Importante sobre implantes

Transcription

1 Importante sobre implantes Alergias en implantes de titanio. Resultados de un test Melisa ( M ELISA = memory lymphocyte immunostimulation assay ) Comparación entre zirconio y titanio. Madrid / Junio 2012

2 contenido Estudios sobre las alergias que pueden producir los implantes de titanio (a pesar de que aparentemente no existen) Pagina: Full-mouth oral rehabilitation in a titanium allergy patient using zirconium oxide dental implants and zirconium oxide restorations. Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients. Is Titanium Sensitivity Associated with Allergic Reactions in Patients with Dental Implants? A Systematic Review. Titanium allergy: could it affect dental implant integration? Allergies to dental metals. Titanium: a new allergen. Suspected association of an allergic reaction with titanium dental implants: a clinical report. Diagnosis and treatment of metal-induced side-effects. Hypersensitivity to titanium: clinical and laboratory evidence. Host response to titanium dental implant placement evaluated in a human oral model. Immunocompetent cells adjacent to stainless steel and titanium miniplates and screws. Tissue reaction involving an intraoral skin graft and CP titanium abutments: a clinical report. Estudios realizados en: España, Barcelona, Clínica Oliva España, Oviedo, Clínica Sicilia Varios Nueva Zelanda, Bélgica, Bruselas, Japón, Osaka, Checoslovaquia, Praga Alemania, Isny Noruega, Stavanger Noruega, Haukeland EEUU, Maryland

3 Eur J Esthet Dent Summer;5(2): 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, Oliva J, Oliva JD. Clinica Oliva, Barcelona, Spain. info@clinicaoliva.com This case report describes the full-mouth oral rehabilitation of a titanium allergic patient. The patient was a young female with amelogenesis imperfecta who had generalized massive tooth destruction. All teeth in the mouth were extracted and 15 CeraRoot acid-etched (ICE surface) implants were placed (seven implants in the maxilla and eight implants in the mandible). No immediate temporaries were placed. Temporaries were placed 3 months after surgery, and left in function for 2 months. The case was finally restored with zirconium oxide bridges and ceramic veneering (three bridges in the maxilla and another three in the mandible). The 3-year follow-up showed good stability of soft tissues and bone level. Zirconium oxide implants and restorations might be an alternative for the oral rehabilitation of titanium allergic patients. Página 3

4 Clin Oral Implants Res Aug;19(8): Titanium alergia en los pacientes con implantes dentales: un estudio clínico en pacientes consecutivos. Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients. Sicilia A, Cuesta S, Coma G, Arregui I, Guisasola C, Ruiz E, Maestro A. Clinica Sicilia, Oviedo, Spain. asicilia@clinicasicilia.com BACKGROUND: In dentistry, allergic reactions to Ti implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to nonspecific immune suppression. OBJECTIVE: Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material. MATERIAL AND METHODS: Thirty-five subjects out of 1500 implant patients treated and/or examined ( ) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out. RESULTS: Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)(P=0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight). CONCLUSIONS: Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing postop allergy compatible response (ACRG), in which cases allergy tests could be recommended Página 4

5 Clin Implant Dent Relat Res Mar 17. doi: /j x. [Epub ahead of print] Is Titanium Sensitivity Associated with Allergic Reactions in Patients with Dental Implants? A Systematic Review. Javed F, Al-Hezaimi K, Almas K, Romanos GE. Research associate, Eng A B Growth Factors and Bone Regeneration Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; assistant professor, Eng A B Growth Factors and Bone Regeneration Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; associate professor, Division of Periodontology, School of Dental Medicine, University of Connecticut, Farmington, CT, USA; professor, Eastman Institute for Oral Health, Division of Periodontology, University of Rochester, Rochester, NY, USA. Background: A worrying correlation which seems to be overlooked by clinicians is allergic reactions to titanium (Ti) in patients with dental implants. Purpose: The aim of the present review study was to assess whether or not Ti sensitivity is associated with allergic reactions in patients with dental implants. Materials and Methods: To address the focused question "Can Ti cause allergic reactions in patients with dental implants?", databases were explored from 1977 until May 2010 using a combination of the following keywords: "allergy,""dental,""hypersensitivity,""implant,""oral," and "Titanium." Letters to the editor and unpublished data were excluded. Results: Seven studies (six clinical and one experimental) were included. The participants were aged between 14.3 and 84.1 years. In five clinical studies, Ti implants were inserted in the mandible. Five studies reported dermal inflammatory conditions and gingival hyperplasia as allergic reactions in patients with Ti dental implants. A case report presented swelling in submental and labial sulcus and hyperemia of soft tissues in a patient with Ti dental implants. Two studies reported that Ti implants are well tolerated in host tissues. The patch test was performed in two clinical studies for the diagnosis of allergic reactions. Memory lymphocyte immunostimulation assay and lymphocyte transformation tests were also performed. Conclusion: The significance of Ti as a cause of allergic reactions in patients with dental implants remains unproven Página 5

6 Clin Oral Implants Res Jul;22(7): doi: /j x. Epub 2011 Jan 20. Titanium allergy: could it affect dental implant integration? Siddiqi A, Payne AG, De Silva RK, Duncan WJ. Oral Implantology Research Group, Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand. PURPOSE: Degradation products of metallic biomaterials including titanium may result in metal hypersensitivity reaction. Hypersensitivity to biomaterials is often described in terms of vague pain, skin rashes, fatigue and malaise and in some cases implant loss. Recently, titanium hypersensitivity has been suggested as one of the factors responsible for implant failure. Although titanium hypersensitivity is a growing concern, epidemiological data on incidence of titanium-related allergic reactions are still lacking. MATERIALS AND METHODS: A computer search of electronic databases primarily MEDLINE and PUBMED was performed with the following key words: 'titanium hypersensitivity', 'titanium allergy', 'titanium release' without any language restriction. Manual searches of the bibliographies of all the retrieved articles were also performed. In addition, a complementary hand search was also conducted to identify recent articles and case reports. RESULTS: Most of the literature comprised case reports and prospective in vivo/in vitro trials. One hundred and twenty-seven publications were selected for full text reading. The bulk of the literature originated from the orthopaedic discipline, reporting wear debris following knee/hip arthroplasties. The rest comprised osteosynthesis (plates/screws), oral implant/dental materials, dermatology/cardiac -pacemaker, pathology/cancer, biomaterials and general reports. CONCLUSION: This review of the literature indicates that titanium can induce hypersensitivity in susceptible patients and could play a critical role in implant failure. Furthermore, this review supports the need for long-term clinical and radiographic follow-up of all implant patients who are sensitive to metals. At present, we know little about titanium hypersensitivity, but it cannot be excluded as a reason for implant failure. Página 6

7 Allergies to dental metals. Titanium: a new allergen. Evrard L, Waroquier D, Parent D. Service de Stomatologie et de Chirurgie Maxillo-faciale, Hôpital Erasme, Bruxelles. levrard@ulb.ac.be Oral allergies are underdiagnosed by dental health professionals. Patients with an oral allergy complain of various symptoms such as burning or tingling sensations, with or without oral dryness or loss of taste, or of more general symptoms such as headache, dyspepsia, asthenia, arthralgia, myalgia. The signs of oral allergy include erythema, labial oedema or purpuric patches on the palate, oral ulcers, gingivitis, geographical tongue, angular cheilitis, perioral eczematous eruption, or lichenoid reactions localized on the oral mucosa. There is an increase in the prevalence of oral allergies to metals used in dental materials. Allergy to gold included in dental prosthesis has been well documented since the years eighties. Recently, titanium, used in orthopedic devices and oral implants, considered as an inert material, can induce toxicity or allergic type I or IV reactions. These reactions to titanium could be responsible for unexplained successive failure cases of dental implants in some patients (named "cluster patients"). The risk of an allergy to titanium is increased in patients who are allergic to other metals. In these patients, an evaluation of allergy is recommended, in order to exclude any problem with titanium medical devices. We stress the importance of a multidisciplinary approach to take into account patients with an oral allergy, with participation of specialists from dental and dermatologic fields. Página 7

8 J Prosthet Dent Nov;100(5): Suspected association of an allergic reaction with titanium dental implants: a clinical report. Egusa H, Ko N, Shimazu T, Yatani H. Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan. Recent reports have questioned whether metal sensitivity may occur after exposure to titanium. This clinical report demonstrates the emergence of facial eczema in association with a titanium dental implant placed for a mandibular overdenture supported by 2 implants. Complete remission was achieved by the removal of the titanium material. This clinical report raises the possibility that in rare circumstances, for some patients, the use of titanium dental implants may induce an allergic reaction. Página 8

9 Neuro Endocrinol Lett Dec;27 Suppl 1:7-16. Diagnosis and treatment of metal-induced side-effects. Stejskal V, Hudecek R, Stejskal J, Sterzl I. Dept. of Immunology and Microbiology, 1st Medical Faculty, Charles University Prague, Czech Republic. ERRATUM IN Neuro Endocrinol Lett Oct;28(5):iii. Environmental factors are recognized as a cause of the increasing frequency of allergic and autoimmune diseases. In addition to external pollutants, metal ions released from dental restorations or from other body implants might trigger inflammation in susceptible subjects. In humans, genes governing metal-induced inflammation and autoimmunity are not yet known. In clinical praxis, metal-sensitive patients will present various symptoms ranging from oral mucosal changes and skin disease to excessive fatigue and autoimmune diseases. Since genetic markers of genetic susceptibility in man are not known, one has to rely on the phenototypic markers. Such biomarkers might be certain detoxification enzymes but also the presence of metal-specific memory cells in the blood. With the increasing use of metal implants in medicine and dentistry, it is important to have a proper tool for the diagnosis of metal allergy in susceptible subjects. After nickel, gold is now the second most common sensitizer. In addition to patch test, an in vitro blood test, an optimized commercially available lymphocyte transformation test (MELISA) is discussed. Both tests were used for the diagnosis of metal allergy in a selected group of 15 patients who suffered from clinical metal sensitivity in addition to other health problems. The concordance of the two tests was good but MELISA detected more metal allergies than patch test. The removal of incompatible dental material (RID) resulted in long-term health improvement in the majority of patients. We postulate that in vivo, metal ions activate T-cells, initiating systemic inflammation, which, through cytokines, affects the brain and hypothalamus-pituitary-adrenal axis. We postulate that in vivo metal ions will activate T-cells starting systemic inflammation which, through cytokines affect Página 9

10 Neuro Endocrinol Lett Dec;27 Suppl 1:31-5. Hypersensitivity to titanium: clinical and laboratory evidence. Müller K, Valentine-Thon E. Practice for Dermatology and Environmental Medicine, Isny, Germany. ERRATUM IN Neuro Endocrinol Lett Oct;28(5):iii. OBJECTIVES: This study was carried out to investigate the potential of titanium to induce hypersensitivity in patients chronically exposed to titanium-based dental or endoprosthetic implants. METHODS: Fifty-six patients who had developed clinical symptoms after receiving titanium-based implants were tested in the optimized lymphocyte transformation test MELISA against 10 metals including titanium. Out of 56 patients, 54 were patch-tested with titanium as well as with other metals. The implants were removed in 54 patients (2 declined explantation), and 15 patients were retested in MELISA. RESULTS: Of the 56 patients tested in MELISA, 21 (37.5%) were positive, 16 (28.6%) ambiguous, and 19 (33.9%) negative to titanium. In the latter group, 11 (57.9%) showed lymphocyte reactivity to other metals, including nickel. All 54 patch-tested patients were negative to titanium. Following removal of the implants, all 54 patients showed remarkable clinical improvement. In the 15 retested patients, this clinical improvement correlated with normalization in MELISA reactivity. CONCLUSION: These data clearly demonstrate that titanium can induce clinically-relevant hypersensitivity in a subgroup of patients chronically exposed via dental or endoprosthetic implants. Página 10

11 J Periodontol Jul;77(7): Host response to titanium dental implant placement evaluated in a human oral model. Flatebø RS, Johannessen AC, Grønningsaeter AG, Bøe OE, Gjerdet NR, Grung B, Leknes KN. Department of Oral Sciences - Periodontology, Faculty of Dentistry, University of Bergen, Bergen, and Department of Oral and Maxillofacial Surgery, Stavanger University Hospital, Stavanger, Norway. BACKGROUND: Recent reports have questioned if metal sensitivity may arise from exposure to titanium. The objective of this study was to histologically evaluate non-perforated mucosa covering submerged maxillary titanium implants with regard to induced tissue reactions. METHODS: Thirteen patients, 21 to 69 years of age, without previous implants were included. After initial examination, the bone crest areas destined for dental implant placement were exposed, and threaded external hex dental implants were inserted. Prior to wound closure, a full mucosal tissue slice was biopsied from the edge of the mucoperiosteal flap (baseline). The patients were monitored monthly for 6 months. At the abutment connection, biopsies were taken by a 6-mm punch, altogether yielding 26 specimens. Tissue reactions were analyzed by coded histometric analysis at four defined areas at increasing distance from the oral epithelium, including ratios of inflammatory cells (IC)/epithelial cells, IC/fibroblasts, and number of dense particles. RESULTS: The stained sections portrayed gingival tissue with intact oral epithelium and connective tissue with variable accumulation of IC. Experimental biopsies demonstrated mineralized areas and dense particles of different sizes. Analysis of variance revealed a higher IC/fibroblast ratio for level 3 at baseline compared to level 3 at 6 months (P<0.01). Furthermore, a significant decrease in IC/ fibroblast ratio was observed between levels 2 and 3 and 2 and 4 at 6 months (P<0.001). The connective tissue level facing the cover screw contained the highest number of dense particles (P<0.01). CONCLUSIONS: Tissue sensitivity reactions to titanium implants were not disclosed. All 6-month biopsies contained dense particles that were most likely metals. Página 11

12 Eur J Oral Sci Feb;103(1): Immunocompetent cells adjacent to stainless steel and titanium miniplates and screws. Torgersen S, Moe G, Jonsson R. Department of Dental Biomaterials, School of Dentistry, Haukeland Hospital, Norway. Subepithelial soft tissue and bone obtained from the implant bed in the vicinity of stainless steel and titanium miniplates and screws were evaluated with respect to the presence of immunocompetent cells. The study included tissue specimens from 19 patients, in whom the implants (14 stainless steel and 5 titanium) had been in situ for more than 6 months. The ABC (avidin-biotincomplex) immunoperoxidase staining technique using monoclonal antibodies defining T lymphocytes (CD3+), macrophages (CD11c+) and Class II MHC (HLA-DR) was performed on EDTA demineralized, frozen bone tissue, and on fresh frozen soft tissue specimens. The results showed scattered T lymphocyte clusters, small numbers of macrophages and abundant expression of HLA-DR in the soft tissue adjacent to both stainless steel and titanium implants. There was no substantial difference in tissue reactions between implants of the two materials. The demineralized bone sections disclosed presence of immunocompetent cells in the connective tissue lining the periphery of the screw holes. Metal particles were seen in both the soft tissue and the bone specimens. We conclude that a mild tissue reaction takes place in the vicinity of miniplates and screws of stainless steel and titanium, and that the intensity of the reaction indicates that the implants are well tolerated by the host tissue. Página 12

13 Int J Oral Maxillofac Implants Spring;5(1): Tissue reaction involving an intraoral skin graft and CP titanium abutments: a clinical report. Mitchell DL, Synnott SA, VanDercreek JA. Prosthodontics Department, National Naval Dental Center, Bethesda, Maryland. Focal areas of gingival hyperplasia surrounding the transmucosal portions of titanium implants have been attributed to poor hygiene, lack of attached gingival tissues, and titanium allergy. Following mandibular vestibuloplasty and placement of a split-thickness skin graft, two of five patients developed persistent proliferation of the epithelial tissue surrounding endosseous CP titanium dental implants. In both circumstances, traditional gingivectomy procedures, chemotherapeutic agents, and aggressive oral hygiene measures failed to adequately control the hyperplastic response. Following replacement of the titanium abutments with custom-fabricated gold abutments, the epithelial condition appeared to return to normal. Página 13

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