title: Is titanium sensitivity associated with allergic reactions in patients with dental implants? A systematic review.
abstract: BACKGROUND
  A worrying correlation which seems to be overlooked by clinicians is allergic reactions to titanium (Ti) in patients with dental implants.
  
  
  OBJECTIVE
  The aim of the present review study was to assess whether or not Ti sensitivity is associated with allergic reactions in patients with dental implants.
  
  
  METHODS
  To address the focused question "Can Ti cause allergic reactions in patients with dental implants?", databases were explored from 1977 until May 2010 using a combination of the following keywords: "allergy,""dental,""hypersensitivity,""implant,""oral," and "Titanium." Letters to the editor and unpublished data were excluded.
  
  
  RESULTS
  Seven studies (six clinical and one experimental) were included. The participants were aged between 14.3 and 84.1 years. In five clinical studies, Ti implants were inserted in the mandible. Five studies reported dermal inflammatory conditions and gingival hyperplasia as allergic reactions in patients with Ti dental implants. A case report presented swelling in submental and labial sulcus and hyperemia of soft tissues in a patient with Ti dental implants. Two studies reported that Ti implants are well tolerated in host tissues. The patch test was performed in two clinical studies for the diagnosis of allergic reactions. Memory lymphocyte immunostimulation assay and lymphocyte transformation tests were also performed.
  
  
  CONCLUSIONS
  The significance of Ti as a cause of allergic reactions in patients with dental implants remains unproven.
authors.affiliation: Research associate, Eng A B Growth Factors and Bone Regeneration Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Fawad
authors.initials: F
authors.lastname: Javed
authors.affiliation: assistant professor, Eng A B Growth Factors and Bone Regeneration Research Chair, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Hezaimi
authors.affiliation: associate professor, Division of Periodontology, School of Dental Medicine, University of Connecticut, Farmington, CT, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Almas
authors.affiliation: professor, Eastman Institute for Oral Health, Division of Periodontology, University of Rochester, Rochester, NY, USA.
authors.forename: George E
authors.initials: GE
authors.lastname: Romanos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015921:Dental Implants / Q000009:adverse effects*; D005148:Facial Dermatoses / Q000209:etiology; D005260:Female; D005885:Gingival Hyperplasia / Q000209:etiology; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D014025:Titanium / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D015921:Dental Implants; D014025:Titanium