Statement of problem: Dental casting alloys are widely used in applications that place them into contact with oral tissues for many years. With the development of new dental alloys over the past 15 years, many questions remain about their biologic safety. Practitioners must choose among hundreds of alloy compositions, often without regard to biologic properties.
Purpose: This article is an evidence-based tutorial for clinicians. Concepts and current issues relevant to the biologic effects of dental casting alloys are presented.
Summary: The single most relevant property of a casting alloy to its biologic safety is its corrosion. Systemic and local toxicity, allergy, and carcinogenicity all result from elements in the alloy being released into the mouth during corrosion. Little evidence supports concerns of casting alloys causing systemic toxicity. The occurrence of local toxic effects (adjacent to the alloy) is not well documented, but is a higher risk, primarily because local tissues are exposed to much higher concentrations of released metal ions. Several elements such as nickel and cobalt have relatively high potential to cause allergy, but the true risk of using alloys containing these elements remains undefined. Prudence dictates that alloys containing these elements be avoided if possible. Several elements in casting alloys are known mutagens, and a few such as beryllium and cadmium are known carcinogens in different chemical forms. Despite these facts, carcinogenic effects from dental casting alloys have not been demonstrated. Prudent practitioners should avoid alloys containing these known carcinogens.
Conclusion: To minimize biologic risks, dentists should select alloys that have the lowest release of elements (lowest corrosion). This goal can be achieved by using high-noble or noble alloys with single-phase microstructures. However, there are exceptions to this generality, and selection of an alloy should be made on a case-by-case basis using corrosion and biologic data from dental manufacturers.