melisa test for titanium allergy

If a non-metal option is a consideration, then I would recommend if multiple patch tests are positive. Their are hundreds of people on the web reporting similar symptoms to Titanium. Second, post-surgery, MELISA can be used to identify if metal hypersensitivity is responsible for any of the symptoms that have developed. iii. V. A. Zejnullahu, B. X. Bicaj, V. A. Zejnullahu, and A. R. Hamza, Retained surgical foreign bodies after surgery, Open Access Maced J Med Sci., vol. Other materials are recent or less proven. Concerned this may give false negative results with patch testing. Neuroendocrinology Letters 2003; 24(1/2):57-64, Copyright 2022 MELISA Diagnostics Limited. Mediators of Inflammation. 2016;2016:15. doi: 10.1155/2016/8769347.8769347 A 72- and 96-hour reading is provided. 2014;102(2):392399. Diagnostic laparoscopy evaluation with fluoroscopic guidance was performed to locate the exact positioning of the pigtail catheter within the cecum before surgery (a) and after pigtail catheter removal (b). A quote from Fishers textbook on contact dermatitis is the following: if metal salts were tested close to each other a strong positive to nickel would be accompanied by false positive patch test reactions to adjacent metal salts, particularly cobalt and copper (2). However, in the lymphocyte transformation test, the patient's lymphocytes showed markedly enhanced proliferation in vitro totitanium. All rights reserved. The clips were made of nickel and titanium, and a metal sensitivity test confirmed that he was sensitive to nickel. Contact Dermatitis 2005; 53:1. The patient tolerated the procedure well with no postoperative complications. Bethesda, MD 20894, Web Policies Have new referral 62 year-old female smoker with focal seizure in 2017 - evaluation showed brain tumor confirmed to be malignant with primary in lung. Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [3]. In the study, 35 patients with failed orthopedic implants and 15 patients scheduled for orthopedic implant surgery were tested for metal hypersensitivity using the MELISA test. The patient had delayed hypersensitivity reaction to nickel in the past with erythematous rash formation and severe itching. 2006 Dec;27 Suppl 1:31-5. Minimization of Adverse Effects Associated with Dental Alloys. In the case of implants, the few people that report having them removed also report immediate improvement. LTT-MELISA is touted as superior to other testing modalities, such as patch testing, particularly for titanium, possibly due to the reduced immunologic reactivity of titanium (4,5). The .gov means its official. Therapy resistant dermatitis Six metal surgical clips removed from the RUQ via fluoroscopic guidance. 3, pp. 201207, 2012. Phil Lieberman, M.D. One year post-implantation (72 patients), 5 patients who had initially tested negative for a metal allergy became positive for at least one or more metal constituents of the prosthesis on at least one or the other test. 5, no. For statistical analysis, the Fisher's exact test and paired T-test were used. Dermatitis 26;2015:1-25. LTT is another more sensitive test than the skin-patch test; however, there are reports of some false-positive results [3]. There are zyrconia implants like White Sky, that are monoblock type implants, and that are a real option for you.Also Rocksolid from straumann is a combination that may also help you Therfore a immediate or a delayed immediate response can be excluded. Type I hypersensitivity reaction may manifest as anaphylaxis causing urticarial plaques or papules on the skin [3]. The patients past medical history consists of depression, polycythemia vera, hypothyroidism, mitral valve prolapse, chronic back pain, and deep vein thrombosis of nonextremity and acute cholecystitis. The hypothesis of this study is that In summary, there is no official recommendation to use in vitro methodology as the testing has not been validated by multiple investigators and the FDA has not approved the testing. I have been to 7 dr. Could this be form the 3 rods in my femur carol. Immediately after removal of his last palladium containing white gold crown all of his paralysis resolved.At the November 2019 meeting of the FDA's Committee Investigating Metals Used in Medical Devices, Dr. Schroeder presented Jeske's case and the cases of some of his other patients. They are real and they manifest themselves over time. This test is also available in the US. Published by Elsevier Ltd. All rights reserved. 3. Carol: keep an eye on the situation and as you already have consult with your physician. The International Journal of Implant Dentistry points out that zirconia implants can be an alternative to titanium implants. iv. All Rights Reserved. I would emphasize the lymphocyte testing is a challenge due to delivery of viable cells and lack of FDA approval and insurance coverage. The https:// ensures that you are connecting to the The most commonly used test to diagnose a metal allergy is skin patch testing. Dr Lieberman provided a response, which I have provided for you here: Within a few days, she started having vomiting, bloating, weakness, fatigue, and intense RLQ abdominal pain. 2020;276, article 102083 doi: 10.1016/j.cis.2019.102083. She had to be hospitalized with strict isolation to wait for her medication regimen to work along with the infusion of IV fluids. I have summarized her observations and suggestions below. Fage, Simon W., et al. Suspicion for titanium allergy is generally localized to the hardware site and may initially be thought to be an infectious process. b. allergic reaction to bio oss is it possible. The easiest and most affordable way to clinically deliver bone graft for socket preservation. Her symptoms became chronic and progressed further to abdominal distension with increasing abdominal girth, fever, and several episodes of watery diarrhea. Neuro Endocrinol Lett 2006; 27(Suppl 1):1724). In: StatPearls [Internet]. A pigtail catheter is a universal drain used to remove fluids or abscesses from organs, ducts, or body cavities. To confirm, the patient was further ordered for memory lymphocyte immunostimulation assay (MELISA) that also showed equivocal results for titanium allergy. v. Postoperative testing may help in determining if metal allergy is responsible; Sincerely, Only osteolytic THA subjects demonstrated increased cytokine responses with >two-fold (p <0.05) increases in soluble interferon- (IFN-) and interleukin-2 (IL-2) levels in response to Cr challenge. Objectives: In candidates for hip or knee joint prosthesis implantation, to evaluate preoperative assessments for identifying patients with metal sensitivity, to determine the percentage of patients who developed metal sensitivity at 1 year after prosthesis implantation, and to examine the clinical relevance of patch tests and lymphocyte transformation tests (LTT-MELISA) for the evaluation of metal sensitization. If the patches were removed and read at 72 hours, the response was most likely an irritant reaction I would repeat the patch tests with the chamber more than 6 inches apart, take pictures before and at 48 hours, 72 hour, and possibly 4, 5 and 6 days. Just some thoughts. You should get titanium implants bc you probably don't have an allergy to it or you can just get a zirconia based implant and have it fracture shortly after due to a reaction with fluids/water, then have someone remove it, place another, then removed, place another, etc. please note that there are many brands of implants which are used to titanium alloys in making implants so i agree with whose are believe in allergist consultation. This started at 45 minutes per day but the periodic paralysis progressed to 10-12 hours per day of immobility. There are more than 28 million surgical procedures with up to 1500 cases of retained foreign bodies estimated in the United States per year [13]. Thank you again for your inquiry and we hope this response is helpful to you. Some of the reported complications of pigtail catheter insertion include lung penetration during pleural effusion removal and entrapment of the catheter in the tricuspid valve leaflet during heart catheterization [8, 14, 15]. However, IFN-gamma responses towards chromium chloride were significantly correlated with the strength of patch test reactivity (r=0.49, P=0.002). d. most literature continue to recommend patch testing as the standard, possibly with the exception of titanium due to potential occurrence of false negative patch skin test results. She was diagnosed with pneumonia twice followed by two sinusitis episodes from January 2020 to March 2020. 18, no. The patient initially had intermittent RLQ abdominal pain accompanied by nonspecific symptoms. In cases of documented delayed type metal hypersensitivity or when an individual has a strong belief related to this possibility, legal concerns may outweigh medical concerns; All the best! Zirkonia crowns or bridge, and be cemented. The one we elected is from a German/Swiss based company called Z-Systems. We present a case of a 28-year-old female with a chronic history of intermittent abdominal pain aggravated due to titanium allergy and retained foreign surgical body. 15, 2019. Further test applications include Lyme disease. Toxics. Clin Exp Allergy. Since Dr Schroeder had been studying metal allergies for years he sent Jeskes blood for MELISA testing for metal allergies. We report on a patient in whom impaired fracture healing and eczema localized to the perioperative area developed upon titanium-based osteosynthesis. WebThis test is used to determine whether titanium dental implants, metal bridges,crowns and over dentures or amalgam fillings are causing allergic reactions within the body. Even low grade allergies are causing significant symptoms. Effect of blood component coatings of enosseal implants on proliferation and synthetic activity of human osteoblasts and cytokine production of peripheral blood mononuclear cells. 7. ii. Thus interpreting these tests is much like interpreting the immediate hypersensitivity skin tests and tests for serum-specific IgE. WebTitanium is a reactive metal with a including titanium may mediate metal hypersen- titanium allergy, titanium release without any native oxide film thickness of about 4 The test Therefore, objective determination of metal sensitivity at preoperative assessment should be considered in planning arthroplasty intervention, as it would help the surgeon in selecting the most appropriate prosthesis for the patient and could benefit implant performance. i. Dermatitis overlying the implant The results of the initial and follow-up MELISA tests; Percentage of patients in individual intervals of the stimulation index: green 2.0, yellow = 2.14, orange = 4.110.0, and red 10.1; comparison of the initial with the follow-up values of the stimulation indexmetals with significant differences. THA subjects with moderate vs mild osteolysis (Group 3b vs 3a) were more reactive to Co (43% vs 0% incidence). Thirty-two patients reported that they followed the recommendations based on the results of the initial MELISA tests, and of these, 30 patients (94%) confirmed significant health improvement. These metals ions bind to proteins in the body. For those who react, the bodys immune system will attack this new protein/metal structure. This may start an immune reaction. The MELISA test a scientifically-proven test which can objectively test for the presence of titanium hypersensitivity and measure its severity. Thank you for submitting a question to Ask the Expert. Evaluation of symptoms suspected to be dependent on immunologic responses to implanted metals is complicated by the limitations of testing. We discuss the presentation, investigations, and treatment of this unusual case. Trying to find LTT for titanium but cannot find - is LTT available anywhere in US for metals? See MoreSee Less, Metal hypersensitivity and pro-inflammatory cytokine production in patients with failed orthopedic implants: A case-control study, Valentine-Thon E, Schiwara HW. Questionnaire data was processed, and the follow-up MELISA test results were compared with the results of the initial MELISA tests. From these patients, a final group of 42 patients agreed to participate in the study, 35 of which were female and 7 were male. 2008 Sep;38(9):1468-75. doi: 10.1111/j.1365-2222.2008.02970.x. 2/12/2021 Conclusions: In contrast to the patch test, the LTT appears to be a method that is predictive of chromium allergy. Six patients did not follow the recommendation, and from these, only one patient reported an improvement in his health problems. 2/20/2020: Metal patch test positive with rash and knee replacement There are 'allergies' that one can have to certain substances that don't cause you to break out in hives or go into anaphylactic shock. Testing for titanium However, there is no consensus for the utility of the test with critics arguing the test is overly sensitivity (5,6,7). The patient was referred to an infectious disease specialist and kept on a course of oral vancomycin and fidaxomicin. No buccal sulcus after closure of OAC: advice. This might be therefore be a solution for about 10 years oral function. Fishers textbook on contact dermatitis provides a summary of the state of the art for in vitro lymphocyte proliferation (2): Contact dermatitis 79.2 (2018): 85-90. I also had titanium screws inserted into my mouth giving me alot of pain. Carol: This sounds more like a vitamin B 12 deficiency, but see what your Drs. Valentine-Thon E, Mller K, Guzzi G, Kreisel S, Ohnsorge P, Sandkamp M. Neuro Endocrinol Lett. 2, 2020. M. Tu and Y. Wu, Multiple allergies to metal alloys, Dermatologica Sinica, vol. -, Erakovi S., Jankovi A., Ristoscu C., et al. Lisa Eads. The test will also tell the patient I hope this information is of help to you and your practice. LTT is another more sensitive test than They can work from 8years to 15,inimum. G. Forte, F. Petrucci, and B. Bocca, Metal allergens of growing significance: epidemiology, immunotoxicology, strategies for testing and prevention, Inflammation & Allergy Drug Targets, vol. However, this test has been criticized as generating false positives, and my guess would be that titanium allergy is less prevalent than that. Although extremly rare, allergic reaction is far more often seen in pure titanium implants then in titanium alloys of TiAlVa or Ti/Al/Niob or Molybden. It can be challenging to diagnose and discover RFB due to the different manifestations of each case and nonspecific symptoms. Stejskal, V. D. M., et al. We investigated these questions by measuring lymphocyte responses to implant metals (Cr+3, Co+2, Ni+2 at 0.1 mM, and Ti+4 at 0.001 mM) in six subject groups: Group 1a = young controls, Group 1b = age matched controls, Group 2a = subjects with osteoarthritis (OA) and no history of metal sensitivity, Group 2b = OA subjects with history of metal sensitivity, Group 3a = total hip arthroplasty (THA) subjects with no to mild radiographic osteolysis, and Group 3b = THA subjects with moderate osteolysis. Background: 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. Making this recommendation on a test that is not generally accepted is difficult, but you may wish to document a shared decision making discussion regarding this controversy. Schalock PC, Menn T, Johansen JD et al. How effective this is in detecting contact dermatitis to metal still remains somewhat undecided, but there is evidence in the literature that the test can detect delayed hypersensitivity to metals. Neuro Endocrinol Lett. M. Little, P. C. Munipalle, and O. Nugud, A rare late complication of laparoscopic cholecystectomy, Case Reports, vol. J Biomed Mater Res 2000: 53: 480489. By comparison of the initial and follow-up MELISA test results, it can be stated that the hypersensitivity to the given metal decreased or disappeared after the therapeutic interventions performed based on the initial MELISA test results. We've been working on metal free implants in my clinic since 2005, so we have mid term results showing the amazing results on our patients. But what if you feel like your body is rejecting your new dental implant? doi: 10.1002/jbm.a.34721. PMC They work even in a periodontic compromised oral situations. Abstract Moreover, titanium has been described to activate macrophages through phagocytosis to cause the release of pro- and anti-inflammatory cytokines [9]. It is used worldwide by healthcare professionals to help determine whether patients are An implant is a great replacement because it looks and feels like a real tooth. However, THA subjects (Groups 3a & b) were >3 fold more reactive to Cr (p < 0.04), than were controls (Groups 1a & b) or OA subjects (Groups 2a & b). Once you heal from the implant surgery, a crown is attached to the part of the implant that protrudes through the gumline. HHS Vulnerability Disclosure, Help See this image and copyright information in PMC. Federal government websites often end in .gov or .mil. MELISA Test MELISA test, validated by an independent laboratory [ 43 ], was used in this study for assessment of metal hypersensitivity reactions. suggested using 0.1% and 0.2% titanium sulfate solution and 0.1% and 0.2% titanium chloride as alternative reagents to titanium oxide in skin-patch testing [11]. Usualy allergic response is seen on epidermis. 1, pp. Toxicology in vitro 8.5 (1994): 991-1000. 2. Orthopedic Analysis a. iii. Fowler, Joseph F., and Matthew J. Zirwas. Combining the results of chromium chloride and potassium dichromate LTT, a positive reaction to at least one of the stimuli was highly predictive of allergy [sensitization with vs. without allergy: Odds ratio (OR)=6.4, P=0.004; sensitization with allergy vs. controls: OR=11.5, P<0.0001]. The Mayo Clinic had diagnosed him with Stiff Person Syndrome. What good is using titanium (that will last forever) if it is wreaking havoc with one's immune system, and instead of just having an infected/rotten tooth, now they have rheumatoid arthritis? This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. 426431, 2018. The test you referred to is not actually a serum test, but a whole blood test which measures lymphocyte reactivity upon exposure to metal. 2019. W. S. Towers and K. Kurtom, Rare systemic response to titanium spinal fusion implant: case report, Cureus, vol. It's simple, cheap, and reliable. I would recommend though that you take a clifford test first on Zircon Oxide due to your allergic component. After your implant is placed, your oral surgeon will encourage you to rest and practice good oral hygiene to heal the area around the titanium screw. Hypersensitivity to titanium: diagnosis and management. Neuroendocrin Letters 2006;27:17-24. WebDrugs are compounded specifically for each patients allergy test and cannot be used on another patient, so please keep your appointment. It can feel both disappointing and overwhelming to learn that youre not taking to your new implant as well as you'd hoped. An exact breakdown, which includes trace amounts of metals present, is needed prior to testing, but below is a guideline. WebMELISA reactivity is directly dependent on lymphocyte concentration: the higher the lymphocyte concentration per test, the stronger the reactivity. I had a hip replaced with titanium. 2. Histology consistent with eczema They were clinically examined, and peripheral blood samples were taken to perform follow-up MELISA tests. Proper history taking, appropriate physical exams, and specific diagnostic modalities can identify rare causes of chronic abdominal pain. Dear Sarah, Systemic allergic skin symptoms or signs Dental implant surgery is performed in stages, requiring adequate healing time after each one. It is used worldwide by healthcare professionals to help determine whether patients are hypersensitive to metals WebMetal allergy was measured by a lymphocyte transformation test, MELISA. Since then, has had persistent systemic pruritic papular rash - worse in scalp and hairline. The use of viable lymphocytes and the absence of 3rd payer coverage also limit the utility of the testing. The better the coating (cristaliniy degree) the later this happens. In our case, the patients nonspecific symptoms due to the titanium clips were quite different from the symptoms reported in other studies and may not wholly be attributable to titanium hypersensitivity since the patient had known allergic reactions to various other allergens as well. National Library of Medicine Just wondering. "LTT-MELISA is clinically relevant for detecting and monitoring metal sensitivity". Some things are not clear cut. She also reported low-grade fever, nausea, vomiting, joint pain, bloody diarrhea, and inability to keep her food down. 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. Ask The Expert Archive Main Page Validity of MELISA for metal sensitivity testing. A group of 305 patients aged 20-75 years with previously proven metal hypersensitivity (initial MELISA test), mainly to titanium and then to another fifteen metals, was chosen from the database at the Institute of Dental Medicine. I had bone tumor & metal rods placed in my femor a 1 yr & 6 months ago .. His case is described in the YouTube video by Dr Scott Schroeder. coating disolves over the years. The results of the initial and follow-up MELISA tests; significant decrease (, Percentage of patients in individual intervals of the stimulation index: green 2.0,, MeSH Although contact allergic reactions to titanium have been very rarely reported, these findings support a diagnosis of titanium allergy in our patient. The commercially licensed, in vitro lymphocyte transformation test for detecting sensitivity to metals (LTT-MELISA) is not FDA approved and generally is not covered by insurance (1,2). While titanium generally causes fewer problems than other metals, some people may be allergic to it. Find out how to recognize those symptoms and when to approach your dentist for a complete diagnosis. The ideal barrier membrane for most applications. I hope Sarah was able to discern what she needs to do for her particular situation. Suspecting systemic contact dermatitis to metal buttons and I have been asked to evaluate. Dental implants are typically made from titanium metal alloys, and in some rare cases, people may experience titanium allergy symptoms. The body does not uptake B 12 via tablets or injections. Allergic responses to metals such as nickel, chromium, mercury, cobalt, and gold are widely recognized [1]. Concentrations of Medical content developed and reviewed by the leading experts in allergy, asthma and immunology. 145162, 2008. More information about the metals commonly contained in stents can be foundHERE. Ask the Colgate Chatbot! Simply cut, peel, & apply to protect wounds, & more! Thanks. I am severely allergic to many metals..confirmed nickel was "off the charts"..worst case they'd ever seen which I'd know obviously for my entire life. The results of a MELISA test came back negative for a titanium allergy but revealed Peters is allergic to nickel. b. in vitro testing is only available for a limited number of metals; It is a very real reaction that needs to be dealt with. For almost 6 years, this was his life. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A dental professional can help you treat your titanium allergy and ensure that you fill the gap in your mouth with a treatment that works for you! However, all the symptoms were resolved after the removal of the offending agent [57]. I have found through the years that it is females that have these unusual allergies to metals. 2013, no. Would you like email updates of new search results? Filipoiu DC, Bungau SG, Endres L, Negru PA, Bungau AF, Pasca B, Radu AF, Tarce AG, Bogdan MA, Behl T, Nechifor AC, Hassan SSU, Tit DM. In the study, 35 patients with failed orthopedic implants and 15 patients scheduled for orthopedic implant surgery were tested for metal hypersensitivity using the MELISA test. Due to another foot problem requiring surgery, he returned to his surgeon Dr Schroeder, who noticed swelling over the areas the screws were placed and recommended removal of the screws. 78, p. 1135, 1999. Both bare metal and drug eluting stents have been occasionally implicated in the developments of various hypersensitivity reactions. doi: 10.1016/j.apsusc.2013.12.029. The German S3 guideline on titanium hypersensitivity in implant dentistry: consensus statements and recommendations. v. Positive in vitro test to metals 29, no. We thank Dr. Guirguis, Department of Radiology, and Williamson Medical Center for their contributions in this case report. Is there any validity to Lymphocyte Transformation testing (LTT) and/or Metal ION testing? If you have any questions, call the Drug Allergy Clinic at (615) 936-2727, 8 a.m.-4:30 p.m. Monday through Thursday or 8 Any suggestions on the root cause? However, it indeed seems titanium allergy had a significant role in her abdominal discomfort owing to her positive allergy test results further proving titanium hypersensitivity in this patient. Is there any other material used as an alternate to titanium in the implant fixtures? Since titanium, in the form of titanium dioxide (E171), is used as white pigment in toothpaste, cosmetics and medication, the latent sensitization of susceptible individuals is possible. It also sheds light on retained foreign bodies as a possible cause of abdominal pain in patients who have gone through various surgical procedures in the past. For those affected with titanium allergy, the symptoms can be multiple and bewildering. When exposed to oxygen, titanium oxidizes and Was the patch test removed at 48 hours and what was the reading at that time? This may be the situation you are facing. Zimmer dental, former Sulzer-Calcitek, stil have HA-(hydroxylapatit) coated implants. Chronic dermatitis beginning weeks to months after the transplant 59, no. Contact Dermatitis 2011;66:4-19. WebThe only current blood test for titanium allergy, a test called the MELISA(R) test, is available through Breakspear. But there isnt long-term clinical data associated with their usage, and so your dental professional is the best person to speak to about alternative options. This can be seen on the fact that bone attachment is usualy tighter and faster with pure ti-implants then in Ti-alloy-implants. Background: Sensitization to orthopaedic implant materials is an unpredictable event that might affect implant performance. cureus.com/articles/136554-diagnosis-and-management-of-a-hypersensitivity-reaction-to-titanium-containing-surgical-clips-a-case-report See MoreSee Less, Diagnosis and Management of a Hypersensitivity Reaction to Titanium-Containing Surgical Clips: A Case Report, Two weeks after gallbladder surgery, a 53-year-old man experienced constant abdominal pain in addition to nausea. Referred to me to patch testing. These HA-implants heel quite well and also fast. The test itself, that is, the lymphocyte transformation test, is a validated means of testing for delayed hypersensitivity, the type of hypersensitivity that results in contact dermatitis. Beware the cosmetics and sun blocker you use !!!!! Following craniotomy, titanium alloy buttons were used to secure skull fragments. This is of course important in dealing with metal implants. Documented titanium allergy is very rare, if other metals are test positive then titanium would be an alternative; WebMELISA is a blood test to aid the diagnosis of metal hypersensitivity. Titanium is a known metal used widely in the medical field and can cause allergic reactions with complications. These stages include removing the damaged tooth, bone grafting (if needed), dental implant placement, abutment placement, and the placement of your artificial tooth (crown). 5. sharing sensitive information, make sure youre on a federal Enfermedades de Inmunodeficiencia Primaria, AAAAI Diversity Equity and Inclusion Statement, Titanium allergy and lymphocyte transformation test. P. H. Wu, J. H. Chen, and K. E. Chu, Successful endoscopic management of double iatrogenic perforations induced by endoscopic retrograde cholangiopancreatography and computed tomography-guided colon drainage, Case Reports in Gastroenterology, vol. So how can I recognize if I have a dental implant allergy? 4. "MELISAan in vitro tool for the study of metal allergy." Its possible to detect a titanium hypersensitivity ahead of time with a MELISA test. I realize that the data is limited but at least one reference indicates possible value for these modalities. Frigerio E, Pigatto PD, Guzzi G, Altomare G. Retained foreign bodies (RFB) are also possible complications of any surgical procedure. C. Shi, Y. Xi, B. Their disadvantage is that in some individuals the HA Percentage of patients in individual intervals of the stimulation index: green 2.0, yellow = 2.14, orange = 4.110.0, and red 10.1; comparison of the initial with the follow-up values of the stimulation indexmetals with nonsignificant differences. Preoperative testing may identify preexisting sensitivity but does not predict likelihood of joint failure and may help with selection of type of implant; I strongly recommend zircon implants.

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