The Role of Polyether Ether Ketone (Peek) in Dentistry - A Review

A digital chairside repair protocol for removable partial dentures with polyetheretherketone frameworks

Polyetheretherketone (PEEK) has become popular for removable partial denture (RPD) frameworks but reports on their clinical follow-up and repair are lacking. Two defective PEEK-framework RPDs were repaired with computer-aided design and manufacturing technology, saving costs and time and simplifying the treatment process.

Effects of PEEK surface treatment using alumina blasting or concentrated sulfuric acid etching in combination with functional monomers on shear bond strength to adhesive cement after artificial aging

The purpose of this study is to investigate the effects of surface treatment methods using polyetheretherketone (PEEK) (with or without a functional monomer-containing primer following treatment with alumina blasting or concentrated sulfuric acid) on the shear bond strength (SBS) of resin luting material after artificial aging. The PEEK specimens were classified into five groups according to their treatment methods: untreated, alumina blasting (AB), concentrated sulfuric acid (SA), alumina blasting+primer (ABP), and concentrated SA+primer (SAP). The SBS score of each group was determined experimentally using a universal testing machine. The SBS tests revealed that the initial bond strengths of ABP and SAP were significantly higher than those of AB and SA. In addition, both SBS after 20,000 thermal cycles remained high (>15 MPa). These results suggest that the ABP and SAP groups are the best predictive methods for evaluating SBS with PEEK and resin cement.

Evaluation of Shear Bond Strength and Failure Modes of Lithium Disilicate Ceramic Veneering Material to Different High-Performance Polymers

This study assessed the shear bond strength (SBS) and failure modes of lithium disilicate ceramic veneering material to different high-performance polymers. Thirty-six square specimens measuring 7 × 7 × 2 ± 0.05 mm were prepared from pure polyetheretherketone (PEEK), Bio-high performance PEEK (BioHPP) and Trilor discs. Polymer specimens were air-borne abraded utilizing aluminum oxide particles, cleaned, and a bonding agent was applied (visio. link). The veneering LDC material (3 × 2 mm) was milled, hydrofluoric acid etched (9.5%) and primed (Clearfil ceramic). The LDC was bonded to the polymer specimens using dual-cured resin cement (Panavia V5) and light polymerized. The bonded specimens were subjected to 5000 cycles of physiological aging by thermocycling, and the SBS test was performed in a universal testing machine at 0.5 mm/min cross-head speed. The debonded specimens were analyzed to determine the primary bond failure sites (adhesive, mixed or cohesive). Data analysis was performed using one-way ANOVA and a post hoc Tukey test (α ≤ 0.05). The BioHPP material demonstrated the highest SBS values (23.94 ± 1.43 MPa), and the Trilor group recorded the lowest SBS values (17.09 ± 1.07 MPa). The PEEK group showed a mean SBS of 21.21 ± 1.51 MPa. The SBS comparison showed significant variations across all material groups (p < 0.001). Regarding failure modes, adhesive failure was observed in 40% of BioHPP and PEEK specimens and 90% of Trilor specimens. The cohesive failure occurred in 50% of PEEK and 30% of BioHPP specimens, while the Trilor specimens showed no cohesive failure. Mixed failures were reported in 30% of BioHPP and 10% of PEEK and Trilor specimens. The BioHPP material demonstrated high SBS followed by PEEK and Trilor. The SBS between the tested materials was statistically significant. However, the SBS of the tested implant framework materials was above the limit stipulated by the ISO 10477 standard (5 MPa) and the clinically acceptable range of 10-12 MPa.

Influence of different polymeric materials of implant and attachment on stress distribution in implant-supported overdentures: a three-dimensional finite element study

PURPOSE

Investigating high performance thermoplastic polymers as substitutes to titanium alloy, in fabrication of implants and attachments to support mandibular overdenture, aiming to overcome stress shielding effect of titanium alloy implants. AIM OF STUDY: Assessment of stress distribution in polymeric prosthetic components and bone around polymeric implants, in case of implant-supported mandibular overdenture.

MATERIALS AND METHODS

3D finite element model was established for mandibular overdenture, supported bilaterally by two implants at canine region, and retained by two ball attachments. Linear static stress analysis was carried out by ANSYS 2020 R1. Three identical models were created with different materials for modeling of prosthetic components (implant body, gingival former, ball attachment and matrix). The Monolithic principle was applied as the same material was used in modelling all the prosthetic components in each model (Titanium alloy grade V, poly-ether-ether-ketone (PEEK) and poly-ether-ketone-ketone (PEKK)). Simultaneous Force application of 60 N was carried out bilaterally at the first molar occlusal surface area using 3 runs (vertical, lateral and oblique).

RESULTS

PEEK and PEKK prosthetic components exhibited the highest total deformation and critical Maximum von Mises stresses values in implant body and gingival former under lateral and oblique loads. The stress values approached the fatigue limit of both polymeric materials presenting low factor of safety (< 1.5). The Peri-implant cortical bone in case of PEEK and PEKK showed nearly double maximum principal stresses compared with the titanium model. Conversely, Maximum von Mises stresses in spongy bone were lower in polymeric models than those of titanium ones. Additionally maximum equivalent strain values in spongy peri-implant bone of polymeric models were also lower than those of titanium model.

CONCLUSION

Critical high stresses were induced in implant body and gingival former under oblique or lateral loadings, accordingly, fatigue failure of both PEEK and PEKK polymer prosthetic elements was estimated due to low factor of safety. Both PEEK and PEKK Polymer models offered no advantage over titanium one regarding stress shielding effect, due to low stress and strain values generated at spongy peri-implant bone in polymer models.

A comprehensive review on the State of the Art in the research and development of poly-ether-ether-ketone (PEEK) biomaterial-based implants

Polyetheretherketone (PEEK) is a preferred high-performance polymer in the spine, orthopedic, and craniomaxillofacial implant industry. However, despite its commendable mechanical properties, its bioinert nature limits the implants from integrating with neighboring tissues, impacting the implant's long-term performance. To address this limitation, various kinds of surface functionalization techniques have been developed over the years. Noteworthy efforts have been made to incorporate bioactive fillers in the PEEK matrix to develop standalone bioactive composites. In personalized medicine, significant advances have been made in the 3D Printing of PEEK implants. 3D-printed PEEK implants are now being developed at Point-of-Care, significantly reducing manufacturing and logistic time. Given the recent clinical follow-up updates and advancements in PEEK-based implants, PEEK implants are witnessing an important phase in its history. Recognizing this vital phase, this paper aims to comprehensively review the advancements of PEEK implants over the past decade. The review starts with an overview of the clinical impact of varying PEEK implants, followed by PEEK's surface functionalization techniques and engineering of PEEK-based bioactive composites. Next, this review describes the advancements made in the 3D printing of PEEK implants and points out the essential considerations that should be considered when developing 3D-printed PEEK-based implants. Finally, the review ends with an estimated projection about the future of PEEK-based implants. Readers are expected to gain an all-encompassing and in-depth understanding of PEEK biomedical implants' past, present, and future, enabling researchers to advance the research and development of PEEK-based implants in the required direction. STATEMENT OF SIGNIFICANCE: PEEK is a preferred high-performance polymer in the implant industry, with notable benefits over metallic and ceramic implants, such as bone-matching stiffness and durability. Significant strides have been made in the last decade to make PEEK implants bioactive and utilize 3D Printing to develop patient-specific implants. Given the recent advancements in PEEK-based implants, this review aims to provide an all-encompassing and in-depth understanding of PEEK biomedical implants' past, present, and future. It will comprehensively discuss the know-how gained from the clinical follow-up, the strategies to address the limitations of PEEK implants, and the essential considerations in 3D Printing of PEEK implants. This review will enable researchers to advance the research and development of PEEK implants in the required direction.

Revolutionizing Dental Polymers: The Versatility and Future Potential of Polyetheretherketone in Restorative Dentistry

Polyetheretherketone (PEEK) has emerged as a revolutionary material in modern dentistry because of its unique combination of mechanical strength, biocompatibility, and versatility. This literature review examines the current applications and future potential of PEEK in various dental disciplines. PEEK's favorable properties, including its low specific weight, high strength-to-weight ratio, and ability to be easily machined, have led to its adoption in prosthetics, implantology, and dental esthetic restorations. This material has shown promise for fabricating crowns, bridges, removable partial denture frameworks, and implant components. PEEK's radiolucency and bone-like elastic modulus make it particularly suitable for dental implants and abutments. Additionally, its resistance to degradation and compatibility with various surface treatments enhances its long-term performance in the oral environment. While challenges such as bonding to other dental materials and aesthetic limitations exist, ongoing research is addressing these issues through surface modifications and composite formulations. As the dental field continues to evolve, PEEK's adaptability and biocompatibility position it a key player in the development of next-generation dental materials and techniques, potentially transforming patient care and treatment outcomes in dentistry.

A bacteriocin-based coating strategy to prevent vancomycin-resistant Enterococcus faecium biofilm formation on materials of interest for indwelling medical devices

The ever-increasing use of exogenous materials as indwelling medical devices in modern medicine offers to pathogens new ways to gain access to human body and begin, in some cases, life threatening infections. Biofouling of such materials with bacteria or fungi is a major concern during surgeries, since this is often associated with biofilm formation and difficult to treat, recalcitrant infections. Intense research efforts have therefore developed several strategies to shield the medical devices' surface from colonization by pathogenic microorganisms. Here, we used dopamine as a coupling agent to coat four different materials of medical interest (plastic polyetheretherketone (PEEK), stainless steel, titanium and silicone catheter) with the bacteriocins, enterocin EJ97-short and the thiopeptide micrococcin P1. Water contact angle measurements and x-ray photoelectron spectroscopy were used to verify the effective coating of the materials. The effect of bacteriocins coated on these materials on the biofilm formation by a vancomycin resistant Enterococcus faecium (VRE) strain was studied by biofilm-oriented antimicrobial test (BOAT) and electron scanning microscopy. The in vitro biocompatibility of bacteriocin-modified biomaterials was tested on cultured human cells. The results demonstrated that the binding of the bacteriocins to the implant surfaces is achieved, and the two bacteriocins in combination could inhibit biofilm formation by E. faecium on all four materials. The modified implant showed no cytotoxicity to the human cells tested. Therefore, surface modification with the two bacteriocins may offer a novel and effective way to prevent biofilm formation on a wide range of implant materials.

Evaluation of polyaryletherketone materials as post-core abutments for removable partial dentures: A finite element analysis

OBJECTIVE

The purpose was to compare the biomechanical behavior of single-piece post-core restorations made from polyaryletherketone materials with fiber post-core restorations when serving as abutments for RPD using finite element analysis (FEA).

METHODS

Phantom maxillary central incisor and mandibular second premolar were trimmed 1-mm coronally to cemento-enamel junction; root canals were enlarged and the teeth were scanned. Data was transferred to a solid modeling software.Twenty four models, including six post-core restorations:glass-fiber post/composite core (GFH/GFL) and single-piece post-core groups as, PEKK(PKH/PKL);Ti02-reinforced PEEK(TH/TL);ceramic reinforced PEEK(CeH/CeL);carbon fiber reinforced PEEK(CaH/CaL);glass fiber reinforced PEEK(GFPH/GFPL) with hybrid ceramic/lithium disilicate crowns on each tooth were constructed.Loads of 100 N for central incisor, and 300 N for premolar in a 45°oblique direction were applied to simulate masticatory forces. Clasp removal force of a RPD was simulated as 5 N vertically.FEA was employed to evaluate the von Mises stresses.Strain at cement layer was also investigated.

RESULTS

CaH/CaL groups revealed the lowest stress for both teeth at root while TH/TL groups revealed the highest stress. The lowest stress values in the post-core were in GFH/GFL groups while the highest stress occurred in the CaH/CaL groups for both teeth.

SIGNIFICANCE

Glass-fiber post-cores exhibited the lowest stresses in the post under masticatory and clasp removal forces. It may suggest a potentially lower risk of post fracture compared to polyaryletherketone group materials. TiO2-reinforced PEEK post-cores exhibited the lowest stresses among PAEK materials, indicating a potentially high fracture resistance.

Comparative Assessment of Post-Fatigue Resistance of Mandibular First Molars Restored With Polyether Ether Ketone and Lithium Disilicate Endocrowns

Background and Objectives: Contemporary dentistry focuses on more conservative treatment options such as endocrown restorations and application of dental materials with higher resemblance to tooth structure. Polyether ether ketone (PEEK) polymer is a material used for the fabrication of endocrowns. This study aimed to compare the post-fatigue resistance (PFR) of mandibular first molars restored with PEEK and lithium disilicate (LS2) endocrown restorations. Materials and Methods: This in vitro, experimental study was conducted on 20 human mandibular first molars with similar dimensions. The teeth were prepared for endocrown restoration and were assigned to two groups (n = 10) of PEEK and LS2 endocrowns. After fabrication by the computer-aided design and computer-aided manufacturing (CAD-CAM) technique, the restorations were cemented with resin cement. Next, the teeth underwent 15,000 thermal cycles followed by cyclic loading with 600,000 cycles of compressive force (100 N, 4 Hz) and were then subjected to compressive load application in a universal testing machine. The load causing endocrown failure was recorded as the PFR of the respective restoration. The failure mode was also inspected under a light microscope. Data were analyzed by the independent t-test and also chi-square, Mann-Whitney, and Fisher's exact tests (α < 0.05). Results: The teeth with PEEK endocrowns showed significantly higher PFR than those with LS2 endocrowns. Irreparable fractures were dominant in both groups. Conclusion: PEEK may serve as a suitable alternative to LS2 for the fabrication of endocrown restorations.

Investigating the Effect of Polyetheretherketone (PEEK) Veneers on Bond Strength and Discoloration When Repairing Various Composites

OBJECTIVES

This study aimed to examine the impact of the strength and color change of composite materials that could be utilized in the repair of polyetheretherketone (PEEK) veneer fractures.

METHODS

The 220 nanoceramic-filled PEEK specimens used in the study were divided into four groups, and color measurements were made on a gray background (n=55): Group N, 1-mm-thick monochromatic composite; Group NN, 2-mm-thick monochromatic composite; Group F, 1-mm-thick 2-mm-diameter short fiber-reinforced composite, placed in the center and polymerized; and Group FF, 2-mm-thick 2-mm-diameter short fiber-reinforced composite, placed in the center and polymerized. The remaining mating surfaces were restored by filling with monochromatic composite and adhesion strength testing by re-measuring the color.

RESULTS

The results of the two-way ANOVA indicated that there was a significant color change caused by both thickness and composite type (p<0.001). Additionally, a significant difference in bond strength was observed between the groups.

CONCLUSION

In PEEK restorations, short fiber-reinforced composites significantly increase bond strength, while the use of monochromatic composites of a certain thickness ensures that color change remains within acceptable limits.

SIGNIFICANCE

 Although PEEK has a superior mechanical structure, it does not meet the aesthetic expectations and needs to be veneered. However, fractures are frequently seen due to low bond strength. Therefore, this study is important because it aims to provide guidance to clinicians on aesthetic and mechanical methods that can be used in PEEK prosthesis repair.

Effect of Different Cantilever Lengths in Polyether Ether Ketone Prosthetic Framework in All-on-Four Technique on Stress Distribution: A Three-Dimensional (3D) Finite Element Analysis

BACKGROUND

Determining the distal cantilever length in All-on-Four (All-on-4) implant-supported prostheses is a major factor in the long-term success of these prostheses. The difference in mechanical properties of materials used in the fabrication of these prostheses, such as polyether ether ketone (PEEK), may have an impact on the determination of the cantilever length that best distributes stress.

AIM

To study the distribution of stress in All-on-4 mandibular prostheses in the bone, implants, and framework according to difference cantilever length in PEEK prosthetic framework using three-dimensional finite element analysis.

MATERIALS AND METHODS

A three-dimensional (3D) model of an edentulous mandible was constructed, implants and abutments models were designed by the All-on-4 concept, and two frameworks were constructed from PEEK with different cantilever lengths of 10 and 15 mm. Two study groups were created. Occlusal oblique forces of 600N were applied from the right side at a 45-degree angle, and finite element analysis was performed to obtain the stress distribution in the bone, implants, and framework.

RESULTS

At cantilever length of 10 mm, in the PEEK model, this study found an increase in stress compared to PEEK model at cantilever length of 15 mm in the cortical bone and implants and framework, but PEEK models showed a similar distribution of stress in the spongy bone.

CONCLUSIONS

Decreasing the cantilever length in the PEEK model will increase the stress. PEEK models showed deformation of the structure material.

Improving accuracy and efficiency of the machined PEEK denture based on NSGA-II integrated GABP neural network

OBJECTIVES

The polymer polyetheretherketone (PEEK) is gradually being used in dental restorations because of its excellent mechanical properties, chemical resistance, fatigue resistance, thermal stability, radiation translucency and good biocompatibility. To process PEEK dentures with lower surface roughness as quickly as possible, the non-dominated sorting genetic algorithm-II (NSGA-II) integrated genetic algorithm back propagation (GABP) neural network was proposed, which can adjust the combination of process parameters for milling PEEK dentures.

METHODS

The PEEK machining was conducted using a four-axis dental milling machine at different process parameters. The surface roughness of PEEK dentures was characterized using surface roughness profiler and scanning electron microscopy (SEM). The optimum machining performance of milling PEEK dentures was investigated using a multi-objective optimization model named as NSGA-II integrated GABP neural network algorithm. The surface roughness (Ra) and material removal rate (MRR) were used as optimization objectives.

RESULTS

The multi-objective optimization model effectively improved surface roughness and machining efficiency for milling PEEK dentures. The validation experiments showed that the surface roughness of all PEEK dentures was less than 0.2μm, which was within the range of surface roughness set in this paper. The GABP surface roughness prediction model had an average error of 6 %. For the same surface roughness value, the optimized milling parameters all had a greater material removal rate.

SIGNIFICANCE

The research results can improve current PEEK denture CAD/CAM technology by providing appropriate milling parameters using NSGA-II integrated GABP algorithm.

Comparative Evaluation of Surface Roughness and Color Stability of Polyetheretherketone with Conventional Interim Prosthetic Materials: An In Vitro Study

AIM

The aim of this in vitro study was to compare the surface roughness and color stability of polyetheretherketone (PEEK) with those of conventional interim prosthetic materials like polymethylmethacrylate, bis-acrylic composite, and rubberized diurethane dimethacrylate, following immersion in solutions of varying pH value.

MATERIALS AND METHODS

A total of 320 circular discs with 10 mm diameter and 2 mm height were divided based on the fabrication (n = 80)-group A: polymethylmethacrylate; group B: bis-acrylic composite; group R: rubberized diurethane; and group P: hot-pressed PEEK-and were subjected to baseline measurement of roughness (n = 40) and color (n = 40) using 3D profilometer and UV-Vis spectrophotometer, respectively. Later, 10 samples from each group were immersed in distilled water, black coffee, green tea, and Pepsi, respectively, for 120 days, and measurements of roughness and color were repeated. The differences in roughness (ΔRa) and color change(ΔE) were calculated and statistically analyzed with a significance level of p-value < 0.05.

RESULT

Irrespective of the immersion solution, the highest mean difference in the roughness values was shown by rubberized diurethane specimens: ΔRa = 3.574880 (0.0048350) in carbonated beverages, and lowest difference was shown by bis-acrylic composite: ΔRa = 0.29004 (0.0017473) in distilled water. The greatest color stability was exhibited by PEEK. The type of interim material and immersion solution had a statistically significant effect on change in color and roughness values.

CONCLUSION

The immersion in solutions of varying pH had a significant effect on surface roughness and color stability of all the tested materials. The Ra value of all specimens after immersion was still within the clinically acceptable range. Polyetheretherketone was the most color stable material in all solutions, except in green tea.

CLINICAL SIGNIFICANCE

This study will provide guidance to dentists and patients regarding the selection of interim material for long-term use, depending on the effect of beverage consumption on its color stability and roughness. How to cite this article: Saraswathy A, Latha N, Ayyadanveettil P, et al. Comparative Evaluation of Surface Roughness and Color Stability of Polyetheretherketone with Conventional Interim Prosthetic Materials: An In Vitro Study. J Contemp Dent Pract 2024;25(10):930-935.

Biomedical Device Surface Treatment by Laser-Driven Hydroxyapatite Penetration-Synthesis Technique for Gapless PEEK-to-Bone Integration

Polyetheretherketone (PEEK), a bioinert polymer known for its mechanical properties similar to bone, is capable of averting stress shielding. Due to these attributes, it finds applications in diverse fields like orthopedics, encompassing cervical disc replacement for the neck and spine, along with dentistry and plastic surgery. However, due to insufficient bonding with bone, various methods such as hydroxyapatite (HA) coating on the surface are attempted. Nonetheless, the interface between the polymer and ceramic, two different materials, tended to delaminate after transplantation, posing challenges in preventing implant escape or dislodgement. This research delves into the laser-driven hydroxyapatite penetration-synthesis technique. Differing from conventional coating methods that bond layers of dissimilar materials like HA and PEEK, this technology focuses on synthesizing and infiltrating ionized HA within the PEEK substrate resulting in an interface-free HA-PEEK surface. Conversely, HA-PEEK with this technology applied achieves complete, gap-free direct bone-implant integration.  Our research involved the analysis of various aspects. By means of these, we quantitatively assesed the enhanced bone bonding characteristics of HA-PEEK surfaces treated with this approach and offered and explanation for the mechanism responsible for direct bone integration.

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.

Finite Element Analysis of the Stress and Deformation in Bone Caused by CFR-PEEK, Titanium, and Zirconia Ceramic Implants

Introduction

Glass or carbon fiber-reinforced polyetheretherketone (CFR-PEEK) composites and zirconia ceramic have been offered as more modern implant biomaterials.

Objectives

This study examined the effects of zirconia ceramic implants, titanium, and CFR-PEEK on bone stress and deformation.

Materials and Methods

A geometric model of a mandibular molar replaced with an implant-supported crown was created for this in vitro finite element analysis investigation. The dimensions of the implant employed in the study are 11.0 mm in length and 4.5 mm in diameter. Using finite element analysis, three implant assemblies composed of zirconium, titanium, and CFR-PEEK were produced. 150 N loads were applied both vertically and obliquely on the long axis of the implant. The von-Mises stresses and deformation were compared using ANSYS Workbench 18.0 and finite element software, with a significance threshold of P < 0.05.

Results

All three implant assemblies-zirconia, titanium, and CFR-PEEK-showed comparable stresses and deformation in bone with no appreciable variations.

Conclusion

Zirconia and PEEK reinforced with carbon fibers (CFR-PEEK) have been found to be viable replacements for titanium in implant biomaterials.

Mechanical Integrity of All-on-Four Dental Implant Systems: Finite Element Simulation of Material Properties of Zirconia, Titanium, and PEEK

Background

Dental implants are critical for restoring functionality and aesthetics in patients with missing teeth. The all-on-four treatment concept utilizes four dental implants to support a full-arch prosthesis. Material choice for these implants plays a crucial role in the long-term success of the treatment, affecting everything from biomechanical stability to osseointegration and patient comfort.

Aim

The purpose of this study is to analyze the biomechanical performance of three different materials used in all-on-four dental implant designs through finite element analysis (FEA). The aim is to determine which material optimally balances stress and deformation under various loading conditions.

Objective

The main objective of this research is to evaluate the effects of stress, strain, and deformation on all-on-four dental implants made from titanium, zirconia, and polyether ether ketone (PEEK). The study seeks to identify which material demonstrates the best mechanical properties under simulated functional loads.

Methods

A 3D model simulating the dental implants integrated with cancellous and cortical bone was developed. Finite element analysis was conducted to assess the biomechanical performance of the implants made from titanium, zirconia, and PEEK. A perpendicular load of 100 N was applied to the tips of the implants, followed by an oblique load of 100 N at a 30-degree angle, to simulate different chewing forces.

Results

The deformation analysis indicated that implants made of zirconia exhibited significantly lower maximum and average deformation compared to those made from titanium and PEEK. Although PEEK implants showed lower maximum and average stress, they did not perform well in stress dissipation compared to zirconia. Similar patterns of stress and deformation were observed under both perpendicular and oblique loading conditions.

Conclusion

Zirconia implants outperformed titanium and PEEK in terms of deformation and stress distribution under simulated loading conditions. This suggests that zirconia could be a superior material for all-on-four dental implants, offering better mechanical stability and potentially enhancing the longevity and success of dental restorations. Further clinical trials are recommended to validate these findings and assess the long-term outcomes of zirconia-based implants.

Effect of Different Primers on the Shear Bond Strength of Orthodontic Brackets Bonded to Reinforced Polyetheretherketone (PEEK) Substrate

This in vitro study assessed the effect of different primers on the shear bond strength (SBS) and adhesive remnant index (ARI) of orthodontic brackets bonded to reinforced polyetheretherketone (PEEK) substrate. A total of 40 specimens were randomly distributed to two groups based on the primer used for orthodontic bonding: group 1 (control)-Transbond XT adhesive with Visio.link primer and group 2 (test)-orthodontic adhesive (Transbond XT) with traditional orthodontic primer. After bonding, specimens were thermocycled followed by SBS testing and ARI scoring of debonded specimens. Data were analyzed using the unpaired independent t-test and the Chi-square test. Group 1 specimens showed significantly higher SBS values (21.38 ± 1.48 MPa) compared to group 2 specimens (18.63 ± 1.29 MPa) (p < 0.0001). Adhesive remnant index scores showed no significant variations in bond failure modes and distributions between groups. The SBS obtained by the tested primers exceeded the clinically recommended value. Consequently, there is a comparable clinical application for both tested primers in orthodontic bonding, especially the traditional orthodontic primer, where the availability of Visio.link in clinical practice is not ensured.

Effect of laser surface treatment on shear bond strength between polyetheretherketone and heat-activated polymethylmethacrylate resin

PURPOSE

To compare the shear bond strength between polyetheretherketone (PEEK) and heat activated polymethylmethacrylate (PMMA) resin after laser treatment.

MATERIALS AND METHODS

A total of 128 PEEK discs were fabricated (10 mm diameter and 2 mm thickness) and allocated into two groups. Group 1 was subjected to surface treatment followed by thermal cycling for 5000 cycles and group 2 was subjected to surface treatment followed by thermal cycling for 10,000 cycles. Each group was further subdivided into four subgroups (n = 16) which were: no surface treatment; primer treatment; acid etching; and laser surface treatment. PEEK was then bonded with PMMA resin using the conventional flasking technique. The shear bond strength was evaluated using a universal testing machine with a crosshead speed of 1 mm/min. Statistical analysis was done using one-way ANOVA for comparing within groups, followed by Tukey HSD test. Student's T-test was done to evaluate between the two groups.

RESULTS

In group 1, the highest shear bond strength was exhibited by the laser group (19.08 ± 0.16 MPa) followed by the acid etch group (14.84 ± 0.23 MPa), and the primer group (6.43 ± 0.20 MPa), while the least shear bond strength was observed in the no surface treatment group (4.98 ± 0.34 MPa) which was found to be significant (p < 0.05). In group 2, the highest shear bond strength was observed in the laser group (18.21 ± 0.23 MPa) followed by the acid etch group (13.77 ± 0.48 MPa), and the primer group (6.04 ± 0.11 MPa), while the least shear bond strength was observed in no surface treatment group (4.35 ± 0.21 MPa) which was found to be significant (p < 0.05).

CONCLUSION

The shear bond strength between PEEK and PMMA resin was highest for specimens that were surface treated with laser and followed by specimens treated with acid etching, primer application, and without surface treatment, respectively. Increasing thermal cycling from 5000 cycles to 10,000 cycles also reduced the bond strength.

Retention and fatigue performance of modified polyetheretherketone clasps for removable prosthesis

PURPOSE

Polyetheretherketone (PEEK) is considered as an alternative to metal material for removable partial denture (RPD). However, the retentive force is not strong as a metal RPD. This study investigated the retention and fatigue performance of PEEK clasps with different proportions of clasp arm engaging the undercut to verify a new strategy to improve their clinical performance.

METHODS

Three groups (n = 10/group) of PEEK clasps with their terminal 1/3, 2/3 and the whole of retentive arms engaging the undercut were fabricated along with a group (n = 10) of conventional cobalt-chrome (CoCr) clasps as control group. Retentive forces were measured by universal testing machine initially and at an interval of 1500 cycles for a total of 15,000 fatigue cycles. The fatigue cycles were conducted by repeated insertion and removal of the clasp using fatigue testing machine. Each clasp was scanned by Trios3 scanner before and after fatigue test to obtain digital models. The deformation of the clasp was evaluated by root mean square (RMS) through aligning the two models in Geomagic wrap (2021). Scanning electron microscopy (SEM) and finite element analysis were carried out to observe the abrasion and the von Mises stress of the clasp arm. Kruskal-Wallis H test was used to compare the retentive forces and the RMSs of the studied groups followed by Bonferroni multiple comparisons.

RESULTS

The whole of PEEK clasp arm engaging the undercut provided higher mean retentive forces (7.99 ± 2.02 N) than other PEEK clasp groups (P < 0.001) and was closer to CoCr clasps (11.88 ± 2.05 N). The RMSs of PEEK clasps were lower than CoCr clasps (P < 0.05) while the differences among PEEK clasps were of no statistical significance (P > 0.05). SEM showed that evidences of surface abrasion were observed on the section that engaged the undercut for all groups of clasps. The stress concentration mainly occurred on the initial part of the retentive arm. The maximum von Mises stress of each group was below the compressive strength of PEEK.

CONCLUSIONS

Proportions of PEEK clasp arm engaging the undercut positively influenced the retentive force and the fatigue resistance of PEEK clasps was superior than CoCr clasps. It is a feasible method to improve the retention of PEEK clasps by increasing the proportion of clasp arm engaging the undercut. Clinical trials are needed to further verify this innovation.

Polyetheretherketone bioactivity induced by farringtonite

Polyetheretherketone (PEEK) is considered as an excellent biomaterial for bone grafting and connective tissue replacement. The clinical potential is, however, limited by its bioinertness, poor osteoconduction, and weak antibacterial activity. These disadvantages can be overcome by introducing suitable additives to produce mineral-polymer composites or coatings. In this work, a PEEK-based bioactive composite has been obtained by blending the polymer with magnesium phosphate (Mg3(PO4)2) particles in amounts ranging from 1 to 10 wt.% using the hot press technique. The obtained composite exhibited improved mechanical and physical properties, above the lower limits set for bone engineering applications. The tested grafts were found to not induce cytotoxicity. The presence of magnesium phosphate induced the mineralisation process with no adverse effects on the expression of the marker crucial for osteoblastic differentiation. The most promising results were observed in the grafts containing 1 wt.% of magnesium phosphate embedded within the PEEK matrix. The improved bioactivity of grafts, together with suitable physical-chemical and mechanical properties, indicate this composite as a promising orthopaedic implant material.

Dental implant and abutment in PEEK: stress assessment in single crown retainers on anterior region

OBJECTIVE

Stress distribution assessment by finite elements analysis in poly(etheretherketone) (PEEK) implant and abutment as retainers of single crowns in the anterior region.

MATERIALS AND METHODS

Five 3D models were created, varying implant/abutment manufacturing materials: titanium (Ti), zirconia (Zr), pure PEEK (PEEKp), carbon fiber-reinforced PEEK (PEEKc), glass fiber-reinforced PEEK (PEEKg). A 50 N load was applied 30o off-axis at the incisal edge of the upper central incisor. The Von Mises stress (σvM) was evaluated on abutment, implant/screw, and minimum principal stress (σmin) and maximum shear stress (τmax) for cortical and cancellous bone.

RESULTS

The abutment σvM lowest stress was observed in PEEKp group, being 70% lower than Ti and 74% than Zr. On the implant, PEEKp reduced 68% compared to Ti and a 71% to Zr. In the abutment screws, an increase of at least 33% was found in PEEKc compared to Ti, and of at least 81% to Zr. For cortical bone, the highest τmax values were in the PEEKp group, and a slight increase in stress was observed compared to all PEEK groups with Ti and Zr. For σmin, the highest stress was found in the PEEKc. Stress increased at least 7% in cancellous bone for all PEEK groups.

CONCLUSION

Abutments and implants made by PEEKc concentrate less σvM stress, transmitting greater stress to the cortical and medullary bone.

CLINICAL RELEVANCE

The best stress distribution in PEEKc components may contribute to decreased stress shielding; in vitro and in vivo research is recommended to investigate this.

Suitability and Trueness of the Removable Partial Denture Framework Fabricating by Polyether Ether Ketone with CAD-CAM Technology

The object of the study was to evaluate the suitability and trueness of the removable partial denture (RPD) framework fabricated by polyether ether ketone (PEEK) with the CAD-CAM technology in vitro. Four different types of dentition defects were selected. In each type, five PEEK RPD frameworks were fabricated by the CAD-CAM technology, while five Co-Cr RPD frameworks were made by traditional casting. The suitability of the framework was evaluated by silicone rubber film slice measurement and the three-dimensional image overlay method. The trueness of the PEEK framework was detected by the three-dimensional image overlay method. Data were statistically analyzed with the use of an independent samples t-test (α = 0.05). The suitability values by silicone rubber film slice measurement of the PEEK group were lower than those of the Co-Cr group in four types, with the differences indicating statistical significance (p < 0.05) in type one, type two, and type four. The suitability values using the three-dimensional image overlay method showed no statistical differences (p > 0.05) between the two groups in four types. The trueness values of the PEEK group were within the allowable range of clinical error. The suitability and trueness of the PEEK RPD framework fabricated by CAD-CAM technology met the requirements of the clinical prosthesis.

Evaluation and assessment of the wettabilty and water contact angle of modified poly methyl methacrylate denture base materials against PEEK in cast partial denture framework: an in vitro study

INTRODUCTION

The prevalence of adults with partially dental arches is expected to be more than imagined and patients requiring replacement of missing teeth are slowly increasing in number too. Removable partial dentures are known to provide for substantial replacement for the missing teeth with also added advantages when compared to fixed or implant prosthesis, mainly in elderly patients. Denture base material performance and durability are greatly influenced by wettability and water contact angle. In the case of dentures; adequate moisture distribution is necessary to ensure excellent wettability which has an influence on comfort and oral health. The purpose of conducting this study was to find out whether the advancements made using PEEK (Polyether ether ketone) would prove to be more beneficial than the current upgrades in the current material spectrum.

MATERIALS AND METHODS

This study was performed under in vitro conditions. All the fabrication and processing was done only by one operator. The materials used were divided into three groups each comprising 20 samples. Group A was modified polymethylmethacrylate (Bredent Polyan), Group B was polyoxymethylene acetal resin (Biodentaplast) and Group C was PEEK. An Ossila Goniometer was used to measure the contact angle. The three types of liquids used for the testing included distilled water, natural saliva and mouth wetting solution (Wet Mouth Liquid, ICPA India). Human saliva was collected from an individual with no medical conditions and normal salivary secretion.

RESULTS

The data was analyzed using One-way ANOVA test and a pairwise comparison using the Post Hoc Tukey's Honest Significant Difference. Table 1 consists of the mean water contact angles of the denture base materials and mean contact angles of various denture base materials. In saliva, mouth wetting solution and distilled water, the highest mean and least mean contact angle was seen in Polyan and Biodentaplast respectively. A signicant difference was seen between PEEK and Polyan and Biodentaplast and Polyan on further comparison.

CONCLUSION

From the resources and the materials at our disposal, it could be concluded that Polyan, Biodentaplast and PEEK and could be used as viable options in cast partial denture framework.

Effect of thermocycling on the retentive force of the retentive inserts in three denture attachments and their water absorption ability

This study aimed to evaluate the thermocycling effect on the retentive force of 3 different retentive inserts in 3 denture attachments (Blue, Pink, Clear retentive inserts in LOCATOR; Blue, Pink, Clear retentive inserts in LOCATOR R-Tx; and White, Yellow, Green retentive inserts in Novaloc) (n=10). Maximum retentive force of each retentive insert was evaluated at baseline, 7-day water storage, and after 5,000-, and 10,000- cycle thermocycling. The water absorption percentage of the retentive inserts was also determined. Comparing between baseline and 7-day water storage, the retentive forces of the LOCATOR and LOCATOR R-Tx groups were significantly reduced (p<0.05), while the retentive force of the Novaloc group was significantly increased (p<0.05). Comparing between 7-day water storage and 10,000-cycle thermocycling, the retentive force of most retentive inserts remained unchanged (p>0.05). The water absorption percentage of the LOCATOR and LOCATOR R-Tx groups was significantly greater than that of the Novaloc group (p<0.05).

Graphene loaded into dental polymers as reinforcement of mechanical properties: A systematic review

Graphene compounds are incorporated into polymers in order to improve their mechanical properties and in dentistry this modification favors the clinical performance of these materials. The aim of this review was to evaluate graphene compounds, their concentrations, and their effect on mechanical properties as flexural, tensile, and compressive strength and hardness of polymethylmethacrylate (PMMA) and polyether-ether-ketone (PEEK) for dental application. The search was carried out in two steps in PubMed/Medline, Embase, Scopus, and Web of Science databases. The eligibility criteria included studies that incorporated pure graphene compounds into dental polymers and evaluated their mechanical properties. Were found 4984 results, of which 11 articles were included in this review. Graphene compounds: graphene oxide (GO), reduced graphene oxide (rGO), and graphene nanoplatelets (GNP) were incorporated into PMMA and PEEK, in concentrations ranging from 0.1 to 10 wt%. Concentrations lower than 0.75 wt% of GO in PMMA and 1 wt% of GNP in PEEK resulted in increased flexural, tensile, compression strength, and hardness of these polymers. It was concluded that the incorporation of graphene compounds in low concentrations increases dental polymers' mechanical properties.

Ion Bombardment-Induced Nanoarchitectonics on Polyetheretherketone Surfaces for Enhanced Nanoporous Bioactive Implants

In spite of the biocompatible, nontoxic, and radiolucent properties of polyetheretherketone (PEEK), its biologically inert surface compromises its use in dental, orthopedic, and spine fusion industries. Many efforts have been made to improve the biological performance of PEEK implants, from bioactive coatings to composites using titanium alloys or hydroxyapatite and changing the surface properties by chemical and physical methods. Directed plasma nanosynthesis (DPNS) is an atomic-scale nanomanufacturing technique that changes the surface topography and chemistry of solids via low-energy ion bombardment. In this study, PEEK samples were nanopatterned by using argon ion irradiation by DPNS to yield active nanoporous biomaterial surface. PEEK surfaces modified with two doses of low and high fluence, corresponding to 1.0 × 1017 and 1.0 × 1018 ions/cm2, presented pore sizes of 15-25 and 60-90 nm, respectively, leaving exposed PEEK fibers and an increment of roughness of nearly 8 nm. The pores per unit area were closely related for high fluence PEEK and low fluence PEEK surfaces, with 129.11 and 151.72 pore/μm2, respectively. The contact angle significantly decreases in hydrophobicity-hydrophilicity tests for the irradiated PEEK surface to ∼46° from a control PEEK value of ∼74°. These super hydrophilic substrates had 1.6 times lower contact angle compared to the control sample revealing a rough surface of 20.5 nm only at higher fluences when compared to control and low fluences of 12.16 and 14.03 nm, respectively. These super hydrophilic surfaces in both cases reached higher cell viability with ∼13 and 34% increase, respectively, compared to unmodified PEEK, with an increased expression of alkaline phosphatase at 7 days on higher fluences establishing a higher affinity for preosteblasts with increased cellular activity, thus revealing successful and improved integration with the implant material, which can potentially be used in bone tissue engineering.

Novel Carboxylation Method for Polyetheretherketone (PEEK) Surface Modification Using Friedel-Crafts Acylation

Recently, polyetheretherketone (PEEK) has shown promising dental applications. Surface treatment is essential for dental applications owing to its poor surface energy and wettability; however, no consensus on an effective treatment method has been achieved. In this study, we attempted to carboxylate PEEK sample surfaces via Friedel-Crafts acylation using succinic anhydride and AlBr3. The possibility of further chemical modifications using carboxyl groups was examined. The samples were subjected to dehydration-condensation reactions with 1H,1H-pentadecafluorooctylamine and N,N'-dicyclohexylcarbodiimide. Furthermore, the sample's surface properties at each reaction stage were evaluated. An absorption band in the 3300-3500 cm-1 wavenumber region was observed. Additionally, peak suggestive of COOH was observed in the sample spectra. Secondary modification diminished the absorption band in 3300-3500 cm-1 and a clear F1s signal was observed. Thus, Friedel-Crafts acylation with succinic anhydride produced carboxyl groups on the PEEK sample surfaces. Further chemical modification of the carboxyl groups by dehydration-condensation reactions is also possible. Thus, a series of reactions can be employed to impart desired chemical structures to PEEK surfaces.

Evaluation and comparison of retention and patient satisfaction with milled polyetheretherketone versus metal maxillary obturators

STATEMENT OF PROBLEM

Metal and polyetheretherketone (PEEK) have been used to rehabilitate maxillary defects with obturators, each having advantages and disadvantages. However, patient satisfaction with the obturator retention of each material is unclear.

PURPOSE

The purpose of this crossover clinical study was to compare retention and patient satisfaction between a milled cobalt chromium and a milled PEEK framework, each with a hollow bulb extension in polymethyl methacrylate (PMMA).

MATERIAL AND METHODS

Twenty patients who had received unilateral total maxillectomy and were treated in the prosthodontic department's maxillofacial clinic were enrolled in this crossover study. Each participant wore 2 different types of obturators for 6 months after insertion. Type CoCr received a milled cobalt chromium framework with a hollow bulb extension in PMMA first, and type Pk received a milled modified PEEK (BioHPP) framework with a hollow bulb extension in PMMA first. Patient satisfaction and retention force were measured immediately, at 3 months, and at 6 months after obturator insertions. The Fischer exact, chi-squared, and Monte Carlo tests were used to compare qualitative data. One-way ANOVA with the post hoc Tukey test was used for pair-wise comparison, and repeated measures ANOVA was used to compare before and after treatment at 3 and 6 months.

RESULTS

No significant difference was found between types in obturator insertion (P>.999), appearance of the upper lip (P>.999), mouth feeling (P=.301), pronunciation of words (P=.217), and talking in public (P=.589). A significant difference between types was found in speech after 6 months of obturator insertion (P=.016), swallowing liquids and food (P=.04), masticating foods (P=.007), appearance of clasps on anterior teeth (P=.002), satisfaction with appearance (P=.005), or avoidance of family events (P=.014) after 6 months of insertion. Types of obturators showed a statistically significant decrease in retention force with time (P<.001).

CONCLUSIONS

Although the retention force was less with PEEK than with Co-Cr clasps engaging the same undercuts, this retention force was adequate for retaining removable partial dentures. Co-Cr clasps can be considered better than PEEK clasps because they engage the same undercuts regarding loss of retention with time. Quality of life in patients after maxillary resection could be improved by using maxillary obturators. Type Pk was better than type CoCr in terms of esthetics, but the retention of the PEEK obturator after 6 months decreased because of wear, leading to difficulty swallowing food or liquids, mastication, and speech.

Chemoselective Coatings of GL13K Antimicrobial Peptides for Dental Implants

Dental implant-associated infection is a clinical challenge which poses a significant healthcare and socio-economic burden. To overcome this issue, developing antimicrobial surfaces, including antimicrobial peptide coatings, has gained great attention. Different physical and chemical routes have been used to obtain these biofunctional coatings, which in turn might have a direct influence on their bioactivity and functionality. In this study, we present a silane-based, fast, and efficient chemoselective conjugation of antimicrobial peptides (Cys-GL13K) to coat titanium implant surfaces. Comprehensive surface analysis was performed to confirm the surface functionalization of as-prepared and mechanically challenged coatings. The antibacterial potency of the evaluated surfaces was confirmed against both Streptococcus gordonii and Streptococcus mutans, the primary colonizers and pathogens of dental surfaces, as demonstrated by reduced bacteria viability. Additionally, human dental pulp stem cells demonstrated long-term viability when cultured on Cys-GL13K-grafted titanium surfaces. Cell functionality and antimicrobial capability against multi-species need to be studied further; however, our results confirmed that the proposed chemistry for chemoselective peptide anchoring is a valid alternative to traditional site-unspecific anchoring methods and offers opportunities to modify varying biomaterial surfaces to form potent bioactive coatings with multiple functionalities to prevent infection.

Polyetheretherketone Material in Dentistry

A polyaromatic nearly-crystalline thermoplastic polymer, polyetheretherketone (PEEK), has become a useful biomaterial and its use has increased in dentistry because of its properties. PEEK is scientifically approved and is among the safest material used to restore lost orofacial tissues at present. PEEK has a property of high biocompatibility, therefore there is increased utilization of PEEK in orthopaedic and trauma cases. PEEK has several excellent properties due to which it has been used in several fields of dentistry such as orthodontic wires, implants, removable dentures, fixed partial dentures, finger prostheses, temporary abutments, implant-supported provisional crowns, healing caps, maxillofacial prostheses, etc. Due to its modification, PEEK material is used more frequently in clinical dentistry. PEEK can be used as a material that is not traditional in the realm of dental care. Modification of PEEK has led to an increase in its use in the field of dentistry.

Biomechanical behavior of carbon fiber-reinforced polyetheretherketone as a dental implant material in implant-supported overdenture under mandibular trauma: A finite element analysis study

Context

Implant-supported overdentures are well-known and widely accepted treatment modality to increase retention which is a crucial factor for determining patient satisfaction. The placement of two implants in the anterior region can be selected as a first-line treatment in patients with the atrophic mandibular ridge.

Aims

The purpose of this research was to assess the biomechanical effects of carbon fiber-reinforced polyetheretherketone (CFR-PEEK) implant-supported overdenture in the event of 2,000 N forefront trauma to an atrophic edentulous mandible by using the finite element analysis method.

Materials and Methods

Three types of mandible models were simulated; the first one was an edentulous atrophic mandible model; in the second model, 3.5 × 11.5 mm CFR-PEEK implants; and in the third model, 4.3 × 11.5 mm CFR-PEEK implants were positioned in the region of the lateral incisor of the identical edentulous atrophic mandible.

Results

Maximum Von Misses stresses 979.261 MPa, 1,454.69 MPa, and 1,940.71 MPa and maximum principal stresses 1,112.74 MPa, 1,249.88 MPa, and 1,251.33 MPa have been detected at the condylar neck area and minimum principal stresses - 1,203.38 MPa, -1,503.21 MPa, and - 1,990.34 MPa have been recorded at the symphysis and corpus regions from M1 to M3, respectively. In addition, the M2 and M3 models showed low-stress distributions around the implant-bone interface, particularly where the implants were in contact with cancellous bone.

Conclusions

The results showed that the insertion of different diameters of CFR-PEEK implants led to low and homogenous stress distribution all around the implant-bone interface and stresses transferred directly to the condylar neck areas. Therefore, it was observed that CRF-PEEK implants did not change the basic behavior of the mandibula in response to frontal stresses.

Escherichia coli Cellular Activity and Frontal Trizonal Evaluation of Microspace Between Implants and Abutments Under Calibrated Cyclic Stress

AIM

To evaluate microspace and microleakage between implant and abutments subjected to pre- and post-calibrated cyclic stress.

MATERIALS AND METHODS

Twelve screw-retained implant prostheses with BioHPP polyetheretherketone (PEEK) abutment (Noris Dental Implant System Ltd., Nesher, Israel) (Group I) and 12 screw-retained implant prostheses with computer-assisted design/computer-assisted manufacturing (CAD/CAM) milled zirconia abutment (DentGallop, Houston, TX, USA) (Group II) were connected to their respective implant, and the prosthetic screw was torqued to 30N/cm (Noris). The microspace was evaluated using scanning electron microscopy (SEM; TeScan, Brno, Czech Republic). Twenty-four samples were then induced to cyclic stress (Lokesh Industries, Pune, India) simulating 180 days duration of oral stress. The microspaces (Group IA and Group IIB) were measured post-cyclic stress. Group I and II were again renamed into Group Ia and Group IIb for microbial study. Both implant assemblies were immersed in fresh soybean casein digest broth (SCDB) (Himedia, Mumbai, India) and subsequently inoculated with 1.0µL E. coli suspension (Himedia) at the open end and incubated at 37ºC for seven days. After the incubation period, cellular activity was determined by the spread plate method, and total colony-forming units (CFU) were calculated. The results were evaluated using independent T and Mann-Whitney tests.

RESULT

Average and microspace at the implant-abutment junction of Group I samples in the front right was 12.98µm, center 13.76µm, front left 13.22µm, and in Group II samples, the front right was 18.52µm, center 17.84µm, front left 18.58µm.After being subjected to cyclic loading, the mean levels of the vertical microgap for Group IA samples were: in the front right region 10.37µm, in the center 9.34µm, in the front left 10.51µm and in Group IIB samples front right was 14.59µm, center 13.39µm, front left 13.8µm. Independent t-tests showed insignificant differences between the two groups. The median value of microbial leakage of Group Ia samples after cyclic loading was 30 x 103 CFU/ml, and Group IIb samples were 42 x 103 CFU/ml and were significant.

CONCLUSION

There was minimal variation in the mean microspace between the BioHPP PEEK abutment and CAD/CAM milled zirconia abutment, and it was insignificant before and after cyclic stress. BioHPP PEEK abutment-titanium implant interfaces showed significantly decreased microbial leakage than CAD/CAM milled zirconia abutment-titanium implant interfaces after cyclic stress.

Precision of polyether ether ketone (PEEK) or cobalt-chrome implant bar fit to implants after mechanical cycling

Based on its mechanical properties, PEEK (polyether-ether-ketone) might be useful in restorative procedures. In oral rehabilitation, its viability has been studied mainly for prostheses and dental implants.

AIM

The aim of this study was to evaluate the fit accuracy of dental implant bars made of either PEEK or cobalt-chrome submitted to cycling mechanics.

MATERIALS AND METHOD

This was an experimental in vitro study, where units were treated with two implants and mini-abutments, joined by cobalt-chrome or polyether-ether-ketone PEEK bars. A total 20 bars were prepared (n=10 per group) and subjected to mechanical cycling tests (1 million cycles on the distal cantilever of the bar in the vertical direction, 120N and sinusoidal loading, at a frequency of 2Hz). The fit at the abutment/implant interface was measured before and after cycling, and the counter-torque of the vertical screw of the mini abutments was measured after cycling, using a digital torquemeter. Data were analyzed by three-way ANOVA and Tukey's test at 5% significance level.

RESULTS

No statistically significant interaction was found among the three factors considered (bar material, implant positioning and mechanical cycling) (p = 0.592). No significant difference was identified in the interaction between bar material and implant positioning (p = 0.321), or between implant positioning and mechanical cycling (p = 0.503). The association between bar material and mechanical cycling was statistically significant (p = 0.007), with the cobalt-chrome bar resulting in greater misfit with mechanical cycling. There was no difference in counter-torque values between groups.

CONCLUSIONS

The PEEK bar provided better fit of the mini abutments to the implants, even after mechanical cycling. The counter-torque of the screws was similar in all scenarios considered.

A comparative study of CAD/CAM fabricated polyether ether ketone and fiber-glass reinforcement composites versus metal lingual retainers under vertical load (an in vitro study)

BACKGROUND

Retainer is a necessary procedure when orthodontic treatment complete to avoid relapse due to periodontal fiber elasticity and to allow for alveolar bone regeneration. Compare the influence of vertical force on the failure of three fixed retainers: CAD/CAM polyether ether ketone (PEEK), CAD/CAM fiber glass reinforced composites (FRCs), and lingual retainer wire "Bond-A-Braid™".

MATERIALS AND METHODS

One hundred and eight maxillary first premolars teeth were randomly allocated to three groups: Group A (CAD/CAM PEEK), Group B (CAD/CAM FRC), and Group C (lingual retainer wire " Bond-A-Braid™"). These retainers were bonded using Assure Plus Bonding Resin and GO TO Paste. For each specimen, a loading cycling and thermocycling machine was used. The failure debonding forces were measured on the interproximal segments using a universal testing machine with a cross-head speed of 1 mm/min. The adhesive remnant index (ARI) was calculated after identifying types of failure with a stereomicroscope at (X 20) magnification.

RESULTS

Group B and group C showed the highest failure bonding forces, with a mean of 209.67 ± 16.15 and 86.81 ± 4.59 N, respectively. However, Group A had a statistically significant lower bond failure force, with a mean value of 45.73 ± 4.48 N. At baseline, there was a statistically significant difference in connector retainer displacement between the three studied groups (p < .001). The ARI score was not statistically significant (p < .001) between the three study groups; for groups A and B, the ARI was predominantly score 3, and group C showed a mixed score of 2 and 3. The failure mode of retainers was investigated using an optical stereomicroscope. In group B, there was a cohesive breakdown in the retainer, and groups A and C exhibited failures primarily in the adhesive at the retainer interface.

CONCLUSION

All groups differed significantly, with group A having the lowest debonding force and group B having the highest. Furthermore, there was not a substantial variation in ARI, but there was a significant difference in connector retainer displacement and the types of failure amongst the three groups.

Evaluation of mechanical properties of different polyetheretherketone endodontic post systems: an in vitro study

BACKGROUND

Survival of endodontically treated teeth depends on an efficient restoration of the missing tooth structure.

OBJECTIVES

This study aimed to investigate the mechanical properties of different endodontic post systems.

MATERIALS AND METHODS

Human permanent maxillary central incisors (no.=58) were decoronated and root-filled. The specimens with prepared root canals were randomly divided into Group P: Polyether Ether Ketone (PEEK) post and composite core and Group C: custom-made post-core of PEEK. The cementation of the posts was carried out using self-adhesive resin cement. Nano-hybrid composite resin was used for core fabrication. After cementation, the specimens from each group were randomly divided into two subgroups according to the types of tests utilized: 14 from each group were for the fracture strength test, which was restored with IPS e-max CAD crown, and 15 from each group for the pullout resistance test. A universal testing machine was used for the test performance.

RESULTS

The fracture resistance test showed that the values significantly differed among tested posts (P = 0.013). Group P showed the highest fracture resistance. Group C exhibited higher mean pullout resistance values than the other group (P) (P = 0.059). In the two-piece PEEK post and composite core, the predominant type of failure was a core fracture, while in the one-piece PEEK post-core, most types of failures were either in the crown or in the post.

CONCLUSIONS

The prefabricated posts are more resistant to fracture than the custom-made posts, with fracture and displacement mainly of the core. In contrast, both showed similar pullout resistance.

Polyetheretherketone (PEEK) as a Biomaterial: An Overview

Polyetheretherketone (PEEK) is a very powerful biomaterial that is increasingly used in dentistry. It has superior properties, which make it desirable in implantology. The applications of PEEK include finger prosthesis, RPD and FPD framework, and dental implants. Changes in the production of polyketone-based materials have been made to ensure consistent production of polymers for medical applications. PEEK is a high-performance semicrystalline material that has physical properties such as high resilience and strength. It is a tooth-colored material, making it desirable for its aesthetic appearance. Traditional manufacturing methods like injection molding, extrusion, and compression molding are used for PEEK. Despite the high price of the polymer, the additional value that PEEK materials bring by offering the possibility of manufacturing parts include lightweight, strength or toughness and able to survive longer in harsh environments. PEEK has trauma or shock cancelling abilities, fracture resisting abilities, stress distributing ability, osseointegrating abilities, With such great qualities PEEK has an increased demand in the market, and this biomaterial never failes to surprise with its amazing success rate. Even in dentistry PEEK has a wide range of applications which includes, as a dental implants biomaterial, prosthetic material, abutment material, post and core material, crowns, removable partial denture framework. With such a huge range of applications PEEK is said to have been providing an all in one package for dentistry. PEEK biomaterial shows great compatibility with bioactive materials which has proven to be of great help to mankind as not only it is involved in life sciences but also in automotives and aerodynamics as well. The main motto of this review is to know the qualities and the properties of PEEK as a capable implant prosthesis for its application focusing on dental implants. This review tells us about the challenges faced when using this material and benefits and advantages of this biomaterial.

Polymeric Denture Base Materials: A Review

An ideal denture base must have good physical and mechanical properties, biocompatibility, and esthetic properties. Various polymeric materials have been used to construct denture bases. Polymethyl methacrylate (PMMA) is the most used biomaterial for dentures fabrication due to its favorable properties, which include ease of processing and pigmenting, sufficient mechanical properties, economy, and low toxicity. This article aimed to comprehensively review the current knowledge about denture base materials (DBMs) types, properties, modifications, applications, and construction methods. We searched for articles about denture base materials in PubMed, Scopus, and Embase. Journals covering topics including dental materials, prosthodontics, and restorative dentistry were also combed through. Denture base material variations, types, qualities, applications, and fabrication research published in English were considered. Although PMMA has several benefits and gained popularity as a denture base material, it has certain limitations and cannot be classified as an ideal biomaterial for fabricating dental prostheses. Accordingly, several studies have been performed to enhance the physical and mechanical properties of PMMA by chemical modifications and mechanical reinforcement using fibers, nanofillers, and hybrid materials. This review aimed to update the current knowledge about DBMs' types, properties, applications, and recent developments. There is a need for specific research to improve their biological properties due to patient and dental staff adverse reactions to possibly harmful substances produced during their manufacturing and use.

Evaluation of stress and deformation in bone with titanium, CFR-PEEK and zirconia ceramic implants by finite element analysis

Background

As more recent implant biomaterials, Zirconia ceramic and glass or carbon fibre reinforced PEEK composites have been introduced. In this study, bone stress and deformation caused by titanium, carbon fiber-reinforced polyetheretherketone (CFRPEEK), and zirconia ceramic implants were compared.

Materials and Methods

In this in vitro finite element analysis study, a geometric model of mandibular molar replaced with implant supported crown was generated. The study used an implant that was 5 mm diameter and 11.5 length. Three implant assemblies made of CFR- polyetheretherketone (PEEK), zirconium, and titanium were created using finite element analysis (FEM). On the implant's long axis, 150 N loads were applied both vertically and obliquely. ANSYS Workbench 18.0 and finite element software were used to compare the Von Mises stresses and deformation produced with a significance level of P < 0.05.

Results

With no discernible differences, all three implant assemblies that is CFR-PEEK, titanium, and zirconia demonstrated similar stresses and deformation in bone.

Conclusion

It was determined that zirconia and PEEK and reinforced with carban fibres (CFR-PEEK) can be used as titanium-free implant biomaterial substitutes.

Description of Poly(aryl-ether-ketone) Materials (PAEKs), Polyetheretherketone (PEEK) and Polyetherketoneketone (PEKK) for Application as a Dental Material: A Materials Science Review

Poly(aryl-ether-ketone) materials (PAEKs), a class of high-performance polymers comprised of polyetheretherketone (PEEK) and polyetherketoneketone (PEKK), have attracted interest in standard dental procedures due to their inherent characteristics in terms of mechanical and biological properties. Polyetheretherketone (PEEK) is a restorative dental material widely used for prosthetic frameworks due to its superior physical, mechanical, aesthetic, and handling features. Meanwhile, polyetherketoneketone (PEKK) is a semi-crystalline thermoplastic embraced in the additive manufacturing market. In the present review study, a new way to fabricate high-performance polymers, particularly PEEK and PEKK, is demonstrated using additive manufacturing digital dental technology, or 3-dimensional (3D) printing. The focus in this literature review will encompass an investigation of the chemical, mechanical, and biological properties of HPPs, particularly PEEK and PEKK, along with their application particularly in dentistry. High-performance polymers have gained popularity in denture prosthesis in advance dentistry due to their flexibility in terms of manufacturing and the growing interest in utilizing additive manufacturing in denture fabrication. Further, this review also explores the literature regarding the properties of high-performance polymers (HPP) compared to previous reported polymers in terms of the dental material along with the current advancement of the digital designing and manufacturing.

Comparative evaluation of internal fit and marginal gap of endocrowns using lithium disilicate and polyether ether ketone materials - an in vitro study

BACKGROUND

The aim of the study was to investigate the effect of material and occlusal preparation design on the internal fit and marginal gap of endocrowns made of Polyether ether ketone (PEEK) and lithium disilicate.

METHODS

32 endocrowns were fabricated on prepared mandibular molars and divided into two groups (n = 16) according to the material. Group L: lithium disilicate and Group P: PEEK. Each group was further subdivided into two subgroups (n = 8) according to the occlusal preparation design: full occlusal coverage (LF and PF) and partial occlusal coverage (LP and PP). Samples were analyzed using microcomputed tomography (µCT) with a voxel size of 6 μm to evaluate internal fit, and an optical microscope was used to evaluate the marginal gap. Data were collected, tabulated, and statistically analyzed. Numerical data were described as mean and standard deviation and compared using the ANOVA test. The level of significance was set at α P ≤ 0.05.

RESULTS

All groups' internal fit and marginal gaps values were within the acceptable clinical range. However, the lithium disilicates group recorded statistically significantly higher mean internal gap values than the PEEK groups. Regardless of the material, the difference between the two occlusal designs was not statistically significant in both internal fit and marginal gap records.

CONCLUSION

Within the limitations of this study, PEEK endocrown restorations revealed better internal fit and marginal gap than lithium disilicate endocrown restorations. The marginal and internal fit of both lithium disilicate and PEEK endocrown restorations were within the clinically acceptable range. The occlusal preparation design had no influence on the internal fit and marginal gap of the endocrown restoration.

Stress distribution in bone around an implant-supported three-unit fixed dental prosthesis using two different computer-aided designing/computer-aided milling provisional crown materials: Milled polymethylmethacrylate and milled polyetheretherketone - A finite element analysis

Background

Occlusal loading of osseointegrated implants is believed to be an essential determining factor in the long-term success of an implant treatment. Numerous studies have been conducted on the evaluation of stress distribution by definitive restoration materials for Implant-supported fixed prosthesis, but very few have evaluated provisional restoration materials for the same. This study aims to evaluate the influence of provisional restoration material - Milled Polymethylmethacrylate (PMMA) and Milled Polyetheretherketone (PEEK), over stress distribution on the peri-implant bone around an implant-supported three-unit, fixed dental prosthesis using finite element analysis method.

Materials and Methods

Three-dimensional models of a pair of bone-level implant system and titanium base abutments were created using the standard tessellation language data of original implant components. A bone block representing the mandibular posterior area was created, and the implants were placed in the bone block with 100% osseointegration in the 2nd premolar to 2nd molar region. A superstructure of an implant-supported 3-unit bridge was modeled on top of the abutments, each crown to be 8 mm in height and with an outer diameter of 6 mm in 2nd premolar region and 10 mm in 1st molar and 2nd molar region. Two different models were created according to combinations of provisional restoration materials, namely, Milled PMMA and Milled PEEK based on. In each model, the implants were loaded vertically (300 N) and obliquely (150 N at 30°). The stress distribution in the cortical bone, cancellous bone, and implant was evaluated through the von Mises stress analysis.

Results

The results showed no difference in stress distribution due to the different provisional restorations - Milled PMMA and Milled PEEK. In addition, the vertical load resulted in higher stress values in the implant components, cortical bone, and cancellous bone in both PEEK and PMMA models as compared to oblique loading.

Conclusion

The new polymer, PEEK was seen to provide comparable stress generation in the current study without exceeding the physiological limits of peri-implant bone. Thus, it can be considered as a good alternative to PMMA resin as a provisional crown material since it provides certain additional benefits.

Internal Adaptation and Marginal Accuracy of Two Different Techniques-based Poly (ether ether ketone) Single Crowns: An In Vitro Study

PURPOSE

The goal of this study was to evaluate how different fabrication techniques affected the marginal accuracy and internal adaptability of poly (ether ether ketone) (PEEK) molar single crowns.

MATERIALS AND METHODS

Twenty PEEK crowns were constructed using two different fabrication techniques, and they were divided into two main groups (PEEK-CAD and PEEK-pressed). PEEK-CAD crowns were numbered from 1 to 10. PEEK-pressed crowns were numbered from 11 to 20. Each group had 10 PEEK crowns, and both were constructed over a master die. For internal fit measurements, silicone replica bodies were built and cut into two halves buccolingually. Marginal accuracy was measured using three evenly spaced landmarks along the specimen's cervical circumference on each surface using a Leica L2 APO* microscope.

RESULTS

In terms of marginal accuracy, the Press group had a statistically significant greater mean marginal gap value than the computer aided-designing (CAD) group. While in terms of internal fit, there was no statistically significant difference in internal fit between the CAD and Press groups. At a significance level of two-tailed p-value = 0.21 (p > 0.05).

CONCLUSION

PEEK-CAD crowns demonstrated higher marginal accuracy and nearly similar internal fit when compared to PEEK-pressed crowns.

CLINICAL SIGNIFICANCE

PEEK material could be used as a substitute for zirconia for a full coverage posterior restoration.

Tribological Behavior of TiO2 PEEK Composite and Stainless Steel for Pediatric Crowns

Dental decay still presents a major health problem among children. Its treatment usually requires the use of stainless steel crowns. This study compares the wear behavior of 316 L stainless steel and polyetheretherketone (PEEK) composite under identical test conditions. The wear tests were conducted in a reciprocating ball-on-plate tribometer (Plint TE67/R) using alumina balls as a counterface and artificial saliva as a lubricant at 37 °C to faithfully mimic oral conditions. The coefficient of friction (COF) and specific wear rate (k) values were determined and SEM/EDS examinations were performed to identify the predominant wear mechanisms. Results showed that PEEK exhibited a significantly lower coefficient of friction (COF = 0.094 ± 0.004) and thus lower wear volume (ΔV = 0.0078 ± 0.0125 mm³) and higher wear resistance, with an average value of specific wear rate of k = 9.07 × 10^-6 mm³N^-1m^-1 when compared to stainless steel (COF = 0.32 ± 0.03, ΔV = 0.0125 ± 0.0029 mm³, k = 1.45 × 10^-5 mm³N^-1m^-1). PEEK was revealed to be a potential material for use in pediatric crowns due to its high wear resistance while overcoming the disadvantages associated with steel at both an aesthetic and biological level.

Bacterial Adhesion on Dental Polymers as a Function of Manufacturing Techniques

The microbiological behavior of dental polymer materials is crucial to secure the clinical success of dental restorations. Here, the manufacturing process and the machining can play a decisive role. This study investigated the bacterial adhesion on dental polymers as a function of manufacturing techniques (additive/subtractive) and different polishing protocols. Specimens were made from polyaryletherketone (PEEK, PEKK, and AKP), resin-based CAD/CAM materials (composite and PMMA), and printed methacrylate (MA)-based materials. Surface roughness (R_z; R_a) was determined using a laser scanning microscope, and SFE/contact angles were measured using the sessile drop method. After salivary pellicle formation, in vitro biofilm formation was initiated by exposing the specimens to suspensions of Streptococcus mutans (S. mutans) and Streptococcus sanguinis (S. sanguinis). Adherent bacteria were quantified using a fluorometric assay. One-way ANOVA analysis found significant influences (p < 0.001) for the individual parameters (treatment and material) and their combinations for both types of bacteria. Stronger polishing led to significantly (p < 0.001) less adhesion of S. sanguinis (Pearson correlation PC = -0.240) and S. mutans (PC = -0.206). A highly significant (p = 0.010, PC = 0.135) correlation between S. sanguinis adhesion and R_z was identified. Post hoc analysis revealed significant higher bacterial adhesion for vertically printed MA specimens compared to horizontally printed specimens. Furthermore, significant higher adhesion of S. sanguinis on pressed PEEK was revealed comparing to the other manufacturing methods (milling, injection molding, and 3D printing). The milled PAEK samples showed similar bacterial adhesion. In general, the resin-based materials, composites, and PAEKs showed different bacterial adhesion. Fabrication methods were shown to play a critical role; the pressed PEEK showed the highest initial accumulations. Horizontal DLP fabrication reduced bacterial adhesion. Roughness < 10 µm or polishing appear to be essential for reducing bacterial adhesion.

Osseointegration behavior of carbon fiber reinforced polyetheretherketone composites modified with amino groups: An in vivo study

Polyetheretherketone (PEEK) has become increasingly popular in dentistry and orthopedics due to its excellent chemical stability, reliable biosafety, and low elastic modulus. However, PEEK's biomechanical strength and bioactivity are limited and need to be increased as an implant material. The previous study in vitro has shown that the amino-functionalized carbon fiber reinforced PEEK (A-30%-CPEEK) possessed enhanced mechanical property and bioactivity. This study aims to evaluate the effect of amino groups modification on the osseointegration behavior of carbon fiber reinforced PEEK (30%-CPEEK) in rabbits. Herein, 30%-CPEEK and A-30%-CPEEK implant discs were implanted in rabbit skulls for 5 weeks, with pure titanium implants serving as a control. The bone-forming ability and osseointegration in vivo were systematically investigated by micro-computed tomography analysis, scanning electron microscope observation, and histological evaluation. Our results showed that all detection parameters were significantly different between the A-30%-CPEEK and 30%-CPEEK groups, favoring those in the A-30%-CPEEK, whose appraisal parameters were equal to or better than pure titanium. Therefore, this study supported the importance of amino groups in facilitating the new bone formation and bone-implant integration, suggesting that A-30%-CPEEK with enhanced osseointegration will be a promising material for dental or orthopedic implants.

Correlation between Friction and Wear in Cylindrical Anchorages Simulated with Wear Machine and Analyzed with Scanning Probe and Electron Microscope

This paper presents the possibilities of applying atomic force microscopy (AFM) techniques to the study of the wear of prosthetic biomaterials. In the conducted research, a zirconium oxide sphere was used as a test piece for mashing, which was moved over the surface of selected biomaterials: polyether ether ketone (PEEK) and dental gold alloy (Degulor M). The process was carried out with constant load force in an artificial saliva environment (Mucinox). An atomic force microscope with an active piezoresistive lever was used to measure wear at the nanoscale. The advantage of the proposed technology is the high resolution of observation (less than 0.5 nm) in the three-dimensional (3D) measurements in a working area of 50 × 50 × 10 µm. The results of nano wear measurements in two measurement setups are presented: zirconia sphere (Degulor M and zirconia sphere) and PEEK were examined. The wear analysis was carried out using appropriate software. Achieved results present a tendency coincident with the macroscopic parameters of materials.

Retentive Forces and Deformation of Fitting Surface in RPD Clasp Made of Polyether-Ether-Ketone (PEEK)

BACKGROUND

Polyetheretherketone (PEEK) has provided the option to fabricate RPDs with aesthetics unlike metal RPDs, but little attention has been paid to its suitability, especially towards the retentive forces and deformation of the clasp. This study aimed to examine the retentive forces and the fitting surface (inner surface) deformation of clasps made from PEEK and compare it with cobalt-chromium (Co-Cr) clasp.

METHODS

Forty-two circumferential clasps (14 Co-Cr and 28 PEEK) were fabricated and divided into two groups with clasp undercuts (0.25 mm and 0.5 mm) with thicknesses of 1 mm and 1.5 mm. Each was examined for retentive forces after cycle test on its abutment for 360 cycles. Initial and final retentive forces were recorded. The fitting surface deformation was determined using 3-Matic research analysis software.

RESULTS

The results revealed that highest mean initial retentive force was of Co-Cr clasps with 0.50 mm undercut 22.26 N (±10.15 N), and the lowest was the 1 mm PEEK clasps with 0.25 mm undercut 3.35 N (±0.72 N) and highest mean final retentive force was the Co-Cr clasps with 0.50 mm undercut 21.40 N (±9.66 N), and the lowest was the 1 mm PEEK clasps with 0.25 mm undercut 2.71 N (±0.47 N). PEEK clasps had a lower retentive force than Co-Cr clasps with 0.50 undercut. PEEK clasps (1.5 mm) at 0.25 mm undercut had the least deformation (35.3 µm). PEEK showed significantly less deformation (p ≤ 0.014) than Co-Cr.

CONCLUSION

The deformation of PEEK clasps fitting surface was lower than Co-Cr clasps and retentive forces were close to the Co-Cr clasps, suggesting the use of PEEK as an aesthetic clasp option for RPD framework.

Design, Analysis, and 3D Printing of a Patient-Specific Polyetheretherketone Implant for the Reconstruction of Zygomatic Deformities

The reconstruction of craniomaxillofacial deformities, especially zygomatic bone repair, can be exigent due to the complex anatomical structure and the sensitivity of the crucial organs involved. The need to reconstruct the zygomatic bone in the most precise way is of crucial importance for enhancing the patient outcomes and health care-related quality of life (HRQL). Autogenous bone grafts, despite being the gold standard, do not match bone forms, have limited donor sites and bone volume, and can induce substantial surgical site morbidity, which may lead to adverse outcomes. The goal of this study is to provide an integrated approach that includes various processes, from patient scanning to implant manufacture, for the restoration of zygomatic bone abnormalities utilizing Polyetheretherketone (PEEK) material, while retaining adequate aesthetic and facial symmetry. This study takes an integrated approach, including computer-aided implant design using the mirror reconstruction technique, investigating the biomechanical behavior of the implant under loading conditions, and carrying out a fitting accuracy analysis of the PEEK implant fabricated using state-of-the-art additive manufacturing technology. The findings of the biomechanical analysis results reveal the largest stress of approximately 0.89 MPa, which is relatively low in contrast to the material's yield strength and tensile strength. A high degree of sturdiness in the implant design is provided by the maximum value of strain and deformation, which is also relatively low at roughly 2.2 × 10^-4 and 14 µm. This emphasizes the implant's capability for load resistance and safety under heavy loading. The 3D-printed PEEK implant observed a maximum deviation of 0.4810 mm in the outside direction, suggesting that the aesthetic result or the fitting precision is adequate. The 3D-printed PEEK implant has the potential to supplant the zygoma bone in cases of severe zygomatic reconstructive deformities, while improving the fit, stability, and strength of the implant.