Type IV Cell-Mediated Hypersensitivity Reaction Caused by Titanium Implant Following Double Calcaneal Osteotomy and First Metatarsal-Cuneiform Arthrodesis: A Case Report and Review of the Literature

Razzante, Mark C.; Ehredt, Duane J.; Clougherty, Coleman O.; Kriger, Stephen J.; Menninger, Brennan A.; Dionisopoulos, Shontal Behan; Bhakta, Parth J.; Bruning, Nicholas G.

doi:10.1053/j.jfas.2018.11.031

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…It is worth mentioning that, sometimes, it is possible to notice “metal-like” unstained particles located in the peri-implant tissues. Spectroscopic techniques identified this foreign material as Ti particles or particles originated from other metals belonging to dental implant components [ 7 , 12 , 13 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…In regards to Ti implant failures, they are generally linked to biologically related complications, more specifically recognized as peri-implant mucositis and peri-implantitis [ 8 , 9 , 10 , 11 , 12 , 13 ]. Besides disease entities induced by dental biofilms, another biological issue is related to allergic reactions to Ti.…”

Section: Introductionmentioning

confidence: 99%

“…Given what has been analysed in the literature so far, there is no conclusive evidence that directly relates Ti allergy to dental implant failure. A literature review has shown the development of pyogenic granulomas and haemangiomas after dental implant installation [ 12 , 13 , 16 ]. Some of these cases exhibited metal particles in the histopathological analysis as a possible consequence of tribocorrosion.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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(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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The material was extracted and converted to external fixation; during this second surgery, samples for histological examination ware taken, which revealed obvious marks of acute skin and dermis inflammation without any signs of osteomyelitis. After the conversion, the problems regressed (25). The positivity of the patch test should be pointed out -in such an extreme case, even the patch test proved the reaction.…”

Section: Dental Implantsmentioning

confidence: 97%

Type IV Titanium Hypersensitivity: Rare, or Rarely Detected?

VOVES,

MĚRKA,

ČABANOVÁ

et al. 2023

Acta Chir. orthop. Traum. Cech.

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The presented review aims to summarize the current knowledge of hypersensitivity to titanium -a material widely used in medical applications thanks to its exceptional chemical stability, resistance to corrosion, low specific weight and high strength. The hypersensitivity to metals is usually caused by the Type IV immunopathological reaction. Case reports on allergic reactions to titanium are rare but the actual occurrence can be expected to be much higher, especially due to its problematic detection. Although cutaneous patch tests are widely accepted and used for the diagnosis of hypersensitivity of numerous metals (e.g. Ni), it is notoriously unreliable in case of allergies to titanium, which may be associated with the low percutaneous transport of titanium and its salts. The Lymphocyte Transformation Test has superior sensitivity but it remains mostly unknown among clinicians and there are not many laboratories capable of performing it. This review presents numerous case reports indicating, in combination with the above-mentioned facts, that hypersensitivity to titanium should be considered as a possible cause also in non-specific problems associated with titanium implant failure.

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“…For medical applications, especially dispersion ceramics like alumina toughened zirconia (ATZ) ceramics as well as ZTA (zirconia toughened alumina) are reliable materials, since they ideally combine a good biocompatibility (inertness) with a high wear resistance, exceptional hardness, high mechanical strength, and slow hydrothermal aging [17][18][19]. In addition to their outstanding biomechanical properties, the fast and stable ingrowth of host tissue into superficial implant structures is advantageous to inhibit intolerances, hypersensitivities, or allergic reactions, and to promote good osseointegration [20][21][22]. Crucial for this purpose is the availability of a defined pore gradient as a combination, for example from nano-, microand macrostructures which might combine complex microstructures and fine features on the nanoscale [23].…”

Section: Introductionmentioning

confidence: 99%

Process Development for Additive Manufacturing of Alumina Toughened Zirconia for 3D Structures by Means of Two-Photon Absorption Technique

et al. 2021

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Additive manufacturing is well established for plastics and metals, and it gets more and more implemented in a variety of industrial processes. Beside these well-established material platforms, additive manufacturing processes are highly interesting for ceramics, especially regarding resource conservation and for the production of complex three-dimensional shapes and structures with specific feature sizes in the µm and mm range with high accuracy. The usage of ceramics in 3D printing is, however, just at the beginning of a technical implementation in a continuously and fast rising field of research and development. The flexible fabrication of highly complex and precise 3D structures by means of light-induced photopolymerization that are difficult to realize using traditional ceramic fabrication methods such as casting and machining is of high importance. Generally, slurry-based ceramic 3D printing technologies involve liquid or semi-liquid polymeric systems dispersed with ceramic particles as feedstock (inks or pastes), depending on the solid loading and viscosity of the system. This paper includes all types of photo-curable polymer-ceramic-mixtures (feedstock), while demonstrating our own work on 3D printed alumina toughened zirconia based ceramic slurries with light induced polymerization on the basis of two-photon absorption (TPA) for the first time. As a proven exemplary on cuboids with varying edge length and double pyramids in the µm-range we state that real 3D micro-stereolithographic fabrication of ceramic products will be generally possible in the near future by means of TPA. This technology enables the fabrication of 3D structures with high accuracy in comparison to ceramic technologies that apply single-photon excitation. In sum, our work is intended to contribute to the fundamental development of this technology for the representation of oxide-ceramic components (proof-of-principle) and helps to exploit the high potential of additive processes in the field of bio-ceramics in the medium to long-term future.

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Type IV Cell-Mediated Hypersensitivity Reaction Caused by Titanium Implant Following Double Calcaneal Osteotomy and First Metatarsal-Cuneiform Arthrodesis: A Case Report and Review of the Literature

Cited by 5 publications

References 30 publications

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

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

Type IV Titanium Hypersensitivity: Rare, or Rarely Detected?

Process Development for Additive Manufacturing of Alumina Toughened Zirconia for 3D Structures by Means of Two-Photon Absorption Technique

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