Treatment of a patient with metal hypersensitivity after orthognathic surgery

In this case report, orthodontic materials may have induced metal allergic reactions in the form of lip swelling and redness after orthognathic surgery. Two months after surgery, the patient suffered continuous lip swelling and redness. She visited a dermatological hospital and was diagnosed with herpes. However, since her symptoms did not improve after 1-month of drug therapy, a metal allergy was subsequently suggested. Patch tests conducted in the dental hospital revealed reactions to chromium, which is not used in prosthetic appliances. For confirmation, the metal composition of all prosthetic appliances was examined using a fluorescent x-ray analyzer, but no chromium was detected (copper, gold, palladium, and silver were detected). However, the orthodontic brackets, wires, and bands do contain chromium and, considering that they may have induced the metal allergic reactions, they were replaced with materials made of polymer with no metals. As a result, the lip swelling and redness improved. For retention, the anterior part of the retainer was bonded on the lingual side of the anterior lower and upper jaws. During retention, no further symptoms of hypersensitivity were observed, suggesting that the nonmetal polymer is useful for treatment of metal allergic patients.