Patient: A 70-year-old man. Eczema of the palm (Pustulosis palmaris et plantaris). A positive response to chromium was identified by a dermatological patch test. Metal elements used in his dental restorations were analyzed by non-destructive metal element analysis, and chromium was identified only in the porcelain-fused-to-metal crowns restored in his maxillary central and lateral incisors and canines. Resin facing crowns made of a gold, silver and palladium alloy were installed after those crowns were removed.
Discussion: With all of the interviews performed with this patient, identification of the allergenic restoration in his mouth was difficult. For this kind of metal allergy patient, a combination of metal element analysis of intra-oral restorations with a dermatological patch test seems to be very useful.
Conclusion: This patient's allergic symptoms were ameliorated with minimal selective removal of his intra-oral metal restorations by non-destructive, intra-oral metal element analysis.