Titanium Allergy Caused by Dental Implants: A Systematic Literature Review and Case Report

Abstract

(1) Background: Hypersensitivity reactions to metals may arise in predisposed patients chronically exposed to metallic materials, including dental implants made of titanium alloys. The purpose of this article was to systematically review titanium allergy manifestations in patients treated with dental implants and report a clinical case; (2) Methods: A systematic electronic search was performed for articles published in the English language until July 2021. The following eligibility criteria were adopted: (1) Population: individuals undergoing titanium and/or titanium alloy implant-supported rehabilitations; (2) Exposure: peri-implant soft tissue reactions attributable to implant insertion; (3) Outcome: evidence of titanium allergy, diagnostic methods, and forms of resolution; (3) Results: The included studies, in summary, presented evidence that titanium should not be considered an inert material, being able to trigger allergic reactions, and may be responsible for implant failure. A 55-year-old male patient received 3 implants in the posterior region of the left mandible and presented an epulis-like lesion developed from the peri-implant mucosa. The immunohistochemical analysis of the biopsy specimen confirmed the initial diagnosis of allergic reaction to titanium; (4) Conclusions: Although the evidence is weak, and titanium allergy has a low incidence, hypersensitivity reactions should not be underestimated. A rapid and conclusive diagnosis is mandatory to prevent further complications.

Effect of restoration material on marginal bone resorption around modified anatomic zirconia dental implants: A randomised controlled trial

“…However, titanium dental implants possess unaesthetic color. Also, allergic reactions to titanium have been reported [ 11 ]. Zirconia appears to be a suitable implant material due to its tooth-like color, mechanical properties, biocompatibility and low plaque affinity [ 12 , 13 ].…”

Reações alérgicas e suas manifestações na odontologia: revisão integrativa

“…O titânio vem sendo muito utilizado na odontologia para implantes dentários, coroas, pontes e aparelhos ortodônticos devido a sua capacidade de induzir a osseointegração, a sua elevada biocompatibilidade e a sua resistência (Poli et al, 2021).…”

“…Portanto, chegaram à conclusão que reações cruzadas com outros metais podem causar alergia ao titânio e pacientes que continham implantes dentários apresentaram maior prevalência de reações alérgicas quando comparados ao grupo que não possuíam. Poli et al (2021) realizaram uma revisão sistemática da literatura sobre alergia a implantes dentários de titânio e relataram o caso de um paciente que após cinco meses da instalação de dois implantes dentários foi observado uma área mesial ao implante com um tecido queratinizado e nessa área não foi detectada nenhuma lesão, sugerindo que a presença desse tecido poderia ser capaz de proteger os tecidos de uma potencial alergia. Também foi observada uma lesão epúlide a qual passou por uma biópsia constatando um infiltrado inflamatório contendo eosinófilos e neutrófilos polimorfonucleares sendo sugestivo o caso de uma reação alérgica em que o paciente foi submetido a testes alérgicos e respondeu positivamente aos compostos de titânio confirmando a hipótese de alergia.…”

Recent Advancements in Metallic Drug-Eluting Implants

“…In order to influence the regeneration process dynamically, they are first supposed to interfere with the response of the host body, then increase the integration with the implant, promote osteoconduction and the angiogenesis on the surface of them, and finally slow down the microbial infection process. All these steps will lead to increased tissue healing speed [ 16 , 17 , 18 ]. It is particularly promising to use localized therapeutic strategies because they have a better bioavailability, and they result in immediate bone healing as opposed to systemic therapies [ 19 , 20 , 21 ].…”