ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Studies Suggest Nickel Free Brackets Produce a Reduction in Allergic Symptoms in Cases of Orthodontic Patients Displaying Nickel Sensitivity
Clinical Question In an orthodontic patient displaying sensitivity to nickel, does the use of nickel free brackets produce reduction of allergic symptoms.
Clinical Bottom Line Studies suggest that nickel free alternatives reduce hypersensitivity reactions in a majority of patients with nickel sensitivity.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21359455Pazzini / 2011137 orthodontic patients, 52 animals (ratsSystematic review of Clinical trials and In-vitro studies
Key results“Best evidence” is a systematic review by Pazzini et al. The search criteria produced 89 papers, of those only 4 qualified for this review. Differences in methodological approach, reporting, and sample size made quantitative statistical analysis impossible. The only article deemed to be of high quality in the systematic review tested 70 individuals in a double blind RCT. All subjects tested positive to nickel patch test and displayed typical allergic symptoms after beginning orthodontic treatment. Results of the trial: 40% showed complete remission of symptoms 6 months after changing from the standard 18-8 (8% Nickel) brackets to a nickel free alternative. 44% showed partially improved and 15% had no change. Two theories were suggested for those that did not show improvement. 1) Nickel hypersensitivity can be produced from other sources of nickel exposure and 2) Patients with nickel sensitivity often have sensitivity to other metals as well, thus other metals in the brackets could also be causing the symptoms. Results from the three other articles included in the systematic review also suggest nickel free alternatives to be a plausible treatment for Nickel allergy patients.
Evidence Search (orthodontic[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("nickel"[MeSH Terms] OR "nickel"[All Fields]) AND ("hypersensitivity"[MeSH Terms] OR "hypersensitivity"[All Fields] OR "allergy"[All Fields] OR "allergy and immunology"[MeSH Terms] OR ("allergy"[All Fields] AND "immunology"[All Fields]) OR "allergy and immunology"[All Fields])) AND ("2002/08/04"[PDat] : "2012/07/31"[PDat] AND systematic[sb])
Comments on
The Evidence
Nickel hypersensitivity is known to produce hyperplasia, hyperemia and edema in the gingival tissues of orthodontic patients. These conditions are capable of producing periodontal health problems if left untreated over time. Nickel free brackets are available and pose no known health risk, thus they are a viable clinical alternative for the patient displaying allergic symptoms. However, more in vivo research is needed to gain a high level of quantitative and qualitative evidence validating this prior to making it a standard in clinical treatment options.
Applicability Applicable to the orthodontic patient displaying nickel hypersensitivity and testing positive to a nickel patch test.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry)
Keywords Orthodontic treatment, nickel allergy, nickel free braces
ID# 2324
Date of submission: 08/06/2012spacer
E-mail martincl@uthscsa.edu
Author Camaron Martin
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ravikumar Anthony, BDS, MDS, MS
Faculty mentor/Co-author e-mail Anthonyr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Cami Martin (Fair Oaks Ranch, TX) on 09/18/2012
Nickel allergy to orthodontic appliances is typically a delayed type IV hypersensitivity immune response caused by prior sensitization to the Nickel antigen. It is part of the cell mediated arm of the immune system. The cell mediated response is activated by stimulation of the monocyte-macrophage system which causes inflammation as well as inducing T-lymphocytes to produce cytokines which further propogate inflammation and gingival hyperplasia.
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