Signs of an unexpected reaction or intolerance to titanium?
- loosening of the implant(s) (or implant failure)
- rash or hives
- acne-like swelling or inflammation of the face
- chronic inflammation around the implant
- problems with wound healing
- chronic fatigue syndrome (CFS)
- confusion, distraction, forgetfulness
- muscle pain
How does a titanium intolerance work?
The reason for the extremely low allergy potential of titanium is the prompt oxidation of the surface, the combination with oxygen, which makes the titanium surface passive. Oxidized titanium is no longer able to cause an allergic reaction. The mechanism of a possible allergenic reaction to titanium is therefore unclear. As far as we currently know, a genuine titanium allergy should be an extremely rare phenomenon. That´s why we call it here an intolerance.
More significant is an intolerance to titanium, which is caused by an individually increased inflammatory tendency of the body’s own macrophages (tissue macrophages, monocytes, phagocytes) after contact with titanium abrasion or eventually a kind of corrosion.
There is also an intense ongoing debate about the interaction of titanium dioxide in the form of nano sized particles with the human body. Titanium dioxide nanoparticles are often used in products that have the potential of presenting allergy risks to human, such as titanium sun protection products, food stuff and paint. Although there were some scientific studies regarding the potential damage to living tissue caused by titanium dioxide nano particles, no final decision has been established yet.
Titanium particles may also have a toxic potential. The storage of more than 300 titanium particles in stem cells leads to their dying off. At lower concentrations there may be an effect on the bone resorption activity around implants.
How to prove titanium intolerance?
Titanium intolerance can be tested with the Lymphocyte Transformation Test (LTT) or the MELISA® test. They are blood in vitro tests for the detection of antigen-specific T-lymphocytes (type 4 allergy). An epicutaneous test (by sticking it on the skin) is useless with titanium (oxide), since titanium particles cannot penetrate the skin.
A test for titanium allergy (LTT) prior to treatment is hardly effective due to its rarity. A titanium stimulation test should make sense especially if a general tendency to inflammation is known.
The application of the tests is discussed controversially.
What can be done if a test was positive?
Since the problems of titanium incompatibility can be caused less by the presence of an implant than by titanium abrasion during insertion, removal of the implant does not always appear to be the best solution. If a corrosive activity is assumed, the removal is indicated.
If symptoms occur, antirheumatic drugs from the cyclooxygenase-2 (Cox-2) inhibitor group or rofecoxib can have a positive effect at least on the inflammatory bone resorption around an implant. Additional measures to minimize reactions of the immune system should be implemented in interdisciplinary cooperation with a general practitioner.
Find some more information here (2014): Titanium allergy: a literature review