Unveiling the Role of Metal Ion Concentration versus Immune Sensitization in Orthodontic Patients—A Long-Term Prospective Evaluation
Abstract
:1. Introduction
- -
- the amount of metal ions released by fixed orthodontic appliances in saliva is not sufficient to cause toxic or allergic reactions; however, prolonged exposure could potentially lead to sensitization in these patients;
- -
- positive sensitization shows a positive correlation to local exposure in saliva.
Author(s) (Year) | Observational Period (OP) | N (Age) | Dental Material and Immune System Tested | Metal Ions | Procedures Employed | Outcome (Metal Release, Immune System, Intraoral Findings) |
---|---|---|---|---|---|---|
Agaoglu et al. (2001) [25] | 1 OP -unique timepoint for each group: before MBA insertion, 1st w, 1st m, 1st y, 2 y later | 100 -5 groups (12–33 y) | -MBA: 4 bd, 20 br and wires: 1. NiTi; 2. SS -Saliva and blood | Ni, Cr | Electrothermal AAS | -Ni, Cr increase in 1st month -Ni, Cr decrease in 2nd year -no toxic levels -no relationship between Ni level in saliva and serum |
Faccioni et al. (2003) [1] | 1 sample collection | 85: 55 MBA, 30 control (12–35 y) | Buccal mucosa cells | Ni, Co | -ICP-MS -Comet assay | -2.8-fold–3.4-fold higher ion levels -DNA damage |
Fernandez-Minano et al. (2011) [17] | 30 d -2 timepoints: -before -30 d after orthodontics | 15 (12–16 y) | -SS, Ni, Ti, Ni-free -Buccal mucosa cells | Ti, Cr, Mn, Co, Ni, Mo, Fe | -ICP-MS -Comet assay | -Ni free MBA higher levels of Cr and Fe -Ti alloys induced increased levels of Mn -Ti alloys no toxic effect -SS and Ni-free MBA greater DNA damage |
Nayak et al. (2015) [26] | Orthodontic treatment -pre-treatment -after aligning -10–12 m after treatment-beginning | 30 (10–25 y) | -Br, bd and wires: 1. NiTi, 2. NiTi (heat activated), 3. SS -saliva (after 30 s rinsing) | Ni, Cr | -ICP-MS | -Ni and Cr increase after aligning phase -after 10–12 m, increased Cr and decreased Ni levels -concern about biocompatibility and allergic reaction frequency |
Gölz et al. (2016) [27] | 8 w: before treatment, after br and bd placement, before and after archwire insertion -4 and 8 w later | 30 (10–13 y) | -br (self-ligating), bd -wires: NiTi -unstimulated saliva | Ni | -ICP-MS | -significant increase after br/bd insertion -decrease after 4 w -below dietary intake |
Pazzini et al. (2016) [28] | -before treatment -12 m: every 3 m -1 m after removal | 42 allergic patients (10–45 y) | -21 conventional br -21 nickel-free br | Ni | -patch test -gingival index -blood | -both groups: increased basophils -conventional group: decreased eosinophils and immunoglobin E -Ni levels: increased while treatment; decreased 1 m after -Ni-free br while treatment: gingival health, smaller blood changes |
Quadras et al. (2019) [29] | 1.5 y -5 timepoints: before archwire insertion; after 1 week, 3 m, 1 y, and 1.5 y | 80 (15–40 y) -50 MBAs -30 controls | -20 br, 4–8 bd: SS -2 wires: NiTi/SS -saliva (after rinsing); blood | Ni, Cr, Zi | AAS | -Increase before and after insertion of the appliance -below toxic levels -after 1.5 y: significant difference between treated and control group |
Lucarelli et al. (2020) [30] | 1 y 2 tests: before and 1 y after treatment | 60 | -Ti rapid palatal expander and corrector | -Ni (allergy) -Ti | -patch test | -first test: sensitivity in 8 patients (2 males/6 females) -second test: 37 positive nickel sensitizations (25 females) -Ti appliances have high resistance and no allergic reaction |
Zigante et al. (2022) [31] | 6 w–1 y treatment | 235 (11–45 y) | -orthodontic appliances -oral mucosa, gingiva, tongue, lips | -Ni -Ti | -Patch test -clinical signs | -clinical predictors of metal sensitization: adult age, female sex, exfoliative cheilitis, history of contact hypersensitivity to metals and piercings -patch test alone not conclusive for allergies |
2. Patients, Materials, and Methods
2.1. Participants’ General Characteristics and Inclusion and Exclusion Criteria
2.2. Material and Methods
2.3. Analytical Methods
2.4. Statistical Analysis
3. Results
3.1. Metal Ion Concentration in Saliva
3.1.1. Ni
3.1.2. Au
3.1.3. Pd
3.1.4. Hg
3.2. Lymphocyte Transformation Test
3.2.1. Debonding Group (G1)
3.2.2. Bonding Group (G2)
3.2.3. Control Group (G3)
3.3. Correlation between LTT and Metal Ion Concentrations
3.3.1. Ni
3.3.2. Au
3.3.3. Pd
3.3.4. Hg
4. Discussion
4.1. Ni
4.1.1. Debonding Group
4.1.2. Bonding Group
4.1.3. Control Group
4.2. Au
4.3. Pd
4.4. Hg
4.5. Metal Ions
4.6. Sensitization
4.7. Patients, Materials, and Methods
5. Strengths and Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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G1 (N = 10) | G2 (N = 10) | G3 (N = 10) | |
---|---|---|---|
Male/female (N) | 6/4 | 5/5 | 5/5 |
Mean age (years) | 20.6 | 20.9 | 22.8 |
Inclusion criteria |
|
| No history of orthodontic treatment or metal dental restorations |
Exclusion criteria |
|
G1 | G2 | G3 | |
---|---|---|---|
T1 | 1st day; before MBA removal | 1st day; before MBA placement | 1st day |
T2 | 1st morning after MBA removal | 1st morning after MBA placement | 2nd morning |
T3 | 7th morning after MBA removal | 7th morning with MBA | 7th morning |
T4 | 21st day after MBA removal | 21st day with MBA | 21st day |
Debonding | Bonding | Control | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Time-Point | R [µg/L] | Median | First Q | Third Q | Median | First Q | Third Q | Median | First Q | Third Q | |
Nickel [µg/L] | T1 | 1.2 | 3.10 | 2.20 | 11.98 | 6.15 | 2.38 | 8.25 | 2.90 | 2.10 | 8.48 |
T2 | 1.2 | 3.95 | 1.50 | 6.88 | 14.35 | 8.03 | 23.20 | 4.25 | 4.05 | 6.85 | |
T3 | 1.2 | 2.75 | 1.25 | 10.30 | 7.70 | 4.40 | 12.53 | 5.85 | 2.70 | 8.68 | |
T4 | 1.2 | 3.90 | 1.93 | 8.65 | 6.25 | 3.23 | 10.53 | 2.50 | 2.23 | 5.70 | |
Gold [µg/L] | T1 | 2 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 |
T2 | 2 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | |
T3 | 2 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | |
T4 | 2 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | 2.00 | |
Palladium [µg/L] | T1 | 1.2 | 0.35 | 0.23 | 0.55 | 0.40 | 0.30 | 0.75 | 0.35 | 0.23 | 0.58 |
T2 | 1.2 | 0.25 | 0.20 | 0.30 | 0.40 | 0.30 | 0.48 | 0.45 | 0.23 | 0.60 | |
T3 | 1.2 | 0.40 | 0.20 | 0.65 | 0.25 | 0.20 | 0.70 | 0.50 | 0.23 | 0.70 | |
T4 | 1.2 | 0.25 | 0.20 | 0.30 | 0.30 | 0.20 | 0.70 | 0.20 | 0.20 | 0.30 | |
Mercury [µg/L] | T1 | 1.5 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 |
T2 | 1.5 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | |
T3 | 1.5 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | |
T4 | 1.5 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 | 1.50 |
Metal | Odds Ratio (95% Confidence Interval) | p-Value | ||
---|---|---|---|---|
Nickel | Group | Debonding | 0.47 (0.10, 2.23) | 0.34 |
Bonding | 0.57 (0.12, 2.82) | 0.49 | ||
Control | Reference | |||
Time | 1 | Reference | ||
2 | 1.56 (0.25, 9.73) | 0.63 | ||
3 | 0.72 (0.15, 3.44) | 0.68 | ||
4 | 0.55 (0.12, 2.49) | 0.44 | ||
Gold | Group | Debonding | 1.89 (0.23, 15.37) | 0.55 |
Bonding | Not estimable | |||
Control | Reference | |||
Time | 1 | Reference | ||
2 | 2.12 (0.30, 14.75) | 0.45 | ||
3 | 4.81 (0.76, 30.70) | 0.10 | ||
4 | Not estimable | |||
Palladium | Group | Debonding | 0.48 (0.05, 4.92) | 0.54 |
Bonding | Not estimable | |||
Control | Reference | |||
Time | 1 | Reference | ||
2 | 1 (0.05, 18.67) | 1 | ||
3 | 1 (0.05, 18.67) | 1 | ||
4 | Not estimable |
Timepoint T1 (Day 0) | Timepoint T4 (Day 21) | ||||||||
---|---|---|---|---|---|---|---|---|---|
Group | Patient (sex) | Pd | Hg | Au | Ni | Pd | Hg | Au | Ni |
G1 | 101 (f) | 1.0 | 1.0 | 1.0 | 1.0 | 3.3 | 1.4 | 1.4 | 2.8 |
102 (m) | 1.1 | 2.4 | 1.0 | 1.2 | 1.1 | 1.0 | 1.0 | 1.0 | |
111 (f) | 1.4 | 1.8 | 1.7 | 2.5 | 1.2 | 1.0 | 1.0 | 1.0 | |
G2 | 202 (m) | 1.3 | 1.6 | 1.8 | 4 | 1.1 | 1.0 | 1.2 | 1.5 |
204 (m) | 1.7 | 1.4 | 1.4 | 4.4 | 1.1 | 1.3 | 1.5 | 1.4 | |
207 (m) | 1.0 | 1.0 | 1.0 | 1.1 | 1.0 | 1.0 | 1.0 | 17.5 | |
208 (f) | 1.3 | 1.2 | 1.5 | 1.6 | 1.0 | 1.0 | 1.0 | 4.8 | |
211 (m) | 1.0 | 1.5 | 1.5 | 1.9 | 2.3 | 1.0 | 1.0 | 4.1 | |
G3 | 303 (f) | 1.0 | 1.0 | 2.9 | 46.3 | - | - | - | - |
305 (m) | 1.4 | 1.7 | 1.4 | 3.3 | - | - | - | - | |
307 (f) | 1.2 | 2.6 | 1.7 | 3.3 | - | - | - | - | |
310 (f) | 1.2 | 3.4 | 1.1 | 1.5 | - | - | - | - |
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Paschaei, N.; Müller, W.-D.; Schmidt, F.; Hüsker, K.; von Baehr, V.; Pandis, N.; Jost-Brinkmann, P.-G.; Bartzela, T. Unveiling the Role of Metal Ion Concentration versus Immune Sensitization in Orthodontic Patients—A Long-Term Prospective Evaluation. J. Clin. Med. 2024, 13, 4545. https://doi.org/10.3390/jcm13154545
Paschaei N, Müller W-D, Schmidt F, Hüsker K, von Baehr V, Pandis N, Jost-Brinkmann P-G, Bartzela T. Unveiling the Role of Metal Ion Concentration versus Immune Sensitization in Orthodontic Patients—A Long-Term Prospective Evaluation. Journal of Clinical Medicine. 2024; 13(15):4545. https://doi.org/10.3390/jcm13154545
Chicago/Turabian StylePaschaei, Nusha, Wolf-Dieter Müller, Franziska Schmidt, Katrin Hüsker, Volker von Baehr, Nikolaos Pandis, Paul-Georg Jost-Brinkmann, and Theodosia Bartzela. 2024. "Unveiling the Role of Metal Ion Concentration versus Immune Sensitization in Orthodontic Patients—A Long-Term Prospective Evaluation" Journal of Clinical Medicine 13, no. 15: 4545. https://doi.org/10.3390/jcm13154545