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Is aseptic bone necrosis a cause for early implant failure in patients with metal allergies? – A case report and literature review

Given the widespread use of titanium and its alloys in dental implantology, implant failures will most likely arise and there will still remain gray areas with regard to the biology and physiology of the interaction of dental implant alloys and the host. Medical literature is abundant with reports of aseptic prosthetic loosening following arthroplasty that may be attributed to many reasons, yet the most important factor appears to be the periprosthetic osteolysis due to unbalanced homeostasis of bone formation and resorption. Although it was previously believed to be a simple mechanical complication resulting from the instability of the implant, it is now widely accepted that particulate implant debris induces local inflammation and osteolysis. The purpose of the current study is to report the atypical and unexpected early implant loss of a titanium implant in an otherwise healthy 60-year-old patient with a previously undiagnosed nickel, palladium, and cobalt allergy. After verification by Melisa test the patient was successfully treated with a ceramic implant. A literature review was performed, which demonstrated that there is abundant scientific evidence that suggests an established correlation between the different metal alloys and peri implant aseptic bone loosening leading to failure of implant osseointegration.