Titanium implants are extensively used to replace the missing natural teeth in prosthodontics. However, allergic reactions to titanium in dentistry has not received its due attention. Literature reports sensitivity to titanium ranging from 0.6 to 5% of the general population. The allergic reactions in patients who are sensitive to titanium ranges from type I to IV with symptoms ranging from vague pain, skin rashes to implant failure. The aim of this study was to evaluate the presence of titanium allergy by anamnesis and examination of subjects using titanium dioxide 0.5% in patch test methodology. A sample size of four hundred healthy subjects with no previous history of immunosuppression were included. Titanium dioxide 0.5% concentration in petrolatum was used to conduct the patch test. A history of allergy to any other allergen was recorded as a part of the study. Under the limitations of this study, it was concluded that, titanium can induce hypersensitivity response in susceptible patients. From this study it was observed that the hypersensitivity reactions to titanium was 0.3% in all the subjects tested. It was also observed that the individuals with a prior history of allergy to other known allergens were more susceptible to allergic reactions to titanium. Limitations of the study was the absence of a wider age group of population for this study. Future research is recommended by considering a wider age group of population and a longterm followup of patients.
Williams DF. Titanium: Epitome of biocompatibility or cause for concern. The J Bone Joint Surg 1994 May;76(3):348-349.
Sicilia A, Cuesta S, Coma G, Areegui I, Guisasola C, Ruiz E, Maestro A. Titanium allergy in dental implant patients: a clinical study in 1500 consecutive patients. Clin Oral Implants Res 2008 Aug;19(8):823-835.
Siddiqi A, Payne AGT, De Silva RK, Duncan WJ. Titanium allergy: could it affect dental implant integration? Clin Oral Implants Res 2011 July;22(7):673-680.
Muller KE, Valentine-Thon E. Hypersensitivity to titanium: clinical and laboratory evidence. Nuero Endocrinol Lett 2006 Dec;27(suppl 1):31-35.
Hensten-Pettersen A. Casting alloys side-effects. Adv Dent Res 1992 Sep;6(9):38-43.
Lalor PA, Revell PA, Gray AB, Wright S, Railton GT, Freeman MA. Sensitivity to titanium: a case of implant failure? British J Bone Joint Surg 1991 Jan;73(1):25-28.
Franchi M, Orsini E, Martini D, Ottani V, Firib M, Giavarisib G, Giardnob R, Ruggeria A. Destination of titanium particles detached from titanium plasma sprayed implants. Micron 2007 Nov;38(6):618-625.
Bass JK, Fine H, Cisneros GJ. Nickel hypersensitivity in orthodontic patients. American J Orthodont Dentofac Orthop 1993 Mar;103(3):280-285.
Mitchell DL, Synott SA, Van Dercreek JA. Tissue reaction involving an intraoral skin graft and CP titanium abutments: a clinical report. Int J Oral Maxillofac Implants 1990 Spring; 5(1):79-84.
Mu Y, Kobayashi T, Tsuji K, Sumita M, Hanawa T. Causes of titanium release from plate and screws implanted in rabbits. J Mater Sci Mater Med 2002 Jun;13(6):583-588.
Clarke MT, Lee PT, Arora A, Villar RN. Levels of metal ions after small and large diameter metal on metal hip arthroplasty. British J Bone Joint Surg 2003 Aug;85(6):913-917.
Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. European J Oral Sci 1998 Jun;106(3):721-764.
Nakajima K. Study on patch test reagent for titanium. Japan J Stomatolog Society 2007 Jun;74(2):92-98.
Kusy RP. Clinical response to allergies in patients. Am J Orthod Dentofac Orthop 2004 May;125(5):544-547.
Brune D. Metal release from dental biomaterials. Biomaterials 1986 May;7(3):163-175.
Cook SD, Mc Cluskey LC, Martin FC, Haddad RJ. Inflammatory response in retrieved noncemented porous coated implants. Clin Orthopaed Rel Res 1991 Mar;26(4):209-222.
Weingart D, Steinemann S, Schilli W, Strub JR, Hellereich U, Assenmacher J, Simpson J. Titanium deposition in regional lymph nodes after insertion of titanium screw implants in maxillofacial region. Int J Oral Maxillofac Surg 1994 Dec; 23(6):450-452.
Thomas P, Bandl WD, Maiser S, Summer B, Prizybillo B. Hypersensitivity to titanium osteosynthesis with impaired fracture healing, eczema and T-cell hyperresponsiveness in vitro: case report and review of literature. Contact Dermatitis 2006 Oct;55(4):199-202.
Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. Am J Bone Joint Surg 2001 Mar;83A(3): 428-436.
Kim SG. Implant-related damage to an adjacent tooth: a case report. Implant Dent 2000;9:278-280.
Margelos JT, Verdelis KG. Irreversible pulpal damage of teeth adjacent to recently placed osseointegrated implants. J Endod 1995;21:479-482.
Rothman SL, Schwarz MS, Chafetz NI. High-resolution computerized tomography and nuclear bone scanning in the diagnosis of postoperative stress fractures of the mandible: a clinical report. Int J Oral Maxillofac Implants 1995;10:765-768.
Mason ME, Triplett RC, van Sickels JE, Parel SM. Mandibular fractures through endosseous cylinder implants: report of cases and review. J Oral Maxillofac Surg 1990;48:311-317.
Tolman DE, Keller EE. Management of mandibular fractures in patients with endosseous implants. Int J Oral Maxillofac Implants 1991;6:427-436.
Shonberg DC, Stith HD, Jameson LM, Chai JY. Mandibular fracture through an endosseous implant. Int J Oral Maxillofac Implants 1992;7:40-44.
Neyt L, De Clercq C, Abeloos J, Mommaerts M. Mandibular fractures following insertion of denial implants. Acta Stomatol Belg 1993;90:251-258.
Kan JY, Lozada JL, Boyne PJ, Goodacre CJ, Rungcharassaeng K. Mandibular fracture after endosseous implant placement in conjunction with inferior alveolar nerve transposition: a patient treatment report. Int J Oral Maxillofac Implants 1997;12: 655-659.
Raghoebar GM, Stellingsma K, Batenburg RH, Vissink A. Etiology and management of mandibular fractures associated with endosteal implants in the atrophic mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:553-559.
Laboda G. Life-threatening hemorrhage after placement of an endosseous implant: report of case. J Am Dent Assoc 1990;121: 599-600.
Mason ME, Triplett RG, Alfonso WF. Life-threatening hemorrhage from placement of a dental implant. J Oral Maxillofac Surg 1990;48:201-244.
Ten Bruggenkate CM, Krekeler G, Kraaijenhagen HA, Foitzik C, Oosterbeek HS. Hemorrhage of the floor of the mouth resulting from lingual perforation during implant placement: a clinical report. Int J Oral Maxillofac Implants 1993;8:329-334.
Mordenfeld A, Andersson L, Bergstrom B. Hemorrhage in the floor of the mouth during implant placement in the edentulous mandible: a case report. Int J Oral Maxillofac Implants 1997; 12:558-561.
Givol N, Chaushu G, Halamish-Shani T, Taicher S. Emergency tracheostomy following life-threatening hemorrhage in the floor of the mouth during immediate implant placement in the mandibular canine region. J Periodontol 2000;71: 1893-1895.
Dwyer MS. Re: Near fatal venous nitrogen/air embolism occurrence while inserting cylindrical endosseous oral implants. J Periodontol 1992;63(1):63.
Theisen FC, Shultz RE, Elledge DA. Displacement of a root form implant into the mandibular canal. Oral Surg Oral Med Oral Pathol 1990;70:24-28.
Bergermann M, Donald PJ, Wengen DF. Screwdriver aspiration: a complication of dental implant placement. Int J Oral Maxillofac Surg 1992;21:339-341.
Li KK, Varvares MA, Meara JG. Descending necrotizing mediastinitis: acomplication of dental implant surgery. Head Neck 1996;18:192-196.
Krepler K, Wedrich A, Schranz R. Intraocular hemorrhage associated with dental implant surgery. Am J Ophthal 1996; 122:745-746.
Strull GE, Dym H. Singultus: a distressing postsurgical complication. J Oral Maxillofac Surg 1995;53:711-713.
Goodacre CJ, Benal G. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003;90:121-132.
Adell R, Lekholm U, Rockler B, Branemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416.
Jemt T. Failures and complications in 391 consecutively inserted fixed prostheses supported by Branemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual check-up. Int J Oral Maxillofac Implants 1991;6:270-276.
Misch CE. Contemporary Implant Dentistry. 3rd ed. St. Louis: CV Mosby; 2008 Feb 4. p. 1120.
Implant text risk factors in implant dentistry: simplified clinical analysis for predictable treatment. 2nd ed. Franck Renouard, DDS.
Implant Dentistry—The Most Promising Discipline of Dentistry. Implant Complications Ma Angeles Sánchez Garcés, Jaume Escoda-Francolí and Cosme Gay-Escoda University of Barcelona, Faculty of Dentistry, Spain.
Mendonca G, Mendonca DB, Fernandes Neto AJ, Neves FD. Use of distraction osteogenesis for repositioning of an osseointegrated implant: a case report. Int J Oral Maxillofac Implants 2008;23(3):551-555.
Georgiev T, Nogalchev K. Local complications occuring during dental implantation. J Int Med Assoc Bulgaria 2010;16(4):35-37.
Elie E. Daou Stud attachments for the mandibular implant retained overdentures: Prosthetic complications. A literature review. Remov able Prosthodontics Department, School of Dentistry, Lebanese University, Beirut, Lebanon The Saudi Dental Journal (2013). Available at: http://dx.doi.org/10.1016/j. sdentj.2012.12.003
Steigmann M. Aesthetic flap design for correction of buccal fenestration defects, practical procedures and aesthetic dentistry: PPAD 2008;20(8):487-493.
Chrcanovic BR, Custodio AL. Mandibular fractures associated with endo steal implants, oral and maxillofacial surgery 2009;13 (4):231-238.
Misch CE, Resnik R. Mandibular nerve neurosensory impairment after dental implant surgery: management and protocol. Implant Dentistry 2010;19(5):378-386.
Wittneben JG, Millen C, Bragger U. Clinical performance of screw-versus cement-retained fixed implant-supported reconstructions—a systematic review. Int J Oral Maxillofac Implants 2014;29(Suppl):84-98.
Moghadam HG, Cols Y, Histomorphometric evaluation of bone regeneration using allogenic and alloplastic bone substitutes. J Oral Maxillofac Surg 2004 Feb;62(2):202-13.
Revie Leziy SS, Miller BA. Guided implant surgery and the use of osteotomes for rehabilitation of the maxilla. Pract Proced Aesthet Dent 2006 Jun;18(5):293-95.
Pereira CC, Gealh WC, Nogueira LM, Garcia IR JR, Okamoto R. Piezosurgey applied to implant dentistry: Clinical and biological aspects. J Oral Implantol 2012 Jan 4[Epub ahead of print].
Viña-Almunia J, Maestre-Ferrín L, Alegre-Domingo T, Peñarrocha-Diago MA. Survival of implants placed with the osteotome technique: An update. Med Oral Patol Oral Cir Bucal 2012;17(5):e765-68.
Piano S. A simple way to plan implant positioning: the ‘Stechnique’. Eur J Esthet Dent Autumn; 2011;6(3):328-41.
Kfir E, Goldestein M, Abramovitz I, Mazor Z, Kfir V, Kaluski E. The effects of sinus membrane pathology on bone augmentation and procedural outcome using minimal invasive antral membrane balloon elevation. J Oral Implantol 2012 Mar
[Epub ahead of print].
Kaneko T, Masuda I, Horie N, Shimoyama T. New bone formation in nongrafted sinus lifting with space-maintaining management: A novel technique using a titanium bone fixation device. J Oral Maxillofac Surg 2012Mar;70(3):e217-24.
Crespi R, Capparè P, Gherlone E. Osteotome sinus floor elevation and simultaneous implant placement in grafted biomaterial sockets: 3 years of follow-up. J Periodontol 2010 Mar;81(3):344-49.
Brägger U, Gerber C, Joss A, Haenni S, Meier A, Hashorva E, Lang NP. Patterns of tissue remodeling after placement of ITI dental implants using an osteotome technique: A longitudinal radiographic case cohort study. Clin Oral Implants Res 2004 Apr;15(2):158-66.
Lindgren C, Mordenfeld A, Hallman M. A prospective 1-year clinical and radiographic study of implants placed after maxillary sinus floor augmentation with synthetic biphasic calcium phosphate or deproteinized bovine bone. Clin Implant Dent Relat Res 2012 Mar;14(1):41-50.
Guyot M, Dubuc O, Richard NP, Dutour O. Comparison between direct clinical and digital photogrammetric measurements in patients with 22q11 microdeletion. Int J Oral Maxillofac Surg 2003 June;32(3):246-52.
Jemt LT. Photogrammetric measurements of implant positions. Description of a technique to determine the fit between implants and superstructures. Clin Oral Implants Res 2003;5(1):30-36.
Summers RB. The osteotome technique: Part 3. Less invasive methods of elevating the sinus floor. Compendium 1994;15: 702-04.
Taschieri S, Corbella S, Saita M, Tsesis I, Del Fabbro M. Osteotome-mediated sinus lift without grafting material: A review of literature and a technique proposal. Hindawi Publishing Corporation. Int J Dent 2012, Article ID 849093, 9 pages.
Taschieri S, Corbella S, Del Fabbro M. Use of plasma rich in growth factor for Schneiderian membrane management during maxillary sinus augmentation procedure. J Oral Implantol 2012;38(5):621-27.
Mol A, Van de Stel APF. Application of digital image analysis in dental radiography for the description of periapical bone lesions: A preliminary study. (Special tissue in dentistry) Trans Biomed Eng 1991;38:357-59.
Palioto DB. Sato S. Computer assisted image analysis methods for evaluation of periodontal wound healing. Braz Dent J 2001;12(3):167-72.
Ganz SD. Cone beam computed tomography-assisted treatment planning concepts. Dent Clin North Am 2011 Jul;55(3):515-36.
Peck JN, Conte GJ. Radiologic techniques using CBCT and 3-D treatment planning for implant placement. J Calif Dent Assoc 2008 Apr;36(4):287-90.
Fienitz T, Schwarz F, Ritter L, Dreiseidler T, Becker J, Rothamel D. Accuracy of cone beam computed tomography in assessing peri-implant bone defect regeneration: A histologically controlled study in dogs. Clin Oral Implants Res 2012Jul;23(7):882-87.
Leziy SS, Miller BA. Guided implant surgery and the use of osteotomes for rehabilitation of the maxilla. Pract Proced Aesthet Dent 2006 Jun;18(5):293-95.
Beretta M, Cicciù M, Bramanti E, Maiorana C. Schneider membrane elevation in presence of sinus septa: Anatomic features and surgical management. Hindawi Publishing Corporation. Int J Dent 2012;Article ID 261905, 6 pages.
Ganz SD. Computer-aided design/computer-aided manufacturing applications using CT and cone beam CT scanning technology. Dent Clin North Am 2008 Oct;52(4):777-808.
Chung S, McCullagh A, Irinakis T. Immediate loading in the maxillary arch: Evidence-based guidelines to improve success rates: A review. J Oral Implantol 2011 Oct; 37(5):610-17.
Bertassoni LE, Marshall GW. Papain-gel degrades intact nonmineralized type I collagen fibrils. Scanning 2009 Nov- Dec;31(6):253-258.
Moon SE, Kim HY, Cha JD. Synergistic effect between clove oil and its major compounds and antibiotics against oral bacteria. Arch Oral Biol 2011 Sep;56(9):907-916.
Pinto E, Vale-Silva L, Cavaleiro C, Salgueiro L. Antifungal activity of the clove essential oil from Syzygium aromaticumon, candida, aspergillus and dermatophyte species. J Med Microbiol 2009 Nov;58(Pt 11):1454-1462.
Olajide OA, Makinde JM, Awe SO. Evaluation of the pharmacological properties of nutmeg oil in rats and mice. Pharma Biol 2000;38(5):385-390.
Thanoon SZ, Al-Refai AS, Kamal A. Antibacterial effect and healing potential of nutmeg oil for chemically induced oral ulcerations in rabbits. Zanco J Med Sci 2013;17(2): 393-399.
Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-09.
Sammour A, Bijan MM, Tan SL, Tulandi T. Prospective randomised trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing superovulation prior to intrauterine insemination (IUI). Fertil Steril 2001;76(Suppl 1):S110.
Mitwally MF, Casper RF. Single-dose administration of an aromatase inhibitor for ovarian stimulation. Fertil Steril 2005;83:229-31.
Fisher SA, Reid RL, Van Vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002;78:280-85.
Fatemi HM, Kalibianakis E, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Clomiphene citrate vs letrozole for ovarian stimulation: A pilot study. Reprod Biomed Online 2003;7:543-46.
Hu Y, Cortvrindt R, Smitz J. Effects of aromatase inhibition on in vitro follicle and oocyte development analyzed by early preantral mouse follicle culture. Mol Reprod Dev 2002;61: 549-59.
Shetty G, Krishnamurthy H, Krishnamurthy HN, Bhatnagar S, Moudgal NR. Effect of estrogen deprivation on the reproductive physiology of male and female primates. J Steroid Biochem Mol Biol 1997;61:157-66.
Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97.
Mitwally MF, Casper RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002;77:776-80.
Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, Chakravarty BN, Kabir SN. A randomized single blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: A preliminary report. Hum Reprod 2004;19:2031-35.
Newkirk KM, Chandler HL, Parent AE, et al. Ultraviolet radiation-induced corneal degeneration in 129 mice. Toxicol Pathol 2007;35:819-26.
Pettenati MJ, Sweatt AJ, Lantz P, et al. The human cornea has a high incidence of acquired chromosome abnormalities. Hum Genet 1997;101:26-29.
Snibson GR. Collagen cross-linking: A new treatment paradigm in corneal disease—a review. Clin Experiment Ophthalmol 2010;38:141-53.
Spoerl E, Raiskup-Wolf F, Kuhlisch E, Pillunat LE. Cigarette smoking is negatively associated with keratoconus. J Refract Surg 2008;24:S737-40.
Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology 1993;100:181-86.
Goodrich DW, Lee WH. The molecular genetics of retinoblastoma. Cancer Surv 1990;9:529-54.
Moodaley LC, Woodward EG, Liu CS, Buckley RJ. Life expectancy in keratoconus. Br J Ophthalmol 1992;76:590-91.
Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, et al. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017 Jan 3;317(1):59-68.
Chervenak FA, Jeanty P, Cantraine F, Chitkara U, Venus I, Berkowitz RL, Hobbins JC. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984 Jul 1;149(5):512-517.
Papageorghiou AT, Thilaganathan B, Bilardo CM, Ngu A, Malinger G, Herrera M, Salomon LJ, Riley LE, Copel JA. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016 Apr;47(4):530-532.
Chibueze EC, Parsons AJ, Lopes KD, Yo T, Swa T, Nagata C, Horita N, Morisaki N, Balogun OO, Dagvadorj A, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017 May 23;7(1):2310.
Cordeiro MT. Zika virus: laboratory diagnosis. In: Zika in focus. Springer International Publishing; 2017. pp. 59-62.
Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, et al. Zika virus associated with microcephaly. N Engl J Med 2016 Mar 10;374(10):951-958.
Zare Mehrjardi M, Keshavarz E, Poretti A, Hazin AN. Neuroimaging findings of Zika virus infection: a review article. Jpn J Radiol 2016 Dec;34(12):765-770.
Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016 Jan;47(1):6-7.
Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016 Dec 15;375(24):2321-2334.