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Metal Allergy pp 321-330 | Cite as

Diagnostic Work-Up of Patients with Metal Implant Failure

  • Peter Thomas
  • Burkhard Summer
Chapter

Abstract

In patients with metal implant failure, all clinical and etiological factors need to be considered, and common causes like infection, malpositioning, or mechanical elicitors should be ruled out. Implant allergy often is a diagnosis of exclusion, supported by evaluation with allergy diagnostics. In view of the lack of consensus, this chapter reports on the different diagnostic approaches suggested by expert groups. Ideally, there should be combined evaluation including patch testing (PT), histology, and lymphocyte transformation testing (LTT). There are several suggestions/limitations. PT: pre-implant testing should be only done in patients with self-reported history of “adverse reaction” to metals—but not as a general prophetic “biocompatibility” test. While an additional late reading (day 6 or 7) increases the yield of positive test reactions, there exist no evaluated test preparations for many implant metals. Testing with metal discs is not recommended. Histology: peri-implant lymphocytic infiltration is suggestive of, but not definitive for, implant allergy. LTT: this rather scientific assay demonstrates sensitization and needs to be evaluated and interpreted with care. Accordingly, each patient should be individually evaluated.

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Dermatologie und AllergologieLudwig-Maximilians-Universität MünchenMunichGermany

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