Dr. Satnam Singh, M.D.S(Orthodontics)Senior LecturerDepartment of OrthodonticsInstitute of Dental Sciences (IDS), Sehora, Jammu (India)e-mail- satnam82_singh@yahoo.comDr. Poonam Bali, M.D.S(Prosthodontics)ReaderDepartment of ProsthodonticsTeerthanker Mahaveer Dental college , Moradabad , Uttar Pradesh (India)e-mail- poonam_4wd@yahoo.co.inDr. Shally Mahajan, M.D.S (Orthodontics)ReaderDepartment of OrthodonticsChandra Dental College and hospital,Barabanki, Uttar Pradesh (India)e-mail- drshally23@gmail.comAbstract-The incidence of allergies in general is on the increase. An allergic reaction can also occur during any dental and orthodontic treatment. However, the allergic potential of orthodontic appliances is frequently overestimated. Nickel is the most common metal to cause contact dermatitis in orthodontics. Chromium and Nickel containing metal alloys are widely used in orthodontic appliances. An allergic reaction to methylmethacrylate self-curing acrylic resin during orthodontic treatment also had been noticed. A localized hypersensitive reaction appeared on the palate after an orthodontic retainer was placed. In general, the most significant human exposure to nickel, chromium and titanium occurs through the diet, atmosphere, drinking water, clothing fasteners, jewelry and iatrogenic uses of articles containing these metals. Since, the oral environment is particularly ideal for the biodegradation of these metals due to its ionic, thermal, microbiologic and enzymatic properties, some level of patient exposure to the corrosion products of these alloys could be assumed, if not assured.Introduction-An increasing concern with the biocompatibility of dental materials might be due to an increase in the frequency of allergic reactions to materials or to an increase in awareness of adverse effects of these materials. Orthodontic bands, brackets and wires universally made of austenitic stainless steel containing approximately 18% chromium and 8% nickel. Nickel is the most common cause of metal induced allergic contact dermatitis in man and second in frequency is chromium.According to Rahilly. G1, nickel is the most common metal to cause contact dermatitis in orthodontics. Nickel-titanium alloys may have nickel content in excess of 50 per cent and can thus potentially release enough nickel in the oral environment to elicit manifestations of an allergic reaction.Another study by Lilian Staerjkaer2 stated that the nickel is the most common contact allergen affecting females in Europe and the USA. Nickel-containing metal alloys are extensively used for dental prostheses and orthodontic appliances. The findings of this study did not indicate that nickel sensitive persons are at greater risk of developing discomfort in the oral cavity when wearing an intraoral orthodontic appliance.The average dietary intake of the three metals have been estimated to be 200 to 300 ug/day for nickel, 280ug/day for chromium and 300 to 2000 ug/day for titanium. Nickel concentrations in drinking water generally measures below 20ug/L. 0.43ug/L are reported to be average chromium level in drinking water and for titanium levels are reported to range from 0.5 to 15 ug/L. 3According to Faribroz.A4 the mean salivary nickel (Ni) content in subjects with and without a fixed orthodontic appliance was 18.5 13.1 and 11.9 11.4 ng/ml, respectively. The mean salivary chromium (Cr) ion level recorded was 2.6 1.6 ng/ml in the study group and 2.2 1.6 ng/ml in the control group. Within the limits of this in vivo study, it is concluded that the presence of fixed orthodontic appliances leads to an increased concentration of metal ions (Ni and Cr) in salivary secretions.Ramandan5 determined the effect of chromium and nickel on gingival tissues during orthodontic treatment and concluded that the patients showed allergic reaction after 3 months of appliance placement and this had disappeared by 1 month after appliance removal. The allergy to either to nickel or chromium is not a serious medical problem; oral hygiene measures in at risk patients should be optimal, with use of fluoride free tooth paste and mouth rinse.To find the incidence of hypersensitivity to orthodontic metals, the patch tests were carried out before and 2 months after the placement of orthodontic appliances in a study by Luciana MM6 . Statistically significant positive reactions were observed for nickel sulfate (21.1%), potassium dichromate (21.1%), and manganese chloride (7.9%). Reactions to nickel sulfate had the greatest intensity and even the potassium dichromate. No differences were observed between the reactions before and after placement of orthodontic appliances. The incidence of allergies in general is on the increase. An allergic reaction can also occur during any dental and orthodontic treatment. However, the allergic potential of orthodontic appliances is frequently overestimated.The incidence of suspected allergic reactions during fixed appliance therapy was determined by questionnaire in which more extraoral (45%) than intraoral (17%) skin changes were registered, with both intraoral and extraoral changes being observed in 38%. Skin changes occurring in the course of orthodontic treatment should be examined and verified if necessary by a dermatologist. Gold plating and other coatings (titanium nitride) of the metal elements even encourage corrosion after a brief protection period. Soldering should be avoided7.An allergic reaction to methylmethacrylate self-curing acrylic resin during orthodontic treatment was also noticed. A localized hypersensitive reaction appeared on the palate after an orthodontic retainer was placed. The residual monomer content was between 0.745% and 0.78%, which did not exceed international standards for this material. Patch tests were performed with several methylmethacrylate resin samples showed positive reactions. Despite this many alternative products available, self-curing acrylic resin remains widely used because of its low cost, ease of use, and diversity of indications8.According to Sidney AK9 , dietary deficiency of chromium has been associated with-impaired growth and fertility, a diabetic like state connected to impaired glucose tolerance, hyperinsulinemia , hypercholesterolemia , enhanced atherogenesis. Human chromium deficiency has been indisputably proved in protein calorie malnutrition and in patients receiving total parenteral- nutrition (TPN) devoid of chromium supplements.Chromium salts were identified as human contact allergens between the two world wars10.Toxicodynamic considerations Iatrogenic exposures to chromium, nickel and titanium can occur from joint prostheses, dental implants, orthopedic plates and screws, surgical clips and steel sutures, pacemaker leads, prosthetic heart valves, dental alloys and orthodontic appliances.It has been reported that in vitro release rate for full mouth orthodontic appliances to be 36ug/day for chromium and 40ug/day for nickel. Nickel release from dental alloys has been reported as 4.2 ug/cm2 per day. Heat treated stainless steel orthodontic archwires showed the release rate for nickel to be 0.26ug/cm2 per day3.In a study in which cultured human cells were used, nickel was reported to be moderately cytotoxic while chromium was considered to have little cytotoxicity injury to skin from mechanical, physical or chemical agents followed by intimate contact with sensitizing allergens favoring the development of allergic eczematous dermatitis11.Diagnosis and detection of chromium allergy-By following the patients history such as previous allergic response after wearing earring or metal watch strap, appearance of allergy symptoms shortly after the initial insertion of orthodontic component containing nickel and chromium and even confined extraoral rash adjacent to head gear studs, provides allergic response history.According to Bukhard Summer12, a study was done to assess the ion release from Cobalt Chromium Molybdenum alloy (CoCrMo) alloy and stainless steel in vitro and the cutaneous reactivity to it by patch test. They concluded that there was low nickel ion release from stainless steel and CoCrMo discs into different elution media. With concomitant eczematous reaction upon patch testing it was found that 5 patients were Cobalt allergic and 3 also of nickel and chromium allergic.The standard assay for the detection of chromium sensitization , the patch test, does not allow discrimination between patients with and without clinical symptoms of allergy. A study by Lindemann.M13 aimed to prove whether cellular in vitro tests are predictive of chromium allergy. Chromium sensitized volunteers with and without clinically manifested allergy and non-sensitized healthy control were analyzed by cellular in vitro methods using tri and hexavalent chromium (chromium chloride and potassium dichromate) as stimuli. Sensitized individuals with an allergy displayed significantly higher lymphocyte transformation test (LTT) responses than volunteers without allergy and controls. Combining the results of chromium chloride and potassium dichromate LTT, a positive reaction to at least one of stimuli was highly predictive of allergy.Another study on chromium contact allergy by D.Tio14 utilized capillary tube leukocyte migration (LMT) inhibition assay as an in vitro method for the demonstration of chromium hypersensitivity on clinically proven or suspected chromium allergy individuals. LMT has found wide employment in immunopathology and denotes delayed type immunity in man. The results of this study were not influenced by skin allergic reactivity to compounds other than chromium and the method was found to be of practical clinical value for diagnosing chromium allergy.Biology of reaction Metallic dental appliances consist of dental amalgams (usually in fillings), solid solution chromium alloys (usually in partial plates) and wrought stainless steel wiring (usually in orthodontic or complex bridge work)15. Chromium elicits contact dermatitis which is delayed hypersensitive immune response. No symptoms at initial exposure, but subsequent exposure lead to more visible reaction.Signs and symptoms-The reaction would be stomatitis from mild to severe erythema , loss of taste, tongue soreness, angular cheilitis, allergic contact dermatitis, wide spread eczema and exacerbation of pre-existing eczema.Many substances used by dental laboratory technicians (occupational toxic risks) can cause either irritation or allergic reactions. Exposure to chromium can cause16:(1)Eczematoid dermatitis with edema and pruritus particularly in forearm (chromium bracelet) . (2)Mucocutaneous ulcerations (chromium holes or tanners ulcers). The most frequent cutaneous localization is on the palm of the hands, while the most frequent mucous localization is the nasal septum due to contamination of hands.(3) chronic rhinitis, pharyngitis, laryngitis and sometimes bronchitis. (4) asthma in workers exposed to chromic acid fumes and hexavalent chromium derivatives.Alternatives to prevent chromium allergy in orthodontics would be the use of Teflon coated (Tooth-colored epoxy resin ) wires, Optifelx archwires, Fibre reinforced composite archwires, Beta III Titanium , CNA Beta Titanium and TMA wires. These wires also prevent allergic reactions from nickel. Ceramic brackets , polycarbonate brackets, polycrystalline brackets, single crystal sapphire and zirconia brackets, gold plated brackets and titanium brackets are also helpful to avoid allergic reactions to chromium and nickel. Plastic coated headgears and glass fibre buccal tubes are also an aid to avoid contact dermatitis 1.Conclusion-While the sensitivity to any of these elements like chromium, nickel, titanium, acrylic or any other dental material may not present an extreme medical risk, the orthodontist must be aware of the problem, possess a basic understanding in occurrence rate, gender predilection, signs and symptoms of allergic reaction. The orthodontist must be familiar with the best possible alternative treatment modalities to provide the safest, most effective care possible in these cases, maintaining optimal oral hygiene.References-Rahilly G. Nickel allergy and orthodontics. J Orthod 2003; 30(2): 171-174Lilian S. Nickel allergy and orthodontic treatment. Eurp. Journal of orthod. 1990; 12(3): 284-289Robert DB. Biodegradation of orthodontic appliances. Part I. Biodegradation of nickel and chromium in vitro. Am J Orthod Dentofacial Orthop. 1993 ; 103 (1)Fariboz A. Metal ion release from fixed orthodontic appliances-an invivo study. Eurp. Journal of orthod 2011; 181Ramandan. Effect of nickel and chromium on gingival tissues during orthodontic treatment-a longitudinal study.World J orthod 2004;5:230-235Lucaine MM. Hypersensitivity to metals in orthodontics .Am J Orthod Dentofacial Orthop. 2004; 126(1)Schuster. Allergies induced by orthodontic alloys: incidence and impact on orthodontic treatment. Journal of orofacial orthopedics 2004;48-59(12)Tatiana SG. Allergy to autopolymerized acrylic resin in an orthodontic patient. Am J Orthod Dentofacial Orthop 2006; 129(3): 431-435Sidney AK.The Toxicology of chromium with respect to its chemical speciation. 1993; 13(3):217-224.(10)David Basketter . Investigation of threshold for allergic reactivity to chromium. Contact Dermatitis .2001; 44, 70-74(11) Park HY. In vitro release of nickel and chromium from simulated orthodontic appliances. Am J Orthod Dentofacial Orthop. 1983; 84 (2)(12)Burkhard Summer .Patch test reactivity to a cobalt-chromium-molybdenum alloy and stainless steel in metal-allergic patients in correlation to the metal ion release. Contact Dermatitis. 2007;57:35-39.(13)Lindemann M. Detection of chromium allergy by cellular in vitro methods.Clinical and Experimental Allergy. 2008; 38:1468-1475.(14) D.Tio .A study on the clinical application of a direct leukocyte migration test in chromium contact allergy.British Journal of Dermatology. 1976 ;94, 65.(15) Hubler WR. Dermatitis from a chromium dental plate. Contact Dermatitis. 1983;9 377-383.(16) Leon Choel .Occupational Toxic Risks in Denatl Laboratory Technicians. J.Environ.Med. 1999; 307-314.

Kromium Alergi di orthodonsi: review

Dr. Satnam Singh, M.D.S(Orthodontics)Dosen seniorDepartemen ortodontikInstitut gigi ilmu (IDS), Sehora, Jammu (India)e-mail-satnam82_singh@yahoo.comDr Poonam Bali, M.D.S(Prosthodontics)PembacaDepartemen ProsthodontikTeerthanker gigi Mahaveer college, Moradabad, Uttar Pradesh (India)e-mail-poonam_4wd@yahoo.co.inDr Shally Mahajan, M.D.S (orthodonsi)PembacaDepartemen ortodontikChandra gigi College dan rumah sakit, Barabanki, Uttar Pradesh (India)e-mail-drshally23@gmail.comAbstrak-Kejadian alergi pada umumnya adalah pada peningkatan. Reaksi alergi juga dapat terjadi selama pengobatan gigi dan orthodontic. Namun, potensi Alergi Ortodonti peralatan sering berlebihan. Nikel adalah logam yang paling umum untuk menyebabkan dermatitis kontak di orthodonsi. Kromium dan nikel paduan logam yang mengandung secara luas digunakan di peralatan orthodontik. Reaksi alergi terhadap methylmethacrylate resin acrylic menyembuhkan diri selama perawatan orthodontik juga telah melihat. Reaksi hipersensitif lokal muncul di langit-langit setelah punggawa Ortodonti ditempatkan. Secara umum, paling signifikan pemaparan manusia nikel, Kromium dan titanium terjadi melalui diet, suasana, air minum, pengencang pakaian, perhiasan dan iatrogenik penggunaan Artikel mengandung logam ini. Sejak, lingkungan mulut sangat ideal untuk biodegradasi logam ini karena sifat ionik, termal, microbiologic dan enzim, beberapa tingkat paparan pasien korosi produk paduan ini bisa diasumsikan, jika tidak yakin.Pengenalan-Keprihatinan yang meningkat dengan biokompatibilitas gigi bahan mungkin disebabkan peningkatan frekuensi reaksi alergi bahan atau peningkatan kesadaran terhadap efek dari bahan-bahan. Ortodonti band, tanda kurung, dan kabel Universal terbuat dari baja stainless steel mengandung sekitar 18% Kromium dan 8% nikel. Nikel adalah penyebab paling umum logam dermatitis kontak alergi disebabkan manusia dan kedua di frekuensi adalah kromium.Menurut Rahilly. G1, nikel adalah logam yang paling umum untuk menyebabkan dermatitis kontak di orthodonsi. Paduan nikel-titanium mungkin memiliki nikel konten lebih dari 50 persen dan justru itu berpotensi dapat melepaskan cukup nikel di lingkungan mulut untuk menimbulkan manifestasi dari reaksi alergi.Studi lain oleh Lilian Staerjkaer2 menyatakan bahwa nikel terhadap alergen kontak paling umum yang mempengaruhi perempuan di Eropa dan Amerika Serikat. Yang mengandung nikel paduan logam secara luas digunakan untuk prostesis gigi dan orthodontic peralatan. Temuan-temuan dari studi ini tidak menunjukkan bahwa nikel sensitif orang berada pada risiko lebih besar terkena ketidaknyamanan di rongga mulut ketika memakai alat Ortodonti intraoral.Asupan makanan rata-rata tiga logam telah diperkirakan menjadi 200 sampai 300 ug/hari untuk nikel, 280ug/hari untuk Kromium dan 300-2000 ug/hari untuk titanium. Nikel konsentrasi di minum air secara umum langkah-langkah di bawah ini 20ug/L. 0.43ug / L dilaporkan menjadi Kromium rata-rata tingkat dalam air minum dan untuk titanium tingkat dilaporkan ke kisaran 0,5 untuk 15 ug/L. 3Menurut Faribroz.A4 mean kelenjar ludah nikel (Ni) konten dalam mata pelajaran dengan dan tanpa alat Ortodonti tetap adalah 18.5 13.1 dan 11,9 11.4 ng/ml, masing-masing. Ion berarti kelenjar ludah Kromium (Cr) tingkat direkam adalah 2,6 1.6 ng/ml dalam kelompok studi dan 2.2 1.6 ng/ml dalam kelompok kontrol. Dalam batas-batas studi ini di vivo, disimpulkan bahwa kehadiran peralatan Ortodonti tetap mengarah ke peningkatan konsentrasi ion logam (Ni dan Cr) dalam sekresi kelenjar ludah.Ramandan5 ditentukan Efek kromium dan nikel pada jaringan gingiva selama perawatan orthodontik dan menyimpulkan bahwa pasien menunjukkan reaksi alergi setelah 3 bulan alat penempatan dan ini telah hilang dengan 1 bulan setelah penghapusan alat. Alergi ke salah satu nikel atau Kromium bukanlah masalah medis serius; kebersihan mulut tindakan di pasien risiko harus optimal, dengan penggunaan pasta gigi gratis fluorida dan bilas mulut.Untuk menemukan insiden hipersensitif terhadap Ortodonti logam, tes patch dilakukan sebelum dan 2 bulan setelah penempatan Ortodonti peralatan dalam sebuah studi oleh Luciana MM6. Reaksi positif yang signifikan secara statistik yang diamati nikel sulfat (21.1%), kalium dichromate (21.1%) dan mangan klorida (7,9%). Reaksi terhadap nikel sulfat memiliki intensitas terbesar dan bahkan dichromate kalium. Ada perbedaan yang diamati antara reaksi sebelum dan setelah penempatan Ortodonti peralatan. Kejadian alergi pada umumnya adalah pada peningkatan. Reaksi alergi juga dapat terjadi selama pengobatan gigi dan orthodontic. Namun, potensi Alergi Ortodonti peralatan sering berlebihan.Kejadian reaksi alergi yang dicurigai selama tetap alat terapi ditentukan oleh kuesioner di mana lebih extraoral (45%) daripada intraoral (17%) perubahan kulit yang terdaftar, dengan perubahan intraoral dan extraoral yang sedang diamati di 38%. Kulit perubahan-perubahan yang terjadi dalam perawatan orthodontik harus diperiksa dan diverifikasi jika diperlukan oleh dokter kulit. Emas plating dan coatings (titanium nitrida) elemen logam bahkan mendorong korosi setelah periode singkat perlindungan. Solder harus avoided7.Reaksi alergi terhadap methylmethacrylate resin acrylic menyembuhkan diri selama perawatan orthodontik juga memperhatikan. Reaksi hipersensitif lokal muncul di langit-langit setelah punggawa Ortodonti ditempatkan. Monomer sisa konten adalah antara 0.745% dan 0.78%, yang tidak melebihi standar internasional untuk bahan ini. Patch tes dilakukan dengan beberapa methylmethacrylate resin sampel menunjukkan reaksi positif. Meskipun ini banyak alternatif produk yang tersedia, Self curing acrylic resin tetap secara luas digunakan karena biaya rendah, kemudahan penggunaan, dan keragaman indications8.Menurut Sidney AK9, Diet kekurangan Kromium telah dikaitkan dengan gangguan pertumbuhan dan kesuburan, diabetes seperti negara yang terhubung ke gangguan toleransi glukosa, hyperinsulinemia, Hiperkolesterolemia, ditingkatkan aterogenesis. Kekurangan Kromium manusia telah disangkal terbukti protein kalori malnutrisi dan pada pasien yang mendapat total-nutrisi parenteral (TPN) tanpa Kromium suplemen.Kromium garam diidentifikasi sebagai manusia alergen kontak antara dua dunia wars10.Pertimbangan Toxicodynamic-Iatrogenik eksposur ke kromium, nikel, dan titanium dapat terjadi dari prostesis bersama, implan gigi, ortopedi piring dan sekrup, bedah klip dan baja jahitan, alat pacu jantung mengarah, katup jantung palsu, paduan gigi dan orthodontic peralatan.Telah dilaporkan bahwa dalam vitro rilis tingkat untuk mulut penuh Ortodonti peralatan 36ug/hari untuk Kromium dan 40ug/hari untuk nikel. Nikel rilis dari paduan gigi telah dilaporkan sebagai ug/cm2 4.2 setiap hari. Panas diperlakukan stainless steel Ortodonti archwires menunjukkan tingkat rilis nikel menjadi 0.26ug / cm2 per day3.Dalam sebuah studi di mana sel-sel manusia yang berbudaya digunakan, nikel dilaporkan menjadi cukup sitotoksik sementara Kromium dianggap memiliki sedikit cytotoxicity cedera kulit dari mekanis, fisik atau bahan kimia yang diikuti dengan kontak intim dengan membuat peka alergen memihak perkembangan Alergi eczematous dermatitis11.Diagnosis dan deteksi Kromium Alergi-Dengan mengikuti sejarah pasien seperti sebelumnya respon alergi setelah memakai anting-anting atau strap watch logam, munculnya gejala alergi tak lama setelah penyisipan awal Ortodonti komponen yang mengandung nikel dan krom dan bahkan terbatas extraoral ruam berdekatan dengan kepala gigi kancing, memberikan respon Alergi sejarah.Menurut Bukhard Summer12, studi ini dilakukan untuk menilai rilis ion dari Cobalt Chromium Molybdenum paduan (CoCrMo) alloy dan stainless steel secara in vitro dan reaktivitas kulit itu oleh tes patch. Mereka menyimpulkan bahwa ada rilis ion nikel rendah dari stainless steel dan CoCrMo disc ke media elution berbeda. Dengan seiring eczematous reaksi berdasarkan pengujian patch ditemukan bahwa pasien 5 adalah kobalt alergi dan 3 juga dari nikel dan krom Alergi.Assay standar untuk deteksi sensitisasi kromium, tes patch, tidak memungkinkan diskriminasi antara pasien dengan dan tanpa gejala klinis Alergi. Sebuah studi oleh Lindemann.M13 bertujuan untuk membuktikan Apakah tes secara in vitro selular prediktif Kromium Alergi. Kromium darinya relawan dengan dan tanpa klinis melaluinya alergi dan kontrol sehat bebas-darinya dianalisis dengan metode secara in vitro selular menggunakan tri- dan kromium hexavalen (Kromium klorida dan kalium dichromate) sebagai rangsangan. Darinya individu dengan alergi ditampilkan tanggapan tes (LTT) limfosit transformasi secara signifikan lebih tinggi daripada relawan tanpa alergi dan kontrol. Menggabungkan hasil Kromium klorida dan kalium dichromate LTT, reaksi positif setidaknya salah satu rangsangan adalah sangat prediktif Alergi.Studi lain pada Kromium kontak alergi oleh D.Tio14 dimanfaatkan tabung kapiler leukosit migrasi (LMT) penghambatan assay sebagai metode secara in vitro untuk demonstrasi Kromium hipersensitif Alergi individu yang secara klinis terbukti atau dicurigai kromium. LMT telah menemukan berbagai pekerjaan di immunopathology dan menunjukkan jenis tertunda kekebalan pada manusia. Hasil studi ini tidak dipengaruhi oleh kulit Alergi reaktivitas senyawa selain Kromium dan metode yang ditemukan untuk menjadi dari nilai praktis klinis untuk mendiagnosa Kromium Alergi.Biologi reaksi-Peralatan gigi logam terdiri dari peleburan gigi (biasanya dalam tambalan), Kromium solusi padat Alloy (biasanya dalam piring parsial) dan tempa kabel baja stainless (biasanya dalam kerja Ortodonti atau kompleks jembatan) 15. Kromium memunculkan dermatitis kontak yang tertunda hipersensitif respon imun. Tidak ada gejala pada paparan awal, tetapi eksposur berikutnya menyebabkan reaksi yang lebih terlihat.Tanda-tanda dan gejala-Reaksi akan stomatitis dari ringan berat eritema, hilangnya rasa nyeri lidah, sudut cheilitis, dermatitis kontak Alergi, luas menyebar eksim dan eksaserbasi eksim yang sudah ada.Banyak zat yang digunakan oleh teknisi laboratorium gigi (kerja beracun risiko) dapat menyebabkan iritasi atau reaksi alergi. Paparan Kromium dapat cause16:(1)Eczematoid dermatitis dengan edema dan gatal terutama di lengan ('Kromium gelang'). (2)Ulserasi mucocutaneous ('Kromium lubang' atau 'tanner ulkus'). Lokalisasi kulit paling sering adalah pada telapak tangan, sementara lokalisasi lendir paling sering adalah septum hidung karena kontaminasi tangan.(3) kronis rhinitis, faringitis, laringitis dan kadang-kadang bronkitis. (4) asma pada pekerja terpapar asap Asam kromat dan hexavalen Kromium derivatif.Alternatif untuk mencegah Alergi Kromium di orthodonsi akan penggunaan kawat dilapisi Teflon (resin epoksi gigi), Optifelx archwires, serat diperkuat komposit archwires, Beta III Titanium, CNA Beta-Titanium dan TMA kabel. Kabel ini juga mencegah reaksi alergi nikel. Keramik kurung, polikarbonat kurung, polycrystalline kurung, satu kristal safir dan kurung zirkonia, berlapis emas kurung dan kurung titanium juga berguna untuk menghindari reaksi alergi terhadap Kromium dan nikel. Headgears dilapisi plastik dan kaca serat bukal tabung juga bantuan untuk menghindari dermatitis kontak 1.Kesimpulan-Sementara kepekaan terhadap salah satu elemen seperti kromium, nikel, titanium, akrilik atau materi apapun lainnya gigi tidak dapat menyajikan risiko medis yang ekstrim, orthodontist harus menyadari masalah, memiliki pemahaman dasar terjadinya tingkat, kegemaran gender, tanda-tanda dan gejala dari reaksi alergi. Orthodontist harus akrab dengan modalitas pengobatan alternatif yang mungkin terbaik untuk memberikan yang paling aman, paling efektif perawatan mungkin dalam kasus ini, menjaga kebersihan mulut yang optimal.Referensi-Rahilly G. nikel alergi dan orthodonsi. J Orthod 2003; 30 (2): 171-174Lilian S. nikel alergi dan perawatan orthodontik. Eurp. Jurnal orthod. 1990; 12 (3): 284-289Robert DB. Biodegradasi Ortodonti peralatan. Bagian I. biodegradasi nikel dan krom secara in vitro. Am J Orthod Dentofacial Orthop. 1993; 103 (1)Ion Fariboz A. Metal rilis dari studi tetap Ortodonti peralatan-an invivo. Eurp. Jurnal orthod 2011; 181Ramandan. Efek nikel dan krom pada gingiva jaringan selama Ortodonti pengobatan-sebuah studi longitudinal.Dunia J orthod 2004; 5:230-235Lucaine MM. hipersensitif terhadap logam di orthodonsi.Am J Orthod Dentofacial Orthop. 2004; 126(1)Schuster. Alergi yang disebabkan oleh Ortodonti paduan: insiden dan dampak pada perawatan orthodontik. Jurnal orofacial ortopedi 2004;48-59(12)Tatiana SG. Alergi terhadap autopolymerized akrilik resin pasien orthodontik. Am J Orthod Dentofacial Orthop tahun 2006; 129(3): 431-435Sidney AK.Toksikologi Kromium sehubungan dengan spesiasi dalam kimia. 1993; 13 (3): 217-224.(10)David Basketter. Penyelidikan ambang batas untuk alergi reaktivitas untuk kromium. Dermatitis kontak. 2001; 44, 70-74(11) Park HY. In vitro rilis nikel dan krom dari simulasi peralatan orthodontik. Am J Orthod Dentofacial Orthop. 1983; 84 (2)(12)Burkhard musim panas.Tes patch reaktivitas kobalt-krom-molibdenum alloy dan stainless steel di logam Alergi pasien korelasi Release ion logam. Dermatitis kontak. 2007; 57:35-39.(13)Lindemann M. deteksi Kromium alergi dengan metode secara in vitro selular.Klinis dan eksperimental Alergi. 2008; 38:1468-1475.(14) D.Tio.Sebuah studi pada aplikasi klinis dari tes migrasi langsung leukosit di Kromium kontak alergi.British Journal of Dermatology. 1976; 94, 65.(15) Hubler WR. Dermatitis dari kromium gigi piring. Dermatitis kontak. 1983; 9 377-383.(16) Leon Choel.Kerja beracun risiko dalam teknisi laboratorium Denatl. J.Environ.Med. 1999; 307-314.