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Response of known nickel-sensitive patient to a removable partial denture with a titanium alloy framework: A clinical report
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Response of known nickel-sensitive patient to a removable partial denture with a titanium alloy framework: A clinical report George William
H. Latta, Jr., DDS,a MS, Sean McDougal, F. Bowles III, DDSC
University Memphis,
of Tennessee, College of Dentistry, Tenn.
and Veterans Administration
P
ubhc awareness of chemical pollution, concern about mercury in dental amalgam, and the unknown effects of other restorative materials used in dentistry has heightened substantially within the past few years. Likewise, governmental agencies have gained considerable notoriety for their oversight activities concerning these and related matters.’ Healthcare providers are cognizant of the necessity for avoiding the use of drugs or materials that cause untoward reactions in their patients. Prosthodontic restorations are often made with alloys containing nickel or beryllium even
aProfessor and Director, Division of Removable Prosthodontics, College of Dentistry, University of Tennessee. l’Genera1 Practice Resident, Veterans Administration Medical Center. cProfessor and Chairman, Division of Removable Prosthodontics, College of Dentistry, University of Tennessee. J PROSTHETDENT~~~~;~~:~O~-~O.)
10/l/48047
Fig.
AUGUST 1993
1. Earring
in place.
DDS,b
and Medical
Center,
though allergy and disease response to these metals has been reported.2 Today’s successes in medical and dental implants can be attributed in large part to the use of titanium, a material that exhibits a high degree of biocompatibility.3 The following report relates the prosthodontic treatment of a patient with a known sensitivity to nickel. TREATMENT A 61-year-old white woman was referred to the student clinic for prosthodontic restoration. The patient’s medical history included a confirmed diagnosis of sensitivity to nickel and remarks concerning difficulty in wearing jewelry because of skin reactions. On examination, she had an illfitting maxillary complete denture and an unrestored partially edentulous mandible. A previous mandibular removable partial denture had caused severe discomfort, possibly the result of allergic response; she did not know the whereabouts of the prosthesis. Before the initiation of treatment, the patient consented to wear costume jewelry for demonstration purposes. Skin
Fig.
2. Evidence
of contact allergy after 72 hours.
109
3. Removable partial denture with titanium framework in place.
Fig.
alloy
irritations were evident in the area of contact within a 72hour period (Figs. 1 and 2). A new maxillary complete denture and a mandibular removable partial denture with a conventional design was made for the patient.4 The partial denture framework was made with a titanium alloy containing no nickel (Tytaniurn R, Generic Pentron, Wallingford, Conn.). The prostheses were placed without complication, and the patient returned for routine postoperative adjustments at 24-hour, 72-hour, and l-week intervals. She experienced a minimal number of minor soft tissue irritations in the area of contact with the resin denture bases, but no allergic response to the metal framework was noticed. She was wearing both prostheses without evidence of discomfort at an evaluation 1 month after their placement (Figs. 3 and 4).
CLINICAL
IMPLICATIONS
A patient with a known sensitivity to nickel was treated for restoration of a partially edentulous mandible with a removable partial denture made with a titanium alloy metal framework. The patient revealed no untoward reac-
110
4. Soft tissue L month after piarr:~t?ir~: (1~:‘xwi. partial denture.
Fig.
::t:!e
tion to the prosthesis after a period of’ 1 month. The use i-1)‘ this highly inert metal appears to provide an alt,ernative for prosthodontic care of patients who exhibit cimmon met.ai allergies. REFERENCES 1. Todd K. What to do if OSHA calls. .I Am Ifeni Awx: 19!13;1%4.‘iTi 8. 2. Jendresen MD, et al. Report of the Committee on Scientific Invest&vtion of the American Academy of Restorative Dent.istry. d ~ROSI‘HII1 DENT 1988;59:703-38. 3. Branemark PI, Zarb GA, Albrektsaon T. Tissue-Integrated prosthot;es: osseointegration in clinical dentistry. Chicago: Quintessence Pub (‘
Reprint requests to: DK. GE~HGE H. LAWA, JR. DEPAH’I’MENT OF PROSTHODONWCS UNIVERSITY OF TENNESSEE, MEMPHIS COLL~KE OF DEN’I’ISTRY 876 UNION AVE. MEMPHIS, TN 38163
VOIAIME
70
NUMBER
2
Response of known nickel-sensitive patient to a removable partial denture with a titanium alloy framework: A clinical report George William
H. Latta, Jr., DDS,a MS, Sean McDougal, F. Bowles III, DDSC
University Memphis,
of Tennessee, College of Dentistry, Tenn.
and Veterans Administration
P
ubhc awareness of chemical pollution, concern about mercury in dental amalgam, and the unknown effects of other restorative materials used in dentistry has heightened substantially within the past few years. Likewise, governmental agencies have gained considerable notoriety for their oversight activities concerning these and related matters.’ Healthcare providers are cognizant of the necessity for avoiding the use of drugs or materials that cause untoward reactions in their patients. Prosthodontic restorations are often made with alloys containing nickel or beryllium even
aProfessor and Director, Division of Removable Prosthodontics, College of Dentistry, University of Tennessee. l’Genera1 Practice Resident, Veterans Administration Medical Center. cProfessor and Chairman, Division of Removable Prosthodontics, College of Dentistry, University of Tennessee. J PROSTHETDENT~~~~;~~:~O~-~O.)
10/l/48047
Fig.
AUGUST 1993
1. Earring
in place.
DDS,b
and Medical
Center,
though allergy and disease response to these metals has been reported.2 Today’s successes in medical and dental implants can be attributed in large part to the use of titanium, a material that exhibits a high degree of biocompatibility.3 The following report relates the prosthodontic treatment of a patient with a known sensitivity to nickel. TREATMENT A 61-year-old white woman was referred to the student clinic for prosthodontic restoration. The patient’s medical history included a confirmed diagnosis of sensitivity to nickel and remarks concerning difficulty in wearing jewelry because of skin reactions. On examination, she had an illfitting maxillary complete denture and an unrestored partially edentulous mandible. A previous mandibular removable partial denture had caused severe discomfort, possibly the result of allergic response; she did not know the whereabouts of the prosthesis. Before the initiation of treatment, the patient consented to wear costume jewelry for demonstration purposes. Skin
Fig.
2. Evidence
of contact allergy after 72 hours.
109
3. Removable partial denture with titanium framework in place.
Fig.
alloy
irritations were evident in the area of contact within a 72hour period (Figs. 1 and 2). A new maxillary complete denture and a mandibular removable partial denture with a conventional design was made for the patient.4 The partial denture framework was made with a titanium alloy containing no nickel (Tytaniurn R, Generic Pentron, Wallingford, Conn.). The prostheses were placed without complication, and the patient returned for routine postoperative adjustments at 24-hour, 72-hour, and l-week intervals. She experienced a minimal number of minor soft tissue irritations in the area of contact with the resin denture bases, but no allergic response to the metal framework was noticed. She was wearing both prostheses without evidence of discomfort at an evaluation 1 month after their placement (Figs. 3 and 4).
CLINICAL
IMPLICATIONS
A patient with a known sensitivity to nickel was treated for restoration of a partially edentulous mandible with a removable partial denture made with a titanium alloy metal framework. The patient revealed no untoward reac-
110
4. Soft tissue L month after piarr:~t?ir~: (1~:‘xwi. partial denture.
Fig.
::t:!e
tion to the prosthesis after a period of’ 1 month. The use i-1)‘ this highly inert metal appears to provide an alt,ernative for prosthodontic care of patients who exhibit cimmon met.ai allergies. REFERENCES 1. Todd K. What to do if OSHA calls. .I Am Ifeni Awx: 19!13;1%4.‘iTi 8. 2. Jendresen MD, et al. Report of the Committee on Scientific Invest&vtion of the American Academy of Restorative Dent.istry. d ~ROSI‘HII1 DENT 1988;59:703-38. 3. Branemark PI, Zarb GA, Albrektsaon T. Tissue-Integrated prosthot;es: osseointegration in clinical dentistry. Chicago: Quintessence Pub (‘
Reprint requests to: DK. GE~HGE H. LAWA, JR. DEPAH’I’MENT OF PROSTHODONWCS UNIVERSITY OF TENNESSEE, MEMPHIS COLL~KE OF DEN’I’ISTRY 876 UNION AVE. MEMPHIS, TN 38163
VOIAIME
70
NUMBER
2