Casting Alloys: Side-Effects

Abstract

Side-effects from dental materials are a minor problem, but should be recognized. In recent questionnaire surveys about side-effects, the incidence was estimated to be 1:300 in periodontics and 1:2600 in pedodontics. None of these reactions was related to dental casting alloys. In prosthodontics, the incidence was calculated to be about 1:400, and about 27% were related to base-metal alloys for removable partial dentures (cobalt, chromium, nickel) and to noble/gold-based alloys for porcelain-fused-to-metal restorations. The complaints consisted of intra-oral reactions (such as redness, swelling, and pain of the oral mucosa and lips), oral/gingival lichenoid reactions, and a few instances of systemic reactions. In orthodontics, the incidence was 1:100, and most reactions (85%) were related to metal parts of the extra-oral anchorage devices. Even though the extensive use of base-metal alloys has been of major concern to the dental profession, relatively few case reports substantiate this concern. Allergy to gold-based dental restorations has been more commonly reported. Palladium-based alloys have been associated with several cases of stomatitis and oral lichenoid reactions. Palladium allergy seems to occur mainly in patients who are very sensitive to nickel. All casting alloys, except titanium, seem to have a potential for eliciting adverse reactions in individual hypersensitive patients. Tolerance induction may be a possible benefit of the use of intra-orally placed alloys. In non-sensitized individuals, oral antigenic contacts to nickel and chromium may induce tolerance rather than sensitization. A variety of systemic diseases and reactions has been claimed to be caused by dental materials. The claims are generally poorly documented.

Biodegradation Of Nickel And Chromium From Stainless Steel Crowns And Space Maintainers - An In Vitro Study

“…The potential health effects from exposure to nickel and chromium and their compounds have been scrutinized for more than 100 years, and it was established that these metals could cause hypersensitivity(l,2,3,4), allergic dermatitis, asthma and ulcers of mucous membrane. (5,6) The nickel one of the most common allergens and the most potent sensitizer of all metals has been described as "ubiquitous contact allergens" . (7) It has been shown (2,6,8,9) that patients who are allergic to nickel will also react to certain nickel chromium dental alloys.…”

An Overview of Adverse Reactions Caused by Prosthetic Biomaterials

“…However, no correlation seems to exist between mucosal reactions to fixed prostheses and corrosion and tarnish [26]. This lack of correlation may indicate that the biological reactions observed are caused by factors other than the material per se.…”

“…Palladium alloys are generally better tolerated than base-metal alloys or gold alloys for metal-ceramic restorations, although they tend to tarnish more than other casting alloys. Palladium alloys have also been reported to cause adverse reactions, and palladium may be linked to cross-reactivity with Ni [26]. Cadmium has been used in solders, but its presence is not considered to have an effect on patients because of the minimal amounts present.…”

The Challenge for Innovation in Direct Restorative Materials

“…Epidemiological data on the frequency of adverse effects caused by dental materials are sparse, but estimates are low (< 0.1%) (Hensten-Pettersen, 1992). For comparison, cosmetics have an adverse effect rate of 12% (Orton and Wilkinson, 2004).…”