Biomaterials

ZIRCONIUM ALLERGIES CAUSED BY ORAL DENTAL MATERIALS.

A GENERAL REVIEW

Georgeta SINIŢCHI1,2

Prof. PhD „Apollonia” University of Iaşi, Romania

1

2
„ATOPIA” Allergology Center of Iaşi, Romania
Corresponding author: Georgeta Siniţchi; e-mail:[email protected]

Abstract
Dental materials may provoke general or local
pathologies and various immune-allergic manifestations.
For example, metal allergies are triggered by environmental
or – mainly – occupational factors, being more numerous
in recent years, particularly through the introduction, in
dentistry, of new types of dentures and implants. Zirconium
is a transition metal with several beneficial effects, namely:
biocompatibility, good aesthetics, slightly translucent
fitting, efficient cohesion with ceramics. Pathological
effects of zirconium: systemic toxicity (carcinogenic
potential), raising syndrome oral allergic dermatitis.
Allergists recommend a thorough knowledge on the
medical history of patients, on the data of personal and Fig. 1. Immunological reactions according to the
hereditary allergic investigations confirming a possible classification of Gell and Coombs [3]
sensitivity. General and specific allergic investigations for
establishing a possible sensitivity to zirconium are:
epicutaneous tests, serological tests (TTL) and, and
confirmation of allergenic eviction. Equally, balancing of
the benefit/cost ratio should be calculated.
Keywords: zirconium, oral allergic syndrome, dental
medicine.

Dental materials may provoke general or local

pathologies and various immune-allergic
manifestations. Allergies to metals are triggered
by environmental and occupational factors,
particularly through the introduction, in
dentistry, of new types of dentures and implants.
Metals release metal ions which act as haptenes
and proteins, forming complexes which can
activate the immune system. The reactions to Fig.2. Immune-inflammatory mechanisms of allergic
dental materials can be: immune-allergic [1], sensitivity in dentistry (Debris-induced
inflammation is primarily mediated by macrophages,
allergic, of type IV (delayed type LT-dependent) which ingest the debris, the result being the release
and of type I (immediate) - rare [2] - Figs. 1 to 3). of proinflammatory cytokines that affect local cell
types and induce an extended soft-tissue damage
and inflammation. Courtesy of Bioengineering
Solutions, Inc., Oak Park, Illinois)

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Georgeta SINIŢCHI

The toxic reactions produced by metals Determination of tumor necrosis factor,

depend on their quantity, once known that toxins alpha (TNFα), is an important cytokine in IgE-
can block the receptors [4,5]. mediated allergic reactions, appearing as another
Magnetic resonance reactions may be produced diagnosis test [20]. Genetic tests can establish
by metals as well as by biophotonic emissions, the susceptibility to inflammation: interlukine 1
thus influencing the cellular biochemical and the receiver of interlukine 1.
processes, provoking modifications which, in Epigenetic tests can assure a preventive diagnosis
their turn, induce various pathologies; they are and the possibility of using epigenetic markers.
detected by bioenergetic methods. The concept of epigenetics, established by Conrad
Clinical diagnosis for detecting the sensitivity Waddigton in 1942, permitted discussions on the
to metals used in dental implants should be following aspects: molecular processes allow
established carefully, after thorough modulation of gene expression, utilization of
investigations, possibly involving clinical epigenetic markers, DNA methylation, spatial
autoanamnesis, as well. The clinical manifestations organization of DNA, non-coding micro-RNA
may be either local, of contact or general. action [21-23].
Confirmation of the diagnosis of allergic
sensitivity to materials used in dental implants
is given by skin and serologic tests [6-9].
Epicutaneous tests (patch) confirm the
sensitivity to dental materials, metals, epoxy
compounds, gutta-percha [10]. The aspects to be
solved refer to: a) is there any risk of
hypersensitivity? b) may it cause an inflammatory
reaction? c) or a toxic reaction?
The lymphocyte transformation test (TTL),
discovered around 1960, is a serological test to
the cellular immune response against foreign
substances [11]. The immunitary system describes
LT with memory according to the first contact Fig. 3. Conrad Waddington [24]
with unknown foreign antigens, acting upon the
antigen-presenting cells [12-14].
TTL - MELISA (Memory Lymphocyte
Stimulation Assay) is a modern immuno-
toxicological technique that allows detection of
sensitivity to metals, infectious agents, as well as
to metabolites of food and alimentary origin.
Metals usually stimulate the immune system,
leading to: allergy, autoimmunity, lipidic or
supraproteic synthesis through oxidative stress,
carcinogenicity caused by nucleic acids [15,16].
TTL measures the proliferation of memory- Fig. 4. Interlukine 1 [25]
possessing cells, integrates nucleic acids
containing radioactive markers in growing DNA, Zirconium (Zr), a chemical element with
operates LTH - CD4 and proliferates LT. It may atomic number 40, is a transition metal, with a
be used as a diagnosis of contact allergies and as silvery-satin color, belonging, together with
an agent preventing the utilization of dental titanium and hafnium, to column IVb of the
materials [17-19]. periodic classification of elements. Zirconium is
Zirconium (Zr), a chemical element with the highly resistant to the corrosion induced by
atomic number 40, is a transition metal. water and sea water.

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 ZIRCONIUM ALLERGIES CAUSED BY ORAL DENTAL MATERIALS. A GENERAL REVIEW

Fig. 5 Zirconium [26]

History of hypersensitivity
Fig. 8. A. G.Werner [28]
to metals or potential
bone cement components Its Persian name is “Zargun”, and “Zarqun”
in Arabic, which means “purple”. Zirconium:
Yes No ZrSiO4 appears as a “Hyacinthe” gem stone.

Allergy (patch) test

with metals and No (prophetic)
bone cement allergy test
components

Allergy yes Allergy no

Fig. 9. Hyacinthe [29]
Consider
”Standard” Forms of utilization: oxide, silicate
”hypoallergic”
implant material
implant material
Zirconium oxide is used for implants and
Fig. 6. Flowchart for the evaluation of potential dentures, crowns, collars, intracoronary
allergy [4] reconstructions, faceted aesthetic stagings
ceramic sintering, dyes, dental plates.

Fig. 10. Zirconium Framework [26]

Fig. 7. M. H. Klaproth [27] Advantages of zirconium: biocompatibility,

good aesthetics, slightly translucent fitting,
Zirconium was discovered in 1789 by Martin effective cohesion with ceramics.
Heinrich Klaproth, in Berlin, as an zirconium Zirconium dioxide (ZrO 2) is used for the
extract: oxide of zirconium. Its name: “Zirkon”, manufacture of ceramic tiles and blades (knives).
was attributed by the mineralogist and geologist The first ceramic blade was produced by the
Abraham Gottlob Werner. Kyocera Japanese group in 1984. Pathological

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Georgeta SINIŢCHI

effects of zirconium are represented by: systemic Zirconium in its pure form has many qualities:
toxicity (potentially carcinogenic), allergic plasticity, electrical conductivity, conductivity to
sensitivity (oral allergic syndrome), dermatitis. heat, metal glow, sensitivity to corrosion.
Zirconium may cause sensitivity when present Zirconium in oxide form is electrically neutral,
in the composition of dental materials and also possesses high hardness, it is white in color,
other effects: there exist, for example, deodorant relatively chemically inert, biocompatible,
creams containing zirconium and zirconium permitting double osseointegration [31, 32].
dioxide. Sensitivity may be also manifested in In dentistry, zirconium entered around the
the industry of explosives, of fire extinguishing year 1990, in the form of zirconium oxide - as a
materials, of nuclear – yet ceramic – fuel and also ceramic material, being wholly accepted in the
in the industry of jewellery, in jewels containing field. In spite of its side effects, causing immuno-
zirconium (imitating gold and diamonds). allergy, toxicity, bimetallism, it helps the dental
practitioner to make resistant, aesthetic,
biocompatible prostheses and implants.
The aspect still to be solved is the cost / benefit
balance, so that cost-benefit and cost-utility
analyses are still necessary to differentiate among
the dental implant systems to be investigated in
future research [33, 34].
In conclusion, Zirconium is an original metal
with many qualities when used as zirconium
oxide for ceramic materials, but it may also
evidence secondary pathologies, such as
immune-allergies with with oral and general
localization.
Fig. 11. Cubic Zirconia [30] For reducing the sensitivity to zirconium,
allergists recommend a careful anamnesis,
Zirconium exists in the atmosphere, the
medical history, observance of one’s personal
allowed amount being of 5 mg / m3 – which
and hereditary allergic signs confirming the
represents an average exposure, as to its duration,
extent of sensitivity, epicutaneous and serological
and 10 mg / m3 - as a short duration exposure
(TTL) tests, alongwith specific anti-allergic
– according to SIMD classification - Quebec.
treatments. Also necessary is to establish the
The international toxicological sheet should be
benefit / cost balance.
filled in as a preventive measure against any
zirconium-induced pathology [13]. Zirconium References
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