Clinical characteristics of an allergic reaction to a polyether dental impression material (2)

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2. Clinical characteristics of an allergic reaction to a polyether dental impression material Caroline Freitas Rafael and Anja Liebermann DR DIVYA JAIN 1 ST YEAR MDS 2 (J Prosthet Dent :April 2017:117(4):470-472

3. Contents Definition Requirements Classification of impression materials Polyether impression material Allergy And Hypersensitivity Main article Clinical report Discussion Conclusion Critical analysis 3

4. Contents… Review of literature Summary Reference 4

5. Definition Biocompatibility Property of the material which remain harmoniously with the living tissues. Sham Bhat-2 nd edition Ability of a material to elicit on appropiate biological response in a given application in the body. Craig -12 edition Impression materials Any substance or combination of a substance used for making an impression or negative reproduction. GPT-8 5

6. Requirement Should not be harmful to pulp and soft tissues Should not contain toxic diffusible substance Should not produce allergic responses Should not be carcinogenic Should not undergo biodegradation Should not show estrogenecity and contain xenoestrogens 6

7. Classification Of Impression Materials 7

8. Depending on elasticity Impression material Elastic Inelastic Hydocolloid Elastomers Impression plaster Impression waxes Impression compound Zinc oxide eugenol paste Agar Alginate P olyether P olysulfide Silicone Condensation Addition 8

9. Depending on setting mechanism Impression Materials Chemical reaction Thermally induced physical reaction -Plaster of paris - Compound wax -Zinc oxide eugenol - Agar Hydrocolloid - Impression Compound -Alginate Hydrocolloid -Non aqueous elastomer Polysulphide Polyether Polysilicone - 9

10. Polyether Impression Material Material was introduced in Germany is 1960. This classified into two category : i ) Light activated polyether ii)Chemically activated polyether 10

11. Polyether Impression Material…. Composition: Supplied in a two-paste system Base paste: Polyether Polymer Colloidal Silica- Filler Glycol Ether/ Phthalate- Plasticizer Catalyst Paste: Sulphonic Acid Ester Glycol Ether/ Phthalate Colloidal Silica-Plasticizer 11

12. Polyether Impression Material…. Setting Reaction: 12

13. Polyether Impression Materials…. Properties : Biological property: Non toxic, non poisonous but irritate. Cause hypersensitivity to some patient. Can cause contact dermatitis. Consistency: Light, Medium And Heavy Bodies Mixing Time: 45seconds To 1minute 13

14. Polyether Impression Material…. Working Time : 3 Minutes . Setting Time:6 Minutes Tear strength:1800-4800(N/m) Percentage contraction(at24 hr):0.19-0.24. Contact angle between set material and water(°):49 Hydogen gas evolution(Y/N):N 14

15. Polyether Impression Material…. Multiple cast(Y/N): Y Stiffness:1 Cost per unit volume (1 indicate most costly material): 1 Dimensional stability :Good dimensional stability . Brands : Impregum F(3M/ESPE). Permadyne (3M/ESPE). Polyjel NF(Caulk). 15

16. Polyether Impression Material…. Advantages : Naturally hydrophillic Accurate and high dimensional stability Good elastic recovery Low setting contraction Excellent surface detail reproduction Fast setting. Shelf life is 2 yr. Disadvantages: 1 . Rather stiff when set material (difficult to remove from mouth) 2. Very expensive. 3. May cause allergic reaction due to the sulphonic acid ester 16

17. Uses : Preparation of crown and bridges. Cavity preparation for inlays and onlays . Construction of partial and complete denture. 17

18. Allergy And Hypersensitivity Hypersensitivity is abnormal reaction that occurs when the body is exposed to a foreign material. Develops only in person whose immune system recognise the material as foreign. Allergic reaction can manifest as a localised reaction in tissues which is directly in contact with material. Systemic manifestation are skin eruption, itching, sneezing, erythema , breathing difficulties. 18

19. Allergy And Hypersensitivity… Te 19

20. Main Article Clinical report Discussion Conclusion 20

21. Dental restorative and impression materials have been known to elicit hypersensitivity reactions. Clinical features include: Burning Mouth Severe Pain Dryness Of Mucosa Non Specific Stomatitis And Cheilitis First allergy with polyether impression material was describe in 1970. 21

22. Catalyst paste contain methyl dichlorobenzene sulfonate in older version causes allergy so that was replaced by sulfonium salt to reduce allergic reaction. Patch test was perform to identify allergen substance. More adequate for type IV hypersensitivity reaction then type II hypersensitivity reaction. 22

23. Clinical Report A 74 year old female sough care at the Department Of Prosthodontics Of the Ludwig- Maximilians University ,Munich, Germany. Rehabilitation of left mandible after medication related osteonecrosis of jaw. The patient’s anamnesis demonstrated allergic hypersensitivity to patches and Novocain. Patient reported painful redness and swelling of the face and upper body skin area a few hours after the intake of novocain . Perviously patient had undergone breast cancer therapy for 18 years . 23

24. Clinical Report… Patient had history of missing teeth i.e.43, 44,45,46,47 24 At the time of dental treatment patient was on bisphosphonate therapy.

25. Clinical Report… So oral surgeon refuses to place implant. Prosthetic rehabilitation using a parallel milled telescopic denture was planned . The dental impression was made with a polyether impression material ( Impregum Penta ; 3M). After 24 hours later patient reported with pain and swelling on lips and tongue and redness and white spots of mandibular mucosa . Patient refuses to take antibiotics and antihistamine . 25

26. Clinical Report… Medication given is pain relief-ibuprofen 600mg and antibacterial mouth rinse- chlorhexamed forte 0.2%solution,,nonalcoholic. After 10 days complete resolution of intraoral mucosa was observed. Silicone based material was used for impression without any signs of allergy or hypersensitivity . 26

27. Discussion Patch testing is commonly performed to verify reactions to dental substances. A major factor may have been that the sulfonium salt used as a catalyst and the polyether macro-monomer pre-polymer were not tested. Symptoms appeared 1hr after the treatment. Patch testing is not the best method of verifying Type 1 reactions. 27

28. Discussion… Clinicians must know how to identify allergies to polyether Select alternative impression materials such as polyvinyl siloxane in hypersensitive patients. Allergic reaction may have been in response to the catalyst, a sulfonium salt, present in the polyether impression material. 28

29. Conclusions Selection of an appropriate impression material with minimal allergic potential is essential for treatment success. It is important to identify and describe specific symptoms accurately with clinical images. 29

30. Critical Analysis Author didn’t describe any relation of cancer therapy with polyether impression materials. There is no valid reason that why patient refuse to take antibiotics and antihistamine. For checking type 1 hypersensitivity reactions test is not specified. 30

31. Review of literature 31

32. Allergic contact stomatitis caused by a polyether dental impression material:J . M. Batchelor and P. M. Todd: Contact Dermatitis 2010: 63: 296–297 Case of allergic contact stomatitis caused by a dental impression material is described. Impregum Penta is a dental impression material based on polyether. Late 1980s there were case reports ofadverse reactions, including mucosal swelling and ulceration Delayed hypersensitivity reactions in guinea pig had been seen due to the catalyst, methyldichlorobenzene sulfonate . 32

33. The catalyst in Impregum was changed in the late 1980s to the sulfonium salt (2-cyano-1-methylethyl] dodecylethylsulpfoniumtetrafluoroborate (1-) , and there have been no subsequent reports of adverse reactions to the material. No other reports of reactions to this new catalyst. 33

34. Prosthodontic treatment of a patient with bisphosphonate -induced osteonecrosis of the jaw using a removable dental prosthesis with a heat-polymerized resilient liner: A clinical report Matthias Göllner , DMD,a Stefan Holst , DMD, PhD,b Matthias Fenner , MD, DMD,c and Johannes Schmitt, DMDd University Clinic Erlangen, Erlangen, Germany. complications. (J Prosthet Dent 2010;103:196-201) Bisphosphonate -induced osteonecrosis of the jaws (BONJ) is reported frequently in patients receiving oral or intravenous bisphosphonates . Dental treatment must be performed with care 34

35. The recurrent incidence of BONJ, noninvasive prosthetic therapy with telescopic overdentures and a heat-polymerized resilient liner was provided. After 2 years, there were no biological or technical complications. 35 Clinical presentation before surgical intervention. Note swelling of mucosa on right buccal vestibule and 2 ulcerated lesions (white arrows) at alveolar mucosa Panoramic radiograph before surgical intervention.

36. 36 Panoramic radiograph after extraction of mandibular incisors and resection of infected necrotic bone. Clinical situation before prosthodontic treatment

37. 37 Removable dental prosthesis with laboratory-processed resilient liner after fabrication. Note interface line (white arrow) between resilient liner and acrylic resin base. Mandibular view of residual ridge and cemented telescopic crowns.

38. In the present situation, a patient with a history of recurrent BONJ was treated with a removable dental prosthesis with a base that had a heat-processed resilient liner and rigid attachment elements 38 Clinical situation after incorporation of dental prosthesis.

39. A rare allergy to a polyether dental impression material Pauline Mittermüller & Rolf-Markus Szeimies & Michael Landthaler & Gottfried Schmalz : Clin Oral Invest (2012) 16:1111–1116 Patients have started to report symptoms that suggest a new allergic reaction from polyether impression materials. Eight patients with clinical symptoms of a contact allergy (swelling, redness or blisters) after exposure to a polyether. Impression material were subjected to patch tests, two of them additionally to a prick test. 39

40. The prick tests showed no immediate reactions in the two patients tested. In the patch tests, all eight patients showed positive reactions to the mixed polyether impression materials. The patient with the atypical clinical symptoms did not show any positive patch test reactions. Polyether impression materials may evoke type IV allergic reactions. Clin Oral Invest (2012) 16:1111–1116 40

41. Allergic Reactions to Dental Materials-A Systematic Review: Meena Syed1 , Radhika Chopra2, VinodSachdev3: Journal of Clinical and Diagnostic Research. 2015 Oct, Vol-9(10): ZE04-ZE09 This review aims to develop a systematic approach for the selection and monitoring of dental materials available in the market thereby giving an insight to predict their risk of inducing allergic reactions. A single allergic case reported in which a patient developed hypersensitivity reaction to polysulfide material in the form of redness, itching and oedema . Secondary impression for upper and lower complete dentures and on treatment with topical corticosteroids ( Betamethasone valerate ointment 0.1%) she recovered . 41

42. Over the last few years, due to the rise in number of patients with allergies from different materials, the practicing dentists should have knowledge about documented allergies to known materials and thus avoid such allergic manifestations in the dental clinic. 42

43. Reference Craig’s Restorative Dental Materials –John M.Power.RonaldL.Sakaguchi-12 th Edition-Elsevier. Science of Dental Materials Clinical applications-V Shama.BT Nandish-2 nd edition-CBC publishers and distributors. Glossary of Prosthodontics Terms-9 th edition. Textbook of Pathology :Harsh Mohan :4 th edition : jaypee brothers. Allergic Reactions to Dental Materials A Systematic Review: Meena Syed1 , Radhika Chopra2, VinodSachdev3: Journal of Clinical and Diagnostic Research. 2015 Oct, Vol-9(10): ZE04-ZE09 43

44. Reference… Allergic contact stomatitis caused by a polyether dental impression material:J . M. Batchelor and P. M. Todd: Contact Dermatitis 2010: 63: 296–297. Clinical characteristics of an allergic reaction to a polyether dental impression material:Caroline Freitas Rafael and Anja Liebermann :J Prosthet Dent :April 2017:117(4):470-472 A rare allergy to a polyether dental impression material Pauline Mittermüller & Rolf-Markus Szeimies & Michael Landthaler & Gottfried Schmalz:Clin Oral Invest (2012) 16:1111–1116. 44

45. Reference… Prosthodontic treatment of a patient with bisphosphonate -induced osteonecrosis of the jaw using a removable dental prosthesis with a heat-polymerized resilient liner: A clinical report Matthias Göllner , DMD,a Stefan Holst , DMD, PhD,b Matthias Fenner , MD, DMD,c and Johannes Schmitt, DMDd University Clinic Erlangen, Erlangen, Germany. complications. (J Prosthet Dent 2010;103:196-201) 45

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