Which of the following is the least biocompatible?

A. TMA

B. Elgiloy

C. Stainless steel

D. Cu-NiTi

The correct answer is B. Elgiloy.

Elgiloy (a cobalt-chromium-nickel alloy) is the least biocompatible among the options due to its higher nickel content (14-16%) compared to stainless steel (8%), leading to greater nickel and chromium ion release in simulated oral environments. Studies show it induces significant neurotoxicity via necrosis, elevated oxidative stress, and higher cytotoxicity (2.7-fold increase in dead cells) relative to stainless steel (apoptosis, 1.7-fold dead cells), TMA (variable but generally low ion release and non-toxic), and Cu-NiTi (lower ion release and minimal cytotoxicity). This increases risks of allergic reactions and tissue irritation in orthodontic use.

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