate. The questionnaire on symptoms potentially linked to titanium and nickel sensitization was used.ResultsPrevalence of the allergic sensitization to titanium in patients undergoing orthodontic treatment was 4% (2% only to titanium without nickel) while to nickel 14% (12% nickel without titanium). Hypersensitivity to both metals at the same time was present in 2% of subjects. Sensitization to nickel was more common in females than in males (17 vs. 8%) and much more common in adults than in adolescents with small effect size (20 vs. 8%; p = 0.013). Sensitization to titanium was more common in females than in males (6 vs. 1%) with no difference in age. Multiple logistic regression analysis revealed that adult age increases the odds for being sensitized to nickel for 2.4 × (95% CI 1.1–5.6; p = 0.044) while watery eyes for 3.7 × (95% CI 1.2–11.1; p = 0.022). None of the symptoms were significant predictors of titanium sensitization.ConclusionAllergic sensitization to titanium and nickel are not very frequent in orthodontic patients, and self-reported symptomatology is a weak predictor of those sensitizations.

Highlights

Orthodontic treatment mostly implies fixed orthodontic appliance which consists of metal brackets bonded to tooth surface and archwire connecting them
Hypersensitivity to both metals at the same time was present in 2% of subjects
Females were more often sensitized to nickel than males (17 vs 8%) and much more adults than adolescents with small effect size (20 vs 8%; p = 0.013; V = 0.169; odds ratios (OR) = 2.8; 95% confidence intervals (CI) 1.2– 6.1)

Summary

Introduction

Orthodontic treatment mostly implies fixed orthodontic appliance which consists of metal brackets bonded to tooth surface and archwire connecting them. Average treatment duration is between 2 and 3 years; safety and interactions of orthodontic materials with saliva, food, oral hygiene products, and oral and dental tissues should be kept in mind. Titanium is present in orthodontic appliances from 50% in NiTi alloys up to 80% in titanium-molybdenum alloy and 90% titanium-aluminum-vanadium alloy used for orthodontic mini implants. Hypersensitivity reactions lead to tissue damage and can cause serious conditions and illnesses. They do not lead to symptomatic reactions at the first exposure, but upon re-exposure to the causative antigen [3]. Positive epicutaneous test signifies allergic sensitization while diagnosis of Zigante et al Progress in Orthodontics (2020) 21:17 allergy can be established only when clinical signs are present and when removing of the allergen causes regression of symptoms

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