Investigation of Contact Allergies to Component and Auxiliary Prosthetic Materials

Abstract

Kontaktna alergija je odgođena reakcija preosjetljivosti u kojoj se lokalizirana lezija kože ili sluznice javlja zbog opetovanoga doticaja s alergenom. Od fiksnog ili mobilnoga protetskog rada u usnoj šupljini nastaju korozijski procesi na površini nadomjestka te otpuštanja iona koji, kao hapteni, mogu pokrenuti alergijsku reakciju. Svrha ovoga istraživanja bila je epikutanim alergološkim testom ispitati pojavnost alergije na gradivne i pomoćne protetske materijale u pacijenta s lihen ruber planusom, stomatitisom i stomatopirozom. U istraživanju su sudjelovala 32 pacijenta s fiksnim i/ili mobilnim nadomjestkom i 7 pacijenata s jednom od navedenih dijagnoza bez nadomjestaka. Ispitivanje je provedeno standardnom tehnikom (patch testom) na 13 alergena. Rezultati istraživanja pokazuju veću vjerojatnost na pozitivan patch test u osoba s navedenim bolestima i s nadomjestkom u usporedbi s ispitanicima bez nadomjestaka (P = 0,62). Pričvršćenjem fiksnog ili postavljanjem mobilnoga nadomjestka raste vjerojatnost da će se simptomi pogoršati (P = 0,019), a pogotovo ako se radi o nadomjescima od Co-Cr-Mo slitine. Povećanjem broja članova fiksnih nadomjestaka, ili pak postojanjem mobilnih nadomjestaka u objema čeljustima, raste i vjerojatnost pozitivnoga rezultata patch testa na kobaltni klorid (P = 0,05). Lichen ruber planus povećava vjerojatnost na pozitivan patch test u najvećem broju slučajeva (P = 0,05). Najviše pozitivnih rezultata bilo je na alergene nikla, kobalta i kroma (svaki 17,95%), a negativan nalaz dobiven je kod dibutilftalata i HH smjese. Stomatopiroza povećava vjerojatnost da ispitanik ima pozitivan rezultat testiranja na krom (P = 0,019). U žena je pojava pozitivnoga patch testa veća na sve alergene (P = 0,05) osim na epoksidne smole, kod kojih je manja nego u muških ispitanika (P = 0,036). Zbog sve češće kontaktne alergije u populaciji potrebno je provesti potanka ispitivanja protetskih materijala prije nego što ih se uvede u kliničku praksu, a u pacijenata s atopijskom anamnezom alergološka testiranja i imunološke testove prije protetske sanacije.Contact allergy is a delayed reaction to sensitivity in which a localised lesion of the skin or mucous membrane occurs as a result of contact with an allergen. The fitting of a fixed, or placement of a mobile, prosthetic appliance in the oral cavity causes corrosive processes to occur on the surface of the restoration and the release of ions which, as haptens, can induce allergic reaction. The aim of this investigation was to examine the occurrence of allergies to component and auxiliary prosthetic materials by patch test in patients with lichen ruber planus, stomatitis and stomatopyrosis. Thirtytwo patients with fixed and/or mobile restorations and seven patients with one of the above diagnoses without a restoration, participated in the investigation. Testing was carried out by standard technique (patch test) with 13 allergens. The results of the investigation indicate the greater probability of a positive patch test in subjects with the aforementioned diseases and with a restoration, in relation to subjects without a restoration (P = 0.62). The probability of symptoms worsening increased with the insertion/ fitting of a fixed or placement of a mobile restoration (P = 0.019). This was particularly so in the case of restorations made of Co-Cr-Mo alloy. With the increase in the number of units of fixed restorations, or the presence of mobile restorations in both jaws, the probability of a positive patch test to cobalt chloride also increased (P = 0.05). Lichen ruber planus increased the probability of a positive patch test in the majority of cases (P = 0.05). The greatest number of positive results were for the allergens nickel, cobalt and chrome (each 17.95%) and a negative finding was obtained for dibutylphthalate and HH mix. Stomatopyrosis increased the probability that the subject would have a positive result for chrome (P = 0.019). The occurrence of a positive patch test was greater in women for all allergens (P = 0.05), apart from epoxy resin, where it was less than in the male subjects (P=0.036). Because of the greater incidence of contact allergies in the population a more detailed investigation of prosthetic materials is needed prior to their introduction into clinical practice. In the case of patients with atopic history allergological testing and immunological tests should be performed prior to prosthetic treatment