Protetik Diş Tedavisinde Materyal Alerjileri
Özet
Protetik diş tedavisinde kullanılan metal alaşımları, kaide materyalleri, ölçü maddeleri ve lateks gibi biyomateryaller, subklinik belirtilerden ölümcül anafilaktik şoka kadar değişen geniş bir yelpazede alerjik reaksiyonlara yol açabilmektedir. Bu immünolojik tepkiler çoğunlukla antijenle temastan 24-72 saat sonra ortaya çıkan Tip IV gecikmiş duyarlılık veya IgE aracılı Tip I atopik reaksiyonlar şeklinde sınıflandırılmaktadır. Ağız mukozası, tükürüğün yıkama etkisi ve yoğun kan akımı sayesinde deriye kıyasla alerjenlere karşı daha dirençli olsa da, dental metallerin korozyona uğramasıyla salınan iyonlar ve akrilik rezinlerdeki artık monomerler yanma, eritem, ülserasyon ve likenoid lezyonlar gibi ciddi objektif klinik tablolara neden olabilmektedir. Teşhiste, dental tarama serilerini içeren yama (epikütan) testleri ve modern hücresel bağışıklık yöntemlerinden MELISA gibi lenfosit transformasyon testleri yaygın olarak tercih edilmektedir. Tedavi sürecinde öncelikle semptomların giderilmesi amacıyla lokal veya sistemik kortikosteroidler uygulanırken, kalıcı çözüm için mevcut restorasyonların uzaklaştırılarak zirkonyum, titanyum, tam seramik, vinilakrilik veya nitril gibi hastanın hassasiyet göstermediği alternatif, biyouyumlu materyallerle değiştirilmesi gerekmektedir.
Prosthetic dental treatments involve various biomaterials like metal alloys, denture base resins, impression compounds, and latex, which can trigger allergic reactions spanning from subclinical symptoms to fatal anaphylactic shock. These immunological responses are primarily classified into Type IV delayed-type hypersensitivity manifesting 24-72 hours post-exposure or IgE-mediated Type I atopic reactions. Although the oral mucosa exhibits higher resistance than skin due to salivary dilution and rich vascularity, ions released through metal corrosion and residual monomers from acrylic resins can cause profound objective manifestations such as burning, erythema, ulcerations, and lichenoid lesions. For diagnosis, patch (epicutaneous) testing utilizing dental screening series and modern cellular assays like MELISA lymphocyte transformation tests are widely preferred. Management typically initiates with local or systemic corticosteroids for symptomatic relief, but definitive resolution requires removing offending materials and substituting them with biocompatible, non-allergenic alternatives such as zirconia, titanium, all-ceramics, vinyl-acrylics, or nitrile gloves.
Referanslar
Baran İ, Nalçacı R. Diş hekimliğinde kullanılan materyaller ve alerjk reaksiyonlar. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2007;17(2): 26–32.
N, Tüfekçioğlu D. Diş hekimliği ve alerji. Cumhuriyet Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2003;6(1): 37–42.
Janeway CA Jr, Travers P. Immunobiology. 3rd ed. Edinburgh: Churchill Livingstone; 1997.
Pretorius E. Basic principles of allergic reactions. South African Dental Journal. 2002;57(8): 332‒334.
Benjamini E, Leskowitz S. Immunology. 2nd ed. New York: Wiley-Liss; 1991.
Lygre H. Prosthodontic biomaterials and adverse reactions: A critical review of the clinical and research literature. Acta Odontologica Scandinavica. 2002;60(1): 1‒9. doi.org/10.1080/000163502753471925
Bakula A, Lugović-Mihić L, Šitum M, et al. Contact allergy in the mouth: Diversity of clinical presentations and diagnosis of common allergens relevant to dental practice. Acta Clinica Croatica. 2011;50(4): 553–561.
Ditrichova D, Kapralova S, Tichy M, et al. Oral lichenoid lesions and allergy to dental materials. Biomedical Papers of the Medical Faculty of Palacky University in Olomouc. 2007;151(2): 333–339. doi: 10.5507/bp.2007.057.
Gawkrodger DJ. Investigation of reactions to dental materials. British Journal of Dermatology 2005;153(3): 479–485. doi.org/10.1111/j.1365-2133.2005.06821.x
Hoskyn J, Guin JD. Contact allergy to cinnamal in a patient with oral lichen planus. Contact Dermatitis. 2005;52(3):160‒161. doi: 10.1111/j.0105-1873.2005.0548b.x.
DeRossi SS, Greenberg MS. Intraoral contact allergy: a literature review and case reports. The Journal of the American Dental Association, 1998;129(10): 1435-1441. doi.org/10.14219/jada.archive.1998.0078
Neville BW, Damm DD, Allen CM, Bouquat JE. Oral & Maxillofacial Pathology. 1st ed, USA:WB Saunders Company; 1995.
Hougeir FG, Yiannias JA, Hinni ML, et al. Oral metal contact allergy: a pilot study on the cause of oral squamous cell carcinoma. International Journal of Dermatology. 2006;45(3): 265–271. doi.org/10.1111/j.1365-4632.2004.02417.x
van der Meij EH, Mast H, van der Waal I. The possible premalignant character of oral lichen planus and oral lichenoid lesions: A prospective five-year follow-up study of 192 patients. Oral Oncology. 2007;43(8): 742–748. doi.org/10.1016/j.oraloncology.2006.09.006
Przybylla B, Rueff F. Contact dermatitis. Braun-Falco O, Plewig G, Wolf Hh, Landthaler (ed.) Dermatology içinde. Berlin: Springer-Verlag; 2009: p. 377‒401.
Sinitchi G. Zirconium allergies caused by oral dental materials. A general review. Internatioal Journal of Medical Dentistry. 2017;7(2) :89–93.
Forte G, Petrucci F, Bocca B. Metal allergens of growing significance: epidemiology, immunotoxicology, strategies for testing and prevention. Inflammation & Allergy-Drug Targets. 2008;7(3): 145‒162. doi: 10.2174/187152808785748146.
Casale TB, Costa JJ, Galli SJ. TNF alpha is important in human lung allergic reactions. American Journal of Respiratory Cell and Molecular Biology. 1996;15(1): 35‒44. doi: 10.1165/ajrcmb.15.1.8679220.
Zhou J, Paul A, Bennani V, et al. New Zealand dental practitioners’ experience of patient allergies to dental alloys used for prosthodontics. New Zealand Dental Journal. 2010;106(2): 55‒60.
Kitagawa M, Murakami S, Akashi Y, et al. Current status of dental metal allergy in Japan. Journal of Prosthodontic Research. 2019;63(3): 309–312. https://doi.org/10.1016/j.jpor.2019.01.003
Basketter D, Dooms-Gossens A, Karlberg AT, et al. The chemistry of contact allergy: why is a molecule allergenic?. Contact Dermatitis. 1995;32(2): 65–73. doi: 10.1111/j.1600-0536.1995.tb00748.x.
Stoeva I, Kisselova A. Prevalence of metal sensitivity in symptomatic patients with dental alloy restorations and the relation to the clinical manifestations. Biotechnology & Biotechnological Equipment. 2010;24(2): 1870–1873. doi.org/10.2478/V10133-010-0037-Z
Wataha JC, Hanks CT. Biological effects of palladium and risk of using palladium in dental casting alloys. Journal of Oral Rehabilitation. 1996;23(5): 309–320. doi.org/10.1111/j.1365-2842.1996.tb00858.x
Akagi K, Okamoto Y, Matsuura T, Horibe T. Properties of test metal ceramic titanium alloys. Journal of Prosthetic Dentistry. 1992;68(3): 462‒467. doi.org/10.1016/0022-3913(92)90411-3
Weingart D, Steinemann S, Schilli W, et al, Titanium deposition in regional lymph nodes after insertion of titanium screw implants in maxillofacial region. International Journal of Oral and Maxillofacial Surgery. 1994;23(6): 450‒452. doi.org/10.1016/S0901-5027(05)80045-1
Egusa H, Ko N, Shimazu T, et al. Suspected association of an allergic reaction with titanium dental implants: a clinical report. Journal of Prosthetic Dentistry. 2008;100(5): 344‒347. doi.org/10.1016/S0022-3913(08)60233-4
Bruze M, Hedman H, Björkner B, et al. The development and course of test reactions to gold sodium thiosulfate. Contact Dermatitis. 1995;33(6): 386–391. doi.org/10.1111/j.1600-0536.1995.tb02072.x
Björkner B, Bruze M, Möller H. High frequency of contact allergy to gold sodium thiosulfate: an indication of gold allergy?. Contact Dermatitis. 1994;30(3): 144–151. doi.org/10.1111/j.1600-0536.1994.tb00695.x
Hiyasad AS, Darmani H. The effects of recasting on the cytotoxicity of base metal alloys. Journal of Prosthetic Dentistry. 2005;93(2): 158-163. doi.org/10.1016/j.prosdent.2004.11.009
Oluwajana F, Walmsley AD. Titanium alloy removable partial denture framework in a patient with a metal allergy: A case study. British Dental Journal. 2012;213(3): 123–124. doi: 10.1038/sj.bdj.2012.667.
Blaschke C, Ulrich V. Soft and hard tissue response to zirconium dioxide dental implants--a clinical study in man. Neuroendocrinology Letters. 2006;27(1): 69‒72.
Sagomonyants KB, Jarman-Smith ML, Devine JN, et al. The invitro response of human osteoblasts to polyetherether ketone (PEEK) substrates compared to commercially pure titanium. Biomaterials. 2008;29(11): 1563‒1572. doi.org/10.1016/j.biomaterials.2007.12.001
Laney RW, Gibilisco A. Diagnosis and Treatment in Prosthodontics. 2nd ed. Philadelphia: Quintessence Pub Co; 2011.
Türkcan İ, Nalbant AD. Dental protetik materyallerin biyolojik uyumluluğu ve test yöntemleri. Acta Odontologica Turcica. 2015;33(2): 145‒152. doi.org/10.17214/aot.05383
Möller B, Terheyden H, Açil Y, et al. A comparison of biocompatibility and osseointegration of ceramic and titanium implants: an in vivo and in vitro study. International Journal of Oral and Maxillofacial Surgery. 2012;41: 638‒645. doi.org/10.1016/j.ijom.2012.02.004
Chaves CA, Machado AL, Vergani CE, et al. Cytotoxicity of denture base and hard chairside reline materials: a systematic review. Journal of Prosthetic Dentistry. 2012;107(2): 114-127. doi.org/10.1016/S0022-3913(12)60037-7
Gautam R, Singh RD, Sharma VP, et al. Biocompatibility of polymethylmethacrylate resins used in dentistry. Journal of Biomedical Materials Research Part B: Applied Biomaterials. 2012;100(5): 1444-1450. doi.org/10.1002/jbm.b.32673
Philips WR. Science of Dental Materials. 8th ed. Tokyo: WB Saunders; 1982.
Goon ATJ, Isaksson M, Zimerson E, et al. Contact allergy to (meth)acrylates in the dental series in southern Sweden: simultaneous positive patch test reaction patterns and possible screening allergens. Contact Dermatitis. 2006;55(4): 219–226. doi.org/10.1111/j.1600-0536.2006.00922.x
Huggett R, Brooks SC, Bates JF. The effects of different curing cycles on levels of residual monomer in acrylic resin denture base materials. Quintessence of Dental Technology. 1984;8(6): 356‒371.
Ali A, Bates JF, Reynolds AJ, et al. The burning mouth sensation related to the wearing of acrylic dentures; an investigation. British Dental Journal. 1986;161(12): 444‒447. doi: 10.1038/sj.bdj.4806008
Hochman N, Zalkind M. Hypersensitivity to methyl methacrylate: Mode of treatment. Journal of Prosthetic Dentistry. 1997;77(1): 93‒96. doi.org/10.1016/S0022-3913(97)70214-2
Van Groeningen G, Nater JP. Reactions to dental impression materials. Contact Dermatitis. 1975;1(6): 373–376. doi.org/10.1111/j.1600-0536.1975.tb05477.x
Dahl BL. Tissue hypersensitivity to dental materials. Journal of Oral Rehabilitation. 1978;5(2): 117–120. doi.org/10.1111/j.1365-2842.1978.tb01203.x
Batchelor JM, Todd PM. Allergic contact stomatitis caused by a polyether dental impression material. Contact Dermatitis. 2010;63(5): 296–297. doi:10.1111/j.1600-0536.2010.01804.x.
Mittermüller P, Szeimies RM, Landthaler M, et al. A rare allergy to a polyether dental impression material. Clinical Oral Investigation. 2012;16(4): 1111–1116. doi 10.1007/s00784-011-0618-8
Rafael CF, Liebermann A. Clinical characteristics of an allergic reaction to a polyether dental impression material. Journal of Prosthetic Dentistry. 2017;117(4): 470–472. doi.org/10.1016/j.prosdent.2016.08.031
Mobeeriek AA, Eshiekh HA. Adverse effect of polysulphide impression material: Case report. The Saudi Dental Journal. 1998;10: 86‒88. doi: 10.14219/jada.archive.1996.0415.
Gangemi S, Spagnolo EV, Cardia G, et al. Fatal anaphylactic shock due to a dental impression material. International Journal of Prosthodontics. 2009;22(1): 33‒34.
Nettis E, Colanardi MC, Ferrannini A, et al. Reported latex allergy in dental patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2002;93(2): 144‒148. doi.org/10.1067/moe.2002.120805
Barclay SC, Forsyth A, Felix DH, et al. Case report- hypersensitivitity to denture materials. British Dental Journal. 1999;187(7): 350‒352.
Blomgren J, Axéll T, Sandahl O, et al. Adverse reactions in the oral mucosa associated with anterior composite restorations. Journal of Oral Pathology & Medicine. 1996;25(6): 311‒313. doi.org/10.1111/j.1600-0714.1996.tb00268.x
Karabulut I, Kartal N, Cimilli H. Endodonti pratiğinde alerjik reaksiyonlar. Cumhuriyet Dental Journal. 2011;12(1): 78‒82.
