O U F U Use of PEEK in Implantology: A Review of Literature. # 2160 School of Dentistry Oclusion, Fixed Prosthesis and Dental Materials Post-Graduation Program in Clinical Dentistry Email:[email protected] Federal University of Uberlândia – – Uberlândia-MG – Brazil *A.C.Brant Filho, D.S. Meireles, M.S.Prudente,T.A.P.N. Carneiro, J.P. Cougoulic, R.J.Almeida, F.D. Neves Polyetheretherketone (PEEK) is an aromatic, rigid, semi-crystaline thermoplastic with good mechanical properties and bone like-stiffness, as well as good biocompatibility. Dental material field and implant dentistry have encouraged investigations of new materials to use as a replacement for dental roots. The aim of this study is to investigate in the dental literature, if there are some research and works on PEEK use in oral implantology. Keywords : PEEK dental , PEEK oral, PEEK oral implantology Inclusion criteria: all articles related about in vitro and in vivo research about PEEK in oral implantology. Exlcusion criteria: articles not related to dental field. Database search in PUBMED (www.pubmed.com), IADR abstracts (http://iadr.confex.com/iadr/search.epl),Patents (http://www.freepatentsonline.com/), and Manual search . Financial support granted by Federal University of Uberlândia-School of Dentistry - FOUFU, CAPES. 82 studies were obtained in the inicial search: 71 were discarded as they did not fit in the search criteria and 10 were kept and are listed below. Authors In Vitro In Vivo Material Analysis Results Lee et all, 2012 Physical and Mechanical Properties yes no (A) GFR-PEEK (Glass Fiber) (B) CFR-PEEK (Carbon Fiber) (C) Pure Titatnium (grade 4) Fatigue tests norm ISO 14801:2003 FEA - GFR-PEEK coating Zirconia & Titanium - GFR-PEEK 0.5mm thick and 5mm long in Ti and Zirconia. FEA- Strain Energy Density (SED) FEA- von-Misses GFR-PEEK fractured at 320 N CFR-PEEK not fractured Pure Titanium not fractured FEA - SED Ti coated GFR-PEEK implants reduce stress shielding Peek coating showed lower von-Mises stress than the bone in direct contact with Ti implant Sarot et al, 2009 Physical and Mechanical Properties yes no (A) Ti-Implant & Ti-Abutment (B) Ti-Implant & CFR-PEEK Abutment (C) CFR-PEEK-Impant & Ti-Abutment (D) CFR-PEEK-Impant & CFR-PEEK- Abutment 3D-FEA - Cortical + trabecular alveolar bone to evalute stress distribution near the peri-implant bone in A,B,C,D von-Misses Analysis in 3D FEA CFR-PEEK implants (C&D) presented higher load concentration in the cervical portion and on the cortical bone than the Titanium implants (A&B) Abutment material had no interference Spintig, Mueller & Abert, 2008 Physical and Mechanical Properties Tribology yes no 45 PEEK specimens (2x10x10mm) 2/3 grinded with bioceramics (1/3 Glass Bone (GB) & 1/3 Tricalcium phosphate (TCP) 1/3 (15) control group. PEEK Only Vickers hardness (VH) Roughness (Ra, Rz, Rmax) Surface Wettabillity SEM- micrographs EDX- analysis and statistics 2 VH 27.87kg/mm to 38.31kg/mm bioceramics Roughness increased with a ratio 1: 1.34: 8.33 (untreated:TCP:GB) Improve in wettabillity EDX- significant change in surface (TCP GB) 2 PEEK + grinded Cook et al, 1995 Physical and Mechanical Properties Tribology yes yes 40 cilindrical implants 4,0mm diameter and 10mm lengh made of PEEK coated 0 and uncoated with Titanium 2000 A 4 Mongrel dogs 1- Pull Out Test 2- Bone Contact Area 3- Roughness 1- uncoated and coated no diference at 8 weeks 2- uncoated= 51.55 to 54.83% / coated= 60.18% to 66.7% 3-no difference found on roughness Koch et al, 2010 Biocompatibillity no yes Zirconia, Zirconia sol gel (Ca+TiO2), Peek Titanium 6 Mongrel dogs Histomorphometric Bone to Implant Contact (BIC) was measured Median BIC Zirconia = 59.24% Median BIC Zirconia Sol gel = 58.34% Median BIC Titanium = 41.22% Median BIC PEEK = 26.82% Wu et al, 2012 Physical and Mechanical Properties Biocompatibillity yes yes 2 (A) PEEK + n-TiO Ra< 0,1 2 2 (B) PEEK + n-TiO blasted TiO Ra=1µm - 2.2µm (C) Unfilled PEEK - control group µm 1- Physical and Chemical caracterization 2- Cytocompatibillity in vitro 3- Biocompatibillity in vivo / Microcomputed tomography (MCT) 1- Optical density value is higher p<0.05 in roughness group (B) 2- Better Cell attachment in (B) group. 3- Bone volume is twice in (B) group MCT Barkarmo et al, 2011 Biocompatibillity no yes (A) PEEK - control group (B) PEEK coated nano Hidroxyapatite (HA) 10 New Zealand rabbits Follow up 12 weeks Scanning Electron Microscopy - SEM Atomic Force Microscopy - AFM X-Ray Photoelectron Spectroscopy - XPS SEM - nano Ha thin layer in PEEK XPS confirmed nano HA in PEEK which showed Ca/P ratio of 1.67 HA/PEEK better integrated but no statistical significance as showed Harmand et al, 2004 Biocompatibillity no yes 2 Composite TiO PEEK + ß-TCP + Cell attachment and proliferation SEM Biocompatible as ISO 10993 Harmand et al, 2010 Biocompatibillity no yes BIOPIK ® 3 clinical cases in humans with 11 PEEK implants X-RAY evaluation Lack of prospective study Marya et al, 2012 Biocompatibillity no yes BIOPIK ® 3 clinical cases in humans with 3 PEEK implants X-RAY evaluation Unitary cases, lack of radiopacity, lack of prospective study, immediate loading PEEK is a material that is being used to produce dental implants (BIOPIK®). However, the results still have to be validated by scientific community and more research has to be done on the real advantages of its use. 2 BIOPIK® Implant System is made of PEEK/ ß-TCP / TiO
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OUFU
Use of PEEK in Implantology: A Review of Literature. # 2160
School of Dentistry
Oclusion, Fixed Prosthesis and Dental Materials
Post-Graduation Program in Clinical Dentistry
Email:[email protected]
Federal University of Uberlândia – – Uberlândia-MG – Brazil
*A.C.Brant Filho, D.S. Meireles, M.S.Prudente,T.A.P.N. Carneiro, J.P. Cougoulic, R.J.Almeida, F.D. Neves
Polyetheretherketone (PEEK) is an aromatic, rigid, semi-crystaline thermoplastic with good mechanical properties and bone like-stiffness, as well as good biocompatibility. Dental material field and implant dentistry have encouraged investigations of new materials to use as a replacement for dental roots.
The aim of this study is to investigate in the dental literature, if there are some research and works on PEEK use in oral implantology.
Keywords : PEEK dental , PEEK oral, PEEK oral implantology
Inclusion criteria: all articles related about in vitro and in vivo research about PEEK in oral implantology.
Exlcusion criteria: articles not related to dental field.
Database search in PUBMED (www.pubmed.com), IADR abstracts ( h t t p : / / i a d r . c o n f e x . c o m / i a d r / s e a r c h . e p l ) , P a t e n t s (http://www.freepatentsonline.com/), and Manual search .
Financial support granted by Federal University of Uberlândia-School of Dentistry - FOUFU, CAPES.
82 studies were obtained in the inicial search: 71 were discarded as they did not fit in the search criteria and 10 were kept and are listed below.
Authors In Vitro
In Vivo
Material Analysis Results
Lee et all, 2012
Physical and Mechanical Properties
yes no (A) GFR-PEEK (Glass Fiber)(B) CFR-PEEK (Carbon Fiber)(C) Pure Titatnium (grade 4)
Fatigue tests norm ISO 14801:2003
FEA - GFR-PEEK coating Zirconia & Titanium - GFR-PEEK 0.5mm thick and 5mm long in Ti and Zirconia.
FEA- Strain Energy Density (SED)FEA- von-Misses
GFR-PEEK fractured at 320 NCFR-PEEK not fracturedPure Titanium not fractured
FEA - SED Ti coated GFR-PEEK implants reduce stress shielding
Peek coating showed lower von-Mises stress than the bone in direct contact with Ti implant
Sarot et al, 2009
Physical and Mechanical Properties
yes no (A) Ti-Implant & Ti-Abutment(B) Ti-Implant & CFR-PEEK Abutment(C) CFR-PEEK-Impant & Ti-Abutment(D) CFR-PEEK-Impant & CFR-PEEK-Abutment
3D-FEA - Cortical + trabecular alveolar bone to evalute stress distribution near the peri-implant bone in A,B,C,D
von-Misses Analysis in 3D FEA
CFR-PEEK implants (C&D) presented higher load concentration in the cervical portion and on the cortical bone than the Titanium implants (A&B)
Abutment material had no interference
Spintig, Mueller & Abert, 2008
Physical and Mechanical PropertiesTribology
yes no 45 PEEK specimens (2x10x10mm)2/3 grinded with bioceramics (1/3 Glass Bone (GB) & 1/3 Tricalcium phosphate (TCP)1/3 (15) control group. PEEK Only
Vickers hardness (VH)Roughness (Ra, Rz, Rmax)Surface Wettabillity SEM- micrographsEDX- analysis and statistics
2VH 27.87kg/mm to 38.31kg/mmbioceramicsRoughness increased with a ratio 1: 1.34: 8.33 (untreated:TCP:GB)Improve in wettabillityEDX- significant change in surface (TCP GB)
2 PEEK + grinded
Cook et al, 1995
Physical and Mechanical PropertiesTribology
yes yes 40 cilindrical implants 4,0mm diameter and 10mm lengh made of PEEK coated
0and uncoated with Titanium 2000 A4 Mongrel dogs
1- Pull Out Test2- Bone Contact Area 3- Roughness
1- uncoated and coated no diference at 8 weeks2- uncoated= 51.55 to 54.83% / coated= 60.18% to 66.7% 3-no difference found on roughness
Koch et al, 2010
Biocompatibillity
no yes Zirconia, Zirconia sol gel (Ca+TiO2), Peek Titanium6 Mongrel dogs
Histomorphometric
Bone to Implant Contact (BIC) was measured
Median BIC Zirconia = 59.24%Median BIC Zirconia Sol gel = 58.34%Median BIC Titanium = 41.22%Median BIC PEEK = 26.82%
Wu et al, 2012
Physical and Mechanical Properties
Biocompatibillity
yes yes 2 (A) PEEK + n-TiO Ra< 0,12 2 (B) PEEK + n-TiO blasted TiO Ra=1µm -
2.2µm(C) Unfilled PEEK - control group
µm 1- Physical and Chemical caracterization 2- Cytocompatibillity in vitro3- Biocompatibillity in vivo / Microcomputed tomography (MCT)
1- Optical density value is higher p<0.05 in roughness group (B)2- Better Cell attachment in (B) group.3- Bone volume is twice in (B) group MCT
Barkarmo et al, 2011
Biocompatibillity
no yes (A) PEEK - control group(B) PEEK coated nano Hidroxyapatite (HA)10 New Zealand rabbitsFollow up 12 weeks
Scanning Electron Microscopy - SEMAtomic Force Microscopy - AFMX-Ray Photoelectron Spectroscopy - XPS
SEM - nano Ha thin layer in PEEKXPS confirmed nano HA in PEEK which showed Ca/P ratio of 1.67HA/PEEK better integrated but no statistical significance as showed
Harmand et al, 2004
Biocompatibillity
no yes 2 Composite TiOPEEK + ß-TCP + Cell attachment and proliferation
SEMBiocompatible as ISO 10993
Harmand et al, 2010
Biocompatibillity
no yes BIOPIK ® 3 clinical cases in humans with 11 PEEK implants
X-RAY evaluation Lack of prospective study
Marya et al, 2012
Biocompatibillity
no yes BIOPIK ®3 clinical cases in humans with 3 PEEK implants
X-RAY evaluation Unitary cases, lack of radiopacity, lack of prospective study, immediate loading
PEEK is a material that is being used to produce dental implants (BIOPIK®). However, the results still have to be validated by scientific community and more research has to be done on the real advantages of its use.
2BIOPIK® Implant System is made of PEEK/ ß-TCP / TiO
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