The patients social history is insignificant, with no smoking or alcohol consumption. Int J Implant Dent. How do you test for titanium allergy? M. Goutam, C. Giriyapura, S. K. Mishra, and S. Gupta, Titanium allergy: a literature review, Indian Journal of Dermatology, vol. Dana Jeske, a mechanical engineer living near Seattle, experienced intermittent paralysis for five years, before regaining his ability to walk and move his b "Metal hypersensitivity testing should be offered to patients before surgery to minimize the risk of implant failure", concluded this study from Charles University, Prague; "especially those with autoimmune diseases, asthma, and/or allergies." However, IFN-gamma responses towards chromium chloride were significantly correlated with the strength of patch test reactivity (r=0.49, P=0.002). C. Shi, Y. Xi, B. The authors conclude: Standardizing allergy tests as part of the pre-operation checklist can prove to be an inexpensive way to eliminate such post-surgical complications. However, there is no consensus for the utility of the test with critics arguing the test is overly sensitivity (5,6,7). After the diagnosis of RFB, the preferred approach is to remove the RFB laparoscopically [13]. These reactions are T cell dependent and patch testing would be the preferred method if we had reagents for each metal and if all of the metals penetrated the epithelium equally. The patient initially had intermittent RLQ abdominal pain accompanied by nonspecific symptoms. In summary, the lymphocyte transformation test itself is a validated test for delayed hypersensitivity. This requires immediate attention and an X-ray for further investigation. In vitro testing with metal ions in solution mixed with lymphocytes from affected subjects has been suggested as means to overcome the reduced reactivity of specific metals or the reduced penetration of the metal through the keratin layer of the skin. Review our cookies information for more details. Furthermore, there are few op Two weeks after gallbladder surgery, a 53-year-old man experienced constant abdominal pain in addition to nausea. YYYY Colgate-Palmolive Company. 1, pp. WebMELISA is a blood test to aid the diagnosis of metal hypersensitivity. So how can I recognize if I have a dental implant allergy? Toxicology in vitro 8.5 (1994): 991-1000. In the past decade Dr Schroeder has removed over 1,000 implants in over 400 patients. If metal allergy is consistent- (beware false positive results) remove all metall in mouth. Ask The Expert Archive Main Page When exposed to oxygen, titanium oxidizes and In most irritant reactions, intensity usually wanes between the time of patch removal and the final reading. Orthopedic implants heal well without complications in most patients but fail for unclear reasons in some individuals. The test you referred to is not actually a serum test, but a whole blood test which measures lymphocyte reactivity upon exposure to metal. 1. The patients completed a special questionnaire aimed at information regarding change of health status from their last visit and determining whether the results of the initial MELISA test and recommendations based on it were beneficial for patients or not. By using casted abutments the problem might can be evitated. Eleven months prior, the patient had undergone cholecystectomy due to acute cholecystitis complicated by a liver abscess. iii. Ten healthy age-matched women were used as controls for in vitro studies. Arakelyan M, Spagnuolo G, Iaculli F, Dikopova N, Antoshin A, Timashev P, Turkina A. I emphasize that this testing is not FDA approved. 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. 13, no. Unauthorized use of these marks is strictly prohibited. See this image and copyright information in PMC. 2008 Sep;38(9):1468-75. doi: 10.1111/j.1365-2222.2008.02970.x. From these patients, a final group of 42 patients agreed to participate in the study, 35 of which were female and 7 were male. ix. coating disolves over the years. 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. 2020;276, article 102083 doi: 10.1016/j.cis.2019.102083. Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [3]. Dr. Jacqueline A. Pongracic, FAAAAI. Any suggestions on the root cause? Documented titanium allergy is very rare, if other metals are test positive then titanium would be an alternative; About 6-8 months ago began with eczematoid/psoriatic rash most prominent over left knee (not present over right knee). By IFN-gamma ELISpot, the average precursor cell frequency reactive to trivalent chromium could be defined as 26, 15, and 11 : 10(6) in volunteers with sensitization and allergy, with sensitization without allergy, and controls, respectively. "Metal allergy and systemic contact dermatitis: an overview." 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. v. Positive in vitro test to metals I have developed skin burning over my neck chest severe. "A retrospective study on titanium sensitivity: Patch test materials and manifestations." The patient initially presented to the clinic with an intermittent right upper quadrant (RUQ) pain in 2016. Toxics. Contact dermatitis 79.2 (2018): 85-90. 3. 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. 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. Beware the cosmetics and sun blocker you use !!!!! Have 79 year-old man with left knee replacement two years ago. If a non-metal option is a consideration, then I would recommend if multiple patch tests are positive. Preoperative testing may identify preexisting sensitivity but does not predict likelihood of joint failure and may help with selection of type of implant; 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. The most commonly used test to diagnose a metal allergy is skin patch testing. W. S. Towers and K. Kurtom, Rare systemic response to titanium spinal fusion implant: case report, Cureus, vol. 2. Frigerio E, Pigatto PD, Guzzi G, Altomare G. 40% of patients with failing implants had hypersensitivity reactions to a metal present in their implant. All but one clip was removed and the patient reported resolution of most symptoms within one week of surgery. MELISA Test MELISA test, validated by an independent laboratory [ 43 ], was used in this study for assessment of metal hypersensitivity reactions. True positive responses tend to persist for 7-10 days, false positives do not. 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 A LTT metal allergy test showed a mild reactivity to nickel and titanium. Zirkonia crowns or bridge, and be cemented. The patient did not report any screening for immunodeficiency in the past. Disclaimer. Suspect he will need joint revision but concerned about angry back syndrome with so many positives - orthopod may have great difficulty choosing a new joint. Epub 2008 Mar 31. 7. These artificial substitutes for tooth roots are either screw, cylinder, or blade-like in form. Correction on the last thread last word should read capsules, not injections. Retained foreign bodies (RFB) are also possible complications of any surgical procedure. All Rights Reserved. Have you seen an allergist to confirm you are allergic? Moreover, the patient was under multiple specialists care and had many hospitalizations and a history of various medication intake, including antibiotics and painkillers. 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. b. in vitro testing is only available for a limited number of metals; Orthopedic Analysis All but one clip was removed and the patient reported resolution of most symptoms within one week of surgery. Once you heal from the implant surgery, a crown is attached to the part of the implant that protrudes through the gumline. The criteria are a bit confusing as the recommendation is not to use the in vitro test but a minor criteria is a positive in vitro test. This test is also available in the US. 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). Results: Sensitized individuals with an allergy displayed significantly higher lymphocyte transformation test (LTT) responses than sensitized volunteers without allergy and controls (P<0.05 and P<0.01, respectively). Chapter 8, Medical devices, implants and equipment. A 72- and 96-hour reading is provided. She reported extensive health issues such as skin rash, hair loss, memory loss, difficulty concentrating, severe shortness of breath, hot and cold flashes, metallic taste in the mouth, abdominal bloating, joint and body aches, muscle pain and tightness, insomnia and more. If the patches were removed and read at 72 hours, the response was most likely an irritant reaction These can range from simple skin rashes to muscle pain and fatigue. 2011 May;64(5):273-9. doi: 10.1111/j.1600-0536.2011.01886.x. Our profession has 0ver 30 years experience with titanium. By postoperative day 6, the patients symptoms of abdominal distension resolved and her RLQ pain also diminished. It's simple, cheap, and reliable. The patient has been recommended to do a close follow-up for a few months to monitor her progress. MELISA also discovered he was HIGHLY allergic to palladium; the 2 white gold crowns in his mouth contained 26% palladium! The patient also started having low-grade fever, nausea, vomiting, joint pain, diffuse rash, and fatigue. If you have history of metal allergy it may be recommended to have a MELISA test before you get an implant. However, this test has been criticized as generating false positives, and my guess would be that titanium allergy is less prevalent than that. Journal of Biomedical Materials Research PART A. Goolge Titanium allergy test and I'm sure you will find it. Histology consistent with eczema THA subjects with moderate vs mild osteolysis (Group 3b vs 3a) were more reactive to Co (43% vs 0% incidence). Parallel to this, in vitro hyperreactivity to titanium disappeared. The pain was sharp and stabbing in nature and radiated from the umbilicus, and the patient rated the pain 10/10 on a scale, causing her significant discomfort. 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; In this study, blood from 250 patients with clinical symptoms of type IV hypersensitivity to metal were tested with MELISA against up to 20 metals in 23 concentrations. 6. de Graaf, Niels PJ, et al. Stainless steel: chromium, manganese, molybdenum, nickel, tungsten I also think this form of dentistry s/b considered and covered as MEDICAL. aseptic osteolysis. WebMELISA test for the minimization or complete elimination of health problems in patients with conrmed hypersensitiv-ity to metals. The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. Minor WebTitanium allergy and lymphocyte transformation test 2/12/2021 Have new referral 62 year-old female smoker with focal seizure in 2017 - evaluation showed brain tumor See MoreSee Less, Share on FacebookShare on TwitterShare on Linked InShare by Email, Another incredible case report of a woman with 18 surgical clips in her neck. Trouble is in the United States there are NO approved dental materials (metals and other) patch tests and most allergists will not help you w/o that. 2014;293:3745. New comments are currently closed for this post. Titanium has also been reported as an allergen in a few studies, causing type I or type IV hypersensitivity reactions [3]. Hypersensitivity to titanium: clinical and laboratory evidence. I hope this information is of help to you and your practice. HIGHLIGHTS SUMMARY Intolerance reaction to pure titanium implants (grade 4) is more likely a pro-inflammatory reactivity of tissue macrophages in contact with titanium oxide particles disseminated into the peri-implant tissue by tribocorrosion rather than a systemic allergic reaction. Patch testing gave no reactions to titanium nor to nickel, chromium, or cobalt. Metal allergies and MELISA testing were featured in the podcast Jump in Detox! created by Nicolas Mayaud N.D., a heavy metal detox expert in Switzerland. "A possible metal allergy could be considered when a patient presents with nonspecific, possibly life-threatening complications, as seen with the patient in this case report." Most likely the allergy to the other metals in the alloy. Exposition doesn`t come over night- but gradualy. Although contact allergic reactions to titanium have been very rarely reported, these findings support a diagnosis of titanium allergy in our patient. WebMELISA reactivity is directly dependent on lymphocyte concentration: the higher the lymphocyte concentration per test, the stronger the reactivity. Fonacier L, Bernstein D, Pacheco K et al. WebMELISA is a blood test to aid the diagnosis of metal hypersensitivity. a. viable lymphocytes are required therefore logistical issues of shipping often complicate testing; If medical or dental professionals suspect that you might be allergic to the titanium in your dental implant, the first step is to take diagnostic tests, such as a patch test. Three months after surgery, in which 8 small stainless steel screws were placed in Jeske's, feet he started developing periodic episodes, where his body would go completely rigid. The clips were made of nickel and titanium, and a metal sensitivity test confirmed that he was sensitive to nickel. i. Even low grade allergies are causing significant symptoms. Mediators of Inflammation. I would emphasize that the in vitro testing is an option but currently not recommended. 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 426431, 2018. 4, pp. 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? 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. 62, no. Proprietary process produces the highest quality allograft tissues. 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). I would have a few questions about this case Klinik und Poliklinik fr Dermatologie und Allergologie der Ludwig-Maximilians-Universitt, I'm with Aaron. Neuro Endocrinol Lett. I have copied the question and our response below. In addition to metal allergies, retained foreign surgical bodies are a potential postoperative complication. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Jurczak P., Witkowska J., Rodziewicz-Motowido S., Lach S. Proteins, peptides and peptidomimetics as active agents in implant surface functionalization. Methods: Chromium-sensitized volunteers with and without clinically manifest allergy and non-sensitized healthy controls (n=37, 19, and 26, respectively) were analysed by cellular in vitro methods using tri- and hexavalent chromium (chromium chloride and potassium dichromate) as stimuli. 1, pp. Please let me know what my possibilities are. 2022 Jul 11;8(1):29. doi: 10.1186/s40729-022-00428-0. Reference: Is there any other material used as an alternate to titanium in the implant fixtures? An implant is a great replacement because it looks and feels like a real tooth. J Biomed Mater Res 2000: 53: 480489. 639644, 2020. This may be the situation you are facing. There is also no risk of allergic reactions, galvanic shock, or battery effects with ceramic like there is with metal implants. If LTT-MELISA testing is to be considered, test kits, locations of laboratories offering this test and other information is available at FAQs for US Customers - MELISA. Pernicious anemia (B 12 def) sneaks up on people very slowly. 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. 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 She reported extensive health issues such as skin rash, hair loss, memory loss, difficulty concentrating, severe shortness of breath, hot and cold flashes, metallic taste in the mouth, abdominal bloating, joint and body aches, muscle pain and tightness, insomnia and more. 2013, no. 4. vii. WebThe patch test is considered the reference method for diagnosing contact allergy, but its use in detecting hypersensitivity to implant materials is controversial. Advances in Colloid and Interface Science. Professor Vera Stejskal is the inventor of the MELISA test. A positive to 14 metals is very unusual. iii. Simply cut, peel, & apply to protect wounds, & more! This might be therefore be a solution for about 10 years oral function. Unable to load your collection due to an error, Unable to load your delegates due to an error. As with all tests, there are false-positives and false-negatives, and the diagnosis of contact allergy remains a clinical diagnosis in which tests are used to add additional evidence of its existence to a specific agent. Your question was shared with Dr. Luz Fonacier, chief of allergy/immunology at Winthrop University and chair of the work group that produced the practice parameter on contact dermatitis (1). Also, each product contains different ingredients and alloyes almost always contain some nickel or other allergent. The German S3 guideline on titanium hypersensitivity in implant dentistry: consensus statements and recommendations. 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. Would lymphocyte transformation testing help me determine more accurate picture of his metal contact allergy and help orthopod choose appropriate joint for revision? 1, pp. Suspecting systemic contact dermatitis to metal buttons and I have been asked to evaluate. "Titanium allergy is barely recognized in mainstream medicine - yet laboratories using the MELISA technology have reported that about 4% of all patients tested to titanium will be allergic to it (Valentine-Thon E., et al. J Allergy Clin Immunol Pract 2015;3:S1-S39. But the good news is that there are other options available to you. Conclusions: In contrast to the patch test, the LTT appears to be a method that is predictive of chromium allergy. Answer: Thanks. No buccal sulcus after closure of OAC: advice. Carol: keep an eye on the situation and as you already have consult with your physician. Effect of blood component coatings of enosseal implants on proliferation and synthetic activity of human osteoblasts and cytokine production of peripheral blood mononuclear cells. His case is described in the YouTube video by Dr Scott Schroeder. I realize that the data is limited but at least one reference indicates possible value for these modalities. This resulted in approximately 75lbs. Have you seen a rheumatologist? Good Luck! 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. Dermatology research and practice 2012 (2012). Transpiration sweat is very aggressive and can induce allergic response to materials we never had problem with. Titanium is another type of metal that is utilized extensively in cardiac pacemakers, dental procedures, arthroplasty, body piercing, and spectacle frames [2]. The most likely adverse effect of an allergy to an orthopedic implant is dermatitis, often at the site of the implant but can become generalized and affect the hands; M. Tu and Y. Wu, Multiple allergies to metal alloys, Dermatologica Sinica, vol. She reported a complete resolution of all symptoms one-month postsurgery. 5. This patient is concurrently found to have a retained pigtail catheter in the cecum discovered incidentally through radiology. The CT scan showing a portion of the pigtail catheter lodged within the cecum in a coronal view (a), sagittal view (b), and axial view (c). Validity of MELISA for metal sensitivity testing. Another helpful test is called the Memory Lymphocyte Immunostimulation Assay, or MELISA test. i. Six patients did not follow the recommendation, and from these, only one patient reported an improvement in his health problems. Just wondering. The use of low-dose naltrexone (LDN) is also discussed. All rights reserved. Trying to find LTT for titanium but cannot find - is LTT available anywhere in US for metals? LTT is another more sensitive test than FOIA I am skeptical that the in vitro testing would facilitate a better alloy than titanium. M. Little, P. C. Munipalle, and O. Nugud, A rare late complication of laparoscopic cholecystectomy, Case Reports, vol. 8487, 2019. If one of your teeth is damaged, youre probably excited to learn that you can replace it with a dental implant. We report on a patient in whom impaired fracture healing and eczema localized to the perioperative area developed upon titanium-based osteosynthesis. I live with constant pain and stiffness that changes by the minute and radiates through my pelvis and legs. iii. By continuing to browse this site, you are agreeing to our use of cookies. Treasure Island (FL): StatPearls Publishing; 2022 Jan. i. Dermatitis overlying the implant 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. Moreover, all her aforementioned symptoms were alleviated once the metal surgical clips were removed surgically. Was the patch test removed at 48 hours and what was the reading at that time? This is why we are seeing long term immune assaults on people with titanium implants and/or replacement surgeries. This can take several months. WebThe MELISA test a scientifically-proven test which can objectively test for the presence of titanium hypersensitivity and measure its severity. Fage, Simon W., et al. With her history of allergy to other metals in the past, a titanium allergy was suspected at this visit, and the patient promptly underwent a titanium skin patch test that turned out positive. Metal sensitivity in patients with orthopaedic implants: a prospective study. Sarah, a potential dental implant patient, asks:I am allergic to titanium. 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. An official website of the United States government. WebMELISA ( Memory Lymphocyte Immunostimulation Assay) is a blood test that detects type IV hypersensitivity to metals, chemicals, environmental toxins and molds. Federal government websites often end in .gov or .mil. To confirm, the patient was further ordered for memory lymphocyte immunostimulation assay (MELISA) that also showed equivocal results for titanium allergy. Accessibility Contact Dermatitis 2005; 53:1. Metal allergies are becoming more recognized within the surgical field. 4/25/2017: Lymphocyte Transformation testing and Metal ion testing Showed many positives at 72 and 96 hours including 14 metals and methacrylate glue. 26 Its usefulness may be improved if patients are tested with chemicals relevant to their problem. How lymphocyte-mediated metal sensitivity affects orthopaedic implant performance remains poorly understood. say. This can be seen on the fact that bone attachment is usualy tighter and faster with pure ti-implants then in Ti-alloy-implants. She had to be hospitalized with strict isolation to wait for her medication regimen to work along with the infusion of IV fluids. On November 5, 2020, the embedded right colon foreign body was identified with fluoroscopic guidance (Figures 3(a) and 3(b)) and removed surgically (Figure 4). Within a few days, she started having vomiting, bloating, weakness, fatigue, and intense RLQ abdominal pain. Its possible to detect a titanium hypersensitivity ahead of time with a MELISA test. The pigtail catheter in the cecum was removed carefully, and the foreign body was measured 10.0cm in length and 0.3cm in diameter. The International Journal of Implant Dentistry notes that due to implants' corrosion and wear, titanium alloy particles can get deposited in the surrounding tissues. 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. After removal of the titanium material, fracture healing was achieved and the eczema cleared. WebTitanium, Whole Blood TEST: 792620 CPT: 83018 Print Share Include LOINC in print Expected Turnaround Time 3 - 7 days Turnaround time is defined as the usual number of Since Dr Schroeder had been studying metal allergies for years he sent Jeskes blood for MELISA testing for metal allergies. 59, no. 3, no. 2022 May 18. of weight loss in only four months of duration. These stages include removing the damaged tooth, bone grafting (if needed), dental implant placement, abutment placement, and the placement of your artificial tooth (crown). The use of low-dose naltrexone (LDN) is also discussed. The researchers forecast that by 2030, more than 11, 000 people a day will have implant surgeries in the U.S. alone. I have attached some archived Ask the Expert questions about metal allergy. 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. apr18 1, article bcr2013009070, 2013. Many will have seen the devastating news that singer Celine Dion has been diagnosed with Stiff Person Syndrome. During the cholecystectomy, six titanium surgical clips were placed in the RUQ. 6. The additional challenge is that the only option, to my knowledge, would be to surgically remove the implanted metal with the associated risks inherent in this surgery. 1. The site is secure. zirconia has never osseointegrated to bone as titanium or titanium alloys can do. Alas, such is not the case. Yoshihisa, Yoko, and Tadamichi Shimizu. The Mayo Clinic had diagnosed him with Stiff Person Syndrome. 7, no. The symptoms were so severe that they interfered with the mans lifestyle. Schalock PC, Menn T, Johansen JD et al. Therapy resistant dermatitis 145162, 2008. The dr confirms thru xray that it is in properly. Vaelentin-Thon E, Mller K, Guzzi G et al. I had a hip replaced with titanium. His case is described in the YouTube video by Dr Scott Schroeder. With a vit B 12 deficiency, you need to eat beef liver or receive the B 12 injections. This has been confirmed by my health care giver. The criteria for postimplant metal hypersensitivity are: Mller-Heupt LK, Schiegnitz E, Kaya S, Jacobi-Gresser E, Kmmerer PW, Al-Nawas B. Int J Implant Dent. Some symptoms include chronic dermatitis and other reactions depending on the specific organ involved [10]. 3. Carol: This sounds more like a vitamin B 12 deficiency, but see what your Drs. 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. Among different RFB, sponges are one of the most common retained foreign bodies in the abdomen, pelvis, and retroperitoneal cavities [13]. 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 Lymphocyte proliferation, using Lymphocyte Transformation Testing (LTT), and cytokine release provided quantitative reactivity measurement, where a stimulation index of >2 indicated metal sensitivity. The patients past surgical history includes a tonsillectomy, an appendectomy, and cholecystectomy.