Nickel hypersensitivity-related periodontitis
The purpose of this article was to review the literature on the subject of intraoral sensitivity to nickel and to present a case. Non-precious alloys containing nickel are used in porcelain fused to metal crowns in substi- tution for precious metal alloys in response to economic pressures. Nickel sensitivity is very common (9% of women and .9% of men) and the element pro- duces more allergic reactions than all other metals combined. The authors quote findings that suggest that a positive nickel allergy does not necessarily prevent an individual from wearing a nickel-containing prosthesis. Oral manifestations from nickel hypersensitivity are very diverse due to many variables such as tissue trauma, location of the non-precious alloy, corrosion, T-lymphocyte immune response levels, plaque control, acidic foods, bruxism, and physical and/or psychological conditions. The authors presented a case of a patient who manifested new pocket formation with deep vertical osseous defects that correlated with the location of new crowns. Upon investigation, a patch test for the non-precious alloy of the crowns Rexillum III) revealed a positive result. The crowns were replaced with new crowns whose metal component was white palladium gold, silver-free ceramic noble alloy. In addition, the patient underwent periodontal surgery and guided tissue regeneration. The area healed with improved gingival contours and probing depth, less angular vertical defects, and significant regeneration of bone. The authors concluded in areas of isolated periodontal destruction that persist around crowns where adequate plaque control and periodontal therapy have been rendered, nickel hypersensitivity should be considered. [C.S.]
Bruce, G.J., and W.B. Hall, Comp Dent Educ., 16:2, 1995