Amato Alessandra, Martina Stefano, De Benedetto Giuseppina, Michelotti Ambrosina, Amato Massimo, Di Spirito Federica
Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy.
Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy.
J Clin Med. 2025 Jul 5;14(13):4766. doi: 10.3390/jcm14134766.
: This systematic review analyzed the epidemiologic and macro/microscopic features of manifestations of hypersensitivity reactions with oral and extra-oral involvement in orthodontic patients with fixed (FAs) or removable (RAs) appliances or clear aligners (CAs), and evaluated them based on patient and treatment characteristics to provide clinical recommendations. : The study protocol followed the PRISMA guidelines and was registered on PROSPERO (CRD42024517942). : Thirty-one studies were qualitatively assessed and synthetized, involving 858 subjects (114 males and 714 females, 9-49 years old), of whom there were 86 with a history of allergy, and 743 wearing recorded appliances (FAs = 656, FAs and RAs = 81, intra- and extra-oral RAs = 3, CAs = 3), with a mean treatment duration of 21.5 months (6 weeks-40 months). Among 75 reports, 29 (38.67%), describing burning, gingival hyperplasia, erythema, and vesicles, had oral involvement, while 46 (61.33%) had skin, eye, and systemic involvement, with erythema, papules, conjunctival hyperemia, and vertigo. Positive allergy tests concomitant with the manifestations identified nickel 451 times, cobalt 6 times, titanium 5 times, and chromium 4 times. Management included antihistamines or corticosteroids and removing the offending materials, with treatment discontinuation/appliance substitution. : Pre-treatment evaluations, including patient histories and allergy testing, are essential to identify potential allergens and select hypoallergenic materials like titanium or ceramic brackets; regular monitoring and early intervention during treatment are crucial to prevent severe outcomes.
本系统评价分析了使用固定矫治器（FAs）、活动矫治器（RAs）或透明矫治器（CAs）的正畸患者发生口腔及口外过敏反应表现的流行病学和宏观/微观特征，并根据患者和治疗特征对其进行评估，以提供临床建议。本研究方案遵循PRISMA指南，并在PROSPERO（CRD42024517942）上进行了注册。对31项研究进行了定性评估和综合分析，涉及858名受试者（男性114名，女性714名，年龄9 - 49岁），其中有86名有过敏史，743名佩戴了记录在案的矫治器（FAs = 656，FAs和RAs = 81，口内及口外RAs = 3，CAs = 3），平均治疗持续时间为21.5个月（六周至40个月）。在75份报告中，29份（38.67%）描述了灼痛、牙龈增生、红斑和水疱，有口腔受累，而46份（61.33%）有皮肤、眼睛和全身受累，表现为红斑、丘疹、结膜充血和眩晕。与这些表现同时出现的阳性过敏试验中，镍出现451次，钴出现6次，钛出现5次，铬出现4次。处理措施包括使用抗组胺药或皮质类固醇，并去除致病物质，同时停止治疗/更换矫治器。治疗前评估，包括患者病史和过敏试验，对于识别潜在过敏原和选择低过敏性材料（如钛或陶瓷托槽）至关重要；治疗期间的定期监测和早期干预对于预防严重后果至关重要。
