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Campbell S, Crean St J et al. Fac ulty Dent J 2014; 5: 18–25

Levels of titanium in tissue may increase from 50 ppm to 100–300 ppm following placement of a dental implant. Those implants manufactured using grade 4 CPTi have the highest proportion of oxygen and iron and are therefore more likely to undergo corrosion, thereby invoking an immune response. Signs and symptoms of allergy to titanium dental implants include facial eczema and painful mucositis of the peri-implant tissues. Interestingly, oral lichen planus is only rarely associated with titanium sensitivity, in contrast to that observed with amalgam restorations. In one study reporting on 56 patients with clinical signs of allergy: 1) over one third tested positive for sensitivity to titanium, 2) almost 60% suffered an immune reaction to contaminating metals such as nickel, and 3) in the 54 patients that had their implants removed, all symptoms and signs resolved with 6-9 months. Despite patch testing not being validated for oral allergies, the authors suggest that those patients with 'a positive history of metal allergy, and those patients who have previously suffered failed implants' should be patch tested.