You are here:

Dentistry/Hives after dental implant

Advertisement


Question
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:

http://www.medhelp.org/posts/Allergy/titanium-vanadium-aluminum-dental-implant/s

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:


"Hi Mark,



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 don’t 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 I’ve 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.



Here’s 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 she’s 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. She’s 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:

http://www.ncbi.nlm.nih.gov/m/pubmed/18705814/

(article on a true allergic reaction to dental implants)





http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753052/

(this one talks about the macrophagic reaction)





http://www.melisa.org/pdf/Hypersensitivity-titanium.pdf







References

   Thyssen JP, Linneberg A, Menn้ T, Johansen JD. The epidemiology of contact allergy in the general population—prevalence and main findings. Contact Dermatitis 2007;57:287–99.
   Thyssen JP, Johansen JD, Zachariae C, Menn้ T. The outcome of dimethylglyoxime testing in a sample of cell phones in Denmark. Contact Dermatitis 2008;59:38–42.
   Heim KE, McKean BA. Children's clothing fasteners as a potential source of exposure to releasable nickel ions. Contact Dermatitis 2009;60:100–5.
   Hansen MB, Menne T, Johansen JD. Cr(III) and Cr(VI) in leather and elicitation of eczema. Contact Dermatitis 2006;54:278–82.
   Cheng TY, Tseng YH, Sun CC, Chu CY. Contact sensitization to metals in Taiwan. Contact Dermatitis 2008;59:353–60.
   Thyssen JP, Johansen JD, Menn้ T, et al. Hypersensitivity reactions from metallic implants: a future challenge that needs to be addressed. Br J Dermatol 2010;162:235–6.
   Gawkrodger DJ. Nickel sensitivity and the implantation of orthopaedic prostheses. Contact Dermatitis 1993;28:257–9.
   Thomas SM, Rademaker M, Goddard NJ, Munro DD. Severe eczema of the hands due to an orthopaedic plate made of Vitallium. Br Med J 1987;294:106–7.
   Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am 2001;83:428–36.
   Thomas P, Bandl WD, Maier S, et al. Hypersensitivity to titanium osteosynthesis with impaired fracture healing, eczema, and T-cell hyperresponsiveness in vitro: case report and review of the literature. Contact Dermatitis 2006;55:199–202.
   Hubler WR Jr, Hubler WR Sr. Dermatitis from a chromium dental plate. Contact Dermatitis 1983;9:377–83.
   Honari G, Ellis SG, Wilkoff BL, et al. Hypersensitivity reactions associated with endovascular devises. Contact Dermatitis 2008;59: 7–22.
   Gawkrodger DJ. Metal sensitivities and orthopaedic implants revisited: the potential for metal allergy with the new metal-onmetal joint prostheses. Br J Dermatol 2003;148:1089–93.
   316/316L stainless steel. Product data sheet. Available at: http://www.aksteel.com/pdf/markets_products/stainless/austenitic/316_316L_Data_S (accessed September 28, 2010).
   ASTM F75 CoCr alloy. Available at: www.arcam.com/CommonResources/Files/www.arcam.com/Documents/EBM%20Materials/Arcam-ASTM-F75-Cobalt-Chrome.pdf (accessed September 28, 2010).
   Granchi D, Cenni E, Trisolino G, et al. Sensitivity to implant materials in patients undergoing total hip replacement. Biomaterials 2006;77B:257–64.
   Gamerdinger K, Moulon C, Karp DR, et al. A new type of metal recognition by human T cells: contact residues for peptideindependent bridging of T cell receptor and major histocompatibility complex by nickel. J Exp Med 2003;197:1345–53.
   Jakobsen SS, Danscher G, Stoltenberg M, et al. Cobalt-chromiummolybdenum alloy causes metal accumulation and metallothionein up-regulation in rat liver and kidney. Basic Clin Pharmacol Toxicol 2007;101:441–6.
   Merle C, Vigan M, Devred D, et al. Generalized eczema from Vitallium osteosynthesis material. Contact Dermatitis 1992;27: 257–8.
   Carlsson A, M๖ller H. Implantation of orthopaedic devices in patients with metal allergy. Acta Derm Venereol 1989;69:62–6.
   Niki Y, Matsumoto H, Otani T, et al. Screening for symptomatic metal sensitivity: a prospective study of 92 patients undergoing total knee arthroplasty. Biomaterials 2006;26:1019–26.
   Eben R, Walk R, Summer B, et al. Implant allergy register—a first report. Orthopade 2009;38:557–62.
   Foussereau J, Langier P. Allergic eczemas from metallic foreign bodies. Trans St Johns Hosp Dermatol Soc 1966;52:220–5.
   Rostoker G, Robin MD, Binet MD, et al. Dermatitis due to orthopaedic implants: a review of literature and report of three cases. J Bone Joint Surg 1987;69:1408–12.
   Kanerva L, Forstrom L. Allergic nickel and chromate hand dermatitis induced by orthopaedic metal implant. Contact Dermatitis 2001;44:103–4.
   Thomas P. Allergic reactions to implant materials. Orthopade 2003;32:60–4.
   Thomas P, Gollwitzer H, Maier S, Rueff F. Osteosynthesis associated contact dermatitis with unusual perpetuation of hyperreactivity in a nickel allergic patient. Contact Dermatitis 2006;54:222–5.
   Carboni GP, Contri P, Pilla G, Vasina PG. Dermatitis associated with orthopaedic prostheses and internal fixations. Contact Dermatitis 1994;31:197–8.
   Ridley CM. How relevant is cobalt sensitivity in a patient with unsatisfactory total knee replacement? Clin Exp Dermatol 1977;2: 401–4.
   Symeonides PP, Paschaloglu C, Papageorgiou S. An allergic reaction after fixation of a fracture using a Vitallium plate. J Allergy Clin Immunol 1993;51:251–2.
   Munro-Ashman D, Miller AJ. Rejection of metal to metal prosthesis and skin sensitivity to cobalt. Contact Dermatitis 1976;2:65–7.
   Tisley DA, Rostein H. Sensitivity caused by internal exposure to nickel, chrome and cobalt. Contact Dermatitis 1980;6:175–8.
   Benson MK, Goodwin PG, Brostoff J. Metal sensitivity in patients with joint replacement arthroplasties. Br Med J 1975;15: 374–5.
   Elves MW, Wilson JN, Scales JT, Kemp HB. Incidence of metal sensitivity in patients with total joint replacements. Br Med J 1975; 15:376–8.
   Carlsson AS, Magnusson B, Moller H. Metal sensitivity in patients with metal-to-plastic total hip arthroplasties. Acta Orthop Scand 1980;51:57–62.
   Jacobs JJ, Urban RM, Hallab NJ, et al. Metal-on-metal bearing surfaces. J Am Acad Orthop Surg 2009;17:69–76.
   Back DL, Young DA, Shimmin AJ. How do serum cobalt and chromium levels change after metal-on-metal hip resurfacing? Clin Orthop Relat Res 2005;438:177–81.
   Gleizes V, Poupon J, Lazennec JY, et al. Value and limits of determining serum cobalt levels in patients with metal on metal articulating prostheses. Rev Chir Orthop Reparatrice Appar Mot 1999;85:217–25.
   MacDonald SJ, McCalden RW, Chess DG, et al. Metal-on-metal versus polyethylene in hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res 2003;406:282–96.
   Schaffer AW, Pilger A, Engelhardt C, et al. Increased blood cobalt and chromium after total hip replacement. J Toxicol Clin Toxicol 1999;37:839–44.
   Thyssen JP, Jakobsen SS, Engkilde K, et al. The association between metal allergy, total hip arthroplasty, and revision. Acta Orthop 2009;80:646–52.
   Thomas P, Braathen LR, Dorig M, et al. Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and periimplant T-lymphocytic inflammation. Allergy 2009;64:1157–65.
   Reed KB, Davis MD, Nakamura K, et al. Retrospective evaluation of patch testing before or after metal device implantation. Arch Dermatol 2008;144:999–1007.
   Savarino L, Tigani D, Greco M, et al. The potential role of metal ion release as a marker of loosening in patients with total knee replacement: a cohort study. J Bone Joint Surg Br 2010;92:634–8.
   Thomas P, Schuh A, Eben R, et al. Allergy to bone cement components. Orthopไde 2008;37:117–20.
   Kuehn KD, Ege W, Gopp U. Acrylic bone cements: composition and properties. Orthop Clin North Am 2005;36:17–28.
   Haddad FS, Cobb AG, Bentley G, et al. Hypersensitivity in aseptic loosening of total hip replacements. The role of constituents of bone cement. J Bone Joint Surg Br 1996;78:546–9.
   Clementi D, Surace A, Celestini M, Pietrogrande V. Clinical investigations of tolerance to materials and acrylic cement in patients with hip prostheses. Ital JOrthop Traumatol 1980;6:97–104.
   Brendlinger DL, Tarsitano JJ. Generalized dermatitis due to sensitivity to a chrome cobalt removable partial denture. J Am Dent Assoc 1970;81:392–4.
   Glendenning WE. Allergy to cobalt in metal denture as cause of hand dermatitis. Contact Dermatitis Newsletter 1971;10:225–6.
   Veien NK, Borchost E, Hattel T, Lauberg G. Stomatitis or systemically-induced contact dermatitis from metal wire in orthodontic materials. Contact Dermatitis 1994;30:210–3.
   Guimaraens D, Gonzalez MA, Conde-Salazar L. Systemic contact dermatitis from dental crowns. Contact Dermatitis 1994;30:124–5.
   Kerouso H, Kanerva L. Systemic dermatitis caused by nickel in a stainless steel orthodontic appliance. Contact Dermatitis 1997;36: 112–3.
   DeSilva BD, Doherty VR. Nickel allergy from orthodontic appliances. Contact Dermatitis 2000;42:102–3.
   Pigaho PD, Guzzi G. Systemic contact dermatitis from nickel associated with orthodontic appliances. Contact Dermatitis 2004; 50:100–1.
   Pigatto PD, Zerboni R, Guzzi G. Local and systemic allergic contact dermatitis due to dental alloys. J Eur Acad Dermatol Venereol 2008;22:124–6.
   Segura-Egea JJ, Bull๓n-Fernandez P. Lichenoid reaction associated to amalgam restoration.Med Oral PatolOral Cir Bucal 2004;9:421–4.
   Laeijendecker R, Van Joost T. Oral manifestations of gold allergy. J Am Acad Dermatol 1994;30:205–9.
   Marcusson JA. Contact allergies to nickel sulfate, gold, sodium thiosulfate and palladium chloride in patients claiming sideeffects from dental alloy components. Contact Dermatitis 1996; 34:320–3.
   Nordlind K, Liden S. Patch test reactions to metal salts in patients with mucosal lesions associated with amalgam restorations. Contact Dermatitis 1992;27:157–60.
   Koch P, Bahmer FA. Oral lichenoid lesions, mercury hypersensitivity and combined hypersensitivity to mercury and other metals: histologically-proven reproduction of the reaction by patch testing with metal salts. Contact Dermatitis 1995;33:323–8.
   Laine J, Kalimo K, Happonen R-P. Contact allergy to dental restorative materials in patients with oral lichenoid lesions. Contact Dermatitis 1997;36:141–6.
   Yannias JA, el-Azhary RA, Hand JH, et al. Relevant contact sensitivities in patients with the diagnosis of oral lichen planus. J Am Acad Dermatol 2000;42:177–82.
   Scalf LA, Fowler JF Jr, Morgan KW, Looney SW. Dental metal allergy in patients with oral, cutaneous, and genital lichenoid lesions. Am J Contact Dermat 2001;12:146–50.
   Ahlgren C, Ahnlide I, Bjorkner B, et al. Contact allergy to gold is correlated to dental gold. Acta Derm Venereol 2002;82:41–4.
   Schaffran RM, Storrs FJ, Schalock P. Prevalence of gold sensitivity in asymptomatic individuals with gold dental restorations. Am J Contact Dermat 1999;10:201–6.
   Bruze M, Edman B, Bjorkner B, Moller H. Clinical relevance of contact allergy to gold sodium thiosulfate. J Am Acad Dermatol 1994;31:579–83.
   Vammes J, Morken T, Helland S, Gjerdet N. Dental gold alloys and contact hypersensitivity. Contact Dermatitis 2000;42:128–33.
   Mallo-Perez L, Diaz-Donado C. Intraoral contact allergy to materials used in dental practice. A critical review. Med Oral 2003;8:334–47.
   Vilaplana J, Romaguera C. Contact dermatitis and adverse oral mucous membrane reactions related to the use of dental prostheses. Contact Dermatitis 2000;43:183–4.
   Veien N. Stomatitis and systemic dermatitis from mercury in amalgam dental restorations. Contact Dermatitis 1990;8:157–60.
   Veien N. Clinical features. In: Rycroft R, Menne T, editors. Textbook of contact dermatitis. Berlin: Springer-Verlag; 1992. p. 154–204.
   Mortz CG, Lauritsen JM, Bindslev-Jensen C, Andersen KE. Nickel sensitization in adolescents and association with ear piercing, use of dental braces and hand eczema. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS). Acta Derm Venereol 2002;82:359–64.
   Martin JM, Nagore E, Cremades A, et al. An amalgam tattoo on the oral mucosa related to a dental prosthesis. J Eur Acad Dermatol Venereol 2005;19:90–2.
   Pigatto PD, Guzzi G, Persichini P, Barbadillo S. Recovery from mercury-induced burning mouth syndrome due to mercury allergy. Dermatitis 2004;15:75–7.
   Pigatto PD, Brambilla L, Guzzi G, Spadari F. Burning lips syndrome. Contact Dermatitis 2007;57:344–6.
   Lamey PJ, Lamb AB. Lip component of burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1994;78:590–3.
   Brown RS, Flaitz CM, Hays GL, Bottomley WK. Five cases of burning lips syndrome. Compend Contin Educ Dent 1996;17: 927–30.
   Dutree-Meulenberg RO, Kozel MM, van Joost T. Burning mouth syndrome: a possible etiologic role for local contact hypersensitivity. J Am Acad Dermatol 1992;26:935–40.
   Koch P, Bahmer FA. Oral lesions and symptoms related to metals used in dental restorations. A clinical, allergological and histologic study. J Am Acad Dermatol 1999;41:422–30.
   Koster R, Vieluf D, Kiehn M, et al. Nickel and molybdenum contact allergies in patients with coronary in-stent restenosis. Lancet 2000;356:1895–7.
   Iijima R, Ikari Y, Amiya E, et al. The impact of metallic allergy on stent implantation: metal allergy and recurrence of in-stent restenosis. Int J Cardiol 2005;104:319–25.
   Hillen U, Haude M, Erbel R, Goos M. Evaluation of metal allergies in patients with coronary stents. Contact Dermatitis 2002;47: 353–6.
   Norgaz T, Hobikoglu G, Serdar ZA, et al. Is there a link between nickel allergy and coronary stent restenosis? Tohoku J Exp Med 2005;206:243–6.
   Saito T, Hokimoto S, Oshima S, et al. Metal allergic reaction in chronic refractory in-stent restenosis. Cardiovasc Revasc Med 2009;10:17–22.
   Hansen PR, Ahlehoff O, Gislason GH, et al. Absence of metal allergy in patients with very late drug-eluting stent thrombosis: a pilot study. Int J Cardiol 2010;145:629–30.
   Svedman C, Ekqvist S, Moller H, et al. A correlation found between contact allergy to stent material and restenosis of the coronary arteries. Contact Dermatitis 2009;60:158–64.
   Bruze M, Andersen KE. Gold—a controversial sensitizer. Contact Dermatitis 1999;40:295–9.
   Svedman C, Tillman C, Gustavsson CG, et al. Contact allergy to gold in patients with gold-plated intracoronary stents. Contact Dermatitis 2005;52:192–6.
   Svedman C, Ekqcist S, Moller H, et al. Unexpected sensitization routes and general frequency of contact allergies in an elderly stented Swedish population. Contact Dermatitis 2007;56:338–43.
   vom Dahl J, Haager PK, Grube E, et al. Effects of gold of coronary stents on neointimal proliferation following stent implantation. Am J Cardiol 2002;89:801–5.
   Ekqvist S, Svedman C, Moller H, et al. High frequency of contact allergy to gold in patients with endovascular coronary stents. Br J Dermatol 2007;157:730–8.
   Park S-J, Lee CW, Hong M-K, et al. Comparison of goldcoated Nir stents with uncoated Nir stents in patients with coronary artery disease. Am J Cardiol 2002;89:872–5.
   Kastrati A, Schomig A, Dirschinger J, et al. Increased risk of restenosis after placement of gold-coated stents: results of a randomized trial comparing gold-coated stents with uncoated steel stents in patients with coronary artery disease. Circulation 2000; 101:2478–83.
   Fukahara K, Minami K, Reiss N, et al. Systemic allergic reaction to the percutaneous patent foramen ovale occluder. J Thorac Cardiovasc Surg 2003;125:213–4.
   Dasika UK, Kanter KR, Vincent R. Nickel allergy to the percutaneous patent foramen ovale occluder and subsequent systemic nickel allergy. J Thorac Cardiovasc Surg 2003;126:2112–3.
   Singh HR, Turner DR, Forbes TJ. Nickel allergy and the Amplatzer septal occluder. J Invasive Cardiol 2004;16:681–2.
   Gimenez-Arnau A, Riambau V, Serra-Baldrich E, Camarasa JG. Metal-induced generalized pruriginous dermatitis and endovascular surgery. Contact Dermatitis 2000;43:35–40.
   Raque C, Goldschmidt H. Dermatitis associated with an implanted cardiac pacemaker. Arch Dermatol 1970;102:646–9.
   Ishii K, Kodani E, Miyamoto S, et al. Pacemaker contact dermatitis: the effective use of a polytetrafluoroethylene sheet. Pacing Clin Electrophysiol 2006;29:1299–1302.
   Hiranaka T, Nomura F, Kurozumi K. Pacemaker contact dermatitis treated by wrapping with a polytetrafluoroethylene (PTFE) sheet. Jpn J Cardiac Pacing Electrophysiol 1992;8:335–8.
   Weiss R. Pacemaker dermatitis. Contact Dermatitis 1989;21:343–4.
   Buchet S, Blanc D, Humbert P, et al. Pacemaker dermatitis. Contact Dermatitis 1992;26:46–7.
   Tujita J, Nakamura K, Yasumoto S, Ueno Y. Pacemaker dermatitis: report of two cases. Nishinihon J Dermatol 1996;58:200–2.
   Dery JP, Gilbert M, O'Hara G, et al. Pacemaker contact sensitivity: case report and review of the literature. Pacing Clin Electrophysiol 2002;25:863–5.
   Freeman S. Allergic contact dermatitis to titanium in a pacemaker. Contact Dermatitis 2006;55:41.
   Kono K, Hara K, Higashi T, et al. Pacemaker contact dermatitis treated with polytetrafluoroethylene sheet. J Arrhythmia 2000;16: 403–7.
   Iguchi N, Kasanuki H, Matsuda N, et al. Contact sensitivity to polychloroparaxylene coated cardiac pacemaker. Pacing Clin Electrophysiol 1997;20:372–3.
   Abdallah HI, Balsara RK, O'Riordan AC. Pacemaker contact sensitivity: clinical recognition and management. Ann Thorac Surg 1994;57:1017–8.
   Hayes DL, Loesl K. Pacemaker component allergy: case report and review of the literature. J Interv Card Electrophysiol 2002;6:277–8.
   Purello D'Ambrosio F, Ricciardi L, Isola S, et al. Systemic contact dermatitis to copper-containing IUD. Allergy 1996;51:658–9.
   Rongioletti F, Rivara G, Rebora A. Contact dermatitis to a coppercontaining intra-uterine device. Contact Dermatitis 1985;13:343.
   Pujol RM, Randazzo L, Miralles J, Alomar A. Perimenstrual dermatitis secondary to a copper-containing intrauterine contraceptive device. Contact Dermatitis 1998;38:288.
   Chapman L, Magos A. Female sterilization. Expert Rev Med Devices 2008;5:525–37.
   Merritt K, Rodrigo JJ. Immune response to synthetic materials. Sensitization of patients receiving orthopaedic implants. Clin Orthop 1996;326:71–9.
   Bruze M. Thoughts on implants and contact allergy. Arch Dermatol 2008;144:1042–4.
   Eben R, Dietrich KA, Nerz C, et al. Contact allergy to metals and bone cement components in patients with intolerance of arthroplasty. Dtsch Med Wochenschr 2010;135:1418–22.
   Verma SB, Mody B, Gawkrodger J. Dermatitis on the knee following knee replacement: a minority of cases show contact allergy to chromate, cobalt or nickel but a causal association is unproven. Contact Dermatitis 2006;54:228–9.
   Gao X, He RX, Yan SG, Wu LD. Dermatitis associated with chromium following total knee arthroplasty. J Arthroplasty, [Epub 2010 Jul 19].
   Handa S, Dogra S, Prasad R. Metal sensitivity in a patient with a total knee replacement. Contact Dermatitis 2003;49:259–60.
   Beecker J, Gordon J, Pratt M. An interesting case of joint prosthesis allergy. Dermatitis 2009;20:E4–9.
   Mikhael MM, Hanssen AD, Sierra RJ. Failure of metal-on-metal total hip arthroplasty mimicking hip infection. A report of two cases. J Bone Joint Surg Am 2009;91:443–6.
   Campbell P, Shimmin LW, Solomon M. Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. J Arthroplasty 2008;23:1080–5.
   Jensen P, Thyssen JP, Retpen JB, Menne T. Cobalt allergy and suspected aseptic lymphocyte-dominated vascular-associated lesion following total hip arthroplasty. Contact Dermatitis 2009; 61:238–9.
   Counsell A, Heasley R, Arumilli B, Paul A. A groin mass caused by metal particle debris after hip resurfacing. Acta Orthop Belg 2008; 74:870–4.
   Pandit H, Vlychou M, Whitwell D, et al. Necrotic granulomatous pseudotumours in bilateral resurfacing hip arthroplasties: evidence for a type IV immune response. Virchows Arch 2008;453:529–34.
   Pandit H, Glyn-Jones S, McLardy-Smith P, et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br 2008;90:847–51.
   Benevenia J, Lee FY, Buechel F, Parsons JR. Pathologic supracondylar fracture due to osteolytic pseudotumor of knee following cementless total knee replacement. J Biomed Mater Res 1998;43:473–7.
   Dietrich KA, Mazoochian F, Summer B, et al. Intolerance reactions to knee arthroplasty in patients with nickel/cobalt allergy and disappearance of symptoms after revision surgery with titaniumbased endoprostheses. J Dtsch Dermatol Ges 2009;7:410–2.
   Thomas P, Schuh A, Summer B, et al. Allergy towards bone cement. Orthopade 2006;35:956–958–60.







ท  Metal Allergens of Growing Significance: Epidemiology, Immunotoxicology, Strategies for Testing and Prevention. Forte G. et al. Inflamm Allergy Drug Targets. 2008 Sep;7(3):145-62.

ท  Full-mouth oral rehabilitation in a titanium allergy patient using zirconium oxide dental implants and zirconium oxide restorations. A case report from an ongoing clinical study.
Oliva X. et al. Eur J Esthet Dent. 2010 Summer;5(2):190-203.

ท  Study on patch test reagent for titanium. Nakajima K. Kokubyo Gakkai Zasshi. 2007 Jun;74(2):92-8.

ท  Allergies to dental metals. Titanium: a new allergen. Evrard L, Waroquier D, Parent D. Rev Med Brux. 2010 Jan-Feb;31(1):44-9.

ท  Implant failure due to Titanium hypersensitivity/allergy? – Report of a case SADJ February 2007

ท  Ultrafine titanium dioxide particles in the absence of photoactivation can induce oxidative damage to human bronchial epithelial cells Toxicology 2005

ท  Titanium particles stimulate bone resorption by inducing differentiation of murine osteoclast J Bone Joint Surg Am. 2001

ท  Immunohistochemical study of the soft tissue around long-term skin-penetrating titanium implants Biomaterials 1995

ท  Titanium dermatitis after failure of metal-backed patellas, Am J Knee Surg 1993

ท  In vitro corrosion of titanium Biomaterials. 1998

ท  Sensitivity to titanium. A cause of implant failure? Bone Joint Surg Br. 1991

ท  A case of allergic reaction to surgical metal clips inserted for postoperative boost irradiation in a patient undergoing breast-conserving therapy Breast Cancer. 2001

ท  Biocompatibility of dental casting alloys Crit Rev Oral Biol Med. 2002

ท  Validity of MELISAฎ for metal sensitivity testing Neuro Endocrinol Lett. 2003

ท  Das Allergiepotenzial von Implantatwerkstoffen auf Titanbasis A. Schuh, et al. Der Orthopไde
Volume 34, Number 4, 327-33

ท  Tissue reaction to bone plates made of pure titanium: a prospective, quantitative clinical study.
A. Ungersboeck, et al. Journal of Materials Science: Materials in Medicine
Volume 6, Number 4, 223-229

ท  Maternal exposure to nanoparticulate titanium dioxide during the prenatal period alters gene expression related to brain development in the mouse.
M Shimizu et al.Particle and Fibre Toxicology 2009, 6:20


------------------------------------------------------------------------

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.

http://www.melisa.org/

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.

Take care.

Mark

Answer
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.

Dentistry

All Answers


Answers by Expert:


Ask Experts

Volunteer


Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

©2016 About.com. All rights reserved.