Polyetheretherketone Applications in

Prosthodontics – A Review
Pai SA, Kumari S, Umamaheswari B, Jyothi M, Lakshmi CBS.
Journal of Advanced Clinical & Research Insights ● Vol. 6:1 ● Jan-
Feb 2019

Presented by :
Dr. Mithileshwari Patil
2nd Year PG student
Guided by-
1
Dept of Prosthodontics.
 Contents :
Sneak Peak into PEEK
Synthesis
History
Properties
Uses of PEEK in dentistry
PEEK reinforcements
Critical evaluation
Conclusion
References

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 A Biomaterial can be simply defined as a synthetic
material used to replace part of a living system or to function in
intimate contact with living tissue

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 Sneak Peak Into PEEK!
PEEK is a member of
the polyaryletherketone
family (PAEK).

PEEK is composed of
repeating units of three
phenyl rings, two ester
groups and one keto
group.

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 Synthesis of PEEK
 A common synthesis route for PEEK is the reaction
between 4,4- difluorobenzophenone and the disodium salt
of hydroquinone in a polar solvent such as diphenyl
sulphone at 300°C.

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 History..
 In 1978, a group of English scientists developed PEEK , a
semicrystalline linear polycyclic aromatic polymer .
 It was first commercialized in the 1980s for industrial
applications in the manufacture of aircraft, turbine blades,
piston parts, cable insulation, and compressor plate valves.
 PEEK was introduced to dental applications in 1992.

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 Properties of PEEK
It is a semi-crystalline polymer.
Its melting point is around 335 °C.
PEEK is a radiolucent material.
Chemically and physically stable and resistant to radiation
damage.
No evidence has been shown of cytotoxicity,
mutagenicity, carcinogenicity or immunogenicity in the
toxic form.

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 PEEK has an elastic modulus (3-4 GPa) close to
human cortical bone, suggesting the potential for a
more homogenous stress distribution to bone
compared to titanium .

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 It is a very light material (27) with a low density
(1.32g / cm3) .
It allows magnetic resonance imaging (MRI).
Laboratory stages are simple.
Compatible with many reinforcing agents such as glass
and carbon fibers.

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 Uses of PEEK in Dentistry

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 Uses in Dental Implantology

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 PEEK as an Implant material
 The major beneficial property for PEEK as a dental implant material remains
its low Young’s (elastic) modulus (3–4 GPa) being close to human bone(14
GPa) while titanium’s elastic modulus is about 102- 110 Gpa.
 It exhibits fewer hypersensitive and allergic reactions in compare to Ti.
 It does not have a metallic color as Ti, so esthetically more pleasing.

 In contrast to titanium, PEEK has very limited inherent osteoconductive

properties. Hence, a considerable amount of research has been conducted to
12 improve the bioactivity of PEEK implants.
  Victrex (now known as Invibio) is a leading manufacturer for
medical grade PEEK. In 1999, they launched PEEK-OPTIMA
for an implant.

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Modification of PEEK dental implants

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 1.Nano-structured PEEK surfaces for the use as dental
implants

(a) Spin-coating is a method for coating a thin layer of

nanoscale hydroxyapatite on PEEK surface .
 In this process nano hydroxyapatite dissolved in organic
solvents is slowly dropped onto the surface of an implant
rotating at high speeds .
 Upon heat-treatment(300ºC) a thin layer of (HAp) is formed on
the implants

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 (b)Plasma spraying

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 (c) Plasma-gas etching
 In this process, low-pressure gases (Oxygen, argon and
ammonia) are used to introduce nano-level surface
roughness on the surface of PEEK implants.
 This induces more hydrophilicity for a better material–
tissue interaction .

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 (d)Electron-beam deposition (e-beam)
 Involves decomposing and depositing a very thin, nanorough
layer of a material on a substrate by exposing the material to a
beam of electrons.
 Coating PEEK with titanium using this method has shown to
increase the hydrophilicity leading to enhanced cellular
proliferation.

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 (e)Plasma immersion ion implantation
A substrate placed in plasma of particles connected to
a high voltage can get coated by a thin layer of the
particles of that material.

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 (f) Sulfonation : etching with sulfuric acid
 PEEK surfaces produced by etching with sulfuric acid
(sulfonation) and rinsing with distilled water have been
observed to induce an accelerated osseointegration
compared to the unmodified PEEK in vitro and in vivo.

 There is a decreased initial bone formation when sulfonated

PEEK is implanted in vivo which could be explained by the
presence of residual sulfuric acid on the surface. This
effect can be minimized by rinsing the implants with
acetone to remove the residual sulfuric acid
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 2.Bioactive PEEK nanocomposites as
dental implants
 In order to increase the bioactivity, bioactive inorganic
particles have been incorporated to PEEK using melt-
blending and compression molding techniques.
 Nano-hydroxyapatite, Nano-hydroxyfluroapatite and Nano-
titanium oxide particles can be used .

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 CASE REPORT

• The implants (Pornichet, France), which were used in this study were
made of the unique PEEK/TiO2/beta-TCP combination named
BIOPIK®.
• These implants are available in three fundamentally different designs;
TAU, THETA and IOTA, for different bone volumes and densities.

Marya K. et al. Polyetheretherketone (PEEK) Dental Implants:

A Case for Immediate Loading. International Journal of Oral Implantology and
22 Clinical Research, May-August 2011;2(2):97-103
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Case 2:

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 PEEK Abutments
 Unmodified PEEK is used as a provisional abutment, because this
material has been demonstrated to reduce stress shielding around the
implant.
 Unmodified PEEK is not used as a definitive abutment material
because its fracture resistance is lower than that of titanium .
 However, the introduction of ceramic reinforced PEEK
(Bio-HPP) made its use as a permanent abutment an advantage.

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  Numerous researches found that PEEK material is resilient up
to 1200N of chewing forces. Due to low Elastic modulous of
the PEEK, literature has stated that the stresses happening both
in abutment teeth and in the cement, interface are condensed to
minimum. Therefore the stress-based problems of PEEK
implant can be minimized.

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 PEEK in Removal Partial Dentures
Disadvantages of metallic
RPD :
■ Esthetically unacceptable
display of metal
clasps
■ Increased weight of the
prosthesis
■ Potential for metallic taste
■ Allergic reactions to metals
Advantages of PEEK RPD:
■ High biocompatibility
■ Good mechanical properties
■ High temperature resistance
■ Chemical stability
■ Due to a 4 GPa modulus of
elasticity, it is as elastic as
bone and can reduce
stresses transferred to the
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abutment teeth
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 PEEK RPD can be manufactured by :
Conventional lost wax technique
CAD-CAM

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 PEEK as crowns and fixed partial
dentures (FPD) frameworks
Advantages of PEEK as an FPD material:
1. Highly polished surface.
2. Less plaque accumulation.
3. Gum irritation is absent.
4. Bond strength is sufficient to be veneered with any
composite material.
5. High fracture resistance.
6. No discoloration, due to the absence of exchange of
ions in the mouth.

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  PEEK granules by vacuum pressing or CAD-CAM milling are
used as a framework for long span FPD which is finally
layered with a nanocomposite.
 It still requires veneering owing to its low translucency and
grayish pigmentation.

PEEK-Composite bond
One disadvantage of PEEK in prosthetic dentistry is a
difficulty to achieve adequate bond strength to composite
resin materials owing to its low surface energy and
resistance to surface modification by different chemical
treatments.
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 PEEK-Dentin bond strength
 To increase the bond strength between PEEK and dentin, the
inner surface of crowns and bridges must be treated either by
SULFURIC ACID or air abrasion with alumina.
 Concentrated sulfuric acid (100%)
can dissolve PEEK at room
temperature.
 (98 %) sulfuric acid causes a
swelling process in PEEK that
creates
porosities on its surface.
 The increase of exposure time to
sulfuric acid promotes an increase
of pore sizes.
 However, the longer the exposure
time, the greater the deterioration
of the surface of PEEK, which could
lead to cohesive failures.
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 Other Uses of PEEK :

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 PEEK as scaffolds for tissue
engineering

 Polyetheretherketone (PEEK) is widely applied in tissue

engineering due to its good biocompatibility and mechanical
properties.
 However, the slow degradation rate limits its further
application.
 PEEK can be blended with other biodegradable polymers to
fabricate porous scaffolds via 3D printing using selective laser
sintering (SLS) technique

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 Methods of PEEK Reinforcement

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 Carbon-fiber reinforced PEEK
(CFR-PEEK)
 PEEK can be reinforced with short
carbon fiber (6–9 μm diameter) and 30
wt %.
 It is mainly used as Dental implants.

 CFR-PEEK has the advantages of high

strength and low modulus of elasticity
(similar to bone) which make it great
potential in human bone tissue repair
and implant materials.
 It appears to stimulate osteoblast protein
content

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 Glass-fiber reinforced PEEK (GFR-PEEK)
 10% glass fibers with diameters ranging from a few
microns to ten microns.
 Glass fiber has the advantages of high elastic modulus,
high strength, good thermal stability and stable expansion
coefficient and it has elastic modulus similar to bone.
 In vitro studies showed that GFR-PEEK can provide a
suitable environment for the formation of osteocalcin.

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 Ceramic reinforced PEEK
(Bio-HPP)
Special ceramic fillers
have a size of about 0.3-
0.5 microns and occupy
20% of the total
volume of BioHPP .

■ It is mainly used as:

1. Dental implant
abutments
2. RPD framework
3. Crowns and bridges
framework
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 Hydroxyapatite reinforced PEEK
HA-PEEK n-HA peek Sr-HA-PEEK
• Particle size of • n-HA (100 nm) • Sr-HA
HA is (3-100) • Good mechanical particles(45μm)
μm properties and • 15–30 vol% Sr-
• Volume fraction high bioactivity HA filler
of HA is 30% • Well-dispersed • Strontium is a
• Elastic modulus HA nanoparticles biologically
similar to human in the PEEK active element.
cortical bone matrix • Can promote the
• Can promote the adhesion and
growth of mineralization of
osteoblasts osteoblasts
• Low physical
bond energy
45 between PEEK
and HA.
Nano-TiO2/PEEK (n-
TiO2/PEEK)
• TiO2 has good
biocompatibility, bioactivity
and is hydrophilic.
• It improves the Nano-fluroapatite
biological activity of PEEK.
• Could promote the adhesion PEEK (n-FA/PEEK)
and proliferation of • The fluoride ions from the n- FA can
osteoblast affect the energy metabolism and
enzyme activity of the bacteria, so n-
FA/PEEK composite has antibacterial
effect.
• Fluoride ion inhibits the activity of
osteoclast and phagocyte and
stimulate new bone formation.

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 CRITICAL EVALUATION
This article provides a comprehensive overview of
PEEK in prosthodontics, there are a few aspects that
could have been addressed for a more thorough
analysis-
1. Long-Term Clinical Studies
2. Cost Considerations
3. Patient Satisfaction and Aesthetics
4. Adverse Effects and Complications
5. Comparative Analysis with Other Materials

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Conclusion
PEEK is a promising polymeric material
that could replace metallic and ceramic
materials in dental applications.
Studies have shown that it performs well as a
dental implant after surface modification to
render it bioactive and increase
osseointegration

Although PEEK has various benefits over

current restoratives, due to its higher cost and
limitation in certain physical properties, it is still
under research It can be a good alternative to various dental
restoratives, but sufficient studies and clinical
trials still required.

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 References
 Costa-Palau S, Torrents-Nicolas J, Brufau-de Barberà M, Cabratosa-Termes J.
Use of polyetheretherketone in the fabrication of a maxillary obturator
prosthesis: A clinical report. J Prosthet Dent 2014;112:680-2.
 Najeeb S, Khurshid Z, Matinlinna JP, Siddiqui F, Nassani MZ, & Baroudi K.
Nanomodified peek dental implants: Bioactive composites and surface
modification-A review. International journal of dentistry, 2015.
 Rahmitasari F, Ishida Y, Kurahashi K, Matsuda T, Watanabe M, Ichikawa T.
PEEK with reinforced materials and modifications for dental implant
applications. Dent J 2017;5:35.
 Sinha N, Gupta N, Reddy KM, Shastry YM. Versatility of PEEK as a fixed
partial denture framework. J Indian Prosthodont Soc 2017;17:80-3
 Tekin S, Cangül S, Adıgüzel Ö, Değer Y. Areas for use of PEEK material in
dentistry. Int Dent Res 2018;8(2):84-92.
 Jain V, Kumar VR, Prakash P, Shankar VU. Role of PEEK biomaterial in
prosthodontics: A literature review. Ann Prosthodont Restor Dent 2019;5(3):63-
7.
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