Dentistry/Hives after dental implant
QUESTION: In Sept 2014 my son underwent a dental implant and thereafter began to experience serious outbreaks of hives. The use of penicillin during the procedure was suspected, but later, after tests, it was determined that the hives breakouts were due to a reaction from vanadium and nickel in the implant. Does this seem logical, and will removal of the implant put an end to the breakouts?
ANSWER: Wayne - that is the first I have heard of this from dental implants. If the testing disclosed an allergy to nickel or vanadium, then the implant needs removal. I just looked up potential allergies to both substances and nickel seems like the culprit. The only problem is that during the removal of the implant the surgeon needs to be very careful and not cut the implant and leave microscopic particles which can continue to produce the reaction.
So it is not logical to me and I have never heard of it before, but if your son did not have the hives until the implant was placed, and testing showed an allergy to the substances in the implant, then the implant is probably the cause. I'm not sure removal with reduce or stop the allergic reaction, but I don't see another option.
---------- FOLLOW-UP ----------
QUESTION: Dr. Teig, my name is Mark--my Dad, Wayne, had sent this question to you awhile back. I wanted to follow up on what has transpired.
I did have the implant removed on March 11th, and the turnaround in my health became very noticeable as quickly as the next day. I had anywhere from 20-30 health problems that had cropped up after I had the implant installed. At this point, twelve weeks later, I am somewhere between 90-100% recovered. I am usually at 100%, but I do have some "down" times where I only feel about 90% recovered. It has been quite a remarkable journey.
I can assure you these problems are very really and very horrible. It is extremely rare, but I have now come across at least 25 other people around the world who have experienced the exact same thing, with almost 100% of them getting complete relief after they had their implant(s) removed. This reaction or allergy or whatever they end up labeling it as some day attacks the auto-immune system and the nervous system, and the effects are devastating. During the last three weeks before removal, I was pretty certain I was dying. This is no normal allergic reaction.
The most striking symptoms are a fatigue beyond belief, a mental fogginess that words cannot even begin to describe, and a muscle and joint pain issue beyond belief. The hives were actually a very small problem compared to several of my symptoms.
The thing that made this most perplexing to my oral surgeon (who placed the implant and then also ended up removing it) was that there were no signs of a problem at the site, the implant took wonderfully. This also made me think it was not the implant for a long time. Then I found a discussion on the internet that has been going on for 5 years now, where people were talking about this very issue. It is an extremely long discussion, but full of a lot of great information. Here is the start of that discussion:
The biggest influence in my decision to have the implant removed was me coming in contact with a man named Chetan K. Mehta, who is an endodontist in Orange County California. He has worked with a couple dozen patience who have had these same issues, and he is at the forefront of learning why and how this problem is occurring. Here is an email that he wrote to me before I had the implant removed:
The information I have is based on anecdotal accounts from many patients. It is probably not what you are looking for. I have included a few references to journal articles at the bottom of this email. I have personally had the experience with dozens of patients who have had similar accounts of problems with titanium implants only to see those symptoms resolve after the implant is removed.
As I tell ALL patients, titanium implants have proven themselves over time and since millions of implants are placed each year with no problems, the likelihood of everything going well is very high. However, as we know with material science, we cannot exclude the possibility of a reaction which we dont understand and as such, if the patient starts complaining of systemic health issues that coincide with implant placement, it is something that we cannot ignore.
I have talked to several researchers on the subject and the current belief is that most of the reactions are not allergic in nature. True allergies are scientifically measurable via a MELISA test or such and since the reaction to titanium is not always a true allergy, it may not entirely be measurable. This ultimately is a problem. The current belief is that there is a macrophagic tissue reaction at the titanium dioxide / bone margin which is causing some people problems.
Most patients that Ive seen report immediate improvement after the implant is removed. Please note that in EVERY case, there was no visible tissue problem around the implant. For all practical purposed, the implant and tissue site looked perfect.
Heres an email of a patient I just received after taking out two implants at #13 and #15 --- both which were done after a lateral sinus lift. I took a CBCT and the implant positions were perfect, the sinus grafting was done with skill and the integration was excellent. The patient had tinnitus (severe) start shortly after the implants were placed in 2012 and has suffered since with the sound from the tinnitus being so loud at points that it would drown out sounds around her. Here is the email. The two implants were removed February 13th, 2015.
Hello, I hope you are doing well. I'm sure the weather there in California is a lot nicer than it is here in DC.
I wanted to let you know I'm about 90 percent better. I feel so much better and it has been only two weeks since you removed the dental implants.
It is an interesting story as for 2+ years shes been suffering with this problem. She attributes it to the implants as at the age of 39, she never had any issues prior to the implants being placed. Shes seen 2 neurologists, 3 ENTs, 2 oral surgeons, etc
and no one could figure it out. The moment the implants were removed on February 13th, she noticed a decrease in the tinnitus. Two weeks later, it was 90% better.
Here are some links to more info:
(article on a true allergic reaction to dental implants)
(this one talks about the macrophagic reaction)
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Dr. Mehta was a tremendous help to me, and he does everything he can for everybody that seeks information. If you have any questions for him, he would be more than happy to do his best to answer him. He is very attentive to his email and will respond. His email address is:
The Melisa organization is another great site for all kinds of information.
I wanted to thank you for answering my dad's question when he wrote to you, your response was actually very helpful. It reminded me to talk to the oral surgeon and make sure he was planning on removing the implant properly. He did, he took it out by cutting just the bone around the entire implant and never cutting into the implant. We did a bone graft, which took fantastically, and at some point in the future I will likely have a zirconium implant placed. For now I am just happy to have my health back and I'm going to leave things at that for awhile.
Mark - I am so pleased that you have responded so well to the implant removal. Titanium reaction, although not very common, does occur in enough that the manufacturers of dental implants need to address this problem. Likewise, research needs to be done by dental schools and manufacturers of implants to define the cause and prevent this from occurring in others. The problem is, manufacturers of the dental implants and manufacturers of surgical implants and hardware for orthopedic surgeons have not fully addressed this problem and look to prevent it in others.