{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:52:27Z","timestamp":1791046347632,"version":"4.1.0"},"reference-count":110,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T00:00:00Z","timestamp":1751673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: 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. Methods: The study protocol followed the PRISMA guidelines and was registered on PROSPERO (CRD42024517942). Results: Thirty-one studies were qualitatively assessed and synthetized, involving 858 subjects (114 males and 714 females, 9\u201349 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\u201340 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. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/jcm14134766","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T06:03:13Z","timestamp":1751868193000},"page":"4766","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Hypersensitivity in Orthodontics: A Systematic Review of Oral and Extra-Oral Reactions"],"prefix":"10.3390","volume":"14","author":[{"given":"Alessandra","family":"Amato","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3877-1671","authenticated-orcid":false,"given":"Stefano","family":"Martina","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6834-2142","authenticated-orcid":false,"given":"Giuseppina","family":"De Benedetto","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambrosina","family":"Michelotti","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9485-0078","authenticated-orcid":false,"given":"Massimo","family":"Amato","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5458-6559","authenticated-orcid":false,"given":"Federica","family":"Di Spirito","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ajodo.2003.05.014","article-title":"Hypersensitivity to Metals in Orthodontics","volume":"126","author":"Menezes","year":"2004","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Yu, L., Jiang, S., Cao, F., Shen, H., Zhang, L., Gu, X., Song, H., and Sun, J. (2021). Thermal Expansion Behavior of Co-Spray Formed Al-20Si\/7075 Bimetallic Gradient Alloy. Materials, 14.","DOI":"10.3390\/ma14154100"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1038\/bdj.2008.198","article-title":"Nickel Allergy and Orthodontics, a Review and Report of Two Cases","volume":"204","author":"Noble","year":"2008","journal-title":"Br. Dent. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"653","DOI":"10.2319\/080211-487.1","article-title":"Longitudinal Assessment of Periodontal Status in Patients with Nickel Allergy Treated with Conventional and Nickel-Free Braces","volume":"82","author":"Pazzini","year":"2012","journal-title":"Angle Orthod."},{"key":"ref_5","first-page":"53","article-title":"Assessment of Allergic Hypersensitivity to Dental Materials","volume":"19","author":"Hosoki","year":"2009","journal-title":"Biomed. Mater. Eng."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1111\/odi.14184","article-title":"mRNA COVID-19 Vaccine and Oral Lichen Planus: A Case Report","volume":"28","author":"Caggiano","year":"2022","journal-title":"Oral Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1111\/odi.14361","article-title":"COVID-19 Vaccine and Oral Lesions: Putative Pathogenic Mechanisms","volume":"28","author":"Contaldo","year":"2022","journal-title":"Oral Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2500\/aap.2023.44.220074","article-title":"How Important Is Patch Testing with Dental Materials in Real-Life Clinical Practice?","volume":"44","author":"Can","year":"2023","journal-title":"Allergy Asthma Proc."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Di Spirito, F., D\u2019Ambrosio, F., Di Palo, M.P., Giordano, F., Coppola, N., and Contaldo, M. (2023). COVID-19 and Related Vaccinations in Children: Pathogenic Aspects of Oral Lesions. Children, 10.","DOI":"10.3390\/children10050809"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"73","DOI":"10.21101\/cejph.a4756","article-title":"Contact Sensitization to Ingredients of Dental Materials and Cosmetics in Dental Students: A Pilot Study","volume":"27","author":"Lyapina","year":"2019","journal-title":"Cent. Eur. J. Public Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"83","DOI":"10.4103\/2278-0203.105871","article-title":"Allergy and Orthodontics","volume":"1","author":"Chakravarthi","year":"2012","journal-title":"J. Orthod. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/j.1600-0536.2012.02097.x","article-title":"Nickel Allergy in Relation to Piercing and Orthodontic Appliances\u2014A Population Study","volume":"67","author":"Fors","year":"2012","journal-title":"Contact Dermat."},{"key":"ref_13","first-page":"35","article-title":"Association between Denture Stomatitis, Candida Species and Diabetic Status","volume":"33","author":"Contaldo","year":"2019","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_14","first-page":"2479","article-title":"Salivary Interleukin-1\u03b2: A Biochemical Marker That Predicts Periodontal Disease in Orthodontic Treatment","volume":"67","author":"Luchian","year":"2016","journal-title":"Rev. Chim."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., and Green, S. (2019). Cochrane Handbook for Systematic Reviews of Interventions, Cochrane.","DOI":"10.1002\/9781119536604"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"A12-3","DOI":"10.7326\/ACPJC-1995-123-3-A12","article-title":"The Well-Built Clinical Question: A Key to Evidence-Based Decisions","volume":"123","author":"Richardson","year":"1995","journal-title":"ACP J. Club"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"19","DOI":"10.51866\/rv1141","article-title":"Prick, Patch or Blood Test? A Simple Guide to Allergy Testing","volume":"16","author":"Muthupalaniappen","year":"2021","journal-title":"Malays. Fam. Physician"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e475","DOI":"10.1016\/j.ajodo.2021.10.015","article-title":"The Impact of Fixed Orthodontic Appliances and Clear Aligners on the Oral Microbiome and the Association with Clinical Parameters: A Longitudinal Comparative Study","volume":"161","author":"Shokeen","year":"2022","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1093\/ntr\/nty147","article-title":"Impact of Smoking Cessation on Periodontitis: A Systematic Review and Meta-Analysis of Prospective Longitudinal Observational and Interventional Studies","volume":"21","author":"Leite","year":"2019","journal-title":"Nicotine Tob. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/DER.0000000000000314","article-title":"Angioedema, Stomatitis, and Urticaria Caused by Contact Allergy to Invisalign","volume":"28","author":"Awosika","year":"2017","journal-title":"Dermatitis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/0889-5406(93)70009-D","article-title":"Nickel Hypersensitivity in the Orthodontic Patient","volume":"103","author":"Bass","year":"1993","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s00056-002-0128-z","article-title":"Nickel Allergy Associated with a Transpalatal Arch Appliance","volume":"63","author":"Counts","year":"2002","journal-title":"J. Orofac. Orthop."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.2319\/092908-509R.1","article-title":"Face and Neck Dermatitis from a Stainless Steel Orthodontic Appliance","volume":"79","author":"Ehrnrooth","year":"2009","journal-title":"Angle Orthod."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/j.1600-0536.2008.01335.x","article-title":"Facial Eczema Because of Orthodontic Fixed Retainer Wires","volume":"59","author":"Feilzer","year":"2008","journal-title":"Contact Dermat."},{"key":"ref_27","first-page":"60","article-title":"An Alternative Technique in the Treatment of Anterior Cross Bite in a Case of Nickel Allergy: A Case Report","volume":"12","author":"Giancotti","year":"2011","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"902","DOI":"10.2319\/100613-736.1","article-title":"Treatment of Adult Class II Division 2 Patient with Metal Hypersensitivity","volume":"84","author":"Haraguchi","year":"2014","journal-title":"Angle Orthod."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/S0889-5406(98)70226-4","article-title":"Nickel Hypersensitivity Reaction before, during, and after Orthodontic Therapy","volume":"113","author":"Janson","year":"1998","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/j.1600-0536.2010.01840.x","article-title":"Nickel Sensitization in Orthodontically Treated and Non-Treated Female Adolescents","volume":"64","author":"Johansson","year":"2011","journal-title":"Contact Dermat."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1111\/j.1468-3083.2004.01014.x","article-title":"Nickel Allergy and Orthodontic Treatment","volume":"18","author":"Kalimo","year":"2004","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S1081-1206(10)60870-8","article-title":"Allergic Contact Stomatitis from Orthodontic Rubber Bands","volume":"98","author":"Kelso","year":"2007","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/S0889-5406(96)70175-0","article-title":"Nickel Allergy in Adolescents in Relation to Orthodontic Treatment and Piercing of Ears","volume":"109","author":"Kerosuo","year":"1996","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1600-0536.1997.tb00431.x","article-title":"Systemic Contact Dermatitis Caused by Nickel in a Stainless Steel Orthodontic Appliance","volume":"36","author":"Kerosuo","year":"1997","journal-title":"Contact Dermat."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"186","DOI":"10.2319\/111507-531.1","article-title":"A Severe Reaction to Ni-Containing Orthodontic Appliances","volume":"79","author":"Kolokitha","year":"2009","journal-title":"Angle Orthod."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1034\/j.1600-0536.2002.460415.x","article-title":"Eyelid Dermatitis and Conjunctivitis as Sole Manifestations of Allergy to Nickel in an Orthodontic Appliance","volume":"46","author":"Mancuso","year":"2002","journal-title":"Contact Dermat."},{"key":"ref_37","first-page":"403","article-title":"Titanium Orthodontic Appliances for Allergic Patients","volume":"63","author":"Maspero","year":"2014","journal-title":"Minerva Stomatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.ajodo.2016.05.009","article-title":"Nickel-Free vs Conventional Braces for Patients Allergic to Nickel: Gingival and Blood Parameters during and after Treatment","volume":"150","author":"Pazzini","year":"2016","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/j.0105-1873.2004.0295b.x","article-title":"Systemic Contact Dermatitis from Nickel Associated with Orthodontic Appliances","volume":"50","author":"Pigatto","year":"2004","journal-title":"Contact Dermat."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5005\/jcdp-5-4-79","article-title":"Nickel and Cobalt Hypersensitivity Reaction before and after Orthodontic Therapy in Children","volume":"5","author":"Saglam","year":"2004","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"580","DOI":"10.12968\/denu.2015.42.6.580","article-title":"An Unusual Allergic Response to Orthodontic Treatment","volume":"42","author":"Shargill","year":"2015","journal-title":"Dent. Update"},{"key":"ref_42","first-page":"103","article-title":"Allergic Contact Dermatitis in Child with Odontoiatric Face-Mask","volume":"47","author":"Tammaro","year":"2015","journal-title":"Eur. Ann. Allergy Clin. Immunol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1600-0536.1994.tb00645.x","article-title":"Stomatitis or Systemically-induced Contact Dermatitis from Metal Wire in Orthodontic Materials","volume":"30","author":"Veien","year":"1994","journal-title":"Contact Dermat."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.aller.2009.05.005","article-title":"Allergic Contact Dermatitis to Manganese in a Prosthodontist with Orthodontics","volume":"38","author":"Zamberk","year":"2010","journal-title":"Allergol. Immunopathol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s40510-020-00318-4","article-title":"Symptoms of Titanium and Nickel Allergic Sensitization in Orthodontic Treatment","volume":"21","author":"Zigante","year":"2020","journal-title":"Prog. Orthod."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Paschaei, N., M\u00fcller, W.-D., Schmidt, F., H\u00fcsker, K., von Baehr, V., Pandis, N., Jost-Brinkmann, P.-G., and Bartzela, T. (2024). Unveiling the Role of Metal Ion Concentration versus Immune Sensitization in Orthodontic Patients\u2014A Long-Term Prospective Evaluation. J. Clin. Med., 13.","DOI":"10.3390\/jcm13154545"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1590\/S1806-83242007000400003","article-title":"Hypersensitivity to Conventional and to Nickel-Free Orthodontic Brackets","volume":"21","author":"Pantuzo","year":"2007","journal-title":"Braz. Oral Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"173","DOI":"10.21101\/cejph.a7122","article-title":"Clinical Predictors of Metal Allergic Sensitization in Orthodontic Patients","volume":"30","author":"Zigante","year":"2022","journal-title":"Cent. Eur. J. Public Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1111\/ocr.12379","article-title":"Smell and Taste in Titanium and Nickel Allergic Sensitization in Orthodontic Patients","volume":"23","author":"Zigante","year":"2020","journal-title":"Orthod. Craniofacial Res."},{"key":"ref_50","first-page":"205","article-title":"Sex-Based Differences in Autoimmune Diseases","volume":"52","author":"Ortona","year":"2016","journal-title":"Ann. Ist. Super. Sanita"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"258","DOI":"10.4103\/jisp.jisp_103_17","article-title":"Reactive Lesions of Oral Cavity: A Retrospective Study of 659 Cases","volume":"21","author":"Babu","year":"2017","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.oooo.2017.02.007","article-title":"Review: Allergic Contact Stomatitis","volume":"123","author":"Feller","year":"2017","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Di Spirito, F., Lo Giudice, R., Amato, M., Di Palo, M.P., D\u2019Ambrosio, F., Amato, A., and Martina, S. (2022). Inflammatory, Reactive, and Hypersensitivity Lesions Potentially Due to Metal Nanoparticles from Dental Implants and Supported Restorations: An Umbrella Review. Appl. Sci., 12.","DOI":"10.3390\/app122111208"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jaad.2021.03.092","article-title":"Cutaneous Reactions Reported after Moderna and Pfizer COVID-19 Vaccination: A Registry-Based Study of 414 Cases","volume":"85","author":"McMahon","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Di Spirito, F., Amato, A., Di Palo, M.P., Contaldo, M., D\u2019Ambrosio, F., Lo Giudice, R., and Amato, M. (2022). Oral Lesions Following Anti-SARS-CoV-2 Vaccination: A Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191610228"},{"key":"ref_56","first-page":"331","article-title":"Mucocutaneous Adverse Effects Following COVID-19 Vaccination: A Case Series with a Comprehensive Review of the Literature","volume":"24","author":"Hatami","year":"2021","journal-title":"Iran. J. Dermatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1038\/modpathol.2016.121","article-title":"Oral Lichenoid Lesions: Distinguishing the Benign from the Deadly","volume":"30","year":"2017","journal-title":"Mod. Pathol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e929690","DOI":"10.12659\/AJCR.929690","article-title":"Use of Diode Laser for Surgical Removal of Pyogenic Granuloma of the Lower Lip in a Pediatric Patient: A Case Report","volume":"22","author":"Pisano","year":"2021","journal-title":"Am. J. Case Rep."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"470","DOI":"10.2500\/aap.2019.40.4274","article-title":"Classification of Hypersensitivity Reactions","volume":"40","author":"Dispenza","year":"2019","journal-title":"Allergy Asthma Proc."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1002\/jat.3129","article-title":"Metals in Cosmetics: Implications for Human Health","volume":"35","author":"Borowska","year":"2015","journal-title":"J. Appl. Toxicol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1365-2249.2008.03716.x","article-title":"Allergy and the Eye","volume":"153","author":"Leonardi","year":"2008","journal-title":"Clin. Exp. Immunol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Habib, N., Pasha, M.A., and Tang, D.D. (2022). Current Understanding of Asthma Pathogenesis and Biomarkers. Cells, 11.","DOI":"10.3390\/cells11172764"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/cod.14199","article-title":"Nickel Allergy Is Associated with a Broad Spectrum Cytokine Response","volume":"88","author":"Roffel","year":"2023","journal-title":"Contact Dermat."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1016\/j.ijporl.2015.09.026","article-title":"Vertigo with Dysautonomia and Serious Allergy: An Unusual Case of Juvenile M\u00e9ni\u00e8re\u2019s Disease","volume":"79","author":"Wu","year":"2015","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"10","DOI":"10.53151\/2531-3916\/2022-12","article-title":"Allergia al Lattice","volume":"36","author":"Arasi","year":"2022","journal-title":"Ital. J. Pediatr. Allergy Immunol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S0091-6749(98)70169-1","article-title":"Prevalence and Risk Factors of Latex Sensitization in an Unselected Pediatric Population","volume":"101","author":"Bernardini","year":"1998","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"s31","DOI":"10.29262\/ram.v69iSupl1.1012","article-title":"Alergia al L\u00e1tex: Una Revisi\u00f3n Sobre Los Aspectos M\u00e1s Importantes","volume":"69","year":"2022","journal-title":"Rev. Alerg. Mex."},{"key":"ref_68","first-page":"369","article-title":"Differentiation of Latex Allergy from Irritant Contact Dermatitis","volume":"96","author":"Burkhart","year":"2015","journal-title":"Cutis"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"100472","DOI":"10.1016\/j.waojou.2020.100472","article-title":"World Allergy Organization Anaphylaxis Guidance 2020","volume":"13","author":"Cardona","year":"2020","journal-title":"World Allergy Organ. J."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1542\/peds.111.S3.1617","article-title":"Skin Manifestations of Food Allergy","volume":"111","author":"Burks","year":"2003","journal-title":"Pediatrics"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Subramani, K., Huja, S., Kluemper, G.T., Morford, L., and Hartsfield, J.K. (2013). Nanotechnology in Orthodontics\u20131. Nanobiomaterials in Clinical Dentistry, Elsevier.","DOI":"10.1016\/B978-1-4557-3127-5.00011-8"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s007840050088","article-title":"Bisphenol-A Content of Resin Monomers and Related Degradation Products","volume":"3","author":"Schmalz","year":"1999","journal-title":"Clin. Oral Investig."},{"key":"ref_73","first-page":"958","article-title":"Mercury Vapors from Premeasured Amalgam Capsules","volume":"103","author":"Wirz","year":"1993","journal-title":"Schweiz. Monatsschr. Zahnmed."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/s007840050027","article-title":"Concepts in Biocompatibility Testing of Dental Restorative Materials","volume":"1","author":"Schmalz","year":"1998","journal-title":"Clin. Oral Investig."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1254\/jjp.76.325","article-title":"Roles of Chemical Mediators in the Taste System","volume":"76","author":"Yamamoto","year":"1998","journal-title":"Jpn. J. Pharmacol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"505","DOI":"10.4103\/ijdr.IJDR_647_20","article-title":"Adverse Effect of Consumption of Carbonated Soft Drinks on Orthodontic Treatment\u2014A Systematic Review","volume":"32","author":"Venkatesan","year":"2021","journal-title":"Indian J. Dent. Res."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jtemb.2015.03.007","article-title":"Do Soft Drinks Affect Metal Ions Release from Orthodontic Appliances?","volume":"31","author":"Mikulewicz","year":"2015","journal-title":"J. Trace Elem. Med. Biol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/adj.12473","article-title":"Adverse Reactions to Orthodontic Materials","volume":"62","author":"Sifakakis","year":"2017","journal-title":"Aust. Dent. J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"102","DOI":"10.2319\/083007-401.1","article-title":"Type of Archwire and Level of Acidity: Effects on the Release of Metal Ions from Orthodontic Appliances","volume":"79","author":"Kuhta","year":"2009","journal-title":"Angle Orthod."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Pastor, F., Rodriguez, J.C., Barrera, J.M., Garc\u00eda-Menocal, J.A.D., Brizuela, A., Puigdollers, A., Espinar, E., and Gil, J. (2023). Effect of Fluoride Content of Mouthwashes on the Metallic Ion Release in Different Orthodontics Archwires. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20042780"},{"key":"ref_81","first-page":"e46615","article-title":"A Review on Orthodontic Brackets and Their Application in Clinical Orthodontics","volume":"15","author":"Mundhada","year":"2023","journal-title":"Cureus"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.reactfunctpolym.2004.02.013","article-title":"Bisphenol A Synthesis\u2014Modeling of Industrial Reactor and Catalyst Deactivation","volume":"60","author":"Prokop","year":"2004","journal-title":"React. Funct. Polym."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/S0045-6535(97)10133-3","article-title":"A Review of the Environmental Fate, Effects, and Exposures of Bisphenol A","volume":"36","author":"Staples","year":"1998","journal-title":"Chemosphere"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.ajodo.2009.03.006","article-title":"Cytotoxicity and Estrogenicity of Invisalign Appliances","volume":"136","author":"Eliades","year":"2009","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.jdsr.2022.03.003","article-title":"Effectiveness of Surgical Procedures in the Acceleration of Orthodontic Tooth Movement: Findings from Systematic Reviews and Meta-analyses","volume":"58","author":"Gasparro","year":"2022","journal-title":"Jpn. Dent. Sci. Rev."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"7014","DOI":"10.1073\/pnas.0502544102","article-title":"Estrogenic Chemicals in Plastic and Oral Contraceptives Disrupt Development of the Fetal Mouse Prostate and Urethra","volume":"102","author":"Timms","year":"2005","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_87","first-page":"2271","article-title":"Control of Cell Proliferation: Evidence for Negative Control on Estrogen-Sensitive T47D Human Breast Cancer Cells","volume":"46","author":"Soto","year":"1986","journal-title":"Cancer Res."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"41","DOI":"10.4103\/1735-3327.372658","article-title":"A Systematic Review of Biocompatibility and Safety of Orthodontic Clear Aligners and Transparent Vacuum-Formed Thermoplastic Retainers: Bisphenol-A Release, Adverse Effects, Cytotoxicity, and Estrogenic Effects","volume":"20","author":"Yazdi","year":"2023","journal-title":"Dent. Res. J."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/0022-3913(80)90176-6","article-title":"Reactions to Acrylic Resin Dental Prostheses","volume":"43","author":"Weaver","year":"1980","journal-title":"J. Prosthet. Dent."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ajodo.2013.09.011","article-title":"Oral Epithelial Cell Reaction after Exposure to Invisalign Plastic Material","volume":"145","author":"Premaraj","year":"2014","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.ajodo.2015.09.020","article-title":"How Long Does Treatment with Fixed Orthodontic Appliances Last? A Systematic Review","volume":"149","author":"Tsichlaki","year":"2016","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_92","unstructured":"Marwa, K., and Kondamudi, N.P. (2024). Type IV Hypersensitivity Reaction, StatPearls."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Primozic, J., Hren, M., Mezeg, U., and Legat, A. (2022). Tribocorrosion Susceptibility and Mechanical Characteristics of As-Received and Long-Term In-Vivo Aged Nickel-Titanium and Stainless-Steel Archwires. Materials, 15.","DOI":"10.3390\/ma15041427"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Mo\u010dnik, P., and Kosec, T. (2021). A Critical Appraisal of the Use and Properties of Nickel\u2013Titanium Dental Alloys. Materials, 14.","DOI":"10.3390\/ma14247859"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.msec.2017.04.050","article-title":"The Effect of PH, Fluoride and Tribocorrosion on the Surface Properties of Dental Archwires","volume":"78","author":"Kosec","year":"2017","journal-title":"Mater. Sci. Eng. C"},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Imani, M., Mozaffari, H., Ramezani, M., and Sadeghi, M. (2019). Effect of Fixed Orthodontic Treatment on Salivary Nickel and Chromium Levels: A Systematic Review and Meta-Analysis of Observational Studies. Dent. J., 7.","DOI":"10.3390\/dj7010021"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/BF01043419","article-title":"Nickel Content of Food and Estimation of Dietary Intake","volume":"179","author":"Flyvholm","year":"1984","journal-title":"Z. Lebensm. Unters. Forsch."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12989-019-0317-1","article-title":"Distribution of Nickel and Chromium Containing Particles from Tattoo Needle Wear in Humans and Its Possible Impact on Allergic Reactions","volume":"16","author":"Schreiver","year":"2019","journal-title":"Part. Fibre Toxicol."},{"key":"ref_99","unstructured":"Justiz Vaillant, A.A., Modi, P., and Jan, A. (2025, June 29). Atopy; StatPearls: St. Petersburg, FL, USA, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/31194344\/."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Lee, J., and Lee, H. (2023). Sacrificial-Rotating Rod-Based 3D Bioprinting Technique for the Development of an In Vitro Cardiovascular Model. J. Funct. Biomater., 15.","DOI":"10.3390\/jfb15010002"},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Wang, Z., Cao, K., Xia, L., Wei, D., and Zhang, Y. (2023). Montmorillonite-Sodium Alginate Oral Colon-Targeting Microcapsule Design for WGX-50 Encapsulation and Controlled Release in Gastro-Intestinal Tract. J. Funct. Biomater., 15.","DOI":"10.3390\/jfb15010003"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Ambrogi, V., Nocchetti, M., Pietrella, D., Quaglia, G., Di Michele, A., and Latterini, L. (2023). Antimicrobial Oleogel Containing Sustainably Prepared Silver-Based Nanomaterials for Topical Application. J. Funct. Biomater., 15.","DOI":"10.3390\/jfb15010004"},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Alfonsi, S., Karunathasan, P., Mamodaly-Samdjee, A., Balathandayutham, K., Lefevre, S., Miranda, A., Gallet, O., Seyer, D., and Hindi\u00e9, M. (2023). Fibronectin Conformations after Electrodeposition onto 316L Stainless Steel Substrates Enhanced Early-Stage Osteoblasts\u2019 Adhesion but Affected Their Behavior. J. Funct. Biomater., 15.","DOI":"10.3390\/jfb15010005"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/cod.13917","article-title":"Chromium and Cobalt Release from Metallic Earrings from the Danish Market","volume":"85","author":"Wennervaldt","year":"2021","journal-title":"Contact Dermat."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/cod.14107","article-title":"Nickel and Cobalt Release from Beauty Tools: A Field Study in the German Cosmetics Trade","volume":"87","author":"Symanzik","year":"2022","journal-title":"Contact Dermat."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Poli, P.P., de Miranda, F.V., Polo, T.O.B., Santiago J\u00fanior, J.F., Lima Neto, T.J., Rios, B.R., Assun\u00e7\u00e3o, W.G., Ervolino, E., Maiorana, C., and Faverani, L.P. (2021). Titanium Allergy Caused by Dental Implants: A Systematic Literature Review and Case Report. Materials, 14.","DOI":"10.3390\/ma14185239"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/j.1708-8208.2010.00330.x","article-title":"Is Titanium Sensitivity Associated with Allergic Reactions in Patients with Dental Implants? A Systematic Review","volume":"15","author":"Javed","year":"2013","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1542\/peds.112.4.815","article-title":"Risk of Anaphylaxis After Vaccination of Children and Adolescents","volume":"112","author":"Bohlke","year":"2003","journal-title":"Pediatrics"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Di Spirito, F., Amato, A., Di Palo, M.P., Ferraro, R., Cannat\u00e0, D., Galdi, M., Sacco, E., and Amato, M. (2024). Oral and Extra-Oral Manifestations of Hypersensitivity Reactions in Orthodontics: A Comprehensive Review. J. Funct. Biomater., 15.","DOI":"10.3390\/jfb15070175"},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Luchian, I., Martu, M.-A., Tatarciuc, M., Scutariu, M.M., Ioanid, N., Pasarin, L., Kappenberg-Nitescu, D.C., Sioustis, I.-A., and Solomon, S.M. (2021). Using FEM to Assess the Effect of Orthodontic Forces on Affected Periodontium. Appl. Sci., 11.","DOI":"10.3390\/app11167183"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4766\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:05:13Z","timestamp":1760033113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,5]]},"references-count":110,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134766"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134766","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,5]]}}}