预防对金属义齿的过敏反应

作者分析义齿修复前需要进行金属过敏试验的病例,探讨对金属义齿过敏的诊断方法。检查124例患者,女性113例,男性11例。其中临床诊断对金属义齿不能耐受118例,接触金属化合物感觉不舒服6例。都进行义齿金属成分的皮肤贴斑试验,用2%氯化钴液3%硫酸镍液,0.5%铬酸钠液,1%氯化钯液,2%硝酸银液和1%金氢氯酸液。皮肤试验阳性结果分4级:     

贵金属烤瓷合金铸态金相学观察

随着国民生活水平的日益改善 ,对齿科修复材料的要求和牙齿保健意识逐渐提高。患者普遍要求制作高质量修复体 ,对其强度、美观、使用寿命、基牙和机体组织的反应更加关注。目前临床普遍开展的烤瓷熔附金属 (ＰＦＭ)修复体基本达到要求 ;但金属基底 (ｍｅｔａｌｓｕｂｓｔｒａｔｅ)多采用非贵金属烤瓷合金 ,如镍铬烤瓷合金 ,其超硬度、高熔点、高收缩及某些有害贱金属元素如铍、镍、钴、铬等 ,使修复体制作困难、精密程度不足、对基牙和机体组织有不良影响。贵金属合金作为齿科修复传统合金在国外应用较普遍 ,价格成为广泛开展的唯一制约因素…     

镍合金铸造钢托过敏1例

铸造钢托在义齿修复中应用已久 ,深受病人喜欢。近年 ,国外有报道铸造所用合金中的镍对一部分人有致敏、致突变作用[1] ,国内少见对此方面报道 ,作者遇到 1例 ,含 0 .99%镍铸造成的钢托过敏病例。患者 ,女 ,70岁。因上颌多个牙缺失 ,曾作可摘局部义齿修复 ,因基托过薄易碎或基托过厚不适而改用铸造钢托 ,试戴时病人满意 ,1月后因舌尖疼痛不适而就诊 ,检查见舌体光滑发红 ,舌乳头退缩 ,未见创伤及溃疡 ,上腭钢托接触区黏膜发红 ,患者述该症状为试戴钢托后 1周出现 ,自行摘除钢托后 3天症状消失 ,再戴再出现 ,再摘除再消失。皮肤斑贴试验对镍…     

新型口腔修复用钛锆铌锡合金的生物安全性评价

目的:评价高强度、高弹性模量的新型口腔修复用钛锆铌锡合金的生物安全性。方法:参照国标GB/T16886.5-2003,GB/T16886.10-2005,YY-T0279-1995,YY-T0127.2-1993所规定的方法,分别进行细胞毒性试验、豚鼠最大剂量迟发型致敏试验、口腔黏膜刺激试验以及急性全身毒性试验。结果:细胞毒性试验显示本研究制备的钛锆铌锡合金细胞相对增殖度为124%,细胞毒性反应分级为0级,无细胞毒性;致敏试验表明移去斑贴物24、48h后,试验动物贴敷部位均无红斑和水肿出现,反应积分为0。根据皮肤致敏实验分级标准,Ti-Zr-Nb-Sn合金对豚鼠无明显的潜在致敏性;口腔黏膜刺激试验未见异常组织学反应;短期全身毒性试验显示无明显短期全身毒性。结论:可以初步认为Ti-Zr-Nb-Sn合金是一种合金具有良好生物安全性口腔修复用金属材料。     

不同牙科金属材料致敏性的比较

目的: 比较分析牙科金属材料的致敏性, 为今后科学选择牙科金属材料提供指导。方法: 对92例口腔内含金属修复体的受试者进行斑贴试验。采用SPSS 17.0软件包对相关数据进行Pearsonχ2检验、校正的χ2检验和Fisher确切概率检验。结果: ①不同金属材料的过敏率不同, 镍(Ni)的过敏率最高22.8%, 铝(Al)的过敏率为0。②对钯(Pd)和镍(Ni)过敏者中, 女性多于男性, 差异具有显著性(P<0.05)。③女性中, 穿耳者镍(Ni)的阳性率较高, 但穿耳与镍(Ni)过敏无相关关系(P>0.05)。④钯(Pd)和镍(Ni)之间存在交叉过敏, 对钯(Pd)过敏者中, 83.3%对镍(Ni)过敏;对镍(Ni)过敏者中, 47.6%对钯(Pd)过敏。⑤斑贴试验可出现迟发反应。结论: 牙科金属材料具有一定的过敏率, 女性对钯(Pd)和镍(Ni)的过敏率显著高于男性。斑贴试验可出现迟发反应, 必要时可观察96 h、7 d甚至更长时间的结果, 以排除假阴性。     

COX-2,HSP60,HSP70在镍铬合金修复体患者牙龈组织中的表达及意义

目的:研究镍铬合金修复体对口腔牙龈组织的影响。方法:本文运用免疫组化染色SP(Streptavidin-peroxidase)法检测COX-2(cyclooxygenase-2)、HSP60(heat shock protein 60)、HSP70(heat shock protein 70)在镍铬合金修复体患者牙龈组织和正常牙龈组织中的表达情况。经患者同意,从临床采集镍铬合金修复体患者牙龈30例作为实验组,采集口内无任何修复体患者的正常牙龈26例,将实验组中同一患者的牙龈组织分成3份,用免疫组织化学技术分别作COX-2、HSP60、HSP70的检测。每种指标检测30例,对照组同实验组。结果进行统计学分析。结果:HSP60和HSP70在镍铬合金修复体患者牙龈组织中表达明显高于对照组正常牙龈组织(P<0.05)。COX-2在实验组中的表达亦高于对照组(P<0.05)。结论:镍铬合金修复体在口腔中游离出的金属离子对牙龈组织具有致敏性和致炎性,但是否具有致癌性还有待研究。     

种植多单位修复中螺丝固位与粘接固位联合运用中机械并发症发生情况的回顾性研究

目的:比较多单位螺丝固位种植修复中,采用口内粘接与技师模型上粘接修复体内外冠的螺丝固位修复体在长期使用后机械并发症发生方面的差异.方法:收集后牙区后多单位螺丝固位种植修复体戴牙后3年的患者205例(414颗种植体),其中技师模型上完成金属内冠和氧化锆外冠粘结而后口内螺丝固定99例(198颗植体);采用口内金属内冠螺丝固...     

金属烤瓷牙崩瓷的口内修补及临床分析

金属烤瓷修复体在临床上的应用越来越广泛 ,部分修复体的脱瓷、崩瓷现象是目前金属烤瓷修复体存在的问题之一。由于修复体与基牙之间是永久粘结 ,不易拆除 ,如强行拆除会增加患者的痛苦及费用。我科自 1995年以来用Ｃｉｍａｒａ修补材料对 97例金属烤瓷崩瓷的患者行口内修补 ,取得了较好的临床效果 ,成功率达 91.8%。材料和方法1 病例的选择　选择金属烤瓷单个牙崩瓷的患者 ,其中单纯性崩瓷无金属外露的有 39例 ,有金属外露但小于牙面1/ 2者有 36例 ,金属外露面积在牙面 1/ 2以上者有 2 2例。2 修补材料　德国Ｃｉｍａｒａ套装材料 ,它包含…     

非贵金属合金的生物相容性

近年来,含有高百分比镍的合金,因具韧性和价格低廉,受到固定修复界的欢迎。自1970年来,美国用这种合金制作的修复体,已由32％上升到80％。这种合金在临床应用上与贵金属合金同样良好。虽然非贵金属合金看来问题不大,但涉及到纵向和流行病学研究时,可能在实验室技术员和牙医师中出现敏感性和致癌作用。敏感性:镍和铬为已知的变应原。对镍的敏感性,曾报告过男性为0.8％至20.7％,女性为9％至31.9％。性别差异是由于女性更多接触到含镍饰物,特别是穿孔式耳环。对铬的过敏性,曾报告过男性为1.5％,女性为4％。口内组织对致敏原有更高的抗力。而口内组织暴露于变应原时,可在远离修复体的部位出现荨麻疹、瘙痒、口腔干燥、湿疹或疱疹等过敏性症状。患者可能由于这些症状求治于皮肤科医师,而未能觉察到口内根源。一     

3种材料用于后牙冠桥的临床效果比较

目的 观察常用的3种材料用于后牙固定修复中的临床效果。方法 以修复体功能与外观及口内组织的健康情况为评价指标,观察202例分别用NPG合金、镍铬合金、金瓷冠桥修复的临床效果。结果 3种修复形式的成功率分别为91.90、89.8％和92.6％(P>0.05)。NPG合金有晦暗变色的问题,镍铬合金与金瓷修复体有可能使对(牙合)牙过度磨耗。结论 后牙全冠以NPG合金和金瓷修复有较理想效果,而固定桥以金瓷修复体为好。     

Current status of dental metal allergy in Japan

PurposeTo assess the current status of patients with dental metal allergies in Japan.MethodsThis study analyzed dental metal allergy in 1225 patients (1:3 male to female ratio; average age 53.0 ±16.5 years), including 300 who were scheduled to undergo dental implant surgery, between 2006 and 2016. For diagnosis of metal allergy, patch tests using metal allergens were performed. Additionally, when necessary, metal element analysis of dental alloys was performed in the mouths of some patients using an X-ray fluorescence analyzer for those who exhibited positive reactions.ResultsAmong 925 patients (i.e., excluding those scheduled to undergo dental implant surgery [n = 300]), nearly one-half (44.0%) exhibited a positive response to any metal element in the patch test. The positivity rates were as follows: nickel (22.5%); palladium (14.8%); and zinc (11.5%). Almost one-half (42.3%) of the patients had diseases associated with metal allergy. Among patients who exhibited a positive reaction to any metal element in the patch test, more than two-thirds (67.9%) had dental alloys containing the positive metal element(s). One-half (55.6%) of the patients who underwent treatment to remove the metal experienced improvement in symptoms. In patients who underwent patch testing as an implant preoperative examination, several (2.7%) exhibited a positive reaction to titanium.ConclusionsDental metals, including nickel, palladium and zinc, which are indispensable to dental treatment in Japan, had high positivity rates in patch testing, and one-half of the patients improved following removal of the metal. Additionally, there were several patients with allergy to titanium.     

Immunological studies on the peripheral blood mononuclear cells in metal allergy patients

Recently, the number of patients with dental metal allergy has risen significantly. The aim of this study was to evaluate the clinical availability of the lymphocyte stimulation test (LST) using metal reagents as a method for diagnosing metal allergy. In vitro, peripheral blood mononuclear cells (PBMC) from 18 patients with metal allergy and five healthy volunteers were examined by LST using 12 metal reagents (HAuCl4, PdCl2, NiSO4, CoCl2, CuSO4, SnCl4, K2Cr2O7, MoCl5, H2PtCl6, IrCl4, AgBr, FeCl3). To define metal allergy, a patch test (PT) was performed with metal reagents, and then the components of dental alloys in their mouth were analyzed. The expressions of CD 4, CD 8, CD 25, and CLA of metal-specific T cells were determined by flow cytometric analysis (FACS). PBMC from patients with positive PT showed LST positive for nickel sulfate (Ni), gold chloride (Au), palladium chloride (Pd) and cobalt chloride (Co). The results of LST in other metals indicated negative in spite of the positive result by PT. FACS results indicated the increase of CD 4 + T/CD 8 + alpha 4 + T cells, CD 4 + T/CD 8 + CLA+ T cells by stimulation with metal reagent. Thus, metal-specific T cells were stimulated in PT positive patients, so LST could be a more specific test for diagnosing dental metal allergy.     

Biological interactions of dental cast alloys with oral tissues.

OBJECTIVE: All dental cast alloys release metal ions into the oral environment which have the potential to interact with the oral tissues. Amount and type of metal elements released are varying and not directly related to the composition of the alloy. The aim of the present literature survey was to describe the interactions of dental cast alloys with living tissues and to relate them to clinically adverse local reactions of the oral tissues. RESULTS: Interactions of dental cast alloys with the oral tissues take place by different mechanisms; e.g. bacterial adherence promotion, toxic and subtoxic effects and allergy. Whereas bacterial adhesion promotion may be counteracted by adequate oral hygiene measures, the other mechanisms may lead to clinically adverse local reactions due to the metal present. However, the number of cases, where such a relation can be safely diagnosed, is small. Safe ground is felt with proven allergies. The comparatively high allergy rate towards nickel should be the impetus to replace those alloys whenever there is a suitable alternative. Medical and dental impairments as well as general medication may lead to symptoms allegedly attributed to metal restorations. CONCLUSIONS AND SIGNIFICANCE: Patients relating oral symptoms to metal restorations should be subjected to a thorough dental and general medical examination in order to exclude non-material related diseases being the cause for their complaints/symptoms. These cases are a challenge for the collaboration between the medical and dental professions.     

Applicability of zirconia dental prostheses for metal allergy patients

The aim of this study was to investigate the applicability of zirconium dioxide (zirconia) as a substitute for metal alloys in a group of metal allergy patients. Fourteen patients (eight women, six men) who had been restored with porcelain-fused-to-metal fixed partial dentures (FPDs) and had exhibited hypersensitivity lesions to dental alloys were enrolled in this study. Patients were previously patch-tested using standard testing substances authorized by the International Contact Dermatitis Research Group. Patients received FPDs with zirconia frameworks and occurrences of oral symptoms were evaluated. No hypersensitivity lesions in the mouth or on the skin were encountered during the follow-up period of 3 years. Zirconia FPDs may be an alternative to porcelain-fused-to-metal FPDs in patients with metal allergies.     

口腔内金属修复物的成分分析

目的：测定口腔内金属修复物的成分，确定使用的合金种类，以使牙科金属过敏患者避免再次使用此种合金。方法：用细砂纸及圆锥形抛光磨头，采取微量口腔内金属修复物，通过EDXRF(荧光X线分析仪)测定所含金属成分，确定合金种类。结果：14例可疑牙科金属过敏患者中，牙科金属修复物120个，按照检出频度的高低．排在前10位的金属元素分别是Ag、Cu、Au、Pd、Zn、Sn、Co、Cr、In和Mo。Au-Ag-Pd合金的使用频度为65％，Ag-Sn-Hg合金为2.5％，Ag合金为5.4％，Au合金为14.6％，Ni-Cr、Co-Cr合金为10.1％，其他2.4％。2种以上异种合金共存同一口腔环境中的患者12例,5种合金同时存在者1例。含Hg的银汞合金的使用频度为2.5％，与10年前的使用频度16％相比下降明显。Ni、Cr、Co的使用频度未见明显改变。结论：被疑牙科金属过敏的患者中，异种金属同存的现象严重，提示在口腔科临床工作中，尽量避免使用异种金属及含Hg和Ni等易诱发过敏的金属合金。     

No evidence of hypersensitivity to dental restorative metals in oral lichen planus

Abstract – Twelve patients with oral lichen planus (OLP) suspected of dental restorative metal allergy were examined. All patients were patch tested with several metals including six different mercury compounds. One (8%) patient showed a positive patch test to two mercury compounds whereas no mercury allergy was found in a reference group of 17 patients suspected of dental restorative material allergy but without OLP lesions. The mercury allergic OLP patient was further tested on palatal mucosa but no reactions developed. Moreover, the energy dispersive X-ray microanalysis failed to show any contaminating metals in his OLP lesion. Mucosal biopsies were taken in close contact with amalgam fillings from nine OLP patients but these disclosed no evidence of lichenoid or dysplastic alterations. In OLP lesions, the immunofluorescence findings showed fibrinogen deposition, altered basement membrane and elastic fiber staining and intense Ulex europeaus I lectin fluorescence through all epithelial cell layers. Therefore, the present patch tests did not reveal increased frequency of mercury or other metal allergy in OLP patients and the mucosal biopsies failed to show any histologic or immunofluorescence alterations deviating from idiopathic OLP lesions.     

No evidence of hypersensitivity to dental restorative metals in oral lichen planus

Twelve patients with oral lichen planus (OLP) suspected of dental restorative metal allergy were examined. All patients were patch tested with several metals including six different mercury compounds. One (8%) patient showed a positive patch test to two mercury compounds whereas no mercury allergy was found in a reference group of 17 patients suspected of dental restorative material allergy but without OLP lesions. The mercury allergic OLP patient was further tested on palatal mucosa but no reactions developed. Moreover, the energy dispersive X-ray microanalysis failed to show any contaminating metals in his OLP lesion. Mucosal biopsies were taken in close contact with amalgam fillings from nine OLP patients but these disclosed no evidence of lichenoid or dysplastic alterations. In OLP lesions, the immunofluorescence findings showed fibrinogen deposition, altered basement membrane and elastic fiber staining and intense Ulex europeaus I lectin fluorescence through all epithelial cell layers. Therefore, the present patch tests did not reveal increased frequency of mercury or other metal allergy in OLP patients and the mucosal biopsies failed to show any histologic or immunofluorescence alterations deviating from idiopathic OLP lesions.     

Allergic palmoplantar pustulosis caused by cobalt in cast dental crowns: a case report

Cobalt chrome alloy is a common material in prosthodontic restorations; however, instances of palmoplantar pustulosis owing to cobalt allergy are rare. Here, we report an unusual case of palmoplantar pustulosis in the hands and feet of a 58-year-old male patient caused by a cobalt allergy. The patient developed palmoplantar pustulosis characterized by redness, pustules, vesicles, and scaly erythema on his hands and feet 1 month after obtaining cobalt chromium alloy cast crowns on his molar teeth. The symptoms persisted for 1 year. He underwent standard patch testing, which showed a strong positive reaction to cobalt chloride. After the crowns were removed, the symptoms disappeared in 3 weeks. This study may serve to remind dental practitioners to be aware of potential allergic reactions to dental materials used in prosthodontic treatment and to enable them to recognize a metal allergy if it appears.     

A rare allergy to a polyether dental impression material

Polyether impression materials have been used in dentistry for more than 40 years. Allergic reactions to these materials such as reported in the 1970s ceased after replacement of a catalyst. Very recently, however, patients have started to report symptoms that suggest a new allergic reaction from polyether impression materials. Here, we report on the results of allergy testing with polyether impression materials as well as with its components. Eight patients with clinical symptoms of a contact allergy (swelling, redness or blisters) after exposure to a polyether impression material were subjected to patch tests, two of them additionally to a prick test. A further patient with atypical symptoms of an allergy (nausea and vomiting after contact with a polyether impression material in the oral cavity) but with a history of other allergic reaction was also patch tested. The prick tests showed no immediate reactions in the two patients tested. In the patch tests, all eight patients with typical clinical symptoms showed positive reactions to the mixed polyether impression materials, to the base paste or to a base paste component. The patient with the atypical clinical symptoms did not show any positive patch test reactions. Polyether impression materials may evoke type IV allergic reactions. The causative agent was a component of the base paste. In consideration of the widespread use of this impression material (millions of applications per year) and in comparison to the number of adverse reactions from other dental materials, the number of such allergic reactions is very low. In very scarce cases, positive allergic reactions to polyether impression materials are possible.