D1.90 - Soft Tissue Loss Due to Allergic Reaction to Ahesive System during Orthodontic Treatment: A Case Report

Relevance of the Problem: The use of dental materials at all treatment stages carries a risk of allergic. Among dental professionals, the most frequent allergens are latex, acrylates, and formaldehyde. Polymethacrylates and latex are typically associated with delayed hypersensitivity, whereas sodium metabisulphite and nickel are linked to immediate reactions. The increasing prevalence of material-related allergies highlights the importance of awareness among dentists to minimize adverse reactions.

Clinical Case: A 21-year-old female presented for orthodontic treatment. During preparation, professional oral hygiene and composite restoration of tooth 26 (mesial and occlusal surfaces) were performed. One month later, a ceramic bracket system was bonded with an adhesive composite cement. Eleven days post-bonding, mild gingival swelling and erythema at tooth 26 were noted; oral hygiene reinforcement and antibacterial rinses were recommended. Four months later, a localized soft tissue lesion appeared between teeth 25 and 26, extending to adjacent gingiva. The patient had no chronic allergic or autoimmune diseases, negative family history of atopy, frequent childhood upper respiratory infections, and a mild COVID-19 course in 2021.

Examination Findings: Hypersensitivity to composite/adhesive monomers was suspected. Patch testing showed a positive reaction to 2-Hydroxyethylmethacrylat (HEMA) on day 7. Specific IgE testing revealed sensitization to house dust mites, with total IgE 193.0 kU/L; complete blood count was normal.

Discussion: As the affected tooth had a composite restoration performed by the same dentist, technique factors, such as a possible overhanging margin, may have played a contributory role in the observed clinical presentation.

Conclusions: Certain dental materials can induce allergic reactions in sensitized patients. Dentists should maintain high standards of cleanliness and precision to minimize risk.

Consent for publication: Written informed consent was obtained from the patient for publication of clinical details and images.