Urinary levels of nickel and chromium associated with dental restoration by nickel–chromium based alloys

Abstract

Dental fillings made of nickel—chromium-based alloys appear to increase the levels of these toxic metals excreted in recipients’ urine. A team led by Qing-wu Jiang of Fudan University in Shanghai, China, compared the urinary concentrations of nickel and chromium in 795 people who had metal dental fillings with 198 people who had no such fillings. Nickel concentrations were significantly higher in people who had received the fillings within the past month compared with controls. Elevated chromium levels were detectably higher in people who had received fillings within the past six months. Urinary concentrations of both metals were also greater in people with more than one nickel–chromium alloy fillings. The authors call for follow-up work to investigate the potential health outcomes of having these metals leaching into the body’s circulation system following dental restoration.

Keywords

dental restoration / nickel–chromium based alloys / population investigation / urinary chromium / urinary nickel

References

[1] Elshahawy W, Watanabe I, Koike M. Elemental ion release from four different fixed prosthodontic materials. Dent Mater, 2009, 25(8): 976-981.

[2] Elshahawy WM, Watanabe I, Kramer P. In vitro cytotoxicity evaluation of elemental ions released from different prosthodontic materials. Dent Mater, 2009, 25(12): 1551-1555.

[3] Wylie CM, Davenport AJ, Cooper PR. Oral keratinocyte responses to nickel-based dental casting alloys in vitro. . J Biomater Appl, 2010, 25(3): 251-267.

[4] Tripuraneni SC, Namburi SK. Evaluation of genotoxicity of recycled Ni–Cr dental casting alloys: an in vitro study. J Appl Biomater Biomech, 2008, 6(1): 47-54.

[5] Lu Y, Chen W, Ke W. Nickel-based (Ni–Cr and Ni–Cr–Be) alloys used in dental restorations may be a potential cause for immune-mediated hypersensitivity. Med Hypotheses, 2009, 73(5): 716-717.

[6] Noble J, Ahing SI, Karaiskos NE. Nickel allergy and orthodontics, a review and report of two cases. Br Dent J, 2008, 204(6): 297-300.

[7] Jones SB, Taylor RL, Colligon JS. Effect of element concentration on nickel release from dental alloys using a novel ion beam method. Dent Mater, 2010, 26(3): 249-256.

[8] Lopez-Alias JF, Martinez-Gomis J, Anglada JM. Ion release from dental casting alloys as assessed by a continuous flow system: Nutritional and toxicological implications. Dent Mater, 2006, 22(9): 832-837.

[9] Wylie CM, Shelton RM, Fleming GJ. Corrosion of nickel-based dental casting alloys. Dent Mater, 2007, 23(6): 714-723.

[10] Denizoglu S, Duymus ZY, Akyalcin S. Evaluation of ion release from two base-metal alloys at various pH levels. J Int Med Res, 2004, 32(1): 33-38.

[11] Baucic M, Celebic A, Stipetic J. In vitro release of metal ions from a gold–platinum alloy in saliva-simulated conditions. Coll Antropol, 2003, 27(Suppl 2): 91-98.

[12] Wataha JC, Nelson SK, Lockwood PE. Elemental release from dental casting alloys into biological media with and without protein. Dent Mater, 2001, 17(5): 409-414.

[13] Staffolani N, Damiani F, Lilli C. Ion release from orthodontic appliances. J Dent, 1999, 27(6): 449-454.

[14] Wataha JC, Lockwood PE. Release of elements from dental casting alloys into cell-culture medium over 10 months. Dent Mater, 1998, 14(2): 158-163.

[15] Liu C, Li R, An F. Changes of serum nickel and chromium content at 6 months and 1 year after porcelain-fused-to-nichrome crown restoration: A comparison with healthy controls. J Clin Rehab Tissue Eng Res, 2008, 12(23): 4583-4585.

[16] Menezes LM, Quintao CA, Bolognese AM. Urinary excretion levels of nickel in orthodontic patients. Am J Orthod Dentofacial Orthop, 2007, 131(5): 635-638.

[17] Bishara SE, Barrett RD, Selim MI. Biodegradation of orthodontic appliances. Part II. Changes in the blood level of nickel. Am J Orthod Dentofacial Orthop, 1993, 103(2): 115-119.

[18] Schram SE, Warshaw EM, Laumann A. Nickel hypersensitivity: a clinical review and call to action. Int J Dermatol, 2010, 49(2): 115-125.

[19] Yin R, Huang XY, Zhou XF. A retrospective study of patch tests in Chongqing, China from 2004 to 2009. Contact Dermatitis, 2011, 65(1): 28-33.

[20] Kolokitha OE, Kaklamanos EG, Papadopoulos MA. Prevalence of nickel hypersensitivity in orthodontic patients: a meta-analysis. Am J Orthod Dentofacial Orthop, 2008, 34(6): 722 e1-e12.

[21] Pierce LH, Goodkind RJ. A status report of possible risks of base metal alloys and their components. J Prosthet Dent, 1989, 62(2): 234-238.

[22] Strauss FG, Eggleston DW. IgA nephropathy associated with dental nickel alloy sensitization. Am J Nephrol, 1985, 5(5): 395-397.

[23] Oriental Horizon. Deep thinking trigged by porcelain fused metal crown. China Central Television 2009; 14 April 2009. http://news.xinhuanet.com/video/2009-04/14/content_11185134.htm ( accessed 20 June 2010).

[24] China national standardization management committee. Health standard. Urine. Determination of nickel. Graphite furnace atomic absorption spectrometry method. WS/T 44-1996. Beijing: Standards Press of China, 1996. Chinese.

[25] China national standardization management committee. Health standard. Urine. Determination of chromium. Graphite furnace atomic absorption spectrometry method. WS/T 37-1996. Beijing: Standards Press of China, 1996. Chinese.

[26] The Working Group on Obesity in China (WGOC) The recommendation of body mass index cut off points for Chinese adult. Chin J Prev Med, 2001, 35: 349-350.

[27] Barrett RD, Bishara SE, Quinn JK. Biodegradation of orthodontic appliances. Part I. Biodegradation of nickel and chromium in vitro. . Am J Orthod Dentofacial Orthop, 1993, 103(1): 8-14.

[28] Messer RL, Lucas LC. Cytotoxicity of nickel–chromium alloys: bulk alloys compared to multiple ion salt solutions. Dent Mater, 2000, 16(3): 207-212.

[29] Sunderman FW Jr, Hopfer SM, Swift T. Cobalt, chromium, and nickel concentrations in body fluids of patients with porous-coated knee or hip prostheses. J Orthop Res, 1989, 7(3): 307-315.

[30] Burian M, Neumann T, Weber M. Nickel release, a possible indicator for the duration of antiplatelet treatment, from a nickel cardiac device in vivo: a study in patients with atrial septal defects implanted with an Amplatzer occluder. Int J Clin Pharmacol Ther, 2006, 44(3): 107-112.

[31] del Rio J, Beguiristain J, Duart J. Metal levels in corrosion of spinal implants. Eur Spine J, 2007, 16(7): 1055-1061.

[32] Kalinich JF, Vergara VB, Emond CA. Urinary and serum metal levels as indicators of embedded tungsten alloy fragments. Mil Med, 2008, 173(8): 754-758.

[33] Flyvholm MA, Nielsen GD, Andersen A. Nickel content of food and estimation of dietary intake. Z Lebensm Unters Forsch, 1984, 179(6): 427-431.

[34] Rose M, Baxter M, Brereton N. Dietary exposure to metals and other elements in the 2006 UK Total Diet Study and some trends over the last 30 years. Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 2010, 27(10): 1380-1404.

[35] Gjerdet NR, Erichsen ES, Remlo HE. Nickel and iron in saliva of patients with fixed orthodontic appliances. Acta Odontol Scand, 1991, 49(2): 73-78.

[36] Wang WJ, Zhang TQ, Wei H. [Study on content of nickel in saliva released from the nickel–chromium and the nickel–chromium–titanium porcelain alloy. Hua Xi Kou Qiang Yi Xue Za Zhi, 2010, 28(1): 45-47.

[37] Yang Y, Jin XM, Yan CH. Urinary level of nickel and acute leukaemia in Chinese children. Toxicol Ind Health, 2008, 24(9): 603-610.

[38] Zhang XH, Zhang X, Wang XC. Chronic occupational exposure to hexavalent chromium causes DNA damage in electroplating workers. BMC Public Health, 2011, 11: 224.