Counts Amy L, Miller Marlo A, Khakhria Milan L, Strange Steven
Department of Orthodontics, University of Oklahoma College of Dentistry, Oklahoma City, OK, USA.
J Orofac Orthop. 2002 Nov;63(6):509-15. doi: 10.1007/s00056-002-0128-z.
The purpose of this article was to present a case in which nickel sensitivity of the oral mucosa was demonstrated during the use of a transpalatal arch appliance (TPA).
An 11-year 8-month old post-menarchal female presented for orthodontic treatment with Class III buccal segments and bilateral open bite. The treatment plan consisted of placing a rapid palatal expansion appliance (RPE) and a TPA with soldered lateral tongue cribs, in order to eliminate her tongue thrusting habit. 8 months into treatment, the gingiva of the right posterior segment began to hypertrophy, particularly around the bands of the right first molar and premolar. A patch test of 5% nickel sulfate indicated a positive reaction to nickel. The treatment was finished without the use of nickel titanium wires and the mucosa reaction resolved. The patient had had her ear pierced at age 2 days old, which was 11 years before orthodontic treatment was initiated. The literature shows that this exposure may have been the sensitizing event.
While the nickel sensitive patient may not present an extreme medical risk, the orthodontist must be aware of the problem and the likelihood of treating patients with this condition. It appears that the reaction may vary from patient to patient. The practitioner should possess a basic understanding of the occurrence rate, sex predilection, and signs and symptoms of allergy to nickel, and should be familiar with the best possible alternative modes of treatment, to provide the safest, most effective care possible in these cases. Practitioners should be aware that symptoms of nickel allergy may closely mimic those of typical gingival changes during orthodontic treatment of circumpubertal children.
本文旨在介绍一例在使用腭弓矫治器（TPA）过程中出现口腔黏膜镍过敏的病例。
一名11岁8个月初潮后的女性前来接受正畸治疗，其双侧颊段为III类错颌且伴有双侧开颌。治疗计划包括放置快速腭扩展矫治器（RPE）和带有焊接侧舌刺的TPA，以消除她的吐舌习惯。治疗8个月后，右侧后段牙龈开始增生，尤其是在右侧第一磨牙和前磨牙带环周围。5%硫酸镍斑贴试验显示对镍呈阳性反应。治疗在未使用镍钛丝的情况下完成，黏膜反应消退。该患者在2日龄时曾穿耳洞，这是在开始正畸治疗前11年。文献表明这种接触可能是致敏事件。
虽然镍过敏患者可能不会带来极端的医疗风险，但正畸医生必须意识到这个问题以及治疗此类患者的可能性。似乎不同患者的反应可能有所不同。从业者应基本了解镍过敏的发生率、性别倾向以及过敏的体征和症状，并应熟悉最佳的替代治疗方式，以便在这些病例中提供最安全、最有效的护理。从业者应意识到，在青春期前后儿童正畸治疗期间，镍过敏症状可能与典型牙龈变化的症状极为相似。
