Dental implants have helped millions of men and women enjoy greater confidence, improved facial aesthetics and better oral function following tooth loss. And for the vast majority of patients, the implant process is straightforward and uneventful, with no serious side effects or complications.
But in very few cases, patients may have allergic reactions to the titanium metal used in dental implants. In past blog posts, we’ve discussed the possible complications and risks associated with mercury amalgam fillings and the pros and cons of zirconia implants compared to titanium implants to help you become more aware and informed. In this post, we delve a little deeper into titanium allergies so you can understand how to assess your risk for allergic reaction and feel more confident about your oral health care. Here’s what you should know.
How common are titanium allergies?
Titanium allergies are rare, occurring in about 0.6% of the population, according to one study. That means as many as 1.8 million people in the U.S. may be allergic to titanium to some degree. Other studies suggest the allergic reaction or hypersensitivity to titanium could be much higher. When they do occur, titanium allergy symptoms can range from mild to severe and can include:
- loosening of the implants (or implant failure)
- rash or hives
- sores and swelling in the soft tissues of the mouth
- chronic inflammation in the gums around the implant
- problems with wound healing
- chronic fatigue syndrome
- acne-like swelling or inflammation of the face
- muscle and joint achiness
- neurological problems
Even though the risk of titanium allergy may be quite low, the reactions can have significant impacts on your overall health and wellness -- which brings us to the next issue: How can you tell if you’re allergic to titanium?
Titanium Allergy Test
Many allergies can be diagnosed through a simple method called a skin patch test. In these tests, suspected allergens are applied to very small areas of skin, usually on your back. Then these areas are covered with waterproof bandages and left alone for a period of time. When the time elapses, the skin areas are evaluated for signs of irritation that indicate an allergic reaction.
But while skin patch tests are ideal for some types of allergies, they’re not very accurate for other, including titanium allergies. To test for a titanium allergy, you’ll need to have a different type of test called MELISA (which is short for (Memory Lymphocyte Immunostimulation Assay). MELISA uses a small sample of your blood to check for titanium sensitivity. During the assay, your white blood cells are isolated from the rest of your blood, then exposed to titanium. Over several days, your blood sample is evaluated for signs of allergic reaction. MELISA offers far more accurate results that traditional skin patch allergy tests, especially for applications where the metal will come in contact with bone and soft tissues. In fact, in addition to its use in dentistry, it’s also used to test for metal allergies prior to joint replacement surgery, and it’s used in other industries where metal allergies are a concern. The table below shows some of the metal allergies that can be evaluated using MELISA. IMPORTANT: HELM NEJAD STANLEY DOES NOT ADMINISTER THE MELISA TEST AND THE PATIENT MUST CONTACT THE COMPANY IN GERMANY ON THEIR OWN.
Chart presents stimulation index of tested metals.
- Gold - 1
- Cobalt - 3
- Chromium - 4
- Palladdium - 10
- Titanium - 6
- Tin - 8
- Nickel - 27
- Cadmium - 10
- Phenyl mercury - 5
- Inorganic mercury - 12
(Photo Courtesy of MELISA.org)
First chart presents MELISA reactivity in a 54-yer-old man before and after removal of Ti-based dental implants and screws. Numbers represents stimulation index.
- Ti: before - 70, after - 1
- Ni: before - 8, after - 2
- Pt: before - 6, after - 0.5
- Cd: before - 3, after - 0
- In: before - 2.5, after - 0
- Be: before - 1, after - 0
- Pd: before - 1, after - 0
- Au: before - 1, after - 0
- Cu: before - 0.5, after - 0
- Pb: before - 0.25, after - 0
Second chart presents MELISA reactivity in a 14-yer-old girl before and after removal of Ti-based brackets. Numbers represents stimulation index.
- Ti: before - 8.5, after - 1.5
- Ni: before - 2, after - 1.5
- Pt: before - 1, after - 1.1
- Cd: before - 2, after - 1.7
- In: before - 0.5, after - 0.5
- Be: before - 1, after - 0.85
- Pd: before - 2, after - 1.9
- Au: before - 1, after - 0.8
- Cu: before - 2, after - 1.8
- Pb: before - 0.75, after - 0.25
How accurate is MELISA?
MELISA can be far more accurate than skin patch tests because MELISA shows how the metal will react when it comes in contact with blood and tissue inside your body rather than just the surface of the skin. Still, there have been some studies that question the accuracy and reliability of the test.
In one study from 2016, 57% of patients who claimed an allergy to titanium reacted to other metals, including nickel. This is especially concerning since even the purest titanium contains a trace amount of nickel. And that means if you have an allergy to nickel, you may have an allergic reaction to dental implants that use the metal. Nickel allergies are extremely common; in fact, after poison ivy, they’re the most common cause of allergic skin rashes. Moreover, MELISA has not been completely accepted as 100% reliable by the medical or research communities, which means you’re more or less left on your own to decide if you feel confident in the results of your test prior to receiving implants. As a result, many patients -- even those with no known titanium allergies -- opt for other alternatives to replace their missing teeth in order to avoid the possible risks associated with titanium allergic reactions.
Zirconia Dental Implants: An Alternative to Titanium
So what if your test shows you are allergic to titanium? Does that mean you have to forego implants in favor of a denture or bridge? No. For patients who test positive for titanium allergy, zirconia dental implants could be a good solution. Zirconia is made primarily of ceramic rather than titanium. As a result, you won’t have to worry about allergic reactions. Why aren't zirconia dental implants used all the time? Well, in part because they lack some of the features of titanium implants, like a two-part design and attachment features that help keep the implant especially stable. As detailed in our earlier blog post, zirconia implants still have their pros and cons, but for patients who are allergic to titanium but still want the benefits of an implant, they can be a good choice.
Bridges: Another Option for Tooth Replacement
Of course, implants are not the only solution for replacing a lost tooth. For decades, people have relied on bridges to literally “bridge” the gap left by a missing tooth, and for many patients, a bridge can be a great option. A traditional bridge (shown below) features one or more artificial teeth or "pontics" supported by the teeth on either side of the gap. Before the bridge is placed, these teeth need to receive crowns to hold the tooth and allow normal forces on the artificial tooth to be supported by the neighboring teeth. That means a considerable amount of tooth material will need to be removed from these teeth to “make room” for the crowns. Once the material is removed, these teeth are at increased risks of complications such as root canals, fractures, and recurrent decay. However, bridges have a long and successful track record in helping restore function and aesthetics following tooth loss, and they can be a great choice for many patients.
A Maryland bridge features a slightly different design and attachment process that eliminates the need to remove surface material from the healthy neighboring teeth. Instead, the bridge is secured in place with an adhesive resin to attach the bridge to one or both teeth on either side, often times with little to no tooth removal. This eliminates some of the risks of traditional bridges. Maryland bridges are an especially good option of replacing front teeth in the “aesthetic zone.” However, the bonding application that’s used means these bridges are not nearly as durable as a traditional bridge, and that means the forces exerted during biting and chewing can lead to fractures or debonding of the artificial tooth (pontic). These bridges, while an attractive option for some, are really only meant for aesthetic enhancement, and not as a functional replacement for a missing tooth.
Another time-tested option for replacing one or more missing teeth, a partial denture is removable and rests on your gums in the gap left by the missing tooth or teeth. Partial dentures are usually less expensive than other options, but many people don’t want a device that’s removable or poses a risk of slipping, nor do they want to have to remove the denture at night while they’re sleeping. What’s more, the partial denture has a rigid metal framework for strength and stability which unfortunately can often be seen in certain areas and may be intolerable by some patients due to allergy or sensitivity. There are some options for all-plastic dentures, but they tend not to be as functional as a traditional denture with a metal framework. No matter which option you select, it’s estimated that removable partial dentures have at most 25% of the function of a real tooth, implant, or bridge.
Titanium Allergy: The Bottom Line
Allergic reactions to titanium are very rare, but they are a possibility. Before having an implant procedure, it’s a good idea to consider the MELISA test to check for a titanium allergy so you can avoid the resulting side effects. And if you are allergic to titanium or if you suspect you may be, schedule a visit to discuss your other options that can help you restore your teeth and maintain your healthy-looking smile. Call our office at 310-278-0440 and schedule a consultation today.
1. Fage et. al. Contact Dermatitis. 2016 Jun;74(6):323-45.
2. Muller et. al. Neuro Endocrinol Lett. 2006 Dec;27 Suppl 1:31-5.