Runny nose

Can you be allergic to implants? What to do if you are allergic to dentures

Only 4% of people are allergic to dental implants. This is, as a rule, a delayed reaction to metals that are present in the dentist’s instruments or dentures themselves, namely:

titanium;
vanadium;
nickel;
tin;
zinc;
copper;
silver;
gold;
platinum;
stainless steel;
molybdenum;
cobalt;
chromium.

This is the most common list of metals used in modern dentistry.

Algorithm for the development of allergies to implants

The mechanism of development of this type of allergic reaction is as follows:

The metal implanted in the jaw comes into contact with body fluids and corrodes.
Metal salts (iron, cobalt, etc.) dissolved in biological fluids play the role of electrolytes.
Ions are released that can form organometallic complexes with body proteins. An allergy to a dental implant appears.

The duration of this process is usually 3-7 days.

Symptoms of the disease

Allergies to dental implants are expressed as follows;

swelling of the gums, tongue, inner surface of the cheeks;
pain in the oral cavity of varying intensity;
dry mouth (or excessive salivation);
specific taste in the mouth;
sore throat;
coating on the tongue;
dry cough;
redness and swelling of mucous membranes;
swelling of the eyelids, lips, nose;
increase in temperature;
rashes on the mucous membranes, face and hands of various types;
Quincke's edema;
hypothermia;
attacks of suffocation.

In some cases, the tongue and gums may become very sore.

Photo of allergies to dental implants

Allergy treatment

Treatment of the disease with medications is carried out in extreme cases. Most often, it is enough to simply remove the implant from the oral cavity for the gradual disappearance of all symptoms of the disease.

Allergy to dental implants: prevention and treatment methods	Peculiarities
What to pay attention to after dental implantation	Slight redness and bleeding from the implantation area for 2 days is a normal reaction (gauze should be applied to the operated area).
	Mandatory oral hygiene to prevent the occurrence of infection. Do not press on the implant.
	It is mandatory to visit your doctor at the appointed time and follow all his recommendations.
Diet	After surgery, the following foods should not be eaten (especially for people prone to allergies): · zucchini; · legumes; · asparagus; · spinach; · herring; · flour products.
Drug treatment	An allergy to a dental implant may appear several days after surgery. It can be determined by the following characteristics: · stomatitis; · pain in the mouth; · metallic taste; inflammation of the lips and gums; · redness and erosion of the tongue. You must contact the clinic for examination and removal of the implant. In severe cases of an allergic reaction (swelling, difficulty breathing), antihistamines are prescribed (,).
People's Pharmacy	Skin rashes are treated with various compresses and lotions: · with apple or potato juice; · with a low concentration soda solution; · with goose fat and sea buckthorn; · with a decoction of chamomile or string.
Prevention	To prevent the development of the disease it is necessary: · follow a diet that includes a sufficient amount of fiber; · spend more time in the fresh air; · maintain a sleep schedule; · give up bad habits; · harden.

At the first symptoms of an allergy to implants, be it an acute reaction or delayed-type manifestations, you should immediately consult a doctor. Otherwise, swelling of the larynx may develop, which will block the airways.

Only 4% of people are allergic to dental implants. This is, as a rule, a delayed reaction to metals that are present in the dentist’s instruments or dentures themselves, namely:

titanium;
vanadium;
nickel;
tin;
zinc;
copper;
silver;
gold;
platinum;
stainless steel;
molybdenum;
cobalt;
chromium.

This is the most common list of metals used in modern dentistry.

Algorithm for the development of allergies to implants

The mechanism of development of this type of allergic reaction is as follows:

The metal implanted in the jaw comes into contact with body fluids and corrodes.
Metal salts (iron, cobalt, etc.) dissolved in biological fluids play the role of electrolytes.
Ions are released that can form organometallic complexes with body proteins. An allergy to a dental implant appears.

The duration of this process is usually 3-7 days.

Symptoms of the disease

Allergies to dental implants are expressed as follows;

swelling of the gums, tongue, inner surface of the cheeks;
pain in the oral cavity of varying intensity;
dry mouth (or excessive salivation);
specific taste in the mouth;
sore throat;
coating on the tongue;
dry cough;
redness and swelling of mucous membranes;
swelling of the eyelids, lips, nose;
increase in temperature;
rashes on the mucous membranes, face and hands of various types;
Quincke's edema;
hypothermia;
attacks of suffocation.

In some cases, the tongue and gums may become very sore.

Photo of allergies to dental implants

Allergy treatment

Allergy to dental implants: prevention and treatment methods	Peculiarities
What to pay attention to after dental implantation	Slight redness and bleeding from the implantation area for 2 days is a normal reaction (gauze should be applied to the operated area).
	Mandatory oral hygiene to prevent the occurrence of infection. Do not press on the implant.
	It is mandatory to visit your doctor at the appointed time and follow all his recommendations.
Diet	After surgery, the following foods should not be eaten (especially for people prone to allergies): · zucchini; · legumes; · chocolate; · citrus fruits; · asparagus; · spinach; · herring; · flour products.
Drug treatment	An allergy to a dental implant may appear several days after surgery. It can be determined by the following characteristics: · stomatitis; · pain in the mouth; · metallic taste; inflammation of the lips and gums; · redness and erosion of the tongue. You must contact the clinic for examination and removal of the implant. In severe cases of an allergic reaction (swelling, difficulty breathing), antihistamines (Tavegil, Suprastin, Diazolin) are prescribed.
People's Pharmacy	Skin rashes are treated with various compresses and lotions: · with apple or potato juice; · with a low concentration soda solution; · with goose fat and sea buckthorn; · with a decoction of chamomile or string.
Prevention	To prevent the development of the disease it is necessary: · follow a diet that includes a sufficient amount of fiber; · spend more time in the fresh air; · maintain a sleep schedule; · give up bad habits; · harden.

Views:

As a result of the loss of one tooth or a whole series for various reasons, the question arises of restoring a full smile line.

In addition to aesthetic discomfort, the absence of teeth over time can lead to serious consequences: deformation of the jaw bone and adjacent teeth, thinning of the bone structure, gum resorption, distortion of facial features, changes in speech, and others.

It is necessary to solve the problem of their absence as soon as possible, and the choice of restoration method should be approached with the utmost responsibility.

Dental restoration and types of implants

Implantation- a type of surgical intervention that involves restoring a lost tooth with an artificial substitute. This method of replacing one or more teeth is known for its efficiency, speed and reliability, which is why many people try to resort to installing implants. There are some main types of implants:

root-like(installation of an artificial tooth root);
lamellar(suitable for installation in a bone that is fairly narrow in structure and provides the future structure with special strength);
combined(a combination of root and plate types; used for serious gum defects);
subperiosteal(otherwise, subperiosteal, which are indicated for severe destruction of the jaw bones, with a thin bone structure);
endodontic(otherwise, stabilization ones, which do not require complete removal of your own tooth, but contribute to its greater strengthening);
intramucosal(indicated for strengthening and stabilizing dentures without direct implantation into the jaw bone);
orthodontic(temporary structures made of titanium alloy, which serve to strengthen support for the entire period of alignment of the bite or teeth using braces);
basal(nowadays this type is practically not used, but was previously used as a deep implantation when restoring several teeth located together at once).

Implantation of one or more teeth is a serious surgical operation that requires careful preparation of the patient and highly qualified implantologist.

In case of non-compliance with the surgical technique, violation of hygiene standards or doctor's instructions, serious consequences with a difficult to predict course may occur.

Possible complications and dangers

Like any operation, the installation of implants may come with some complications. Before implantation, the patient’s clinical history is carefully studied, the installation method and type of implant are determined, taking into account its osteo-maxillary characteristics.

Even with proper training and high professionalism of the surgeon, the possibility of unpleasant sensations cannot be ruled out for sure. There are a number of potential dangers that concern many patients at the very beginning of their journey to the dentist.

Possibility of pain

Proper organization of pain relief and selection of the optimal method guarantees absolute painlessness throughout the entire operation process. Installing one artificial tooth root without additional surgical procedures (for example, bone tissue augmentation, tooth extraction, etc.) takes from 10 to 20 minutes.

There are more complex cases when the operation lasts at least two hours, but it also takes place without pain. To relieve pain, the patient is injected with an anesthetic drug along the line of the nerve canaliculi. After completion of the procedure, minor painful sensations may occur for another 3 to 5 days.

Need for pain relief

Pain relief can be either local or general. The use of local anesthesia is used if it is necessary to install one or more implants in a favorable condition of the musculoskeletal system (sufficient bone volume, absence of inflammation).

To calm the patient emotionally, some clinics use intravenous sedation, which has a relaxing effect. Local anesthesia allows you not to lose direct contact with the patient and monitor his well-being. Benefits for the patient:

possibility of contact with the surgeon;
no hospital recovery from anesthesia is required;
the ability to immediately return to important matters;
clarity of consciousness is maintained.

If local anesthesia is not possible, general anesthesia should be used. The main indications for general anesthesia include the following:

increased gag reflex (especially when working with back teeth);
allergic reactions to local anesthetic drugs;
mental illness;
nervous system disorders of varying severity;
transplantation of a bone block from the ilium or parietal bone.

Many experts claim that there are no contraindications to anesthesia. If a person is properly examined and prepared for surgery, no problems will arise during implant installation under any type of anesthesia.

Only licensed clinics can afford to use general anesthesia, where there is a separate operating room, intensive care equipment, an anesthesia machine and wards for temporary accommodation of patients. Anesthesia is administered by an anesthesiologist, who must be present on the clinic staff.

Damage to the jaw when screwing in the structure

Situations of damage to the jaw when installing a pin are caused by the unprofessionalism of the doctor and violation of the technology of surgical intervention. The main damages include:

the pin exits into the nose or oral cavity;
destruction of the walls of the maxillary sinus;
damage to the nerve of the lower jaw.

Ideally, the metal rod itself has a limited width and a certain length, which prevents serious complications when screwing in. The likelihood of such errors occurring today is minimized, since many clinics rely on digital data as a result of a preliminary examination of the patient to install pins.

Dehiscence of applied sutures

Such situations may arise as a result of non-compliance with the postoperative regimen by the patient or be the result of a doctor’s error. The patient can provoke discrepancy by smoking or mechanical damage to the gums.

Experts recommend not touching the seam if it has come apart at a distance from the smile line. In this case, wait until it grows on its own. When the suture diverges within the visible area, it must be reapplied. In rare cases, it is necessary to expose the neck of the implant and further remove it.

Long healing of the wound

Long healing of a postoperative wound is a rare occurrence. With a thorough examination of the patient before surgery, this is warned in advance. The main reasons for prolonged healing include infection of the wound or a decrease in the body's immune response.

If symptoms are eliminated in a timely manner, you can count on a favorable prognosis. If the situation is not corrected in any way, the pin may be rejected with the development of peri-implantitis.

Severe swelling

The appearance of edema after surgery is a natural process. The state of swelling of the operated tissues in many patients is observed within a week.

If swelling persists for a long time and is accompanied by intense pain, the development of an inflammatory process can be assumed.

Bleeding wound

Minor bleeding is still possible for some time in the postoperative period. Longer discharge indicates the patient’s non-compliance with the doctor’s recommendations, taking certain groups of drugs, mechanical damage to the healing wound, or high blood pressure.

Possibility of implant rejection

Rejection often occurs due to the fault of the doctor and when he violates the operating algorithm. Today, the risk of implant rejection is minimized due to the high quality of materials from which the artificial tooth root and the crown itself are made. According to statistics, only 3% of patients may suffer from this complication.

Allergy to titanium implants

Despite widespread advertising about the absolute safety and hypoallergenicity of titanium, more and more cases of allergies in patients are being recorded. Titanium has a toxic effect on the cells of the soft tissues of the oral cavity, which provokes the risk of allergies to the material. Titanium can provoke:

dermatological rashes (local or generalized);
muscle weakness;
the occurrence of autoimmune diseases.

Studies by European specialists prove the existence of an allergy to titanium in some patients, and these numbers cannot be called low. Among the 9 tested patients, 3 developed an allergy immediately after the end of the operation.

List of prohibitions on surgery

Not all patients can undergo prosthetics. All contraindications are classified into the following groups: absolute, relative, general, local and temporary. Based on the patient's clinical history, the doctor assesses the possibility of surgery.

In case of any absolute contraindications, the dentist offers alternative methods for eliminating dental defects. If the contraindications are temporary, then wait until the causes interfering with implantation are completely eliminated.

Absolute contraindications

Hematological diseases with severe impairment of hemostasis;
immunodeficiency diseases of various etiologies;
oncological formations of any localization;
serious mental disorders;
diabetes mellitus (including decompensated treatment);
tuberculosis of any form;
intolerance to anesthesia;
renal, cardiac and liver failure in terminal stages (including decompensated treatment);
undergone organ transplantation.

The presence of absolute contraindications makes it impossible to perform the operation even with the use of high-quality anesthesia due to the high risk of developing serious complications.

Relative contraindications

The patient's age is less than 22 years;
bite pathology (congenital, acquired);
smoking;
systematic use of alcohol and drugs;
arthrosis or arthritis of the temporomandibular joint;
the presence of other implants in the body.

If there are relative contraindications, surgery is possible, but subject to a number of conditions, serious preparation of the patient and the correct choice of implantation method.

You can learn about the problems that arise when installing teeth from the video.

General contraindications

Diseases of the heart and blood vessels;
infectious diseases (including sexually transmitted diseases);
taking medications that affect blood clotting and the body’s immune response;
stress, nervous exhaustion;
osteoporosis of varying severity;
nervous disorders.

Correction of some conditions involves temporary withdrawal of certain medications, treatment of foci of infection, etc. The presence of general contraindications is not a reason to completely refuse implants.

Local contraindications

Periodontal diseases;
carious lesions of teeth;
severe atrophy of bone tissue (basal implantation is shown here);
poor oral hygiene;
bruxism;
increased wear of teeth (often due to structural features of the jaw and bite).

With adequate treatment of these conditions and hygienic sanitation of the oral cavity, implantation becomes possible.

Temporary contraindications

Pregnancy and lactation;
course of acute infectious diseases;
undergone chemotherapy, radiation.

The list of contraindications for implantation is quite wide, so it is important to choose a qualified specialist who will carry out multi-stage preparation of the patient for surgery and prevent the occurrence of possible complications.

Common Misconceptions

Implantation in dentistry is shrouded in numerous myths and prejudices. Many are born precisely from the ignorance of patients, but those who have ever acquired a negative or positive experience can more specifically debunk all existing speculation.

Implantation is too long a procedure

The operation to install an artificial tooth root lasts from 20 to 40 minutes. After installing the tooth root and permanent crown, it is necessary to wait from 3 months to six months. The installation period for a full-fledged tooth with a permanent crown can reach 1 month (turning, fitting, adjusting parameters).

Being toothless for a long time

If the operation involves manipulation in the area of the smile line, then upon completion of the operation the patient is fitted with a temporary orthopedic structure, with the help of which the desired aesthetic effect is achieved.

When distant teeth are implanted, there is often no need to create an aesthetic effect. The process of osseointegration (implantation) is completely completed only after a year and a half.

Expensive pleasure

The operation is indeed an expensive procedure. The high cost is due to the peculiarity of the method, when there is no impact on neighboring teeth, and the overall functionality of the dentition is completely restored.

The cost of installing one implant depends on the manufacturer of the implantation systems. For example, Korean or Israeli implants from Mirell will cost about 25,000 rubles in Moscow. The most expensive implants are considered to be from the Swedish company Nobel, the cost of which reaches 65,000 per unit.

The same dentures, only more expensive

Denture crowns have an unnatural appearance due to the characteristics of the gum line. Implantation looks more natural.

Long preparation for surgery

For a doctor, a thorough study of the clinical history, test results (detailed biochemical blood test), examination and preparation of the oral cavity for surgery is sufficient. On average, all procedures take about a week.

Imperfections in implementation in Russia

If earlier this statement took place, today it is already a clear misconception. In Russia there is a powerful qualified institute for creating professionals in the field of dental implantology. The cost of services in Russia is significantly lower than abroad, and the quality of performance is often similar.

Long addiction

In almost 98% of all cases, the patient feels the foreign body for only 3 days. Then the implant does not cause any discomfort, and the patient forgets about the operation.

What patients say about the procedure

If you have had a dental implant surgery, you can tell us about your real impressions of the result, the progress of the operation, the quality of the implant and the actual recovery period. This will help many patients avoid possible complications and properly exit the postoperative period.

Where to start and how the dental implantation procedure is carried out is described in detail in the video.

Various allergic reactions in dentistry are not uncommon; one of these is an allergy to a dental implant, which is installed by an oral surgeon or orthodontist.

The selection of an implant, its shape, size and characteristics directly depends on the patient, the condition of the jaws and gums, any functional features or disorders in the body.

Don’t forget about the financial component; before installing an implant, the dentist warns about its properties and potential risks during operation, including not only possible allergic reactions, but also implant rejection, inflammation due to improper care, degenerative changes in the bite, and so on.

How does an allergy to a dental implant manifest itself?

An allergic reaction to a dental implant is a fairly rare occurrence in our time. Modern dentistry mostly uses bioinert materials for the manufacture of implants, these are primarily gold and titanium. But despite this, chromium-cobalt alloys, alloys using stainless steel or nickel are still in use. They cause an allergic response of the body much more often than theoretically, titanium or gold, which are absolutely inert towards the body.

In practice, an allergy to an implant is determined by the following patient symptoms:

Swelling and bleeding in the implantation area for more than 2 days after implantation.
Redness at the location of the implant, pain when touched.
Acute pain when chewing food.

The same symptoms also appear when the implantation site becomes inflamed as a result of infection, improper care and non-compliance with hygiene rules.

An allergic reaction is necessarily accompanied by other manifestations that are not at first glance related to the implant itself:

Redness.
Hives.
Swelling (primarily of the face)
Rash.
General deterioration of the body's condition.

As already noted, the material from which the implant is made primarily plays a role; the main ones used in modern dentistry and orthodontics are:

Nickel, Chrome-Cobalt alloy, stainless steel

Dental implants made from these compounds are among the most allergenic in existence. They have negatively proven themselves to be difficult to take root and difficult to maintain and install. Despite this, unscrupulous experts can still recommend them as cheaper, but at the same time safe analogues of titanium or gold.

How does an allergy to nickel implants manifest itself?

Allergic reactions to nickel, as well as to many other metals, are determined and identified by tests from an allergist, both skin and blood. In addition, there are characteristic symptoms such as:

Sour taste in mouth.
A burning sensation at the implantation site.
Loss of taste.

Allergies appear due to oxidative and corrosive processes on the surface of the implant; dissimilar metal alloys containing nickel in the composition or made on its basis are most susceptible to this.

Under the influence of saliva and food, the surface of the metal is destroyed, and it begins to be deposited (accumulate) in the body, exceeding its normal levels. It is this process that causes an allergic response, not only in the case of nickel, but also in the case of other dissimilar alloys and metals that are non-inert towards humans. One of these is Chrome-Cobalt alloy.

The alloy of Chromium and Cobalt is a heterogeneous alloy, but despite this it causes allergic reactions less often than stainless steel or nickel. Specific symptoms of an allergy to CCS are, as in the case of nickel, a sour taste in the mouth and a burning sensation at the implant site.

Most often, a CCS implant undergoes corrosion when the body is sharply susceptible to one of the metals in the composition or due to an imbalance in the ionic balance in the oral cavity (for example, when there is also a stainless steel crown or implant).

Stainless steel implants

Stainless steel is one of the most dangerous for use in dentistry; it is almost always susceptible to destruction. Corrosion processes begin to manifest themselves several years after the destruction of the crown coating (for example, gold).

Allergic reactions to titanium implants

A very controversial topic in the medical community is an allergic reaction to titanium, because despite the fact that titanium is a completely biologically inert metal, 4% of people who had titanium implants complained of allergic reactions and hypersensitivity at the surgical site.

What is this connected with?

First of all, you need to understand that obtaining absolutely pure titanium is an expensive, labor-intensive and unproductive process, therefore any titanium alloy contains impurities. Their quantity depends on the production technology, the smelting process and the cost of a particular implant.

An allergic reaction that occurs after installation of implants occurs precisely due to oxidation or corrosion of impurity metals. But still, sometimes even tests can show an allergic reaction to titanium, and although this is a tiny percentage, it is not always possible to attribute it to measurement error or poor-quality sample material.

What to do if you are allergic to a dental implant?

Visiting a doctor. Only a competent orthodontist can identify allergies, both by general signs and symptoms. The danger of self-medication is that an allergy to metals is cumulative in nature and entails functional disturbances in the functioning of many organs and systems; as a result, the selection of a good, qualified dentist is important.
Drug therapy. Under the supervision of a specialist, it is possible to take anti-allergy drugs, followed by studying the dynamics of the disease. This method is rarely effective, but it helps a certain percentage of patients, and even if the allergy does not disappear completely, it helps relieve symptoms and reduce the negative impact on the body. Antihistamines may be prescribed to relieve symptoms (Zodak, Cetrin, Erius)
Surgical intervention. The most common treatment for dental implant allergies is deleting the latest. This is not always complete removal; if the cause of corrosion is an imbalance in the ionic balance in the oral cavity, the implants are replaced with ones made of homogeneous metals.

anonymous, Woman, 30 years old

Hello! . Please help.. There is a need to get implants, as many as 6 of them. I live in Moscow myself. I went to my homeland because... Prosthetics and implants are cheaper there. The first OSSTEM implant was placed on the front tooth. The doctor didn’t tell me that I needed allergy tests. He said that the implants are completely hypoallergenic. Everything settled down, but hives started. I didn’t connect this with the implant, I didn’t even know that it could be an allergy. I went to almost all the doctors, passed a bunch of tests, EgE as much as 1050 units, but in all respects I am healthy. I took all possible anti-allergy pills, took drips with Polcortone, etc., but everything continued, although a lot of money was left. Then it seemed to become quieter. I'm all exhausted. After the New Year, I came to my homeland, as many as 5 implants were installed... And a month later the allergy bloomed again. Urticaria and dermatitis. That’s when I realized it was the implants. Although I'm not allergic at all. I would like some advice on what to do. Are OSSTEM titanium dioxide implants completely hypoallergenic or have there been cases of allergies? What tests do I need to take, for what metals? If the implantologist did not warn about the samples, will he be held responsible? Is it possible to remove implants if they have taken root in the bone, but there is an allergy? In this case, is it done for free? Or is it better to look for another implantologist who will remove these implants and, if anything, install others - from a different material? Sorry for so many questions. I don’t really know what to do yet. Still in shock. Thanks a lot.

Allergy to metal implants: an allergist's view

V.V. Osipova

Candidate of Medical Sciences, Senior Researcher, Federal State Budgetary Institution "Research Institute of Pulmonology" FMBA of Russia, Moscow

The increasing proportion of the population in the older age group in Western countries has led to an increase in the use of implanted metal devices. Metal implants are especially widely used in orthopedics, cardiology, gynecology and dentistry. Every year, 500 thousand people in the United States and 300 thousand in Europe are implanted with a joint made of cobalt-chrome, stainless steel or titanium, aluminum and vanadium alloys.

When contacting metal, corrosion products or metal salts, an allergic reaction often occurs, usually of a delayed type. According to foreign researchers, this problem can occur during implantation in almost 10% of patients. Hypersensitivity reactions account for up to 5% of all cases of unsuccessful joint replacement.

The most common clinically significant sensitizations are nickel, cobalt and chromium.

Mechanisms

Implanted metals come into contact with biological fluids and are subject to corrosion. Electrochemical corrosion of implants occurs due to the presence of dissolved substances in tissue fluids.

dissolved metal salts (e, K, Cb, etc.), playing the role of electrolytes. All metals in contact with biological systems are susceptible to it. As a result of corrosion, ions are released that have the ability to form organometallic complexes with native proteins, which cause allergies. Corrosion of stainless steel devices releases ions of iron, chromium, molybdenum and nickel, and of titanium - ions of titanium, vanadium and aluminum.

Allergy to a metal implant is usually caused by a delayed-type hypersensitivity reaction. The most common allergens (haptens) are nickel, cobalt and chromium.

Skin reactions in the area of the implanted device are primarily caused by a delayed-type hypersensitivity reaction (cell-mediated), which is based on the interaction of a sensitized T-lymphocyte with a specific antigen. This initiates the release of a set of cytokines from the T cell that mediate the manifestations of a delayed hypersensitivity reaction.

Studies of tissue adjacent to the implant in patients with metal hypersensitivity have shown increased levels of immune cells (markers), including CD3+ T lymphocytes, CD4+, CD11c+ macrophages, dendritic cells, and major histocompatibility complex class II cells. In addition, it was found that osteoclasts can mature and multiply on titanium and aluminum, which leads to degradation of the metal and the subsequent release of titanium or aluminum ions. This mechanism may explain the increase in levels of measured metal ions in the systemic circulation.

Clinical manifestations

Orthopedics. In the 1960s and early 1970s, the prostheses used for hip replacement were metal. Typically, metal alloys of cobalt and chromium were used, which often cause delayed-type hypersensitivity reactions. Currently, prostheses consisting of various combinations of components (metal, ceramics and polyethylene) are mainly used; dynamic implants, the main part of which are made, are becoming increasingly popular in vertebrology.

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Hand eczema as a reaction to osteosynthesis using titanium.

Made from silicone and polyethylene terephthalate.

But the problem of metal allergy has not lost its relevance in orthopedics. For example, delayed hypersensitivity reactions may occur upon contact with metal screws or plates used in dynamic implants.

An allergic reaction to a metal implant leads to poor wound healing and chronic inflammation. Clinically, it most often manifests itself as a skin reaction (dermatitis) mainly in the area of the implanted metal and pain in the replaced joint (Figure).

Cardiovascular surgery. Hypersensitivity reactions are also observed with intravascular implants. It has been shown that contact allergy to metal compounds released from stainless steel stents can cause in-stent stenosis. Restenosis as a result of metal hypersensitivity occurs in bare metal stents in 16-33% of cases, it usually appears within 3-6 months after intervention, but can occur later.

Metal inserts lead to an increase in the blood level of metals that make up the alloys.

Cobalt and chromium levels increase within 3 months after surgery and remain high after 12 months.

Some investigators have shown a lower risk of restenosis with gold-plated stents than with stainless steel stents of the same configuration. However, C. Svedman et al. their study found a correlation between the use of gold-plated stents, contact allergy to gold, and an increased incidence of restenosis. This correlation was not observed when nickel was used as an implant.

Allergic complications after pacemaker implantation are extremely rare - about 30 cases reported in the literature. There are many components in pacemakers that could potentially cause contact allergies, but the most common cause is titanium alloys. Reactions usually take the form of dermatitis localized at or above the implantation site. Thus, R. Brun and N. Hunziker described granulomatous dermatitis that developed in response to implantation of a titanium-containing pacemaker. Allergies can also impair wound healing.

Gynecology. In gynecology, implanted metals are mainly used as contraceptives. Intrauterine devices used for temporary contraception contain nickel. The literature indicates that allergies to

cell is a contraindication to the placement of such a spiral.

Dentistry. Dental implants are also sources of metal exposure to the body. Potential allergens include metal alloys with nickel-palladium and/or titanium alloys, as well as cobalt-chromium-molybdenum alloys. Cobalt-containing alloys are more often used as substitutes for more expensive precious metal alloys.

Diagnosis and treatment

To diagnose metal allergies, the patch testing method is used. Patch testing is the “gold standard” for assessing type IV hypersensitivity reactions.

For patients with a history of metal allergic contact dermatitis, patch testing is recommended before implant placement.

If metal hypersensitivity reactions are suspected, extensive patch testing is indicated in patients with implanted metal devices. For patients with a history of clinical signs of increased skin sensitivity to metals, prior patch testing is recommended before implant placement.

At the same time, it is important to distinguish between the reactions of a positive patch test (contact allergy) and the clinical picture of allergic contact dermatitis. Put

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A personal patch test in itself does not mean that an asymptomatic patient with a metal implant will necessarily have an allergic reaction. Only a combination of a positive test and an appropriate clinical picture can serve as a basis for repeated surgery. If a patient is asymptomatic, for example with an orthopedic implant, but has a positive patch test performed for other reasons, no intervention should be performed on the implant.

D.W. Lai et al. suggested that treatment with prednisone may be effective in patients with symptomatic dermatitis for whom implant removal is not possible.

Thus, allergy to metal implants is a pressing interdisciplinary problem of modern medicine. Improvements in materials and implantation technologies have not yet made it possible to solve this problem. Knowledge about the clinical signs, features of diagnosis and treatment of metal allergies is extremely necessary not only for allergists, but also for doctors of other specialties, especially surgical specialists.

Bhamra M.S., Case C.P. // J. Eng. Med. 2006. V. 220. P. 379.

Brun R., Hunziker N. // Contact Dermatitis. 1980. V. 6. P. 212.

Essure. Instructions for use. http://www. hcp.essure-us.com/assets/pdf/Link%20 Essure%20IFU.pdf

Gawkrodger D.J. // Br. J. Dermatol. 2003. V. 148. P. 1089.

Hallab N.J., Jacobs J.J. // Bull. NYU Hosp. Jt. Dis. 2009. V. 67. P. 182. Honari G. et al. // Contact Dermatitis. 2008. V. 59. P. 7.

Imanishi T. et al. //Arch. Orthop. Trauma

Surg. 2010. V. 130. P. 1447.

Julander A. et al. // Contact Dermatitis.

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Letter to the editor

Dear editors!

I would like to draw your attention to an error in the article on the topic “Allergies to medications: what you need to know,” published in the journal “Asthma and Allergies” (No. 1, 2015). The table on page 30 in the “Novocaine” section states: “You cannot use any substances whose name contains a combination of the letters “caine” (lidocaine, benzocaine, etc.).” However, cross-reactions with novocaine are caused only by para-aminobenzoic acid derivatives - benzocaine, tetracaine, butamben. Local anesthetics from the group of amide derivatives (lidocaine, bupivacaine, articaine) are distinguished by -

differs from novocaine in structure, so cross allergic reactions between this group of drugs and novocaine do not occur. Thus, if you are allergic to novocaine, treatment under local anesthesia is possible. To do this, you simply need to use local anesthetics from another group listed above.

Fassakhov R.S., allergist, doctor of medical sciences, professor, director of the Kazan Research Institute of Epidemiology and Microbiology of Rospotrebnadzor

From the editor. We express our sincere gratitude to Professor Fassakhov for his very pertinent remark and in the future we undertake to send him our publications on allergology at the stage of their preparation.

Asthma and allergies 3/2015

Dental prosthetics is a procedure that occurs very often. The reason for contacting a dentist can be anything, and the reason for installing artificial teeth can be various circumstances. You just need to be sure that you are not allergic to metal or other materials. After all, dentures can be made from various materials.

What to do if you need to install a denture, but you are allergic to titanium?

Dentures are a good option for restoring a beautiful smile. There is just one drawback - possible allergic reactions to the prosthetic material. First, let's figure out what a denture can be made from.

Option one- plastics. There are more cons than pros. Firstly, dentures made of plastic will last a couple of years, secondly, they require special care, and thirdly, due to their fragility, dentures need to be changed from time to time. An alternative to plastics can be acrylic and nylon. But the quality also leaves much to be desired.

Option two– metal. Not everything is so simple with him either. It is to metal that patients are most often allergic. Allergy to titanium, for example, is not a very common occurrence. But the consequences can be severe. More about this.

As a rule, foreign bodies do not take root well in the human body. Units of materials can be used when necessary for prosthetics or other procedures. There are a number of contraindications when installing titanium implants. For example:

1. Heart diseases.
2. Diabetes.
3. Malignant tumors.
4. Blood diseases.
5. Tuberculosis.
6. And other diseases.

This is not the entire list of possible prohibitions.

Third option material for prosthetics - zirconium oxide (dioxide). The most popular material for dental prosthetics. Its advantages are obvious. Good pricing policy, the color of the material is suitable for making dentures and does not cause allergic reactions. Metal is often coated with a layer of ceramic to make teeth whiter.

The main advantage of this metal is not its reliability indicators and characteristics. The most important advantage is that it can be used in cases where there is an allergy to titanium. Zirconium dioxide is considered the best alternative to titanium prosthetics.

Option four– ceramics. A good match to the natural color of tooth enamel and the absence of allergic reactions in the patient are not the only advantages. The disadvantage is that ceramic is not a durable material. Therefore, only glass ceramics can be an alternative.

What to install besides titanium prostheses?

If during the process of prosthetics it turns out that titanium with good osseointegration(the ability to adapt to tissues) is not suitable for the patient, then you need to look for analogues. As noted earlier, there are several materials available for use in making dentures. And so, for those who are the lucky owner of allergies, the best option for prosthetics is zirconium dioxide or ceramics. The osseointegration of these materials is no worse than that of titanium, but the chances of the absence of allergic reactions are much greater.

In any case, not only the patient, but also his attending physician will make decisions about installing a prosthesis from one material or another. By the way, choosing a specialist is an important process in dental treatment. The result, and therefore the beauty of your smile, depends on the knowledge and experience of the dentist. Treat your teeth responsibly and do not forget about regular examinations and consultations.