Can Dental Implants Make You Sick? Separating Fact from Fiction

#Dental #Implants #Make #Sick #Separating #Fact #from #Fiction

Can Dental Implants Make You Sick? Separating Fact from Fiction

Alright, let's cut to the chase. You're here because you're considering dental implants, or maybe you've already had them placed, and that little voice in the back of your head is whispering, "What if this makes me sick?" It’s a completely valid, deeply human concern. After all, we’re talking about placing a foreign object directly into your bone, connecting it to your bloodstream, and relying on it to become a permanent part of your body. That’s a big deal. The internet, bless its heart, is a swirling vortex of information – some gold, some absolute dross – and it’s easy to get lost in a labyrinth of anecdotal horror stories and half-truths. My goal here, as someone who’s seen a lot of smiles transformed and a few anxieties quelled over the years, is to pull back the curtain. We're going to dive deep, separating the genuine, albeit rare, potential complications from the normal, expected bumps in the road, and yes, even debunking some of the more outlandish myths that tend to circulate. This isn't just about what can go wrong; it's about understanding why, how often, and what you can do about it. So, let’s get real about dental implants and your health.

The Initial Concern: Understanding Post-Operative Sickness

When you walk out of a dental implant surgery, it’s not exactly like leaving a spa day. You've just had a surgical procedure, and your body, being the incredible machine it is, immediately kicks into healing mode. This process, while ultimately beneficial, isn't always comfortable. Many people confuse the normal, anticipated sensations of post-surgical recovery with being "sick" in the conventional sense – like having the flu or a stomach bug. It's crucial to differentiate these experiences, as understanding what's typical can save you a lot of unnecessary worry. Your body is undergoing a significant repair job, and just like after any major renovation project, there's going to be some dust and debris before everything looks pristine. This initial phase is often where the line between "feeling unwell" and "being sick" blurs for many patients, and it's where we need to start our comprehensive exploration.

Expected Post-Op Symptoms vs. "Feeling Sick"

Let's be brutally honest: surgery, by its very definition, involves some trauma to the body. Even a minimally invasive dental implant procedure is a surgical intervention, and your body's response to that trauma is predictable and, for the most part, entirely normal. When I talk to patients, I always emphasize that discomfort is an expected companion for a few days, not a sign that something has inherently gone wrong. The mild pain you feel, for instance, isn't a sign of sickness; it's your body's alarm system telling you to take it easy and allow the healing process to unfold. It’s a dull ache, perhaps a throbbing sensation, which is managed effectively with prescribed pain relief. This is vastly different from a sharp, escalating pain accompanied by other alarming symptoms, which would indeed warrant a call to your clinician.

Then there's the swelling and bruising – oh, the joys of post-op swelling! It’s the body's inflammatory response, a natural and necessary part of healing. Blood vessels dilate, fluids rush to the site, and immune cells get to work. This can make your face look a bit like you’ve gone a round with a prizefighter, and while it might be unsightly, it’s rarely a cause for alarm unless it’s excessively severe, rapidly worsening, or accompanied by a fever. Bruising, too, is simply blood escaping from capillaries and pooling under the skin; it's going to change colors like a sunset, from purplish-blue to greenish-yellow, before fading away. Again, this isn't sickness; it's just your body tidying up after the construction work. It’s important to remember that these are localized responses to a localized event, not systemic illness.

Minor bleeding is another common post-operative experience. You might notice a bit of pink in your saliva, or a slight oozing from the surgical site. This is completely normal and expected for the first 24-48 hours. It's not a hemorrhage, it's just residual blood seeping from the wound as it begins to clot and seal. The taste of blood in your mouth can be unpleasant, even metallic, and can contribute to a general feeling of being "off," but it's not indicative of systemic sickness. Similarly, difficulty eating or speaking comfortably for a few days due to tenderness or numbness isn’t sickness; it’s a temporary functional limitation that improves as healing progresses.

Perhaps one of the most overlooked aspects of post-operative recovery that contributes to feeling "sick" is simple fatigue. Your body is expending an immense amount of energy on healing. Think of it like running a marathon without actually moving – all that cellular repair, tissue regeneration, and immune system activity demands a significant energy budget. This isn't the kind of fatigue you get from a viral infection; it’s a profound tiredness that signals your body needs rest to recover optimally. Ignoring this need can actually prolong your recovery and make you feel more generally unwell. It's your body’s way of saying, "Hey, put your feet up and let me do my job."

Finally, let’s not discount the psychological aspect. The anxiety leading up to surgery, the stress of the procedure itself, and the anticipation of recovery can all take a toll on your mental and emotional well-being. This stress can manifest physically, making you feel generally rundown, irritable, or simply "not yourself." It’s an emotional hangover, if you will, and while it isn't sickness, it certainly contributes to that overall feeling of malaise. Recognizing these expected symptoms for what they are – part of the healing journey – is the first step in managing your recovery effectively and reducing undue worry.

Anesthesia and Sedation After-Effects

Now, let's talk about the initial culprit for a good chunk of that "feeling sick" sensation: the anesthesia and sedation. Whether you had local anesthesia, conscious sedation, or something more profound, these medications are powerful agents designed to make your experience comfortable and pain-free. But, as with any powerful medication, they come with a temporary aftermath. Even local anesthesia, which only numbs a specific area, can leave you feeling a bit odd. That prolonged numbness in your lip, tongue, or cheek can be disorienting. You might drool a bit, struggle to speak clearly, or find it hard to eat without biting yourself. This isn't systemic sickness, but the sensation of being out of control of part of your face can certainly contribute to feeling generally out of sorts and unsettled. It’s a peculiar feeling, like wearing a mask you can’t take off, and for some, it’s enough to make them feel truly unwell until it completely wears off.

When we move into conscious sedation or IV sedation – the stuff that makes you feel wonderfully relaxed and often forgetful of the procedure – the potential for feeling "sick" ramps up significantly. Nausea is a common side effect of many sedatives and anesthetic agents. These medications can directly affect the vagus nerve, which plays a role in controlling the digestive system, or they can simply disrupt the delicate balance of your gut. I’ve seen countless patients wake up from sedation feeling a bit queasy, and it’s completely normal. Some individuals are just more sensitive to these effects than others, and it's not always predictable. This isn't a sign of infection or a deeper problem; it’s just your body processing and eliminating the drugs. It’s often exacerbated by dehydration or an empty stomach, which is why we always recommend clear fluids and light, bland foods post-sedation.

Then there’s the grogginess, the mental fog, the sheer exhaustion that often accompanies sedation. You might feel disoriented, like you’re walking through treacle, or struggle to concentrate. This "hangover" effect isn't sickness; it’s your central nervous system slowly returning to its normal state after being temporarily suppressed. You might feel like you could sleep for a week, and frankly, that's often exactly what your body wants to do. This impaired judgment and fatigue mean you shouldn’t drive, operate machinery, or make important decisions for at least 24 hours post-sedation. It's a temporary state of reduced function, not an illness, but it certainly contributes to that overall feeling of being unwell and out of sync with your normal self.

Furthermore, the post-anesthesia period often involves a disruption to your normal eating and drinking patterns. You might be advised to avoid solid foods for a period, or you might simply not feel like eating. This lack of proper nutrition and hydration can exacerbate feelings of malaise, headache, and weakness. Combine that with the drug effects, and it's a recipe for feeling pretty rough. That’s why gentle rehydration with water or clear broths, and slowly introducing bland foods, is so critical in the immediate hours after surgery. It helps your body bounce back faster from the anesthetic effects and mitigates that "sick" feeling.

The good news is that these anesthesia and sedation after-effects are almost always transient. They typically resolve within 24 hours, though some lingering fatigue might persist for a bit longer. The key is to plan for it: have someone drive you home, prepare a comfortable recovery space, and give yourself permission to simply rest and recover. Don’t push yourself. Your body needs time to metabolize these medications and re-establish its normal rhythms. Understanding that these feelings are a direct, temporary consequence of the necessary medications, rather than a sign of something fundamentally wrong with the implant or your health, is incredibly empowering for patients.

Medication Side Effects (Painkillers, Antibiotics)

Beyond the direct aftermath of surgery and anesthesia, the medications you're prescribed to manage your recovery can be significant contributors to that "sick" feeling. Let's start with the heavy hitters: opioid painkillers. While incredibly effective at managing post-surgical pain, they come with a well-documented list of side effects. Nausea and vomiting are notoriously common, as opioids can affect the chemoreceptor trigger zone in the brain, which controls emesis. They also significantly slow down gut motility, leading to constipation – another deeply uncomfortable sensation that can make you feel generally unwell and bloated. Dizziness and drowsiness are also frequent companions, making you feel lightheaded and unsteady. It’s a trade-off: powerful pain relief for a temporary period of feeling pretty rotten in other ways. And let’s be clear, this isn’t your implant making you sick; it’s the powerful medication designed to make your recovery bearable.

Even non-opioid pain relievers like NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) can cause issues. While generally well-tolerated, they can irritate the stomach lining, leading to heartburn, stomach upset, or even nausea, especially if taken on an empty stomach. I've had patients tell me they felt "sick to their stomach" after taking ibuprofen, only to realize they hadn't eaten anything substantial beforehand. It's a common mistake, but one that can easily be avoided by always taking these medications with food or milk, as advised by your dentist. These effects are usually less severe than with opioids but can still contribute to an overall feeling of discomfort and malaise that masquerades as sickness.

Now, let's talk about antibiotics. These are often prescribed prophylactically (to prevent infection) or therapeutically (to treat an existing one) after implant surgery. While crucial for preventing serious complications, antibiotics are notorious for their gastrointestinal side effects. Diarrhea, stomach cramps, and general stomach upset are incredibly common because antibiotics don't just kill bad bacteria; they also wreak havoc on the beneficial bacteria in your gut microbiome. This disruption can lead to dysbiosis, an imbalance that manifests as digestive distress. For some, it can even lead to more serious issues like Clostridioides difficile (C. diff) infection, though this is rare in the context of typical dental antibiotic courses. Furthermore, women are often susceptible to yeast infections (oral thrush or vaginal yeast infections) while on antibiotics, as the beneficial bacteria that keep yeast in check are wiped out. These are definitely "sickness" symptoms, but they are a direct result of the medication, not the implant itself.

It's also important to differentiate between typical medication side effects and a genuine allergic reaction. An allergic reaction to a prescribed medication is a serious event and will make you sick, potentially severely so. Symptoms can range from skin rashes, hives, and itching to more severe reactions like swelling of the face or throat, difficulty breathing (anaphylaxis). If you experience any of these, it's an emergency and requires immediate medical attention. This is a very different scenario from mild nausea or stomach upset.

Finally, consider drug interactions and timing. Taking medications on an empty stomach, mixing them with alcohol (a definite no-no post-surgery), or combining them with other drugs without consulting your dentist or pharmacist can significantly worsen side effects. Always adhere strictly to the dosing instructions, and never hesitate to call your dental office if you're experiencing severe or concerning side effects. They might be able to suggest an alternative medication or a way to mitigate the discomfort. The takeaway here is that while these medications are vital for a smooth recovery, their side effects are often the primary reason people feel "sick" in the days following implant surgery.

Pro-Tip: The Hydration & Bland Food Rule
Many post-op symptoms, especially nausea from anesthesia or medication, are significantly worsened by dehydration and an empty or irritated stomach. Stick to clear fluids (water, clear broths, diluted juice) and bland foods (toast, crackers, applesauce, plain yogurt) for the first 24-48 hours. This simple strategy can dramatically reduce the feeling of "sickness."

Direct Complications: When Implants Go Wrong (and Cause Sickness)

Okay, so we've covered the normal, expected stuff, and the medication-induced feelings of malaise. Now, let’s talk about the less common, but more concerning, scenarios where an implant-related issue can genuinely make you sick. These are localized problems that, if left unaddressed, can escalate and manifest with systemic symptoms, moving beyond mere discomfort into actual illness. This is where vigilance and prompt action become absolutely critical. While rare, these complications are precisely why choosing an experienced surgeon and following post-operative instructions are non-negotiable.

Peri-Implantitis: The Silent Threat

Peri-implantitis. It’s a mouthful, and it’s a problem that can indeed make you sick, though often insidiously. In essence, peri-implantitis is an inflammatory disease affecting the hard and soft tissues surrounding a dental implant, leading to progressive bone loss. Think of it as gum disease for implants. It starts with peri-implant mucositis (inflammation of the gums around the implant, similar to gingivitis), and if left untreated, it progresses to peri-implantitis, where the infection starts to eat away at the supporting bone. This isn't an immediate post-op issue; it's something that can develop months or even years after the implant has successfully integrated.

The causes are multifaceted, but poor oral hygiene is a primary culprit. If you’re not meticulously cleaning around your implant, plaque and bacteria can accumulate, triggering an inflammatory response. Other risk factors include a history of periodontitis (gum disease) in natural teeth, smoking, poorly controlled diabetes, and sometimes, even excessive biting forces on the implant. Initially, it might be subtle – just a bit of redness or bleeding when you brush around the implant. But as it progresses, the symptoms become more pronounced and can indeed lead to feeling sick. You might experience persistent pain or tenderness around the implant, swelling of the gums, and a noticeable bad taste in your mouth or persistent bad breath, signaling an ongoing infection.

The truly concerning part is when pus starts to form and drain from around the implant. This is a clear sign of an active, advanced infection. At this stage, the bacterial load can become significant enough to trigger systemic responses. Your body is fighting an infection, and that fight can manifest as general malaise, fatigue, and even a low-grade fever. While a high fever is less common with localized peri-implantitis unless it’s very severe or has spread, that persistent feeling of being "run down" or "off" can certainly be attributed to your immune system working overtime to combat the bacterial assault. It's a chronic inflammatory state that drains your body's resources.

If peri-implantitis is left unchecked, the bone loss can become extensive, leading to implant mobility and, ultimately, implant failure. Before it gets to that point, however, the chronic inflammation and potential for bacterial dissemination can have broader health implications. Chronic oral infections are increasingly linked to systemic health issues, including cardiovascular disease and uncontrolled diabetes. So, while you might not wake up with a sudden, acute illness from peri-implantitis, the slow, insidious progression can indeed make you feel chronically unwell and can contribute to a general decline in your health. Early detection and aggressive treatment, which can range from deep cleaning to surgical intervention, are paramount to prevent it from reaching this stage.

Insider Note: The "Metal Taste" Red Flag
While a temporary metallic taste can be a benign post-op side effect, a persistent metallic taste, especially when accompanied by tenderness, swelling, or a strange odor around your implant, should never be ignored. It's often one of the early, subtle signs of a developing peri-implantitis or infection. Your mouth is giving you clues; listen to them!

Infection at the Surgical Site

Unlike peri-implantitis, which is often a slow burn, an acute infection at the surgical site usually rears its head within the first few days or weeks after implant placement. This is a more direct, immediate threat and definitely can make you feel genuinely sick. We’re talking about bacterial invaders setting up shop where they absolutely don’t belong, and your body reacting fiercely to expel them. Despite all the sterile precautions taken during surgery and the prophylactic antibiotics often prescribed, infections can still occur, especially if post-operative care instructions aren’t followed meticulously.

The signs of a surgical site infection are pretty classic inflammatory markers, but when they intensify, they become unmistakable and alarming. You'll likely experience increased pain that doesn't respond well to medication or gets progressively worse instead of better. There will be noticeable redness around the implant site, sometimes extending into the surrounding gum and cheek tissue. The area will feel warm to the touch, indicating increased blood flow as your immune system mobilizes its defenses. Swelling, while expected to some degree, will be excessive and may continue to increase rather than subside.

But the real red flag, the one that screams "infection," is drainage. This might be pus – a thick, yellowish or whitish fluid – or a foul-smelling discharge. You might notice a persistent, unpleasant taste in your mouth that no amount of brushing or rinsing can alleviate. And crucially, this is where the "sickness" comes in: your body's systemic response to fighting off a significant bacterial assault. You'll likely develop a fever, indicating your immune system is in overdrive. You'll feel generally unwell, experiencing symptoms like chills, fatigue, body aches, and a complete lack of energy, much like having a severe flu. This isn't just local discomfort; it's your entire system reacting to an invading pathogen.

If these symptoms appear, it’s not a "wait and see" situation. This is an emergency that requires immediate attention from your dentist or oral surgeon. Untreated surgical site infections can lead to implant failure, extensive bone loss, and in very severe, albeit rare, cases, can even spread to other parts of the body, potentially leading to cellulitis (a serious skin infection), osteomyelitis (bone infection), or even sepsis, a life-threatening condition. The good news is that with prompt diagnosis and aggressive treatment – typically involving drainage of the infection, a course of targeted antibiotics, and sometimes removal of the implant – these infections can usually be brought under control. The key, however, is not to ignore the warning signs and to seek professional help without delay. Your body is telling you something is seriously wrong, and it’s critical to listen.

Nerve Damage and Persistent Pain

While not typically causing "sickness" in the traditional sense of systemic illness, nerve damage resulting from dental implant surgery can profoundly impact a person's quality of life and overall well-being, leading to a kind of chronic suffering that can feel like a pervasive sickness. This complication, though thankfully rare, is one of the more dreaded outcomes because its effects can be long-lasting or even permanent. When we talk about nerve damage in the context of dental implants, we're primarily concerned with injury to the inferior alveolar nerve in the lower jaw or the mental nerve, which branches off it. These nerves are responsible for sensation in the lower lip, chin, and sometimes parts of the tongue.

An injury can occur if the implant is placed too close to, or directly impinges upon, the nerve canal. This can happen due to inadequate pre-surgical imaging, anatomical variations, or surgical error. The immediate aftermath might involve a feeling of numbness or altered sensation (paresthesia) in the affected area, which might initially be dismissed as residual local anesthetic effect. However, if this numbness persists beyond the expected duration of anesthetic wear-off, it's a red flag. The sensation can range from complete numbness to tingling, burning, electric shock-like sensations, or even excruciating, chronic neuropathic pain (dysesthesia).

Imagine having a constant burning sensation in your chin, or a persistent tingle in your lip that never goes away. This isn't a fever or an infection, but it's a persistent, debilitating discomfort that can disrupt sleep, interfere with eating and speaking, and severely impact psychological health. Chronic pain, regardless of its source, is a profound stressor on the body and mind. It can lead to anxiety, depression, social withdrawal, and a general feeling of being unwell and depleted. The constant battle against pain, the frustration of living with altered sensation, and the fear that it might never resolve can be incredibly draining, making one feel "sick" in a deeply emotional and psychological way, even if there are no infectious agents present.

While some nerve injuries can resolve over time (sometimes weeks or months, as nerves slowly regenerate), others can be permanent. Treatment often involves medications to manage neuropathic pain, and in some cases, surgical intervention to remove the offending implant or decompress the nerve may be considered, though these procedures carry their own risks and aren't always successful. The prevention of nerve damage relies heavily on meticulous pre-operative planning, including advanced imaging like CBCT (Cone Beam Computed Tomography) scans, which allow the surgeon to precisely map out the nerve pathways and plan implant placement to avoid them. While not a "sickness" in the traditional infectious sense, the chronic pain and altered sensation from nerve damage can be a life-altering complication that profoundly diminishes a person's overall sense of well-being and health.

Implant Failure and Rejection (Rarely "Sickness")

Let's address a common misconception right off the bat: the idea of your body "rejecting" a dental implant in the same way it might reject a transplanted organ. This is a crucial distinction, because true immunological rejection, which is what happens with organ transplants and requires powerful immunosuppressant drugs, simply doesn't happen with dental implants. Dental implants are typically made of titanium, or increasingly, zirconia – both highly biocompatible materials. They don't contain cells or genetic material that the immune system recognizes as "foreign" in the same way it would a transplanted kidney. So, if your implant "fails," it's almost always a mechanical or biological integration issue, not an immune system-driven "rejection" that would make you systemically sick.

Implant failure typically means the implant hasn't properly osseointegrated – the process where the bone grows directly onto and fuses with the implant surface. This can happen for several reasons:

Poor Bone Quality/Quantity: If there isn't enough healthy bone to begin with, or if the bone is too soft, the implant might not achieve initial stability.

Premature Loading: Placing a crown on the implant too soon, before osseointegration is complete, can put excessive stress on the healing bone.

Smoking/Uncontrolled Diabetes: These systemic factors significantly impair healing and bone regeneration.

Infection: As discussed, an infection around the implant can prevent osseointegration or destroy already integrated bone.

Surgical Trauma: Excessive heat generation during drilling or improper surgical technique can damage the bone, hindering healing.

Micro-motion: If the implant moves too much during the healing phase, the bone cells won't grow onto it properly.

When an implant fails to osseointegrate, it often becomes mobile. You might notice it feeling loose, or it might be detected by your dentist during a routine check-up. This failure is usually accompanied by localized symptoms: mild pain, tenderness, or just a feeling that "something isn't right" in that area. It's frustrating, disappointing, and requires the implant to be removed, but it generally does not cause systemic sickness like fever, body aches, or widespread malaise, unless there's an accompanying infection (which is a separate complication that can cause failure). The body doesn't launch a full-blown systemic immune response against a failing titanium screw.

In very rare cases, an implant might become loose or fail due to severe, chronic peri-implantitis, which, as we discussed, can lead to a feeling of general malaise due to persistent low-grade infection. But even then, the "sickness" is due to the infection, not the material itself being "rejected." The body's response is localized inflammation and bone destruction, not an autoimmune-like systemic attack. Understanding this distinction is vital for peace of mind. While implant failure is a setback, it's typically managed locally and doesn't pose a systemic health risk in the way an organ rejection would. It's usually a mechanical or localized biological issue that needs to be addressed, not a sign your body is fundamentally at war with itself.

Numbered List: Key Red Flags for Post-Op Complications

Worsening Pain: If pain increases significantly after the first 2-3 days, or doesn't respond to prescribed medication.

Excessive Swelling: Swelling that continues to increase after 48-72 hours, or is accompanied by severe pain.

Fever/Chills: Any temperature above 100.4°F (38°C) or feeling generally feverish.

Pus/Foul Drainage: Any yellowish, whitish, or malodorous discharge from the surgical site.

Persistent Numbness: Numbness in the lip, chin, or tongue that lasts beyond 24 hours post-anesthesia.

Implant Mobility: If you feel the implant moving or notice any looseness.

Systemic Health Concerns: The Deeper Dive into "Sickness"

Now we're venturing into the more nuanced, sometimes controversial, territory. This section addresses the less common, often debated, and more complex ways in which dental implants could potentially be linked to systemic health issues, moving beyond localized complications. These are the topics that spark lively discussions among clinicians and researchers, and they often involve rare occurrences or theoretical concepts that lack robust, widespread scientific consensus. It’s important to approach these with a critical, evidence-based mindset, but also with an open mind, acknowledging that medical understanding is always evolving. This is where the question of "Can dental implants make you sick?" takes on a much broader, more speculative dimension.

Allergic Reactions to Implant Materials (Titanium Hypersensitivity)

Let's address one of the most persistent concerns: the idea of being allergic to the implant material itself, specifically titanium. For decades, titanium has been the gold standard for dental implants due to its exceptional strength, corrosion resistance, and, crucially, its remarkable biocompatibility. The vast majority of people tolerate titanium implants without any issue whatsoever. However, the concept of a "titanium allergy" or "titanium hypersensitivity" does exist, though it is exceedingly rare and often difficult to definitively diagnose.

When we talk about an allergic reaction, we're talking about an immune system overreaction to a substance it perceives as harmful. For titanium, this would typically be a Type IV delayed hypersensitivity reaction, similar to a nickel allergy (which is far more common). The symptoms, if they occur, are not usually acute and dramatic like a peanut allergy. Instead, they might be subtle and systemic, making them challenging to link directly to the implant. Patients might report a range of non-specific symptoms, including:

Skin rashes or eczema: Persistent, unexplained skin irritations.

Chronic fatigue: A pervasive tiredness that isn't relieved by rest.

Muscle pain and joint pain: Aching or discomfort in various parts of the body.

Headaches: Frequent or persistent headaches.

Neuropathic symptoms: Tingling or burning sensations.

The challenge lies in the diagnosis. There's no universally accepted, highly reliable test for titanium allergy. Patch tests, often used for contact allergies, can be inconclusive or difficult to interpret for metal implants. Blood tests (like MELISA testing) are sometimes used, but their scientific validity and clinical utility for diagnosing titanium hypersensitivity remain debated within mainstream dentistry and immunology. Many symptoms attributed to titanium hypersensitivity are also common in a myriad of other conditions, making definitive causation extremely difficult to establish. It's often a diagnosis of exclusion, after ruling out all other possibilities.

If a true titanium allergy is suspected and confirmed (to the best of current diagnostic capabilities), alternative materials exist. Zirconia implants, for example, are ceramic-based and completely metal-free. They offer another highly biocompatible option for patients who are genuinely concerned about metal allergies or who may have had a confirmed reaction. However, it’s vital to reiterate: true titanium allergy is an extreme rarity. Most cases of implant failure or discomfort are due to