镍铬合金烤瓷冠修复对人体健康效应的流行病学研究
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摘要
烤瓷熔附金属全冠(简称：金瓷冠,俗称“烤瓷冠”)是瓷粉经过高温烧结熔附于金属内冠表面形成的全冠修复体,其使用的烤瓷合金有贵金属合金、非贵金属合金等,镍铬合金为临床常用的非贵金属合金。镍铬合金烤瓷冠(简称：镍铬烤瓷冠)是最为常用的固定义齿修复方法之一,因其价格相对低廉而在我国人群中广泛使用。据不完全统计,2009年前我国义齿修复材料中镍铬烤瓷冠的市场占有率约占50-80%,戴用人数数以千万计,然而近年来镍铬烤瓷冠的生物相容性、生物安全性在国内外存在较大争议,其焦点在于戴用镍铬烤瓷冠是否导致镍和铬等重金属离子析出而成为机体的潜在暴露源,以及因这些金属离子是否在体内达到较高的水平而导致机体出现肾功能异常、过敏等不良效应。
为回答上述问题,本研究同时开展了相关的流行病学调查。在历史性队列研究中,共收集了对795例镍铬烤瓷冠的戴用者(接触者)和198例相应的对照组的完整资料,详细询问并检查了个体镍铬合金烤瓷冠的佩戴时间、数量和金属内冠裸露水平等信息,采用石墨炉原子吸收分光光度计测定了尿中总镍和总铬水平,观察了镍铬烤瓷冠的戴用与尿镍铬排泄、机体肾功能损伤(采用血生化和尿生化肾功能指标进行评价)以及机体过敏(用TNF-α、IL-1β、和IL-6等免疫学指标评价)之间的关系。主要结果如下：
1.所有对象尿镍、尿铬平均水平分别为0.57μg/L (61.08μg/mol肌酐)和0.51μg/L (53.82μg/mol肌酐),和对照组(尿镍：54.48μg/mol肌酐；尿铬：43.83μg/mol肌酐)相比,戴用镍铬烤瓷冠的接触组尿镍水平(62.84μg/mol肌酐)略有升高,但差异没有统计学意义,尿铬水平(56.65μg/mol肌酐)明显升高(p=0.003)。
2.镍铬烤瓷冠的戴用可导致尿镍水平的暂时性升高,戴用时间在1个月内尿镍水平升高1.61倍(对照组54.48μg/mol肌酐,<1月组87.75μg/mol肌酐,p<0.001),但戴用时间超过1个月后,尿镍的排泄水平逐渐降低,和对照组相比没有显著差异;
3.镍铬烤瓷冠的戴用可导致尿铬水平的暂时性升高,戴用时间<1月组(63.80μg/mol肌酐),1-月组(62.93μg/mol肌酐)和3-月组(57.62μg/mol肌酐)分别为对照组(43.83μg/mol肌酐)的1.46(p<0.001)、1.44(p=0.003)和1.31(p=0.023)倍,戴用时间6-月和≥12月组尿铬水平和对照组间没有统计学差异；
4.镍铬烤瓷冠戴用个数的增加及金属内核裸露程度的增加会造成尿镍铬排泄水平的上升：在戴用时间<1月组的镶牙病人中,戴用个数≥3个组尿镍水平(103.20μg/mol肌酐)明显高于戴用个数<3个组(70.73μg/mol肌酐)(p=0.019),金属内冠裸露水平中／重度组尿镍水平(118.37μg/mol肌酐)明显高于裸露水平无／轻度组(73.02μg/mol肌酐)(p=0.012)；在戴用时间<1月和1-月的接触组中,戴用个数对尿铬水平没有影响,但金属内冠裸露水平中／重度组尿铬水平(79.70μg/mol肌酐)明显高于裸露水平无／轻度组(55.72μg/mol肌酐)(p=0.003)；
5.未能发现镍铬烤瓷冠的戴用时间、数量和金属裸露水平与戴用者肾功能损伤间的任何关系,对尿镍铬水平与肾功能关系的分析也未能发现尿镍铬排泄的上升可导致肾脏损伤；
6.未能发现镍铬烤瓷冠戴用时间、数量和金属裸露水平等与TNF-α、IL-1β和IL-6等炎性介质的显著升高相关。也未发现机体尿镍和尿铬水平与血清中TNF-α、IL-1β和IL-6等炎性介质的升高存在相关关系。
在准实验研究中,共收集了33例样本,同时测定了戴用镍铬烤瓷冠前与后的尿镍、尿铬水平并分析了戴用镍铬烤瓷冠前与后机体肾功能和免疫的变化。主要结果如下：
1.男性尿镍和尿铬在戴用前后均没有明显差异,但女性戴用后尿镍水平略有升高(1.64倍,戴用前：44.77μg/mol肌酐,戴用后：73.69μg/mol肌酐),差异接近统计学意义(p=0.068)；尿铬水平升高明显,(2.08倍,戴用前:59.85μg/mol肌酐,戴用后：124.39μg/mol肌酐),有统计学意义(p=0.023)；女性戴用前后尿镍和尿铬水平的升高与其金属裸露水平偏高有关,33例样本中,女性有52%为重度裸露,而男性仅为2%；
2.未能发现镍铬烤瓷冠戴用与肾功能损伤有关；
3.未能发现戴用镍铬合金后血清TNF-α、IL-1β和IL-6等炎性介质的变化。
结论：
1.镍铬烤瓷冠的戴用可导致尿镍和尿铬水平的暂时性升高,尿镍水平的增加仅局限于1个月内,而尿铬水平的增加为6个月内；
2.镍铬烤瓷冠戴用个数和金属内冠裸露水平是戴用后尿镍铬水平暂时性升高的重要原因；
3.本研究人群尿镍和尿铬水平均远远低于国内或国外的正常参考限值,国内外各参考限值一般超过尿镍铬平均水平的20倍,而镍铬烤瓷冠的戴用虽可导致尿镍和尿铬水平的暂时性升高,但一般不超过2倍；
4.镍铬烤瓷冠的戴用与否,戴用个数和金属内冠裸露水平对戴用者肾功能和机体过敏没有影响；
5.本研究人群中,尿镍和尿铬水平的上升和肾损伤和机体过敏没有关系；
6.综合上述第1至第5点,从肾损伤可能性和机体过敏的角度考虑,可以认为镍铬烤瓷冠是安全的。
建议：
1.佩戴镍铬烤瓷冠前,病人需了解自身是否为对镍的过敏体质。
2.镍铬合金作为烤瓷冠材料无需禁止,但在安装时必须注意避免金属内冠的裸露。
Porcelain fused to metal crown (PFM) is a kind of crown prosthesis whose cast metal crown is veneered with a layer of fused porcelain. By the cost of metal alloy, PFM can be difficienate as noble metal alloy and base metal alloy. Nickel (Ni)-Chromium(Cr) based PFM is one of the most popular fixed-restorations. Due to its low-cost, it has been widely used in our country. According to the incomplete statistics, the occupation rate of Ni-Cr based PFM was about50-80%in the total market of PFM approximately, which means more than ten millions of Chinese had Ni-Cr based PFM. In the recent years, the biocompatibility of Ni-Cr based PFM in the oral cavity has been disputed. The focus of dispution refers to the elemental ion release of toxic metals from casting alloys, which is suspected to accumulate to high level and thus lead to some adverse biological effects such as cytotoxicity, genotoxicity and allergy.
In order to answer these questions, several epidemiological studies have been conducted. In the historical cohort study,795patients in a dental hospital who had single or multiple Ni-Cr alloy restoration recently and198controls were recruited. Detailed information including time of alloy therapies and when and where each therapy was conducted and how many teeth were replaced by alloy. A clinical examination was conducted to determine if the metal crown was fused to the porcelain and to what extent the surface area of metal crown covered with porcelain Urinary concentrations of Ni and Cr from each subject were measure by graphite furnace atomic absorption spectrometry. The correlation of Ni-Cr based alloy dental restoration, the enhanced excretions of nickel (Ni) and Chromium (Cr) in urine, the renal dysfunction (as measured by serum biochemical examination and urine biochemical examination) and immunological function parameters (as measured by TNF-a, IL-1β, IL-6) was observed. Main results can be summarized as follows:
1. The mean urinary level of Ni of all the study population is0.57μg/L (61.08μg/mol creatininea). Urinary level of Ni (62.84μg/mol creatinine) in the patient group was a little higher than that in the control group (54.48μg/mol creatinine), but has no statistical difference. The mean urinary level of Cr of all the study population is0.51μg/L (53.82μg/mol creatinine). Urinary level of Cr in patient group56.65μg/mol creatinine), was significantly higher (p=0.003) than urinary level of Cr in the control group (43.83 creatinine).
2. Dental restoration of Ni-Cr alloy can cause temporary increase of the uinary level of Ni. The urinary level of Ni in the patient group of<1month of the restoration duration (87.75μg/mol creatinine) is significantly higher (1.61, p <0.001) than the urinary level of Ni in the control group (54.48μg/mol creatinine). However, the urinary level of Ni decreases after1month. There is no statistical difference between the control group and patient group.
3. Dental restoration of Ni-Cr alloy can also cause temporary increase of the uinary level of Cr. All of the urinary level of Ni in the patient group of<1month of the restoration duration(63.80μg/mol creatinine),1-month of restoration duration (62.93μg/mol creatinine), and3-month restoration duration (57.62μg/mol creatinine) are significantly higher than the urinary level of Cr in the control group (43.83μg/mol creatinine). They are1.46(p <0.001)、1.44(P=0.003)和1.31(P=0.023) respectiely. There is no statistical difference between the control group and patient group in6-months and12months above.
4. Both higher number of teeth replaced by dental alloys and larger exposure surface of metal crown (not covered with the porcelain) can cause higher Ni excretions. In the patient group of<1month of the restoration duration, the urinary level of Ni in those had3or more Ni-Cr alloys dental restoreation (103.20μg/mol creatinine) is significantly higher than those had less than3Ni-Cr alloys dental restoreation (70.73μg/mol creatinine)(p=0.019) The urinary level of Ni in those have medium and above exposure surface of metal crown (118.37μg/mol creatinine) significantly higher than those who have non or less exposure surface of metal crown (73.02μg/mol creatinine)(p=0.012). In the patient group of<1month and1-month of the restoration duration respectively, there is no significant difference of the urinary level of Cr for the number of teeth replaced by dental alloys. However, the urinary level of Cr in those have medium and above exposure surface of metal crown (19.10μg/mol creatinine) significantly higher than those who have non or less exposure surface of metal crown (55.72μg/mol creatinine)(p=0.003)
5. No associations among the duration, number, exposure surface of metal crown dental alloy and the renal dysfunction are identified. No evidence shows the increased excretion of Ni and Cr can cause the damage of kidney by the analysis of the urinary level of Ni, Cr and the renal function.
6. Neither the duration, number, exposure surface of metal crown dental alloy, nor urinary level of Ni, Cr, has been identified associations with the increase of inflammatory mediators such as TNF-α、IL-1and IL-6.
In the quasi-trial, the urinary level of Ni and Cr were measured in33cases before and after the Ni-Cr alloy dental restoration. The renal function and immunological function parameters before and after the Ni-Cr alloy dental restoration was compared. Main result can be summarized as follows:
1. In male, there is no statistical difference of urinary level of Ni and Cr before and after Ni-Cr alloy dental restoration. In female, the urinary level of Ni after Ni-Cr alloy dental restoration (73.69μg/mol creatinine) is1.64of the urinary level of Ni before dental restoration(44.77(μg/mol creatinine), with borderline significance (p=0.068). Also in female, the urinary level of Cr after Ni-Cr alloy dental restoration (124.39μg/mol creatinine) is2.08times of the urinary level of Ni before dental restoration(59.85μg/mol creatinine), with statistical significance (p=0.023). The increase of urinary level of Ni and Cr before and after Ni-Cr alloy dental restoration.in female might be attributed to the high propotion of cases who have large exposure surface of metal crown (52%in femle vs2%in male).
2. No associations between dental alloy restoration and the renal dysfunction are identified.
3. No associations between dental alloy restoration and the increase of inflammatory mediators such as TNF-α IL-1and IL-6.
Conclusion:
1. The Ni-Cr alloy dental restoration can cause the temperory increase of the urinary level of Ni and Cr, but the increase is limited in one month for urinary level of Ni and6months for the urinary level of Cr.
2. The main causes for the the temperory increase of the urinary level of Ni and Cr are higher number of teeth replaced by dental alloys and larger exposure surface of metal crown.
3. The urinary level of Ni and Cr in the study is much lower than the toxicosis reference value. In the study, the increased urinary level of Ni and Cr is less than double while the the mean toxicosis reference value is about20times.
4. Whether or not taking Ni-Cr alloy dental restoration, neither the number of teeth replaced by dental alloys, nor larger exposure surface of metal crown has effect on the renal dysfunction and systemic anaphylaxis reaction.
5. There is no association between the increased urinary level of Ni and Cr and allergic reaction of human body in this study.
6. In conclusion, from the prospective of renal dysfunction and systemic anaphylaxis reaction, Ni-Cr alloy dental restoration is safe to human.
Recomedation:
1. Patients should make sure if they are allegic to Ni before they have Ni-Cr alloy dental restoration.
2. It is not necessary to prohibit the use of Ni-Cr alloy dental restoration, however, caution should be given to avoid the exposure of of metal crown.
为回答上述问题,本研究同时开展了相关的流行病学调查。在历史性队列研究中,共收集了对795例镍铬烤瓷冠的戴用者(接触者)和198例相应的对照组的完整资料,详细询问并检查了个体镍铬合金烤瓷冠的佩戴时间、数量和金属内冠裸露水平等信息,采用石墨炉原子吸收分光光度计测定了尿中总镍和总铬水平,观察了镍铬烤瓷冠的戴用与尿镍铬排泄、机体肾功能损伤(采用血生化和尿生化肾功能指标进行评价)以及机体过敏(用TNF-α、IL-1β、和IL-6等免疫学指标评价)之间的关系。主要结果如下：
1.所有对象尿镍、尿铬平均水平分别为0.57μg/L (61.08μg/mol肌酐)和0.51μg/L (53.82μg/mol肌酐),和对照组(尿镍：54.48μg/mol肌酐；尿铬：43.83μg/mol肌酐)相比,戴用镍铬烤瓷冠的接触组尿镍水平(62.84μg/mol肌酐)略有升高,但差异没有统计学意义,尿铬水平(56.65μg/mol肌酐)明显升高(p=0.003)。
2.镍铬烤瓷冠的戴用可导致尿镍水平的暂时性升高,戴用时间在1个月内尿镍水平升高1.61倍(对照组54.48μg/mol肌酐,<1月组87.75μg/mol肌酐,p<0.001),但戴用时间超过1个月后,尿镍的排泄水平逐渐降低,和对照组相比没有显著差异;
3.镍铬烤瓷冠的戴用可导致尿铬水平的暂时性升高,戴用时间<1月组(63.80μg/mol肌酐),1-月组(62.93μg/mol肌酐)和3-月组(57.62μg/mol肌酐)分别为对照组(43.83μg/mol肌酐)的1.46(p<0.001)、1.44(p=0.003)和1.31(p=0.023)倍,戴用时间6-月和≥12月组尿铬水平和对照组间没有统计学差异；
4.镍铬烤瓷冠戴用个数的增加及金属内核裸露程度的增加会造成尿镍铬排泄水平的上升：在戴用时间<1月组的镶牙病人中,戴用个数≥3个组尿镍水平(103.20μg/mol肌酐)明显高于戴用个数<3个组(70.73μg/mol肌酐)(p=0.019),金属内冠裸露水平中／重度组尿镍水平(118.37μg/mol肌酐)明显高于裸露水平无／轻度组(73.02μg/mol肌酐)(p=0.012)；在戴用时间<1月和1-月的接触组中,戴用个数对尿铬水平没有影响,但金属内冠裸露水平中／重度组尿铬水平(79.70μg/mol肌酐)明显高于裸露水平无／轻度组(55.72μg/mol肌酐)(p=0.003)；
5.未能发现镍铬烤瓷冠的戴用时间、数量和金属裸露水平与戴用者肾功能损伤间的任何关系,对尿镍铬水平与肾功能关系的分析也未能发现尿镍铬排泄的上升可导致肾脏损伤；
6.未能发现镍铬烤瓷冠戴用时间、数量和金属裸露水平等与TNF-α、IL-1β和IL-6等炎性介质的显著升高相关。也未发现机体尿镍和尿铬水平与血清中TNF-α、IL-1β和IL-6等炎性介质的升高存在相关关系。
在准实验研究中,共收集了33例样本,同时测定了戴用镍铬烤瓷冠前与后的尿镍、尿铬水平并分析了戴用镍铬烤瓷冠前与后机体肾功能和免疫的变化。主要结果如下：
1.男性尿镍和尿铬在戴用前后均没有明显差异,但女性戴用后尿镍水平略有升高(1.64倍,戴用前：44.77μg/mol肌酐,戴用后：73.69μg/mol肌酐),差异接近统计学意义(p=0.068)；尿铬水平升高明显,(2.08倍,戴用前:59.85μg/mol肌酐,戴用后：124.39μg/mol肌酐),有统计学意义(p=0.023)；女性戴用前后尿镍和尿铬水平的升高与其金属裸露水平偏高有关,33例样本中,女性有52%为重度裸露,而男性仅为2%；
2.未能发现镍铬烤瓷冠戴用与肾功能损伤有关；
3.未能发现戴用镍铬合金后血清TNF-α、IL-1β和IL-6等炎性介质的变化。
结论：
1.镍铬烤瓷冠的戴用可导致尿镍和尿铬水平的暂时性升高,尿镍水平的增加仅局限于1个月内,而尿铬水平的增加为6个月内；
2.镍铬烤瓷冠戴用个数和金属内冠裸露水平是戴用后尿镍铬水平暂时性升高的重要原因；
3.本研究人群尿镍和尿铬水平均远远低于国内或国外的正常参考限值,国内外各参考限值一般超过尿镍铬平均水平的20倍,而镍铬烤瓷冠的戴用虽可导致尿镍和尿铬水平的暂时性升高,但一般不超过2倍；
4.镍铬烤瓷冠的戴用与否,戴用个数和金属内冠裸露水平对戴用者肾功能和机体过敏没有影响；
5.本研究人群中,尿镍和尿铬水平的上升和肾损伤和机体过敏没有关系；
6.综合上述第1至第5点,从肾损伤可能性和机体过敏的角度考虑,可以认为镍铬烤瓷冠是安全的。
建议：
1.佩戴镍铬烤瓷冠前,病人需了解自身是否为对镍的过敏体质。
2.镍铬合金作为烤瓷冠材料无需禁止,但在安装时必须注意避免金属内冠的裸露。
Porcelain fused to metal crown (PFM) is a kind of crown prosthesis whose cast metal crown is veneered with a layer of fused porcelain. By the cost of metal alloy, PFM can be difficienate as noble metal alloy and base metal alloy. Nickel (Ni)-Chromium(Cr) based PFM is one of the most popular fixed-restorations. Due to its low-cost, it has been widely used in our country. According to the incomplete statistics, the occupation rate of Ni-Cr based PFM was about50-80%in the total market of PFM approximately, which means more than ten millions of Chinese had Ni-Cr based PFM. In the recent years, the biocompatibility of Ni-Cr based PFM in the oral cavity has been disputed. The focus of dispution refers to the elemental ion release of toxic metals from casting alloys, which is suspected to accumulate to high level and thus lead to some adverse biological effects such as cytotoxicity, genotoxicity and allergy.
In order to answer these questions, several epidemiological studies have been conducted. In the historical cohort study,795patients in a dental hospital who had single or multiple Ni-Cr alloy restoration recently and198controls were recruited. Detailed information including time of alloy therapies and when and where each therapy was conducted and how many teeth were replaced by alloy. A clinical examination was conducted to determine if the metal crown was fused to the porcelain and to what extent the surface area of metal crown covered with porcelain Urinary concentrations of Ni and Cr from each subject were measure by graphite furnace atomic absorption spectrometry. The correlation of Ni-Cr based alloy dental restoration, the enhanced excretions of nickel (Ni) and Chromium (Cr) in urine, the renal dysfunction (as measured by serum biochemical examination and urine biochemical examination) and immunological function parameters (as measured by TNF-a, IL-1β, IL-6) was observed. Main results can be summarized as follows:
1. The mean urinary level of Ni of all the study population is0.57μg/L (61.08μg/mol creatininea). Urinary level of Ni (62.84μg/mol creatinine) in the patient group was a little higher than that in the control group (54.48μg/mol creatinine), but has no statistical difference. The mean urinary level of Cr of all the study population is0.51μg/L (53.82μg/mol creatinine). Urinary level of Cr in patient group56.65μg/mol creatinine), was significantly higher (p=0.003) than urinary level of Cr in the control group (43.83 creatinine).
2. Dental restoration of Ni-Cr alloy can cause temporary increase of the uinary level of Ni. The urinary level of Ni in the patient group of<1month of the restoration duration (87.75μg/mol creatinine) is significantly higher (1.61, p <0.001) than the urinary level of Ni in the control group (54.48μg/mol creatinine). However, the urinary level of Ni decreases after1month. There is no statistical difference between the control group and patient group.
3. Dental restoration of Ni-Cr alloy can also cause temporary increase of the uinary level of Cr. All of the urinary level of Ni in the patient group of<1month of the restoration duration(63.80μg/mol creatinine),1-month of restoration duration (62.93μg/mol creatinine), and3-month restoration duration (57.62μg/mol creatinine) are significantly higher than the urinary level of Cr in the control group (43.83μg/mol creatinine). They are1.46(p <0.001)、1.44(P=0.003)和1.31(P=0.023) respectiely. There is no statistical difference between the control group and patient group in6-months and12months above.
4. Both higher number of teeth replaced by dental alloys and larger exposure surface of metal crown (not covered with the porcelain) can cause higher Ni excretions. In the patient group of<1month of the restoration duration, the urinary level of Ni in those had3or more Ni-Cr alloys dental restoreation (103.20μg/mol creatinine) is significantly higher than those had less than3Ni-Cr alloys dental restoreation (70.73μg/mol creatinine)(p=0.019) The urinary level of Ni in those have medium and above exposure surface of metal crown (118.37μg/mol creatinine) significantly higher than those who have non or less exposure surface of metal crown (73.02μg/mol creatinine)(p=0.012). In the patient group of<1month and1-month of the restoration duration respectively, there is no significant difference of the urinary level of Cr for the number of teeth replaced by dental alloys. However, the urinary level of Cr in those have medium and above exposure surface of metal crown (19.10μg/mol creatinine) significantly higher than those who have non or less exposure surface of metal crown (55.72μg/mol creatinine)(p=0.003)
5. No associations among the duration, number, exposure surface of metal crown dental alloy and the renal dysfunction are identified. No evidence shows the increased excretion of Ni and Cr can cause the damage of kidney by the analysis of the urinary level of Ni, Cr and the renal function.
6. Neither the duration, number, exposure surface of metal crown dental alloy, nor urinary level of Ni, Cr, has been identified associations with the increase of inflammatory mediators such as TNF-α、IL-1and IL-6.
In the quasi-trial, the urinary level of Ni and Cr were measured in33cases before and after the Ni-Cr alloy dental restoration. The renal function and immunological function parameters before and after the Ni-Cr alloy dental restoration was compared. Main result can be summarized as follows:
1. In male, there is no statistical difference of urinary level of Ni and Cr before and after Ni-Cr alloy dental restoration. In female, the urinary level of Ni after Ni-Cr alloy dental restoration (73.69μg/mol creatinine) is1.64of the urinary level of Ni before dental restoration(44.77(μg/mol creatinine), with borderline significance (p=0.068). Also in female, the urinary level of Cr after Ni-Cr alloy dental restoration (124.39μg/mol creatinine) is2.08times of the urinary level of Ni before dental restoration(59.85μg/mol creatinine), with statistical significance (p=0.023). The increase of urinary level of Ni and Cr before and after Ni-Cr alloy dental restoration.in female might be attributed to the high propotion of cases who have large exposure surface of metal crown (52%in femle vs2%in male).
2. No associations between dental alloy restoration and the renal dysfunction are identified.
3. No associations between dental alloy restoration and the increase of inflammatory mediators such as TNF-α IL-1and IL-6.
Conclusion:
1. The Ni-Cr alloy dental restoration can cause the temperory increase of the urinary level of Ni and Cr, but the increase is limited in one month for urinary level of Ni and6months for the urinary level of Cr.
2. The main causes for the the temperory increase of the urinary level of Ni and Cr are higher number of teeth replaced by dental alloys and larger exposure surface of metal crown.
3. The urinary level of Ni and Cr in the study is much lower than the toxicosis reference value. In the study, the increased urinary level of Ni and Cr is less than double while the the mean toxicosis reference value is about20times.
4. Whether or not taking Ni-Cr alloy dental restoration, neither the number of teeth replaced by dental alloys, nor larger exposure surface of metal crown has effect on the renal dysfunction and systemic anaphylaxis reaction.
5. There is no association between the increased urinary level of Ni and Cr and allergic reaction of human body in this study.
6. In conclusion, from the prospective of renal dysfunction and systemic anaphylaxis reaction, Ni-Cr alloy dental restoration is safe to human.
Recomedation:
1. Patients should make sure if they are allegic to Ni before they have Ni-Cr alloy dental restoration.
2. It is not necessary to prohibit the use of Ni-Cr alloy dental restoration, however, caution should be given to avoid the exposure of of metal crown.
引文
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