LAUSR

The adolescent girl was referred for patch testing before placement of a permanent retainer. One year ago, she experienced a severe adverse reaction to the application of standard braces. Two days after placement, she noted a pruritic and burning rash on her forehead that spread down her face and then to her neck and arms. The braces were removed 5 days after placement, leaving the brackets adhered to the teeth. With the rash worsening, the brackets were then removed, and subsequently, the rash resolved completely within a week. Dental alignment was achieved using Invisalign for 1 year, and the patient experienced no further problems. Having completed alignment, a permanent retainer was now planned for maintenance care. The patient and her mother were concerned about the potential risk of allergic reaction to retainer components. The orthodontist provided details on all materials to be used and included samples of the wires, adhesives, curing agents, and other retainer components for product patch testing. The patient was patch tested with the North American Core Allergen Series, dental screening patient grouping, and all retainer components intended for direct application to the oral mucosa. At 48 and 96 hours, she had a 1+ reaction with erythema and pruritis to a 3MTransbond Light Cure adhesive sample provided by the orthodontist, which at 96 hours evolved to a 3+ reaction with blistering and epidermal erosion. No reaction was observed to metal wires or other retainer and installation components. The adhesive ingredients include silane-treated quartz, bisphenol A diglycidyl ether dimethacrylate (Bis-GMA), triethylene glycol dimethacrylate, dichlorodimethylsilane, N,Ndimethylbenzocaine, and diphenyliodoniumhexafluorophosphate. Notably, the same adhesive was used in the original brace brackets, so the patient had a previous exposure, and the timing of both her reaction and recovery implicated the adhesive as the cause of the braces-related rash. Previous similar case reports of dental adhesive reactions identified Bis-GMA as the responsible allergen based on patch testing results. However, the dental screening grouping tested on this patient includes Bis-GMA, which was negative on patch testing, suggesting that either a different ingredient was responsible or the concentration differed. One limitation in the current case is that the adhesive sample was applied undiluted and was not light cured, so the more reactive unpolymerized material was in contact with the epidermis, potentially generating a stronger reaction than if light cured. Based on the patch testing results, a removable Invisalign retainer was chosen for maintenance. With increasing reports of allergies to dental devices, patch testing should be considered in individuals with a history of contact reactions to metals or acrylics. In this case, patch testing was performed after a severe reaction to traditional braces containing metal wires and acrylic bonding materials. Patch testing revealed contact allergies to the dental acrylic adhesive, effectively ruling out installation of a