Abstract：
There is currently a lack of guidelines for clinicians regarding titanium hypersensitivity in implant dentistry. Diagnostic tests such as the epicutaneous test or the lymphocyte transformation test showed inconsistent results regarding reliability and validity and thus, evidence-based consensus recommendations regarding diagnostic and therapeutic options may be helpful in clinical decision-making. Therefore, the German S3 guideline on titanium hypersensitivity in implant dentistry was developed.
In the objectives, procedure, voting method and venue were defined and the consensus participants were invited. A systematic literature research was performed, and the overall quality of the evidence was rated according to the GRADE working group. Eight recommendations were formulated within the framework of a structured consensus conference under independent moderation and could be voted on with strong consensus (> 95% agreement). The formulated statements and recommendations were developed in small groups according to the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) and were discussed and agreed upon in the plenum.
For reasonable decision-making, a patient\'s clinical symptoms should be regarded as leading parameters, which are usually expressed by a local inflammatory reaction with subsequent disturbed osseous integration. Allergy tests, such as the epicutaneous test or the lymphocyte transformation test are not helpful in titanium intolerance assessments, since these tests indicate T cell-mediated allergies, which are not observed in titanium intolerance reactions. Other metals and impurities that might be present in superstructures or alloys also need to be considered as the cause of an intolerance reaction and a trigger for contact sensitization. In the case of a suspected titanium particle-related, local immunologically induced inflammatory reaction with subsequent impaired osseous integration, dental ceramic implants can be considered as a therapeutic option.
In the objectives, procedure, voting method and venue were defined and the consensus participants were invited. A systematic literature research was performed, and the overall quality of the evidence was rated according to the GRADE working group. Eight recommendations were formulated within the framework of a structured consensus conference under independent moderation and could be voted on with strong consensus (> 95% agreement). The formulated statements and recommendations were developed in small groups according to the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) and were discussed and agreed upon in the plenum.
For reasonable decision-making, a patient\'s clinical symptoms should be regarded as leading parameters, which are usually expressed by a local inflammatory reaction with subsequent disturbed osseous integration. Allergy tests, such as the epicutaneous test or the lymphocyte transformation test are not helpful in titanium intolerance assessments, since these tests indicate T cell-mediated allergies, which are not observed in titanium intolerance reactions. Other metals and impurities that might be present in superstructures or alloys also need to be considered as the cause of an intolerance reaction and a trigger for contact sensitization. In the case of a suspected titanium particle-related, local immunologically induced inflammatory reaction with subsequent impaired osseous integration, dental ceramic implants can be considered as a therapeutic option.
摘要：
目前缺乏有关植入物牙科中钛过敏的临床医生指南。诊断测试，如表皮测试或淋巴细胞转化测试显示不一致的结果关于可靠性和有效性，因此，关于诊断和治疗方案的循证共识建议可能有助于临床决策.因此,制定了德国S3关于植入牙科中钛过敏的指南。
在目标中，procedure,确定了投票方式和地点，并邀请了共识参与者。进行了系统的文献研究，根据GRADE工作组对证据的总体质量进行评级。八项建议是在独立主持的结构化共识会议的框架内制定的，可以以强烈的共识（95％的协议）进行投票。根据德国科学医学会协会（AWMF）的指导方针，以小组形式制定了声明和建议，并在全体会议上进行了讨论和商定。
为了做出合理的决策，患者的临床症状应被视为主要参数，通常通过局部炎症反应表达，随后骨整合受到干扰。过敏测试,例如表皮测试或淋巴细胞转化测试对钛不耐受评估没有帮助，因为这些测试表明T细胞介导的过敏，在钛不耐受反应中没有观察到。可能存在于上层结构或合金中的其他金属和杂质也需要被认为是不耐受反应的原因和接触敏化的触发因素。在怀疑与钛颗粒有关的情况下，局部免疫诱导的炎症反应，随后骨整合受损，牙科陶瓷植入物可以被认为是一种治疗选择。
在目标中，procedure,确定了投票方式和地点，并邀请了共识参与者。进行了系统的文献研究，根据GRADE工作组对证据的总体质量进行评级。八项建议是在独立主持的结构化共识会议的框架内制定的，可以以强烈的共识（95％的协议）进行投票。根据德国科学医学会协会（AWMF）的指导方针，以小组形式制定了声明和建议，并在全体会议上进行了讨论和商定。
为了做出合理的决策，患者的临床症状应被视为主要参数，通常通过局部炎症反应表达，随后骨整合受到干扰。过敏测试,例如表皮测试或淋巴细胞转化测试对钛不耐受评估没有帮助，因为这些测试表明T细胞介导的过敏，在钛不耐受反应中没有观察到。可能存在于上层结构或合金中的其他金属和杂质也需要被认为是不耐受反应的原因和接触敏化的触发因素。在怀疑与钛颗粒有关的情况下，局部免疫诱导的炎症反应，随后骨整合受损，牙科陶瓷植入物可以被认为是一种治疗选择。
