Patch test reactivity to a cobalt?chromium?molybdenum alloy and stainless steel in metal-allergic patients in correlation to the metal ion release

A comprehensive summary of disease variants implicated in metal allergy

Allergic disease represents one of the most prominent global public health crises of the 21^st century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described.Abbreviations: ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.

Toxicity assessment and health hazard classification of stainless steels

Stainless steels are widely used iron-based alloys that contain chromium and, typically, other alloying elements. The chromium(III)-rich surface oxide of stainless steels efficiently limits the release (bioaccessibility) of their metal constituents in most physiological environments, influencing the toxicity of the alloy. Of the constituents and impurities of stainless steels, nickel and cobalt are of particular interest, primarily due to skin sensitization and repeated-dose inhalation toxicity of nickel, and (inhalation) carcinogenicity of cobalt. A review of the available toxicological data on stainless steels, and the toxicological, mechanistic, and bioaccessibility data on their constituent metals supports the low toxicity and non-carcinogenicity of stainless steels. The comparative metal release, rather than the bulk composition of stainless steels, needs to be considered when assessing their health hazard classification according to the UN Globally Harmonized System, and the corresponding EU CLP regulation. As an illustrative example, a 28-day inhalation toxicity study on stainless steel powder showed no signs of lung toxicity at exposure levels at which significant toxicity would have been expected on the basis of its bulk nickel content. This finding is associated with the low bioaccessibility of nickel from the alloy in the lungs.

Corrosion behavior of high nitrogen nickel-free austenitic stainless steel in the presence of artificial saliva and Streptococcus mutans

High nitrogen nickel-free austenitic stainless steels (HNSs) have great potentials to be used in dentistry owing to its exceptional mechanical properties, high corrosion resistance, and biocompatibility. In this study, HNSs with nitrogen of 0.88 wt% and 1.08 wt% displayed much lower maximum pit depths than 316L stainless steel (SS) after 21 d of immersion in abiotic artificial saliva (2.2 μm and 1.7 μm vs. 4.5 μm). Microbiologically influenced corrosion (MIC) evaluations revealed that Streptococcus mutans biofilms led to much severer corrosion of 316L SS than HNSs. Corrosion current densities of HNSs were two orders of magnitude lower than that of 316L SS after incubation of 7 d (37.5 nA/cm² and 29.9 nA/cm² vs. 5.63 μA/cm²). The pitting potentials of HNSs were at least 550 mV higher than that of 316L SS in the presence of S. mutans, confirming the better MIC resistance of HNSs. Cytotoxicity assay confirmed that HNSs were not toxic to MC3T3-E1 cells and allowed better sessile cell growth on them than on 316L SS. It can be concluded that HNSs are more suitable dental materials than the conventional 316L SS.

Metals and Metalloids Release from Orthodontic Elastomeric and Stainless Steel Ligatures: In Vitro Risk Assessment of Human Exposure

Elastomeric ligatures are increasingly used as a part of esthetic orthodontic treatment, particularly in children. The aim of the present study was to experimentally test whether these appliances may contribute to exposure to toxic elements. In the present study, elastomeric ligatures (ELs) were incubated in artificial human saliva for 1 month (a typical period of their use) and the release of 21 metals (Ba, Cd, Co, Cr, Cu, Fe, Li, Mn, Mg, Mo, Ni, Pb, Rb, Tl, Ti, Sb, Sr, Sn, Zn, U, V) and 2 metalloids (As and Ge) was studied using inductively coupled plasma-mass spectrometry. For comparison, stainless steel ligatures (SLs) were incubated for 1, 3, and 6 months (since sometimes their use is prolonged) under similar conditions. The determined metal levels were compared to the corresponding safety limits for human exposure. During 1 month, the ELs released Cd, Co, Cr, Mn, Ni, and Sn at total mean ± SD level of 0.31 ± 0.09, 0.98 ± 0.30, 3.96 ± 1.31, 14.7 ± 8.5, 13.8 ± 4.8, and 49.5 ± 27.7 μg, respectively. Other elements were always below the detection limits. In case of SL, the release of Co, Cr, Fe, Ni, Mn, and Sn was observed, and the determined values increased over the studied period. After 6 months, their total mean ± SD levels amounted to 28.6 ± 0.2, 21.7 ± 0.2, 623.5 ± 3.0, 1152.7 ± 1.8, 5.5 ± 0.3, and 22.6 ± 0.2 μg, respectively. The released metal levels from both ligature types were always below safety limits. The release of Ni from SL during 6 months would constitute 5.0 and 11.5% of tolerable intake in adults and children, respectively. The results of this in vitro study highlight that the use of ligatures in orthodontic treatment can be considered safe in terms of metal exposure although elastic ligatures replaced on a monthly basis appear to be advantageous in comparison to the prolonged use of stainless steel appliances.

Evaluation of Heat-Treated AISI 316 Stainless Steel in Solar Furnaces to Be Used as Possible Implant Material

The appropriate selection of implant materials is very important for the long-term success of the implants. A modified composition of AISI 316 stainless steel was treated using solar energy in a vertical axis solar furnace and it was subjected to a hyper-hardening treatment at a 1050 °C austenitizing temperature with a rapid cooling in cold water followed by three variants of tempering (150, 250, and 350 °C). After the heat treatment, the samples were analyzed in terms of hardness, microstructure (performed by scanning electron microscopy), and corrosion resistance. The electrochemical measurements were performed by potentiodynamic and electrochemical impedance spectroscopy in liquids that simulate biological fluids (NaCl 0.9% and Ringer’s solution). Different corrosion behaviors according to the heat treatment type have been observed and a passivation layer has formed on some of the heat-treated samples. The samples, heat-treated by immersion quenching, exhibit a significantly improved pitting corrosion resistance. The subsequent heat treatments, like tempering at 350 °C after quenching, also promote low corrosion rates. The heat treatments performed using solar energy applied on stainless steel can lead to good corrosion behavior and can be recommended as unconventional thermal processing of biocompatible materials.

Utility of Patch Testing and Lymphocyte Transformation Testing in the Evaluation of Metal Allergy in Patients with Orthopedic Implants

Total joint arthroplasties are increasingly common orthopedic procedures performed throughout the United States. Implant failure after these procedures occurs due to a number of causes such as infection or mechanical problems, with metal hypersensitivity being an area of growing interest. The nature and mechanism of a causative relationship between metal hypersensitivity and implant failure have been unclear as it is not known whether implant failure occurs due to a previous metal allergy or metal allergy results from secondary sensitization via metal exposure in existing failing implants. Overall, there appears to be growing support and evidence for metal-hypersensitive patients having worse outcomes with regard to total hip and knee arthroplasties. However, there are conflicting recommendations (outside of Nuss procedures) for pre-implant testing for metal hypersensitivity as testing has not consistently been shown to change patient outcomes.

Corrosion performance of cold deformed austenitic stainless steels for biomedical applications

Austenitic stainless steels possess an excellent balance of strength and ductility along with the high ability to further raise their strength during cold deformation (CD). Corrosion resistance of austenitic stainless steels (SSs) is affected by cold deformation because passive films on the surface of steels are expected to be modified. A low level of CD enhances the surface diffusion, which results in the formation of a stable passive film leading to an increase in the corrosion resistance in neutral chloride solutions. The chromium content in the passive film on a deformed steel surface is usually richer, with a higher Cr/Fe ratio than that formed on annealed steels. A higher chromium content makes surface films more stable, which improves the corrosion resistance. However, severe CD results in the formation of strain-induced martensite phase and deformation twins, which decreases the localized corrosion resistance by increasing the number of active anodic sites on the surface. The corrosion resistance, especially the pitting resistance, in SSs is diminished with increasing volume fraction of the martensite. In this review, we highlighted the failure modes of corrosion of stainless steel implants, factors affecting corrosion, and effect of CD on mechanical properties and emphatically on the corrosion resistance of SSs for biomedical applications.

In vivo study on the release of nickel, chromium, and zinc in saliva and serum from patients treated with fixed orthodontic appliances

Background:

Fixed orthodontic appliances can release metal ions such as nickel, chromium, and zinc into saliva and blood, which can cause contact dermatitis, hypersensitivity, and cytotoxicity. This study was undertaken to assess the release of nickel, chromium, and zinc in saliva and serum of patients undergoing fixed orthodontic treatment.

Materials and Methods:

This in vivo study was conducted on 80 participants with an age range of 15–40 years. Thirty were included as controls and 50 participants were treated with fixed orthodontic appliances. Saliva and blood samples were collected at five different periods, before insertion of fixed orthodontic appliance and at 1 week, 3 months, 1 year, and 1.5 years after insertion of appliance, respectively. The metal ion content in the samples were analyzed by atomic absorption spectrophotometry. Mean levels of nickel, chromium, and zinc in saliva and serum were compared between groups using independent sample t-test and before and after results using paired t-test. P < 0.05 was considered as statistically significant.

Results:

At the end of 1.5 years, the mean salivary levels of nickel, chromium, and zinc in controls were 5.02 ppb, 1.27 ppb, and 10.24 ppb, respectively, as compared to 67 ppb, 30.8 ppb, and 164.7 ppb at the end of 1.5 years. This was statistically significant with P < 0.001. A significant increase in the metal ion levels were seen in participants with before and after insertion of appliance (P < 0.001).

Conclusion:

Orthodontic appliances do release considerable amounts of metal ions such as nickel, chromium, and zinc in saliva and serum. However, it was within permissible levels and did not reach toxic levels.

Making Sense of Metal Allergy and Hypersensitivity to Metallic Implants in Relation to Hand Surgery

All metals implanted into a biological system undergo some degree of corrosion depending upon its composition. The electrochemical process of corrosion produces free metal ions, which may activate the host's immune system through a variety of mechanisms. Whereas dermal metal hypersensitivity is common, affecting 10% to 15% of the population, the immune reaction from implanted metals is much less common (< 0.1%), but has been associated with metal allergy and hypersensitivity producing a multitude of patient symptoms. Superficial symptoms may be mild to severe forms of dermatitis, urticaria, pruritus, and vasculitis, whereas deep sequelae include metallosis-related pseudotumor, implant loosening, and joint stiffness. Currently, there are clinical tests to evaluate patients for metal hypersensitivity, but there is little agreement regarding the ideal timing and clinical situation prompting the work-up of a patient for a metal allergy or hypersensitivity. An understanding of the epidemiology, etiology, basic science, diagnostic testing, and treatment of patients with suspected metal allergy, as it pertains to the current literature, will aid orthopedic and plastic surgeons of all subspecialties in the management of patients requiring metallic implants.

Cobalt release and complications resulting from the use of dental prostheses

BACKGROUND

Cobalt release from dental prostheses has been shown to elicit allergic reactions in cobalt-allergic patients. It is therefore important to investigate whether these prostheses are possible sources of sensitization.

OBJECTIVES

To assess (i) cobalt release from dental prostheses and (ii) allergic reactions to components of dental prostheses, and (iii) to investigate the oral mucosa for inflammation 1-5 years after insertion of the prostheses.

METHOD

Clinical oral examination was conducted in 66 patients with 84 dental prostheses. Cobalt release from 84 functional (used) and 32 non-functional (new) prostheses was investigated with the cobalt spot test. Contact allergy was assessed by patch testing. Smear tests for Candida spp. were performed in patients showing signs of inflammation of the oral mucosa. The prostheses were assessed for biological and technical complications.

RESULTS

None of the functional prostheses released cobalt, whereas this was observed in 24 of 32 non-functional prostheses. None of the patients had contact allergy to cobalt. Of the 66 patients, 11 showed signs of inflammation of the oral mucosa, 2 had oral candidiasis, 16 had ill-fitting prostheses, and all had insufficient oral hygiene.

CONCLUSIONS

Dental prostheses released cobalt during the fabrication stages, but not 1-5 years after insertion. No allergic reactions were observed. Signs of inflammation were related to candidiasis, insufficient oral hygiene, and ill-fitting prostheses.

Influence of Surface Coating on Metal Ion Release: Evaluation in Patients With Metal Allergy

Nickel, chromium, and cobalt in stainless steel and Cobalt-chrome-molybdenum (CoCrMo) alloys may induce allergy. The objectives of this study were to evaluate surface coating regarding ion release, patch test reactivity, and arthroplasty performance. Materials and methods included patch test in 31 patients with metal allergy and 30 patients with no allergy to stainless steel and CoCrMo disks that are uncoated or coated by titanium nitride/zirconium nitride (TiN/ZrN). Assessment include atomic absorption spectrometry of released nickel, cobalt, and chromium from the disks after exposure to distilled water, artificial sweat and culture medium. Results showed that both coatings reduced the nickel and chromium release from stainless steel and CoCrMo disks and mostly the cobalt release from the disks (maximally 11.755 µg/cm(2)/5 d to 1.624 by Ti-N and to 0.442 by ZrN). Six of the 31 patients with metal allergy reacted to uncoated disks, but none reacted to the coated disks. The current authors report on exemplary patients with metal allergy who had symptom relief by revision with surface-coated arthroplasty. The authors concluded that the surface coating may prevent cutaneous and peri-implant allergic reactions. [Orthopedics. 2016; 39(3):S24-S30.].

Microstructure, mechanical property and metal release of As-SLM CoCrW alloy under different solution treatment conditions

In the study, the microstructure, mechanical property and metal release behavior of selective laser melted CoCrW alloys under different solution treatment conditions were systemically investigated to assess their potential use in orthopedic implants. The effects of the solution treatment on the microstructure, mechanical properties and metal release were systematically studied by OM, SEM, XRD, tensile test, and ICP-AES, respectively. The XRD indicated that during the solution treatment the alloy underwent the transformation of γ-fcc to ε-hcp phase; the ε-hcp phase nearly dominated in the alloy when treated at 1200°C following the water quenching; the results from OM, SEM showed that the microstructural change was occurred under different solution treatments; solution at 1150°C with furnace cooling contributed to the formation of larger precipitates at the grain boundary regions, while the size and number of the precipitates was decreased as heated above 1100°C with the water quenching; moreover, the diamond-like structure was invisible at higher solution temperature over 1150°C following water quenching; compared with the furnace cooling, the alloy quenched by water showed excellent mechanical properties and low amount of metal release; as the alloy heated at 1200°C, the mechanical properties of the alloy reached their optimum combination at UTS=1113.6MPa, 0.2%YS=639.5MPa, and E%=20.1%, whilst showed the lower total quantity of metal release. It is suggested that a proper solution treatment is an efficient strategy for improving the mechanical properties and corrosion resistance of As-SLM CoCrW alloy that show acceptable tensile ductility.

Human epithelial tissue culture study on restorative materials

OBJECTIVES

Health condition of the gingival tissues contacting the surfaces of fixed prostheses is a result of multiple etiologic factors. The aim of the investigation discussed here was to evaluate the attachment and proliferation rate of cultured human epithelial cells on three commonly used restorative materials under in vitro conditions.

METHODS

Morphological and chemical structure of polished lithium-disilicate (IPS e.max Press, Ivoclar Vivadent AG, Germany), yttrium modified zirconium dioxide (5-TEC ICE Zirkon Translucent, Zirkonzahn GmbH Srl, Germany) and cobalt chromium alloy (Remanium star, Dentaurum GmbH & Co. KG, Germany) discs were examined by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS) and atomic force microscopy (AFM). Human epithelial cells harvested and cultured from one donor, were applied to investigate cell attachment (24h observation) and proliferation (72h observation) via dimethylthiazol-diphenyl tetrazolium bromide (MTT) and AlamarBlue(®) (AB) assays on control surface (cell-culture plate) and on the restorative materials (n=3×20 specimens/material).

RESULTS

SEM and AFM revealed typical morphology and roughness features for the materials. Zirconia presented significantly higher Ra value. EDS confirmed typical elements on the investigated restorative materials: lithium-disilicate (Si, O); Zirconia (Zi, Y, O); CoCr (Co, Cr, W). All surfaces except CoCr exhibited significant cell proliferation according to MTT and AB assays after 72h compared to 24h. Among the restorative materials, CoCr samples showed the highest cell attachment as indicated by MTT assay. AB results showed that attachment and proliferation of human epithelial cells is supported more on lithium-disilicate. Both assays indicated the lowest value for zirconia.

CONCLUSIONS

The results indicate that the restorative materials examined are equally suitable for subgingival restorations. Lithium-disilicate exhibited the best biocompatibility.

CLINICAL SIGNIFICANCE

The examined materials are indicated for use in restorative procedures, directly contacting the sulcular epithelial tissues. Thus it is essential to monitor the biological acceptibility of these materials in order to better understand their clinical properties. The results indicate that Lithium-disilicate is a suitable material for such purposes.

Mesenchymal stem cell proliferation and differentiation on load-bearing trabecular Nitinol scaffolds

Bone tissue regeneration in load-bearing regions of the body requires high-strength porous scaffolds capable of supporting angiogenesis and osteogenesis. 70% porous Nitinol (NiTi) scaffolds with a regular 3-D architecture resembling trabecular bone were produced from Ni foams using an original reactive vapor infiltration technique. The "trabecular Nitinol" scaffolds possessed a high compressive strength of 79 MPa and high permeability of 6.9×10(-6) cm2. The scaffolds were further modified to produce a near Ni-free surface layer and evaluated in terms of Ni ion release and human mesenchymal stem cell (hMSC) proliferation (AlamarBlue), differentiation (alkaline phosphatase activity, ALP) and mineralization (Alizarin Red S staining). Scanning electron microscopy was employed to qualitatively corroborate the results. hMSCs were able to adhere and proliferate on both as-produced and surface-modified trabecular NiTi scaffolds, to acquire an osteoblastic phenotype and produce a mineralized extracellular matrix. Both ALP activity and mineralization were increased on porous scaffolds compared to control polystyrene plates. Experiments in a model coculture system of microvascular endothelial cells and hMSCs demonstrated the formation of prevascular structures in trabecular NiTi scaffolds. These data suggest that load-bearing trabecular Nitinol scaffolds could be effective in regenerating damaged or lost bone tissue.

Inhalation toxicity of 316L stainless steel powder in relation to bioaccessibility

The Globally Harmonized System for Classification and Labelling of Chemicals (GHS) considers metallic alloys, such as nickel (Ni)-containing stainless steel (SS), as mixtures of substances, without considering that alloys behave differently compared to their constituent metals. This study presents an approach using metal release, explained by surface compositional data, for the prediction of inhalation toxicity of SS AISI 316L. The release of Ni into synthetic biological fluids is >1000-fold lower from the SS powder than from Ni metal, due to the chromium(III)-rich surface oxide of SS. Thus, it was hypothesized that the inhalation toxicity of SS is significantly lower than what could be predicted based on Ni metal content. A 28-day inhalation study with rats exposed to SS 316L powder (<4 µm, mass median aerodynamic diameter 2.5–3.0 µm) at concentrations up to 1.0 mg/L showed accumulation of metal particles in the lung lobes, but no signs of inflammation, although Ni metal caused lung toxicity in a similar published study at significantly lower concentrations. It was concluded that the bioaccessible (released) fraction, rather than the elemental nominal composition, predicts the toxicity of SS powder. The study provides a basis for an approach for future validation, standardization and risk assessment of metal alloys.

Metal release from stainless steel powders and massive sheets--comparison and implication for risk assessment of alloys

Industries that place metal and alloy products on the market are required to demonstrate that they are safe for all intended uses, and that any risks to humans, animals or the environment are adequately controlled. This requires reliable and robust in vitro test procedures. The aim of this study is to compare the release of alloy constituents from stainless steel powders of different grades (focus on AISI 316L) and production routes into synthetic body fluids with the release of the same metals from massive sheets in relation to material and surface characteristics. The comparison is justified by the fact that the difference between massive surfaces and powders from a metal release/dissolution and surface perspective is not clearly elucidated within current legislations. Powders and abraded and aged (24 h) massive sheets were exposed to synthetic solutions of relevance for biological settings and human exposure routes, for periods of up to one week. Concentrations of released iron, chromium, nickel, and manganese in solution were measured, and the effect of solution pH, acidity, complexation capacity, and proteins elucidated in relation to surface oxide composition and its properties. Implications for risk assessments based on in vitro metal release data from alloys are elucidated.

Metallic ions released from stainless steel, nickel-free, and titanium orthodontic alloys: toxicity and DNA damage

INTRODUCTION

The aims of this study were to determine the amounts of metallic ions that stainless steel, nickel-free, and titanium alloys release to a culture medium, and to evaluate the cellular viability and DNA damage of cultivated human fibroblasts with those mediums.

METHODS

The metals were extracted from 10 samples (each consisting of 4 buccal tubes and 20 brackets) of the 3 orthodontic alloys that were submerged for 30 days in minimum essential medium. Next, the determination of metals was performed by using inductively coupled plasma mass spectrometry, cellular viability was assessed by using the tetrazolium reduction assay (MTT assay) (3-[4,5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide), and DNA damage was determined with the Comet assay. The metals measured in all the samples were Ti(47), Cr(52), Mn(55), Co(59), Ni(60), Mo(92), Fe(56), Cu(63), Zn(66), As(75), Se(78), Cd(111), and Pb(208).

RESULTS

The cellular viability of the cultured fibroblasts incubated for 7 days with minimum essential medium, with the stainless steel alloy submerged, was close to 0%. Moreover, high concentrations of titanium, chromium, manganese, cobalt, nickel, molybdenum, iron, copper, and zinc were detected. The nickel-free alloy released lower amounts of ions to the medium. The greatest damage in the cellular DNA, measured as the olive moment, was also produced by the stainless steel alloy followed by the nickel-free alloy. Conversely, the titanium alloy had an increased cellular viability and did not damage the cellular DNA, as compared with the control values.

CONCLUSIONS

The titanium brackets and tubes are the most biocompatible of the 3 alloys studied.

Metallic ion content and damage to the DNA in oral mucosa cells of children with fixed orthodontic appliances

Although the metal devices used in orthodontic treatments are manufactured highly resistance to corrosion, they may still suffer some localized corrosion resulting from the oral cavity conditions. The corrosion causes the release of metals from the alloys used for their manufacture. In this report, we evaluated the in vivo metal ions release of three alloys (stainless steel, titanium and nickel-free) usually used in the orthodontics treatments and its genotoxicity. We applied to 15 patients, between 12 and 16 years, 4 tubes and 20 brackets. Samples from oral mucosa were taken before the treatment and 30 days later. The concentration of the titanium, chromium, manganese, cobalt, nickel, molybdenum and iron were detected using inductively coupled plasma mass spectrometry (ICP-MS). The genotoxicity was measured with a comet assay (Olive moment). The oral mucosa cells in contact with the stainless steel alloy displayed the greatest titanium and manganese concentrations and those in contact with the nickel-free alloy presented the greatest concentration of chromium and iron. Both alloys, stainless steel and nickel-free, induced a higher DNA damage in the oral mucosa cells than the titanium alloy, in which the Olive moment was similar to controls. Based on the results of our study, we can conclude that titanium brackets and tubes are the most biocompatible of the three alloys.

[Preclinical evaluation of coated knee implants for allergic patients]

BACKGROUND

10-15% of the population show allergic reactions against skin contact to metals as nickel, cobalt or chromium and have thus a risk of not tolerating implants containing those materials. The relationship between periimplantary hypersensivity reaction and given cutaneous contact allergy is currently unknown. A new developed multilayer coating system is supposed to prevent long-term allergic reactions that may result from uncoated implants.

METHODS

Stability and function (concerning bonding durability, wear and ion release to the serum) of the multilayer coating system has been examined in a test series.

RESULTS

The specific architecture of the multilayer coating system evidences a very good bonding durability. The results of the test in the simulator show a reduction of wear of approximately 60% compared to the uncoated implants. Ion concentrations within the serum of the wear tests were by magnitudes lower than those measured in reference tests on uncoated components.

CONCLUSION

The results of the preclinical evaluation prove that the durability and function of the multilayer coating system are as intended.

Bioaccessibility studies of ferro-chromium alloy particles for a simulated inhalation scenario: a comparative study with the pure metals and stainless steel

The European product safety legislation, REACH, requires that companies that manufacture, import, or use chemicals demonstrate safe use and high level of protection of their products placed on the market from a human health and environmental perspective. This process involves detailed assessment of potential hazards for various toxicity endpoints induced by the use of chemicals with a minimum use of animal testing. Such an assessment requires thorough understanding of relevant exposure scenarios including material characteristics and intrinsic properties and how, for instance, physical and chemical properties change from the manufacturing phase, throughout use, to final disposal. Temporary or permanent adverse health effects induced by particles depend either on their shape or physical characteristics, and/or on chemical interactions with the particle surface upon human exposure. Potential adverse effects caused by the exposure of metal particles through the gastrointestinal system, the pulmonary system, or the skin, and their subsequent potential for particle dissolution and metal release in contact with biological media, show significant gaps of knowledge. In vitro bioaccessibility testing at conditions of relevance for different exposure scenarios, combined with the generation of a detailed understanding of intrinsic material properties and surface characteristics, are in this context a useful approach to address aspects of relevance for accurate risk and hazard assessment of chemicals, including metals and alloys and to avoid the use of in vivo testing. Alloys are essential engineering materials in all kinds of applications in society, but their potential adverse effects on human health and the environment are very seldom assessed. Alloys are treated in REACH as mixtures of their constituent elements, an approach highly inappropriate because intrinsic properties of alloys generally are totally different compared with their pure metal components. A large research effort was therefore conducted to generate quantitative bioaccessibility data for particles of ferro-chromium alloys compared with particles of the pure metals and stainless steel exposed at in vitro conditions in synthetic biological media of relevance for particle inhalation and ingestion. All results are presented combining bioaccessibility data with aspects of particle characteristics, surface composition, and barrier properties of surface oxides. Iron and chromium were the main elements released from ferro-chromium alloys upon exposure in synthetic biological media. Both elements revealed time-dependent release processes. One week exposures resulted in very small released particle fractions being less than 0.3% of the particle mass at acidic conditions and less than 0.001% in near pH-neutral media. The extent of Fe released from ferro-chromium alloy particles was significantly lower compared with particles of pure Fe, whereas Cr was released to a very low and similar extent as from particles of pure Cr and stainless steel. Low release rates are a result of a surface oxide with passive properties predominantly composed of chromium(III)-rich oxides and silica and, to a lesser extent, of iron(II,III)oxides. Neither the relative bulk alloy composition nor the surface composition can be used to predict or assess the extent of metals released in different synthetic biological media. Ferro-chromium alloys cannot be assessed from the behavior of their pure metal constituents.