Comparison Between Nickel and Chromium Levels in Serum and Urine in Patients Treated with Fixed Orthodontic Appliances: A Longitudinal Study

Susilowati Mudjari, Muhammad Harun Achmad


Objective: To compare levels of nickel and chromium in serum and urine in orthodontic patients treated with fixed orthodontic appliances. Material and Methods: Nickel and chromium ion concentration were measured in serum and urine of twenty patients (12 females and 8 males, aged 17-28 years old) who had fixed orthodontic treatment using Coupled Plasma-Atomic Emission Spectroscopy. The samples were taken before treatment (Baseline), two months, and six months later during treatment. Data were analyzed using repeated ANOVA, Bonferroni post-hoc test, and paired t-tests. The level of significance was set at 5%. Results: Average serum nickel level changed from 6.420 ppb to 6.855 ppb. Average serum chromium level changed from 5.305 ppb to 5.505 ppb in 6 months. Average urinary nickel level changed from 5.320 ppb to 5.610 ppb. Average urinary chromium level changed from 5.370 ppb to 5.520 ppb in 6 months. There was a statistically significant difference in serum (p<0.001) and urinary chromium (p=0.007) levels between observation times. Conclusion: Orthodontic treatment might raise both urinary and serum nickel levels, but the differences were not statistically significant; the alterations in chromium levels were not consistent; nickel levels were higher in serum than in urine; chromium levels were higher in urine than in serum.


Orthodontic Appliances; Serum; Orthodontic Brackets

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Chaturvedi TP, Bansal R. Biocompatibility of dental implant materials: An overview. J Indian Dent Assoc 2008; 2:335-7.

Mikulewicz M, Chojnacka K. Trace metal release from orthodontic appliances by invivo studies: A systematic literature review. Biol Trace Elem Res 2011; 137(2):127-38. doi: 10.1007/s12011-009-8576-6.

Rafeeq RA. Saleem AI. Nissan LM. Ions release from fixed orthodontic appliance in two different mouthwash. J Baghdad Coll Dent 2014; 26(4):152-5.

Forgacs Z, Massányi P, Lukac N, Somosy Z. Reproductive toxicology of nickel – Review. J Environ Sci Health A Tox Hazard Subst Environ Eng 2012; 47(9):1249-60. doi: 10.1080/10934529.2012.672114.

Kerosuo H, Moe G, Hensten-Pettersen A. Salivary nickel and chromium in subjects with different types of fixed orthodontic appliances. Am J Orthod Dentofac Orthop 2003; 111(6):595-8. doi: 10.1016/S0889-5406(97)70310-X.

Talic NF, Alnahwi HH, Al-Faraj AS. Nickel and chromium levels in the saliva of a Saudi sample treated with fixed orthodontic appliances. Saudi Dent J 2012; 25(4):129-33. doi: 10.1016/j.sdentj.2013.10.001.

Amini F, Rakhsan V, Mesgarzadeh N. Effect of long-term fixed orthodontic treatment on salivary nickel and chromium levels: A 1-year prospective cohort study. Biol Trace Elem Res 2012; 150(1-3):15-20. doi: 10.1007/s12011-012-9457-y.

Rai RV, Shetty S, Ahluwalia R, George S. Quantitative assessment of serum nickel and chromium levels in orthodontic patients: An in vivo study. J Indian Orthod Soc 2011; 45(4):251-5.

Satija A, Sidhu MS, Grover S, Malik V, Yadav P. Evaluation of salivary and serum concentration of Ni and Cr ions in orthodontic patients and their possible influence on hepatic enzyme: An in vivo study. J Indian Orthod Soc 2014; 48(4):518-24.

Amini F, Rakhshan V, Sadeghi P. Effect of fixed orthodontic therapy on urinary nickel levels: A long-term retrospective cohort study. Biol Trace Elem Res 2012; 50(1-3):15-20.

Menezes LM, Quintão CA, Bolognese AM. Urinary excretion levels of nickel in orthodontic patients. Am J Orthod Dentofac Orthop 2007; 131(5):635-8. doi: 10.1016/j.ajodo.2005.07.022.

Yassae S, Dadfamia S, Ahadian H, Moradi F. Nickel and chromium levels in the saliva of patients with fixed orthodontic appliances. Orthodontics 2013; 14(1):e76-81. doi: 10.11607/ortho.810.

Neamah ZT. Nickel and chromium ions levels in saliva of patients with fixed orthodontic appliances. Med J Babylon 2014; 11(3):557-66.

Nayak BR, Khanna B, Pasha A, Vinay K, Narayan A, Chaitra K. Evaluation of nickel and chromium Ion release during fixed orthodontic treatment using Inductively Coupled Plasma-Mass Spectrometer: An in vivo study. J Int Oral Health 2015; 7(8):14-20.

Agaoglu G, Arun T, Izgi B, Yarat A. Nickel and chromium levels in the saliva and serum of patients with fixed orthodontic appliances. Angle Orthod 2001; 71(5):375-9.

Agarwal P, Upadhyay U, Tandon R, Kumar S. Nickel allergy and orthodontics. Asian J Oral Health Allied Sci 2011; 1(1):61-3.

Dayan AD, Paine AJ. Mechanisms of chromium toxicity, carcinogenicity and allergenicity: Review of the literature from 1985 to 2000. Hum Exp Toxicol 2001; 20(9):439-51. doi: 10.1191/096032701682693062.

Hyun Soo Kim, Yeo Jin Ki, Young Rok Seo. An overview of carcinogenic heavy metal: Molecular mechanism an prevention. J Cancer Prev 2015; 20(4):232-40. doi: 10.15430/JCP.2015.20.4.232.

Faccioni F, Franceschetti P, Cerpelloni M, Fracasso M E. In-vivo study on metal release from fixed orthodontic appliances and DNA damage in oral mucosal cells. Am J Orthod Dentofac Orthoped 2003; 124(6):687-93. doi: 10.1016/S0889540603007418.

Sunderman FW Jr. Biological monitoring of nickel in human. Scand J Work Environ Health1993; 19(Suppl1):34-8.

Achmad H, Adam M, Oktawati S, Karim SR, Thahir H, Pratiwi R, Wicita A. An overjet reduction of class II, division 1 malocclusion in twin block dentofacial orthopedic and fixed orthodontic treatment: Case report. J Int Dent Med Res 2017; 10(3):1010-16.

Saleem AS, Aldaggistany MS, Ahmed AS. Nickel & chromium ion release from fixed orthodontic appliances in Iraqi patients. Mustansiria Dent J 2011; 8(2):139-43.

Pazzini CA, Júnior GO, Marques LS, Pereira CV, Pereira LJ. Prevalence of nickel allergy and longitudinal evaluation of periodontal abnormalities in orthodontic allergic patients. Angle Orthod 2009; 79(5):922-7. doi: 10.2319/081408-430.1.

Achmad H, Tahir H, Adam M, Ramadhany YF. Increased overjet in growing child, problem solving in pediatric dentistry. J Int Dent Med Res 2017; 10(2):374-9.