Chemical, microscopic, and microbiological analysis of a functionalized poly-ether-ether-ketone-embedding antibiofilm compounds

The research status and future direction of polyetheretherketone in dental implant -A comprehensive review

Currently, dental implants primarily rely on the use of titanium and titanium alloys. However, the extensive utilization of these materials in clinical practice has unveiled various problems including stress shielding, corrosion, allergic reactions, cytotoxicity, and image artifacts. As a result, polyetheretherketone (PEEK) has emerged as a notable alternative due to its favorable mechanical properties, corrosion resistance, wear resistance, biocompatibility, radiation penetrability and MRI compatibility. Meanwhile, the advancement and extensive application of 3D printing technology has expanded the range of medical applications for PEEK, including artificial spines, skulls, ribs, shinbones, hip joints, and temporomandibular joints. In this review, we aim to assess the advantages and disadvantages of PEEK as a dental implant material, summarize the measures taken to address its shortcomings and their effects, and provide insight into the future potential of PEEK in dental implant applications, with the goal of offering guidance and reference for future research endeavors.

Methods to improve antibacterial properties of PEEK: A review

As a thermoplastic and bioinert polymer, polyether ether ketone (PEEK) serves as spine implants, femoral stems, cranial implants, and joint arthroplasty implants due to its mechanical properties resembling the cortical bone, chemical stability, and radiolucency. Although there are standards and antibiotic treatments for infection control during and after surgery, the infection risk is lowered but can not be eliminated. The antibacterial properties of PEEK implants should be improved to provide better infection control. This review includes the strategies for enhancing the antibacterial properties of PEEK in four categories: immobilization of functional materials and functional groups, forming nanocomposites, changing surface topography, and coating with antibacterial material. The measuring methods of antibacterial properties of the current studies of PEEK are explained in detail under quantitative, qualitative, andin vivomethods. The mechanisms of bacterial inhibition by reactive oxygen species generation, contact killing, trap killing, and limited bacterial adhesion on hydrophobic surfaces are explained with corresponding antibacterial compounds or techniques. The prospective analysis of the current studies is done, and dual systems combining osteogenic and antibacterial agents immobilized on the surface of PEEK are found the promising solution for a better implant design.

Oral microbial colonization on titanium and polyetheretherketone dental implant healing abutments: An in vitro and in vivo study

STATEMENT OF PROBLEM

Although polyetheretherketone (PEEK) implant healing abutments have become popular because of their esthetic, mechanical, and chemical properties, studies analyzing oral polymicrobial adhesion to PEEK abutments are lacking.

PURPOSE

The purpose of this in vitro and in vivo study was to evaluate oral microbial adhesion and colonization on titanium (Ti) and PEEK healing abutments.

MATERIAL AND METHODS

Ti (N=35) and PEEK substrates (N=35) were evaluated in vitro in terms of the initial adhesion (1 hour) or biofilm accumulation (48 hours) of Candida albicans and a polymicrobial inoculum using stimulated human saliva to mimic a diverse oral microbiome. Surface decontamination ability was evaluated after 24 hours of in vitro biofilm formation after exposure to an erbium-doped yttrium aluminum garnet (Er:YAG) laser. Conventional and flowable composite resin veneering on PEEK was also tested for microbial adhesion. In addition, an in vivo model with 3 healthy volunteers was conducted by using a palatal appliance containing the tested materials (3 or 4 specimens of each material per appliance) for 2 days to evaluate the effect of substrate on the microbial profile. Biofilms were evaluated by live cell counts and scanning electron microscopy images, and the microbial profile by Checkerboard deoxyribonucleic acid (DNA)-DNA hybridization. The t test and Mann-Whitney test were used to compare the groups (α=.05).

RESULTS

PEEK and Ti materials showed similar fungal adhesion (P>.05). Although the PEEK surface limited the initial in vitro polymicrobial adhesion (approximately 2 times less) compared with Ti (P=.040), after 48 hours of biofilm accumulation, the microbial load was statistically similar (P=.209). Er:YAG laser decontamination was more effective on PEEK than on Ti surfaces, reducing approximately 11 times more microbial accumulation (P=.019). Both composite resins tested showed similar microbial adhesion (1 hour). In vivo, the PEEK material showed reduced levels of 6 bacterial species (P<.05), including the putative pathogen Treponema denticola.

CONCLUSIONS

Although PEEK and Ti had similar bacterial and fungus biofilm attachment and accumulation, PEEK promoted a host-compatible microbial profile with a significantly reduced T. denticola load.

Research progress and future prospects of antimicrobial modified polyetheretherketone (PEEK) for the treatment of bone infections

Infection of the bone is a difficult problem in orthopedic diseases. The key and basis of the treatment of bone infection is the effective control of local infection, as well as the elimination of infection focus and dead cavities. The most commonly used approach utilized for the prevention and management of bone infection is the application of antibiotic bone cement. However, the incorporation of antibiotics into the cement matrix has been found to considerably compromise the mechanical characteristics of bone cement. Moreover, some investigations have indicated that the antibiotic release rate of antibiotic bone cement is relatively low. Polyetheretherketone (PEEK) and its composites have been considered to perfectly address the challenges above, according to its favorable biomechanical characteristics and diverse surface functionalizations. This article provides a comprehensive overview of the recent advancements in the antimicrobial modification of PEEK composites in the field of antibacterial therapy of bone infection. Furthermore, the potential application of PEEK-modified materials in clinical treatment was discussed and predicted.

Surface Treatments of PEEK for Osseointegration to Bone

Polymers, in general, and Poly (Ether-Ether-Ketone) (PEEK) have emerged as potential alternatives to conventional osseous implant biomaterials. Due to its distinct advantages over metallic implants, PEEK has been gaining increasing attention as a prime candidate for orthopaedic and dental implants. However, PEEK has a highly hydrophobic and bioinert surface that attenuates the differentiation and proliferation of osteoblasts and leads to implant failure. Several improvements have been made to the osseointegration potential of PEEK, which can be classified into three main categories: (1) surface functionalization with bioactive agents by physical or chemical means; (2) incorporation of bioactive materials either as surface coatings or as composites; and (3) construction of three-dimensionally porous structures on its surfaces. The physical treatments, such as plasma treatments of various elements, accelerated neutron beams, or conventional techniques like sandblasting and laser or ultraviolet radiation, change the micro-geometry of the implant surface. The chemical treatments change the surface composition of PEEK and should be titrated at the time of exposure. The implant surface can be incorporated with a bioactive material that should be selected following the desired use, loading condition, and antimicrobial load around the implant. For optimal results, a combination of the methods above is utilized to compensate for the limitations of individual methods. This review summarizes these methods and their combinations for optimizing the surface of PEEK for utilization as an implanted biomaterial.

Strategies to improve bioactive and antibacterial properties of polyetheretherketone (PEEK) for use as orthopedic implants

Polyetheretherketone (PEEK) has gradually become the mainstream material for preparing orthopedic implants due to its similar elastic modulus to human bone, high strength, excellent wear resistance, radiolucency, and biocompatibility. Since the 1990s, PEEK has increasingly been used in orthopedics. Yet, the widespread application of PEEK is limited by its bio-inertness, hydrophobicity, and susceptibility to microbial infections. Further enhancing the osteogenic properties of PEEK-based implants remains a difficult task. This article reviews some modification methods of PEEK in the last five years, including surface modification of PEEK or incorporating materials into the PEEK matrix. For surface modification, PEEK can be modified by chemical treatment, physical treatment, or surface coating with bioactive substances. For PEEK composite material, adding bioactive filler into PEEK through the melting blending method or 3D printing technology can increase the biological activity of PEEK. In addition, some modification methods such as sulfonation treatment of PEEK or grafting antibacterial substances on PEEK can enhance the antibacterial performance of PEEK. These strategies aim to improve the bioactive and antibacterial properties of the modified PEEK. The researchers believe that these modifications could provide valuable guidance on the future design of PEEK orthopedic implants.

The Use of the Three-Dimensional Printed Polyether Ether Ketone Implant in Secondary Craniosynostosis Revision

BACKGROUND

Skull deformities may be seen in patients years after craniosynostosis correction. These deformities cause psychosocial distress in affected patients. In this series, the authors describe the use of patient specific polyether ether ketone (PEEK) implants for correction of skull deformities after cranial vault remodeling for craniosynostosis.

METHODS

A chart review was conducted for 3 revision procedures performed by 1 plastic surgeon in collaboration with 1 neurosurgeon, both affiliated with Northwell Health. Preoperative computed tomography scans were used to design three-dimensional (3D) printed PEEK implants manufactured by KLS Martin. Implants were used to correct frontal and orbital asymmetry and skull deformities in each patient. Outcomes were assessed at 1 week, 1 month, and 3 months post-operation.

RESULTS

Two males and 1 female, ages 13, 17, and 19, underwent revision cranioplasty or orbital rim reconstruction using a custom, single piece 3D printed PEEK implant. All 3 patients underwent cranial vault remodeling in infancy; 1 was treated for coronal craniosynostosis and 2 were treated for metopic craniosynostosis. Revision cranioplasty operative times were 90, 105, and 147 minutes, with estimated blood loss of 45 mL, 75 mL, and 150 mL, respectively. One patient went home on post op day 1 and 2 patients went home on post op day 2. All patients had an immediate improvement in structural integrity and cranial contour, and all patients were pleased with their aesthetic results.

CONCLUSIONS

Custom 3D printed PEEK implants offer a single piece solution in revision cranioplasty surgery to correct skull deformities after cranial vault remodeling for craniosynostosis.

Design and development of biomimetic electrospun sulphonated polyether ether ketone nanofibrous scaffold for bone tissue regeneration applications: in vitro and in vivo study

Bone defect restoration remains challenging in orthopedic medical practices. In this study an attempt is carried out to probe the use of new biomimetic SPEEK (sulfonated polyether ether ketone) based nanofibrous scaffold to deliver amine functionalized hydroxyapatite nanoparticles loaded resveratrol for its potent functionality in osteogenic differentiation. SPEEK polymer with reactive functional group SO₃H was synthesized through process of sulphonation reaction. Amine functionalized nanoparticles with protonated amino groups revamp the molecular interaction by the formation of hydrogen bonds that in turn intensify the bioactivity of the nanofibrous scaffold. Osteoconductive functionalized nanohydroxyapatite enhances the cell proliferation and osteogenicity with improved cell attachment and spreading. The results of FT-IR, XRD, Carbon-Silica NMR and EDX analysis confirmed the amine functionalization of the hydroxyapatite nanoparticles. Surface morphological analysis of the fabricated nanofibers through SEM and AFM analysis shows vastly interconnected porous structure that mimics the bone extracellular matrix, which enhances the cell compatibility. Cell adhesion and live dead assay of the nanoscaffolds express less cytotoxicity. Mineralization and alkaline phosphatase assay establish the osteogenic differentiation of the nanofibrous scaffold. The in vitro biocompatibility studies reveal that the fabricated scaffold was osteo-compatible with MG63 cell lines. Hemocompatibility study further proved that the designed biomimetic nanofibrous scaffold was highly suitable for bone tissue engineering. The results of in vivo analysis in zebrafish model for the fabricated nanofibers demonstrated significant increase in the caudal fin regeneration indicating mineralization of osteoblast. Thus, the commending results obtained instigate the potentiality of the composite nanofibrous scaffold as an effective biomimetic substrate for bone tissue regeneration.

Cadiolide analogues and their precursors as new inhibitors of bacterial quorum sensing and biofilm formation

Bacterial quorum sensing (QS) and biofilm formation are promising targets for developing new therapies to treat chronic infections. Herein, we report the stereoselective synthesis of 18 new analogs of natural cadiolides. Among the new compounds, substances 8b, 8f, 8i, 9a, 9b and 9e completely inhibited the biofilm formation of Escherichia coli RP347 in vitro. In addition, compound 8b interfered acyl-homoserine lactone (AHL) mediated QS, while 9e interrupted the QS via autoinducer-2 (AI-2). Biological assays also revealed that synthetic intermediates alkynones are potent inhibitors of AI-2 and AHL-mediated QS. These results indicate that cadiolides and alkynones are good candidates for further structural modification for a new generation of more potent antimicrobial agents.

A Highly Reversible Zinc Anode for Rechargeable Aqueous Batteries

Zinc metal holds a great potential as an anode material for next-generation aqueous batteries due to its suitable redox potential, high specific capacity, and low cost. However, the uncontrollable dendrite growth and detrimental side reactions with electrolytes hinder the practical application of this type of electrodes. To tackle the issues, an ultrathin (∼1 μm) sulfonated poly(ether ether ketone) (SPEEK) solid-electrolyte interphase (SEI) is constructed onto the Zn anode surface by a facile spin-coating method. We demonstrate that the polymeric SEI simultaneously blocks the water molecules and anions, uniformizes the ion flux, and facilitates the desolvation process of Zn2+ ions, thus effectively suppressing the side reactions and Zn dendrite formation. As a result, the newly developed Zn@SPEEK anode enables a symmetric cell to stably operate over 1000 cycles at 5 mA cm-2 without degradation. Moreover, with the Zn anode paired with a MnO2 cathode, the full cell exhibits an improved Coulombic efficiency (over 99% at 0.1 A g-1), a superior rate capability (127 mA h g-1 at 2 A g-1), and excellent cycling stability (capacity retention of 70% over 1000 cycles at 1 A g-1). This work provides a facile yet effective strategy to address the critical challenges in Zn anodes, paving the way for the development of high-performance rechargeable aqueous batteries.

A tannic acid-reinforced PEEK-hydrogel composite material with good biotribological and self-healing properties for artificial joints

Polyetheretherketone (PEEK) is widely considered as a promising material for joint implants but it still has limitations involving high friction and wear. To mimic the cartilage-subchondral bone structure in natural joints, a polyvinyl alcohol (PVA) hydrogel layer was fabricated on the PEEK substrate to provide a lubrication mechanism. In addition, tannic acid was applied to form dynamic hydrogen bonds with PVA molecules, for the purpose of strengthening the hydrogel layer and endowing it with self-healing ability. Our experimental results demonstrated that the prepared PEEK-hydrogel composite exhibited good biotribological performance with a low average friction coefficient around 0.06 and little wear after the friction test. It also could repair the scratch made by a blade spontaneously at room temperature taking advantage of the reversibility of the hydrogen bonds. The influence of the properties of the PVA hydrogel and the concentration of tannic acid on the frictional and self-healing behavior of the composite structure was investigated and the internal mechanism was discussed. This work presents a facile method to fabricate a PEEK-hydrogel composite possessing outstanding tribological properties and self-healing capacity simultaneously, hopefully promoting its potential in producing artificial joints.

Remnant oral biofilm and microorganisms after autoclaving sterilization of retrieved healing abutments

OBJECTIVE

The purpose of this study was to evaluate the sterilization effectiveness against biofilms on retrieved healing abutments used in implant dentistry.

BACKGROUND

A large number of clinicians reuse healing abutments to decrease treatment costs although it can promote infection due to the presence of remnant biofilm biomass.

METHODS

One hundred and eighty-five titanium healing abutments previously used for 3 months in oral cavity were assessed in this study. Abutments were submitted to cleaning, chemical disinfection, and autoclave sterilization according to clinical guidelines. The abutments were aseptically placed into glass tubes containing specific bacterial growth medium and then incubated for 10 days. From glass tubes with bacterial growth, 100 µl medium was transferred to Schaedler's agar for morphological identification and counting of strict anaerobes and to Columbia blood agar for presumptive identification of facultative anaerobes after incubation. Isolated strains were then identified at species level by enzymatic and biochemical tests within API microorganism detection platform. Also, polymerase chain reaction (PCR) was performed for identification of undefined strains.

RESULTS

After the standard cleaning and sterilization procedures, fifty-six (approximately 30%) retrieved abutments showed the presence of remnant biofilm biomass. The bacteria identified into the remnant biofilms covering the abutments were representative of the commensal oral microbiota including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Enterococcus faecalis.

CONCLUSION

Although some healing abutments did not reveal the existence of bacteria, organic components from biofilm biomass are still strongly adhered on the retentive micro-regions and surfaces of abutments and therefore that would support the accumulation of biofilm including pathogenic species leading to patients' cross-infections. Further studies should be performed on the assessment of different materials, design, and connections of the healing abutments associated with clinical disinfection procedures in implant dentistry.

Strategies to Reduce Biofilm Formation in PEEK Materials Applied to Implant Dentistry-A Comprehensive Review

Polyether-ether-ketone (PEEK) has emerged in Implant Dentistry with a series of short-time applications and as a promising material to substitute definitive dental implants. Several strategies have been investigated to diminish biofilm formation on the PEEK surface aiming to decrease the possibility of related infections. Therefore, a comprehensive review was carried out in order to compare PEEK with materials widely used nowadays in Implant Dentistry, such as titanium and zirconia, placing emphasis on studies investigating its ability to grant or prevent biofilm formation. Most studies failed to reveal significant antimicrobial activity in pure PEEK, while several studies described new strategies to reduce biofilm formation and bacterial colonization on this material. Those include the PEEK sulfonation process, incorporation of therapeutic and bioactive agents in PEEK matrix or on PEEK surface, PEEK coatings and incorporation of reinforcement agents, in order to produce nanocomposites or blends. The two most analyzed surface properties were contact angle and roughness, while the most studied bacteria were Escherichia coli and Staphylococcus aureus. Despite PEEK's susceptibility to biofilm formation, a great number of strategies discussed in this study were able to improve its antibiofilm and antimicrobial properties.

Fabrication and evaluation of electrospun biomimetic sulphonated PEEK nanofibrous scaffold for human skin cell proliferation and wound regeneration potential

Regeneration of skin wound is a challenging process since functional and architectural restoration of the damaged skin tissue is an arduous task. The use of springing up biomaterials with nano-topographic and bio-mimicking characteristics resembling natural skin's extra cellular matrix (ECM) would be a favorable approach to regenerate such an injured skin tissue. In this study an attempt has been carried out to design and develop sulphonated polyether ether ketone (SPEEK) nanofibrous scaffold to explore its role on skin cell proliferation potential. 2 h-SPEEK portrayed the highest proliferative potential for HaCaT keratinocytes and fibroblasts. It was aimed for the tailored release of bio-actives from the spatiotemporally designed Aloe vera incorporated 2 h-SPEEK nanoscaffold to accelerate the skin wound regeneration. FTIR, EDX and XRD analyses revealed the effective incorporation of Aloe vera in the electrospun nanofibers. SEM analysis revealed the nano-topographical morphology with highly porous, dense and interconnected fibrous structures mimicking the skin ECM. The regulated delivery of Aloe vera demonstrated the biocompatibility of the nanofibrous scaffold in skin keratinocytes (HaCaT) and fibroblasts (3T3) cells through in vitro analysis proving its non-toxic properties. Further, the fabricated nanoscaffolds exhibited excellent anti-microbial efficacy towards the tested human skin pathogenic microbes. The results of in vivo studies in Wistar rat model exhibited scar-less wound healing with complete wound closure. Thus, this nanofiber based drug delivery system implicitly acts as a skin like ECM, bio-mimicking the topographical and chemical cues of the natural skin tissues paving way for a complete regeneration and integration of the injured area strengthening the functional restoration of insulted cells around the wound area.

Coating of Polyetheretherketone Films with Silver Nanoparticles by a Simple Chemical Reduction Method and Their Antibacterial Activity

The coating of polymeric substrate polyetheretherketone (PEEK) with silver nanoparticles (AgNPs) was carried out by a wet chemical route at room temperature. The coating process was developed from the Tollens reagent and D-glucose as reducing agent. The resulting composite exhibited antimicrobial activity. The PEEK films were coated with a single layer and two layers of silver nanoparticles in various concentrations. The crystallographic properties of the polymer and the silver nanoparticles were analyzed by X-ray diffraction (XRD). Fourier transform infrared spectra (FTIR) show the interaction between the silver nanoparticles with the polymeric substrate. Transmission electron microscope (TEM) images confirmed the obtaining of metallic nanoparticles with average sizes of 25 nm. It was possible to estimate the amount of silver deposited on PEEK with the help of thermogravimetric analysis. The morphology and shape of the AgNPs uniformly deposited on the PEEK films was ascertained by the techniques of scanning electron microscopy (SEM) and atomic force microscopy (AFM), evidencing the increase in the amount of silver by increasing the concentration of the metal precursor. Finally, the antibacterial activity of the films coated with Ag in Escherichia coli, Serratia marcescens and Bacillus licheniformis was evaluated, evidencing that the concentration of silver is crucial in the cellular replication of the bacteria.

PEEK materials as an alternative to titanium in dental implants: A systematic review

PURPOSE

Evaluation of the available research on PEEK materials to find that whether PEEK material has favorable properties and can enhance osseointegration, so that they can be utilize as implants material.

MATERIALS AND METHODS

An electronic and structured systematic search was undertaken in May 2018, without any restrictions of time in the Medline/Pubmed, Sci-hub, Ebscohost, Cochrane, and Web of Science databases. To identify other related references further hand search was done. Articles related to PEEK and their applications in implants were only included. Articles not available in abstract form and article other than English language were excluded.

RESULTS

Initially, the search resulted in 153 papers. Independent screenings of the abstracts were done by the reviewers to identify the articles related to the question in focus. Sixty-two studies were selected out of which 10 were further excluded due to not in English language. Two additional papers were obtained after hand searching, and finally 54 articles were included in the review.

CONCLUSIONS

Surface modification of PEEK seems to enhance the cell adhesion, proliferation, biocompability, and osteogenic properties of PEEK implant materials. PEEK had also influence the biofilm structure and reduces the chances of periimplant inflammations. Further research and more number of controlled clinical trials on PEEK implant is required in near future so that it can replace titanium in future.

Effect of γ-lactones and γ-lactams compounds on Streptococcus mutans biofilms

Considering oral diseases, antibiofilm compounds can decrease the accumulation of pathogenic species such as Streptococcus mutans at micro-areas of teeth, dental restorations or implant-supported prostheses.

OBJECTIVE

To assess the effect of thirteen different novel lactam-based compounds on the inhibition of S. mutans biofilm formation.

MATERIAL AND METHODS

We synthesized compounds based on γ-lactones analogues from rubrolides by a mucochloric acid process and converted them into their corresponding γ-hydroxy-γ-lactams by a reaction with isobutylamine and propylamine. Compounds concentrations ranging from 0.17 up to 87.5 μg mL-1 were tested against S. mutans. We diluted the exponential cultures in TSB and incubated them (37°C) in the presence of different γ-lactones or γ-lactams dilutions. Afterwards, we measured the planktonic growth by optical density at 630 nm and therefore assessed the biofilm density by the crystal violet staining method.

RESULTS

Twelve compounds were active against biofilm formation, showing no effect on bacterial viability. Only one compound was inactive against both planktonic and biofilm growth. The highest biofilm inhibition (inhibition rate above 60%) was obtained for two compounds while three other compounds revealed an inhibition rate above 40%.

CONCLUSIONS

Twelve of the thirteen compounds revealed effective inhibition of S. mutans biofilm formation, with eight of them showing a specific antibiofilm effect.