Patch testing prior to getting a dental implant
Question:
3/28/2024
Is testing indicated? Patient is adamant they get tested for metal as he has an upcoming dental implant. Dentist agreed with his suggestion that he be tested. He has never had any reaction to metals (but has not worn them either including metal jewelry, watch straps and belt buckles) and has not had a reaction to chemicals and does not have symptoms of skin rashes. He did have vague symptoms of rash and swelling to an eye antibiotic ointment a few years ago.
His mother's shoulder implants failed due to undiagnosed metal allergy and ended with an amputation presumably due to poor healing. Implants are going to cost about 20K (whole mouth) as he would rather not get them if they need to be taken out if he has a metal allergy like his mother.
Is testing for reassurance indicated? If he is positive will that mean a true previously undiagnosed metal allergy or a false positive? What diagnosis do I use? I discussed false positives and that it is not medically indicated (in the absence of symptoms) and that insurance may not cover it. Do I have the indication to do testing and are there any studies that show a genetic basis for metal allergy? Is testing warranted so that they can get the implants done which will benefit appearance, speech and help meet nutritional needs so he can eat?
Answer:
Dental implants are typically made of titanium alloys that may include trace amounts of other metals like nickel, aluminum, molybdenum, vanadium, niobium, or zirconium.
A family history of a T-cell mediated contact sensitivity is not a significant risk factor for the patient.
Given no history of a T-cell mediated contact dermatitis to any topical metal exposures, there is a very low probability that your patient will have a positive patch test to any metal.
Patch testing prior to dental implants are not indicated unless there is a history of metal associated contact dermatitis.
Hosoki M, Nishigawa K, Miyamoto Y, Ohe G, Matsuka Y. Allergic contact dermatitis caused by titanium screws and dental implants. J Prosthodont Res. 2016 Jul;60(3):213-9.
Whether or not you decide to proceed with patch testing will need to be a shared decision with the patient.
Eric Macy, MD, MS, FAAAAI