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.

Protecting Orthopaedic Implants from Infection: Antimicrobial Peptide Mel4 Is Non-Toxic to Bone Cells and Reduces Bacterial Colonisation When Bound to Plasma Ion-Implanted 3D-Printed PAEK Polymers

Even with the best infection control protocols in place, the risk of a hospital-acquired infection of the surface of an implanted device remains significant. A bacterial biofilm can form and has the potential to escape the host immune system and develop resistance to conventional antibiotics, ultimately causing the implant to fail, seriously impacting patient well-being. Here, we demonstrate a 4 log reduction in the infection rate by the common pathogen S. aureus of 3D-printed polyaryl ether ketone (PAEK) polymeric surfaces by covalently binding the antimicrobial peptide Mel4 to the surface using plasma immersion ion implantation (PIII) treatment. The surfaces with added texture created by 3D-printed processes such as fused deposition-modelled polyether ether ketone (PEEK) and selective laser-sintered polyether ketone (PEK) can be equally well protected as conventionally manufactured materials. Unbound Mel4 in solution at relevant concentrations is non-cytotoxic to osteoblastic cell line Saos-2. Mel4 in combination with PIII aids Saos-2 cells to attach to the surface, increasing the adhesion by 88% compared to untreated materials without Mel4. A reduction in mineralisation on the Mel4-containing surfaces relative to surfaces without peptide was found, attributed to the acellular portion of mineral deposition.

Effect of different surface roughening treatment on polyether ether ketone and acrylic resin bonding: A pilot study

BACKGROUND

As polyether ether ketone (PEEK) is a relatively new material in dentistry, its bonding properties with regard to dental acrylic base materials are not fully known. To ensure the long-term success of removable dentures with a PEEK framework, the base materials must be well bonded to each other.

OBJECTIVES

The study aimed to investigate the effects of different kinds of surface roughening treatment on PEEK and acrylic resin bonding.

MATERIAL AND METHODS

Eighty PEEK specimens (N = 80) were randomly divided into 5 groups (n = 16 per group) and subjected to various surface roughening treatment (control, grinding, sandblasting, tribochemical silica coating (CoJet), and sulfuric acid etching). Heat-polymerized acrylic resin was applied to the treated surfaces of the PEEK specimens. The shear bond strength (SBS) test, environmental scanning electron microscopy (ESEM) analysis and three-dimensional (3D) surface topography analysis were performed. The statistical analysis of the data was conducted using the analysis of variance (ANOVA) and Tukey's multiple comparison test.

RESULTS

The one-way ANOVA showed significant differences in the SBS values between the groups (p = 0.001). Sandblasting, tribochemical silica coating and sulfuric acid etching resulted in high SBS values (p = 0.001). The highest SBS values were observed in the sulfuric acid etching group (8.83 ±3.63 MPa), while the lowest SBS values were observed in the control group (3.33 ±2.50 MPa).

CONCLUSIONS

The additional roughening treatment applied to the PEEK surface increases the bond strength with heat-polymerized acrylic resin.

High-Performance PEEK/MWCNT Nanocomposites: Combining Enhanced Electrical Conductivity and Nanotube Dispersion

High-performance engineering thermoplastics offer lightweight and excellent mechanical performance in a wide temperature range. Their composites with carbon nanotubes are expected to enhance mechanical performance, while providing thermal and electrical conductivity. These are interesting attributes that may endow additional functionalities to the nanocomposites. The present work investigates the optimal conditions to prepare polyether ether ketone (PEEK)/multi-walled carbon nanotube (MWCNT) nanocomposites, minimizing the MWCNT agglomerate size while maximizing the nanocomposite electrical conductivity. The aim is to achieve PEEK/MWCNT nanocomposites that are suitable for melt-spinning of electrically conductive multifilament's. Nanocomposites were prepared with compositions ranging from 0.5 to 7 wt.% MWCNT, showing an electrical percolation threshold between 1 and 2 wt.% MWCNT (107-102 S/cm) and a rheological percolation in the same range (1 to 2 wt.% MWCNT), confirming the formation of an MWCNT network in the nanocomposite. Considering the large drop in electrical conductivity typically observed during melt-spinning and the drawing of filaments, the composition PEEK/5 wt.% MWCNT was selected for further investigation. The effect of the melt extrusion parameters, namely screw speed, temperature, and throughput, was studied by evaluating the morphology of MWCNT agglomerates, the nanocomposite rheology, and electrical properties. It was observed that the combination of the higher values of screw speed and temperature profile leads to the smaller number of MWCNT agglomerates with smaller size, albeit at a slightly lower electrical conductivity. Generally, all processing conditions tested yielded nanocomposites with electrical conductivity in the range of 0.50-0.85 S/cm. The nanocomposite processed at higher temperature and screw speed presented the lowest value of elastic modulus, perhaps owing to higher matrix degradation and lower connectivity between the agglomerates. From all the process parameters studied, the screw speed was identified to have the higher impact on nanocomposite properties.

Influence of aging of PEEK attachment inserts on the pull-off force of implant-retained overdentures - A laboratory study

OBJECTIVES

The aim of the current study is to investigate the influence of mechanical stress as well as cleaning agents on the performance of various polyether ether ketone (PEEK) inserts for implant-retained overdentures (IOD).

MATERIALS AND METHODS

Three different standard PEEK inserts were subjected to rapid artificial aging through storage in chemical denture cleaning agents (acetic acid, sodium hypochlorite, or sparkling denture cleaner) as well as demineralized water. The pre-aged PEEK inserts were then placed in unilateral IOD and subjected to 200,000 chewing loads (5 kg ~ 50 N), with 5000 thermal cycles (5/55°C), and 1100 removal/insertion cycles (vertical movement 2 mm).

RESULTS

For all the PEEK inserts, the retention forces decreased significantly with an increasing number of mechanical load cycles and after exposure to all the cleaning agents. PEEK inserts aged by exposure to chemical cleaning agents showed a significantly higher decline in retention force than the inserts stored in water. Confocal laser scanning microscopy indicated that the decline in retention force might be caused by wear on the internal insert surface in contact with the patrix.

CONCLUSIONS

Within the limitations of this study, it can be concluded that the application of chemical cleaning agents accelerates the decline in the retention forces of PEEK retentive inserts in IODs.

Characterization of the Polyetheretherketone Weldment Fabricated via Rotary Friction Welding

Polyether ether ketone (PEEK) is frequently employed in biomedical engineering due to its biocompatibility. Traditionally, PEEK manufacturing methods involve injection molding, compression molding, additive manufacturing, or incremental sheet forming. Few studies have focused on rotational friction welding (RFW) with PEEK plastics. Based on years of RFW practical experience, the mechanical properties of the weldment are related to the burn-off length. However, few studies have focused on this issue. Therefore, the main objective of this study is to assess the effects of burn-off length on the mechanical properties of the welded parts using PEEK polymer rods. The welding pressure can be determined by the rotational speed according to the proposed prediction equation. The burn-off length of 1.6 mm seems to be an optimal burn-off length for RFW. For the rotational speed of 1000 rpm, the average bending strength of the welded parts was increased from 108 MPa to 160 Mpa, when the burn-off length was increased from 1 mm to 1.6 mm and the cycle time of RFW was reduced from 80 s to 76 s. A saving in the cycle time of RFW of about 5% can be obtained. The bending strength of the welded part using laser welding is lower than that using RFW, because only the peripheral material of the PEEK cylinder was melted by the laser.

An HA/PEEK scaffold with modified crystallinity via 3D-bioprinting for multiple applications in hard tissue engineering

Hard tissues, especially teeth and bones, are highly mineralized and the large-scale defect or total loss of them is irreversible. There is still no ideal strategy for the reconstruction of various hard tissue defects that can achieve the balance between biological and mechanical properties. Polyether ether ketone (PEEK) has the potential to substitute for natural hard tissue in defect areas but is limited by its biological inertness. The addition of hydroxyapatite (HA) can significantly improve the osteogenic properties and osteointegration of PEEK materials. But the mechanical properties of HA/PEEK scaffolds are far from satisfaction making scaffolds easy to fracture. We put forward a strategy to balance the mechanical and biological properties of HA/PEEK scaffolds via the regulation of the inner crystallinity and HA mixing ratio and we systematically evaluated the modified HA/PEEK scaffolds through material characterization,in vitroandin vivoexperiments. And we found that the 20%HA/PEEK scaffolds with low crystallinity achieved the required strength and elasticity, and exhibited the characteristics of promoting the proliferation, migration and osteogenic differentiation of bone marrow mesenchymal stem cells. The results of the implantation of beagles' teeth, mandible and rib showed that the 20%HA/PEEK scaffold with low crystallinity could well withstand the local complex force in the defect area and combine well with natural bone tissue, which made it a candidate for a practical versatile hard tissue engineering scaffold.

A Comparison of In Vivo Bone Tissue Generation Using Calcium Phosphate Bone Substitutes in a Novel 3D Printed Four-Chamber Periosteal Bioreactor

Autologous bone replacement remains the preferred treatment for segmental defects of the mandible; however, it cannot replicate complex facial geometry and causes donor site morbidity. Bone tissue engineering has the potential to overcome these limitations. Various commercially available calcium phosphate-based bone substitutes (Novabone®, BioOss®, and Zengro®) are commonly used in dentistry for small bone defects around teeth and implants. However, their role in ectopic bone formation, which can later be applied as vascularized graft in a bone defect, is yet to be explored. Here, we compare the above-mentioned bone substitutes with autologous bone with the aim of selecting one for future studies of segmental mandibular repair. Six female sheep, aged 7-8 years, were implanted with 40 mm long four-chambered polyether ether ketone (PEEK) bioreactors prepared using additive manufacturing followed by plasma immersion ion implantation (PIII) to improve hydrophilicity and bioactivity. Each bioreactor was wrapped with vascularized scapular periosteum and the chambers were filled with autologous bone graft, Novabone®, BioOss®, and Zengro®, respectively. The bioreactors were implanted within a subscapular muscle pocket for either 8 weeks (two sheep), 10 weeks (two sheep), or 12 weeks (two sheep), after which they were removed and assessed by microCT and routine histology. Moderate bone formation was observed in autologous bone grafts, while low bone formation was observed in the BioOss® and Zengro® chambers. No bone formation was observed in the Novabone® chambers. Although the BioOss® and Zengro® chambers contained relatively small amounts of bone, endochondral ossification and retained hydroxyapatite suggest their potential in new bone formation in an ectopic site if a consistent supply of progenitor cells and/or growth factors can be ensured over a longer duration.

Effects of the Applied Potential on the Performance of Polysulfone Membranes Functionalized with Sulfonated Polyether Ether Ketone Polymers

The global water crisis growth has led to a tremendous increase in membrane technology research. Membranes are favored over many other technologies for water treatment because, in principle, they require no chemical additives and can be used isothermally at low temperatures. Membranes that can reject contaminants and salts, produce adequate permeate flux values, and require minimal cleaning are highly demanded. However, most synthesized membranes on the market have associated problems, such as membrane fouling; inverse relationships between flux and solute rejection; and the high cost of synthesis, operation, and maintenance. Therefore, there is a continuied need to produce membranes with properties that make them able to sustain flux and selectivity over time. This research study focused on increasing the surface charge and hydrophilicity of polysulfone (PSf) membranes by incorporating sulfonate-functionalized poly-ether-ether-ketone (SPEEK) into PSf/N-Methyl-2-pyrrolidone (PSf/NMP) membranes. The sulfonation of the PEEK provided a net increase in negative charge on the surface of the membranes that enabled charge repulsion to take place, thus increasing the rejection of ions. In this project, the effect of the applied potential on the performance of SPEEK: PSf/NMP membranes was evaluated. The characterization of the as-synthesized membranes was carried out using the surface's structure and morphology, contact angle, and zeta potential. Furthermore, a voltage of 1.5 V was applied to the membranes in the presence of various salts (sodium chloride, calcium chloride, and potassium chloride salts) to evaluate the effects of the applied potential on solute rejection. It was found that both the permeability and the selectivity of the membranes increased when the voltage was applied. The obtained results indicate that incorporating SPEEK into PSf/NMP membranes increased the hydrophilicity of the membranes, and under the applied voltage, the incorporation allowed it to function as an electrodialysis process that is capable of removing ions from water bodies by utilizing the charge repulsion of ions.

Biofilm Formation on the Surfaces of CAD/CAM Dental Polymers

Dental polymers are now available as monolithic materials which can be readily used in computer-aided design and computer-aided manufacturing (CAD/CAM) systems. Despite possessing numerous advantages over conventionally produced polymers, the polymers produced by either of these systems fail to exhibit immunity to surface microbial adhesion when introduced into the oral environment, leading to the development of oral diseases. The aim of this study was to analyze the biofilm formation of six microorganisms from the oral cavity and its correlation to the surface characteristics of CAD/CAM dental polymers. A total of ninety specimens were divided into three groups: resin-based composite, polymethyl methacrylate, and polyether ether ketone. The experimental procedure included surface roughness and water contact angle measurements, colony forming unit counting, and scanning electron microscopy analysis of biofilm formed on the surface of the tested materials. The data were analyzed using the Kruskal-Wallis test, with a Dunn's post hoc analysis, and one way analysis of variance, with a Tukey's post hoc test; the correlation between the measurements was tested using Spearman's correlation coefficient, and descriptive statistics were used to present the data. Despite using the same manufacturing procedure, as well as the identical manufacturer's finishing and polishing protocols, CAD/CAM dental polymers revealed significant differences in surface roughness and water contact angle, and the increased values of both parameters led to an increase in biofilm formation on the surface of the materials. The CAD/CAM resin-based composite showed the lowest number of adhered microorganisms compared to CAD/CAM polymethyl methacrylate and CAD/CAM polyether ether ketone.

Improvement of the Surface Properties of Polyether Ether Ketone via Arc Evaporation for Biomedical Applications

Polyether ether ketone is a bioinert polymer, that is of high interest in research and medicine as an alternative material for the replacement of bone implants made of metal. The biggest deficit of this polymer is its hydrophobic surface, which is rather unfavorable for cell adhesion and thus leads to slow osseointegration. In order to address this drawback, 3D-printed and polymer extruded polyether ether ketone disc samples that were surface-modified with titanium thin films of four different thicknesses via arc evaporation were investigated and compared with non-modified disc samples. Depending on the modification time, the thickness of the coatings ranged from 40 nm to 450 nm. The 3D-printing process does not affect the surface or bulk properties of polyether ether ketone. It turned out that the chemical composition of the coatings obtained did not depend on the type of substrate. Titanium coatings contain titanium oxide and have an amorphous structure. Microdroplets formed on the sample surfaces during treatment with an arc evaporator contain a rutile phase in their composition. Surface modification of the samples via arc evaporation resulted in an increase in the arithmetic mean roughness from 20 nm to 40 nm for the extruded samples and from 40 nm to 100 nm for the 3D-printed samples, with the mean height difference increasing from 100 nm to 250 nm and from 140 nm to 450 nm. Despite the fact that the hardness and reduced elastic modulus of the unmodified 3D-printed samples (0.33 GPa and 5.80 GPa) are higher than those of the unmodified extruded samples (0.22 GPa and 3.40 GPa), the surface properties of the samples after modification are approximately the same. The water contact angles of the polyether ether ketone sample surfaces decrease from 70° to 10° for the extruded samples and from 80° to 6° for the 3D-printed samples as the thickness of the titanium coating increases, making this type of coating promising for biomedical applications.

The Effects of Different Molding Orientations, Highly Accelerated Aging, and Water Absorption on the Flexural Strength of Polyether Ether Ketone (PEEK) Fabricated by Fused Deposition Modeling

Rising prices are currently a problem in the world. In particular, the abnormal increases in the price of metals, which are often used in dental prosthetics, have increased the burden of dental costs on the public. There is therefore an urgent need to develop prosthetic devices made from materials that are not affected by the global situation and that have excellent biocompatibility and mechanical properties comparable to those of metals. Polyether ether ketone (PEEK) is a promising alternative to metal in dentistry. This study compared the effects of different molding orientations, highly accelerated aging, and water absorption on the flexural strength of PEEK fabricated by fused deposition modeling (FDM) and examined its potential for dental applications. The flexural strength of PEEK stacked at 0° to the molding stage (0° PF), with and without highly accelerated aging, was significantly greater than for the other molding orientations. As with PD, the maximum test load for 0° PF was measured without fracture. PEEK stacked at 45° (45° PF) and 90° (90° PF) to the molding stage easily fractured, as the applied load pulled the stacked layers. No statistically significant difference was found between the flexural strength of 45° PF and 90° PF. The flexural strength decreased under all conditions due to defects in the crystal structure of PEEK caused by highly accelerated aging.

A Feature-Specific Local Cooling System to Control Tensile Strength and Dimensional Accuracy in Fused Filament Fabrication

There is in-depth understanding of the effects and interactions of various process parameters on the mechanical properties and dimensional accuracy of parts produced through fused filament fabrication (FFF). Surprisingly, local cooling in FFF has been largely overlooked and is only rudimentarily implemented. It is, however, a decisive element of the thermal conditions governing the FFF process and of particular importance when processing high-temperature polymers such as polyether ether ketone (PEEK). This study, therefore, proposes an innovative local cooling strategy, which allows for feature-specific local cooling (FLoC). This is enabled by a newly developed hardware in combination with a G-code postprocessing script. The system was implemented on a commercially available FFF printer and its potential was demonstrated by addressing typical drawbacks of the FFF process. Specifically, with FLoC, the conflicting requirements for optimal tensile strength versus optimal dimensional accuracy could be balanced. Indeed, feature-specific (i.e., perimeter vs. infill) control of thermal conditions resulted in a significant increase in ultimate tensile strength and in strain at failure in upright printed PEEK tensile bars compared with those manufactured with constant local cooling-without sacrificing the dimensional accuracy. Furthermore, to improve the surface quality of downward-facing structures the controlled introduction of predetermined breaking points at feature-specific part/support interfaces was demonstrated. The findings of this study prove the importance and capabilities of the new advanced local cooling system in high-temperature FFF and provide further directions on the process development of FFF in general.

On-Off Phagocytosis and Switchable Macrophage Activation Stimulated with NIR for Infected Percutaneous Tissue Repair of Polypyrrole-Coated Sulfonated PEEK

Intelligent control of the immune response is essential for obtaining percutaneous implants with good sterilization and tissue repair abilities. In this study, polypyrrole (Ppy) nanoparticles enveloping a 3D frame of sulfonated polyether ether ketone (SP) surface are constructed, which enhance the surface modulus and hardness of the sulfonated layer by forming a cooperative structure of simulated reinforced concrete and exhibit a superior photothermal effect. Ppy-coated SP could quickly accumulate heat on the surface by responding to 808 nm near-infrared (NIR) light, thereby killing bacteria, and destroying biofilms. Under NIR stimulation, the phagocytosis and M1 activation of macrophages cultured on Ppy-coated SP are enhanced by activating complement 3 and its receptor, CD11b. Phagocytosis and M1 activation are impaired along with abolishment of NIR stimulation in the Ppy-coated SP group, which is favorable for tissue repair. Ppy-coated SP promotes Collagen-I, vascular endothelial growth factor, connective tissue growth factor, and α-actin (Acta2) expression by inducing M2 polarization owing to its higher surface modulus. Overall, Ppy-coated SP with enhanced mechanical properties could be a good candidate for clinical percutaneous implants through on-off phagocytosis and switchable macrophage activation stimulated with NIR.

Adhesive Property of 3D-Printed PEEK Abutments: Effects of Surface Treatment and Temporary Crown Material on Shear Bond Strength

Three-dimensionally printed polyetheretherketone (PEEK) materials are promising for fabricating customized dental abutments. This study aimed to investigate the adhesive property of a 3D-printed PEEK material. The effects of surface treatment and temporary crown materials on shear bond strength were evaluated. A total of 108 PEEK discs were 3D printed by fused-filament fabrication. Surface treatments, including sandblasting, abrasive paper grinding, and CO2 laser ablation, were applied to the PEEK discs, with the untreated specimens set as the control. Afterward, the surface topographies of each group were investigated by scanning electron microscopy (SEM, n = 1) and roughness measurements (n = 7). After preparing the bonding specimens with three temporary crown materials (Artificial teeth resin (ATR), 3M™ Filtek™ Supreme Flowable Restorative (FR), and Cool Temp NATURAL (CTN)), the shear bond strength was measured (n = 6), and the failure modes were analyzed by microscopy and SEM. The results showed that ATR exhibited a significantly higher shear bond strength compared to FR and CTN (p < 0.01), and the PEEK surfaces treated by sandblasting and abrasive paper grinding showed a statistically higher shear bond strength compared to the control (p < 0.05). For clinical application, the ATR material and subtractive surface treatments are recommended for 3D-printed PEEK abutments.

Based On Confined Polymerization: In Situ Synthesis of PANI/PEEK Composite Film in One-Step

Confined polymerization is an effective method for precise synthesis, which can further control the micro-nano structure inside the composite material. Polyaniline (PANI)-based composites are usually prepared by blending and original growth methods. However, due to the strong rigidity and hydrogen bonding of PANI, the content of PANI composites is low and easy to agglomerate. Here, based on confined polymerization, it is reported that polyaniline /polyether ether ketone (PANI/PEEK) film with high PANI content is synthesized in situ by a one-step method. The micro-nano structure of the two polymers in the confined space is further explored and it is found that PANI grows in the free volume of the PEEK chain, making the arrangement of the PEEK chain more orderly. Under the best experimental conditions, the prepared 16 µm-PANI/PEEK film has a dielectric constant of 205.4 (dielectric loss 0.401), the 75 µm-PANI/PEEK film has a conductivity of 3.01×10-4 S m-1 . The prepared PANI/PEEK composite film can be further used as electronic packaging materials, conductive materials, and other fields, which has potential application prospects in anti-static, electromagnetic shielding materials, corrosion resistance, and other fields.

Evaluation of the failure modes and load-bearing capacity of different surface-treated polyether ether ketone copings veneered with lithium di-silicate compared to polyether ether ketone copings veneered with composite: An in vitro study

Aims:

The purpose of this study is to compare and evaluate the failure modes and load-bearing capacity of different surface-treated polyether ether ketone (PEEK) copings when veneered with lithium di-silicate with that of PEEK veneered with composite.

Settings and Design:

In vitro; comparative study.

Materials and Methods:

Congruently anatomically shaped single unit PEEK copings (n = 40) were fabricated by scanning a prepared typodont tooth. The PEEK copings were subdivided among four groups (n = 10/group). Among all, one group of PEEK coping was veneered with Urethane dimethacrylate (UDMA)-based composite and other groups were veneered with lithium-di-silicate after different surface treatment on peek copings, i.e., (i) composite veneered PEEK fixed dental prosthesis (FDP) (control group: Group PC), (ii) lithium di-silicate veneered PEEK FDP (no surface treatment: Group PCeN), (iii) lithium di-silicate veneered PEEK FDP (sandblasting with 50 μm alumina: Group PCeS), and (iv) lithium di-silicate veneered PEEK FDP (chemical etching with 98% sulfuric acid: Group PCeE). The load-bearing capacity of all specimens was assessed using a universal test machine. All the samples were loaded till the cracking point and load at that point and failure modes were noted down.

Statistical Analysis Used:

One-way ANOVA and post hoc Tukey tests.

Results:

The highest load-bearing capacity was recorded for lithium di-silicate veneered PEEK copings which were chemically etched with 98% sulfuric acid (Group PCeE: 1040.25 ± 77.46) followed by Group PCeS (1017.20 ± 53.70), then Group PC (965 ± 51.57) and least was for Group PCeN (933 ± 97.54). There was a significant reduction in mean load-bearing capacity in Group PCeN (P < 0.05).

Conclusions:

Veneering of PEEK with pressed lithium di-silicate seems to be a viable clinical option in terms of adequate load-bearing capacity. Lithium di-silicate veneered PEEK FDPs were successful against physiological occlusal forces and are a suitable material for FDPs.

Evaluation of the Grafting Efficacy of Active Biomolecules of Phosphatidylcholine and Type I Collagen on Polyether Ether Ketone: In Vitro and In Vivo

Biomolecule grafting on polyether ether ketone (PEEK) was used to improve cell affinity caused by surface inertness. This study demonstrated the sequence-polished (P) and sulfonated (SA) PEEK modification to make a 3D structure, active biomolecule graftings through PEEK silylation (SA/SI) and then processed with phosphatidylcholine (with silylation of SA/SI/PC; without SA/PC) and type I collagen (COL I, with silylation of SA/SI/C; without SA/C). Different modified PEEKs were implanted for 4, 8, and 12 weeks for histology. Sulfonated PEEK of SA showed the surface roughness was significantly increased; after the silylation of SA/SI, the hydrophilic nature was remarkably improved. The biomolecules were effectively grafted through silylation, and the cells showed improved attachment after 1 h. Furthermore, the SA/SI/PC group showed good in vitro mineralization. The new bone tissues were integrated into the 3D porous structures of SA/SI/PC and SA/SI/C in vivo making PEEK a potential alternative to metals in orthopedic implants.

Efficacy of Biocage in treating single-segment lumbar degenerative disease in patients with high risk of non-fusion: a prospective controlled study with at least 2 years' follow-up

Objective

To evaluate the clinical efficacy of an allogeneic bone cage (Biocage; Beijing Datsing Bio-Tech Co., Ltd., Beijing, China) for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion.

Methods

From January 2013 to December 2016, 67 patients who underwent lumbar fusion were divided into the Biocage group (n = 33) and polyether ether ketone (PEEK) group (n = 34). The patients were followed up for 24 to 48 months. The mean intervertebral height of the fusion level, fusion rate, height of the intervertebral foramen, visual analog scale score, and Oswestry disability index were compared.

Results

The PEEK group had a lower fusion rate than the Biocage group (88.24% vs. 90.91%), although the difference was not statistically significant. During follow-up, the height of the intervertebral space was similar between the Biocage and PEEK groups (12.88 ± 0.45 and 12.84 ± 1.01 mm, respectively). The height of the intervertebral foramen was larger in the Biocage than PEEK group (20.67 ± 1.34 vs. 20.00 ± 2.05 mm). Good clinical efficacy was achieved in both groups.

Conclusion

The Biocage is efficient and safe for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion.

Additive Manufacturing of Polyether Ether Ketone (PEEK) for Space Applications: A Nanosat Polymeric Structure

Recent improvements in additive layer manufacturing (ALM) have provided new designs of geometrically complex structures with lighter materials and low processing costs. The use of additive manufacturing in spacecraft production is opening up many new possibilities in both design and fabrication, allowing for the reduction of the weight of the structure subsystems. In this aim, polymeric ALM structures can become a choice, in terms of lightweight and demisability, as far as good thermomechanical properties. Moreover, provided that fused-deposition modeling (FDM) is used, nanosats and other structures could be easily produced in space. However, the choice of the material is a crucial step of the process, as the final performance of the printed parts is strongly dependent on three pillars: design, material, and printing process. As a high-performance technopolymer, polyether ether ketone (PEEK) has been adopted to fabricate parts via ALM; however, the space compatibility of 3D-printed parts remains not demonstrated. This work aimed to realize a nanosat polymeric structure via FDM, including all the phases of the development process: thermomechanical design, raw material selection, printing process tuning, and manufacturing of a proof of concept of a technological model. The design phase includes the application of topology optimization to maximize mass saving and take full advantage of the ALM capability. 3D-printed parts were characterized via thermomechanical tests, outgassing tests of 3D-printed parts are reported confirming the outstanding performance of polyether ether ketone and its potential as a material for structural space application.

Comparison of the Bond Strength of Composite Resin to Zirconia and Composite Resin to Polyether Ether Ketone: An In Vitro Study

Aim:

The aim of the study was to compare the shear bond strength of composite resin bonded to polyether ether ketone (PEEK) and zirconia, and also to evaluate the effect of thermocycling on the shear bond strength.

Materials and Methods:

A total of 22 zirconia (Group 1) and 22 PEEK (Group 2) specimens (disks of 10 mm in diameter and 10 mm in thickness) were machine milled using computer-aided design (CAD)/computer-aided manufacturing (CAM) from commercially available zirconia and PEEK. These specimens were air abraded with 110-μm aluminum oxide. Following which these two groups were subdivided into four groups, that is, Group 1A: 11 zirconia specimens before thermocycling, Group 1B: 11 zirconia specimens after thermocycling, Group 2A: 11 PEEK specimens before thermocycling, and Group 2B: 11 PEEK specimens after thermocycling. These four groups of specimens were embedded in an acrylic block, and bonding agent was applied over the upper surfaces of the disks of each of these specimens. Composite resin was then cured, and then Group 1B and group 2B were thermocycled under a standard temperature. The bond strength of the specimen was tested using universal testing machine.

Result:

The result showed that there was no significant difference in shear bond strength between the groups, although higher shear bond strength was observed in the PEEK group.

Conclusion:

Shear bond strength of PEEK is similar to zirconia. The results suggest that the pretreatment method and primers used were effective in improving the bonding of resin cements to zirconia ceramic and the bonding properties of the veneering resin to the PEEK surface.

Comparing different bar materials for mandibular implant-supported overdenture: Finite-element analysis

Aim

This study was conducted aiming to optimize the selection of bar material that can minimize stresses on mandibular bone.

Subjects and Methods

One finite-element model was created under ANSYS environment to evaluate the use of different materials as a bar-manufacturing material in mandibular implant-supported overdenture (OD). Model components were created on engineering computer-aided design software and then assembled under the finite-element package. A force of 200 N was unilaterally and vertically applied on the left second premolar area.

Results

Within these study conditions, the polyether ether ketone bar produced the lowest Von Mises stress on OD and the maximum value of deformation. Stainless steel bar produced the maximum OD total deformation.

Conclusions

Cortical and spongy bones are not sensitive to the bar material. Increasing bar material stiffness increases Von Mises stresses in the bar itself and reduces its total deformation, in what is called overconstrained system.

Study of High Performance Sulfonated Polyether Ether Ketone Composite Electrolyte Membranes

In this study, high performance composite electrolyte membranes were prepared from polyether ether ketone polymeric material. An initial sulfonation reaction improved the membrane hydrophilicity and its water absorbability and thus enhanced the ionic conductivity in electrochemical cells. Protonic conductivity was improved from 10⁻⁴ to 10⁻² S cm⁻¹ with an increasing sulfonation time from 72 to 175 h. The effects of blending nano SiO₂ into the composite membranes were devoted to improve thermal and mechanical properties, as well as methanol permeability. Methanol permeability was reduced to 3.1 × 10⁻⁷ cm² s⁻¹. Finally, a further improvement in ionic conductivity was carried out by a supercritical carbon dioxide treatment under 20 MPa at 40°C for 30 min with an optimum SiO₂ blend ratio of 10 wt-%. The plasticizing effect by the Lewis acid-base interaction between CO₂ and electron donor species on polymer chains decreased the glass transition and melting temperatures. The results show that sulfonated composite membranes blended with SiO₂ and using a supercritical carbon dioxide treatment exhibit a lower glass transition temperature, higher ionic conductivity, lower methanol permeability, good thermal stability, and strong mechanical properties. Ionic conductivity was improved to 1.55 × 10⁻² S cm⁻¹. The ion exchange capacity and the degree of sulfonation were also investigated.

Permeation of a Range of Species through Polymer Layers under Varying Conditions of Temperature and Pressure: In Situ Measurement Methods

Minimising the transport of corrosive reactants such as carbon dioxide, hydrogen sulfide and chloride ions to the surfaces of carbon steel pipes by the use of polymer barrier layers is of major interest in the oil and gas sector. In these applications, there is a requirement to assess the performance of these barrier layers although it is difficult to perform long-term predictions of barrier properties from the results of short-term measurements. New methodologies have been successfully developed to study the permeability of carbon dioxide (CO₂) and hydrogen sulfide (H₂S) through polymer layers under variable conditions of elevated temperatures of 100 °C and pressures of the order of 400 barg. In situ variation of the temperature and the inlet pressure of the gas (or gas mixture) allowed the activation energy and pressure dependence of the permeability to be determined without outgassing of the specimen. These methodologies have been applied to the measurement of the permeability of moulded polyphenylene sulfide (PPS) to supercritical CO₂ in the presence of H₂S. The diffusion coefficients of sodium chloride and potassium chloride through both PPS and polyether ether ketone (PEEK) at ambient temperature and pressure have also been measured.

Effects of Endodontic Irrigants on Material and Surface Properties of Biocompatible Thermoplastics

Passive irrigation is an efficient method for a successful endodontic treatment. During sonic activation biocompatible polymer tips are used to activate irrigants. Compared to ultrasonic activation with metallic tips, polymer tips have the advantage of a reduced risk of fracture and minimise dentine damage. Hence, two polymers, polyether ether ketones (PEEK) and polyamide (PA6), were identified for the manufacturing of novel irrigation tips. The chemical resistance against the irrigants ethylenediaminetetraacetic acid (EDTA) 20%, chlorhexidine gluconate (CHX) 2% and sodium hypochlorite (NaOCl) 5.25% was analysed. Using microindentation, the change of hardness, elasticity, surface roughness and appearance of the polymers was determined. PA6 had a high absorption of irrigant compared to PEEK. PEEK was resistant to the investigated irrigants and showed no significant alteration of surface and mechanical properties, whereas PA6 slightly increased its hardness, elastic modulus and surface roughness during long-term exposure at 37 °C. However, PA6 tips seem to be a promising disposable product due to the material’s high deformability and low manufacturing costs. Particularly with regard to structural-dynamic properties and high chemical resistance, PEEK can be considered as a material for reusable irrigation tips.

Carbon Fiber Reinforced PEEK Composites Based on 3D-Printing Technology for Orthopedic and Dental Applications

Fused deposition modeling (FDM) is a rapidly growing three-dimensional (3D) printing technology and has great potential in medicine. Polyether-ether-ketone (PEEK) is a biocompatible high-performance polymer, which is suitable to be used as an orthopedic/dental implant material. However, the mechanical properties and biocompatibility of FDM-printed PEEK and its composites are still not clear. In this study, FDM-printed pure PEEK and carbon fiber reinforced PEEK (CFR-PEEK) composite were successfully fabricated by FDM and characterized by mechanical tests. Moreover, the sample surfaces were modified with polishing and sandblasting methods to analyze the influence of surface roughness and topography on general biocompatibility (cytotoxicity) and cell adhesion. The results indicated that the printed CFR-PEEK samples had significantly higher general mechanical strengths than the printed pure PEEK (even though there was no statistical difference in compressive strength). Both PEEK and CFR-PEEK materials showed good biocompatibility with and without surface modification. Cell densities on the "as-printed" PEEK and the CFR-PEEK sample surfaces were significantly higher than on the corresponding polished and sandblasted samples. Therefore, the FDM-printed CFR-PEEK composite with proper mechanical strengths has potential as a biomaterial for bone grafting and tissue engineering applications.

Biomechanical, histological, and computed X-ray tomographic analyses of hydroxyapatite coated PEEK implants in an extended healing model in rabbit

A nanosized hydroxyapatite (HA) modification on polyetheretherketone (PEEK) using a novel spin coating technique was investigated in a rabbit model. Spin coating technique creates a 20-40 nm thick layer of nanosized HA particles with similar shape, size, and crystallinity as human bone. Some implants were designed with a perforating hole in the apical region to mimic a fusion chamber of a spinal implant. The coating nano-structures were assessed using a scanning electron microscope. The in vivo response to HA-PEEK was compared to untreated PEEK with respect to removal torque, histomorphometry, and computed microtomography. The HA-coated and pure PEEK implants were inserted in the tibia and femur bone according to simple randomization. The rabbits were sacrificed 20 weeks after implantation. Removal torque analysis showed significantly higher values for HA-PEEK. Qualitative histological evaluation revealed an intimate contact between PEEK and the bone at the threads and perforated hole. Histomorphometric assessment showed higher bone-implant and bone area values for HA-PEEK but without statistical significance. The effect of the HA coating showed most prominent effect in the removal torque which may be correlated to an alteration in the bone quality around the HA-PEEK implants. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1440-1447, 2018.

Titanium and polyether ether ketone (PEEK) patient-specific sub-periosteal implants: two novel approaches for rehabilitation of the severely atrophic anterior maxillary ridge

The aim of this study was to assess two new protocols for single-stage rehabilitation of the severely atrophic maxillary ridge using customized porous titanium or polyether ether ketone (PEEK) sub-periosteal implants. Ten patients with a severely atrophic anterior maxillary alveolar ridge were divided randomly into two groups (five patients in each) to receive customized sub-periosteal implants fabricated via CAD/CAM technology: group 1, porous titanium implants; group 2, PEEK implants. Prosthetic loading with fixed acrylic bridges was performed 1 month postoperative. The implants were followed-up for 12 months and evaluated for the presence of any sign of radiographic bone resorption, mobility, infection, prosthetic fracture, or implant exposure. The immediate postoperative period was uneventful except for one case complicated by wound dehiscence in group 1. At 12 months, all implants were functionally stable and the patients were comfortable with the prostheses. No signs of radiographic bone resorption, mobility, infection, or prosthetic fracture were observed. Within the limitations of this study, the application of customized porous titanium and PEEK sub-periosteal implants produced through CAD/CAM technology appears to be an acceptable method for single-stage prosthetic rehabilitation of the severely atrophic edentulous anterior maxilla. This study was awarded the best case study at the academy of osseintegration annual meeting 2017, Orlando, Florida.

Mechanical Properties of Plasma Immersion Ion Implanted PEEK for Bioactivation of Medical Devices

Plasma immersion ion implantation (PIII) is used to modify the surface properties of polyether ether ketone for biomedical applications. Modifications to the mechanical and chemical properties are characterized as a function of ion fluence (treatment time) to determine the suitability of the treated surfaces for biological applications. Young's modulus and elastic recovery were found to increase with respect to treatment time at the surface from 4.4 to 5.2 MPa and from 0.49 to 0.68, respectively. The mechanical properties varied continuously with depth, forming a graded layer where the mechanical properties returned to untreated values deep within the layer. The treated surface layer exhibited cracking under cyclical loads, associated with an increased modulus due to dehydrogenation and cross-linking; however, it did not show any sign of delamination, indicating that the modified layer is well integrated with the substrate, a critical factor for bioactive surface coatings. The oxygen concentration remained unchanged at the surface; however, in contrast to ion implanted polymers containing only carbon and hydrogen, the oxygen concentration within the treated layer was found to decrease. This effect is attributed to UV exposure and suggests that PIII treatments can modify the surface to far greater depths than previously reported. Protein immobilization on PIII treated surfaces was found to be independent of treatment time, indicating that the surface mechanical properties can be tuned for specific applications without affecting the protein coverage. Our findings on the mechanical properties demonstrate such treatments render PEEK well suited for use in orthopedic implantable devices.

Nanosized Hydroxyapatite Coating on PEEK Implants Enhances Early Bone Formation: A Histological and Three-Dimensional Investigation in Rabbit Bone

Polyether ether ketone (PEEK) has been frequently used in spinal surgery with good clinical results. The material has a low elastic modulus and is radiolucent. However, in oral implantology PEEK has displayed inferior ability to osseointegrate compared to titanium materials. One idea to reinforce PEEK would be to coat it with hydroxyapatite (HA), a ceramic material of good biocompatibility. In the present study we analyzed HA-coated PEEK tibial implants via histology and radiography when following up at 3 and 12 weeks. Of the 48 implants, 24 were HA-coated PEEK screws (test) and another 24 implants served as uncoated PEEK controls. HA-coated PEEK implants were always osseointegrated. The total bone area (BA) was higher for test compared to control implants at 3 (p < 0.05) and 12 weeks (p < 0.05). Mean bone implant contact (BIC) percentage was significantly higher (p = 0.024) for the test compared to control implants at 3 weeks and higher without statistical significance at 12 weeks. The effect of HA-coating was concluded to be significant with respect to early bone formation, and HA-coated PEEK implants may represent a good material to serve as bone anchored clinical devices.

Biomechanical evaluation and surface characterization of a nano-modified surface on PEEK implants: a study in the rabbit tibia

Polyether ether ketone (PEEK) is today frequently used as a biomaterial in different medical operations due to its excellent mechanical and chemical properties. However, the untreated surface of PEEK is bioinert and hydrophobic, and it does not osseointegrate in its pure form. The aim of this study was to evaluate a unique nano-modified surface of PEEK with respect to osseointegration. Forty-eight threaded, non-cutting PEEK implants were inserted bilaterally in the tibia of 24 rabbits. Half of the implants (n=24) were coated with nanocrystalline hydroxyapatite (test) and the remaining implants (n=24) were left uncoated (control). Half of the animals (n=12) were euthanized after 3 weeks of healing and the remaining (n=12) after 12 weeks. The implant retention was measured with a removal torque apparatus. Surface analysis was performed with interferometry, scanning electron microscopy, and X-ray photon spectroscopy to relate the removal torque to the applied surface. The test implants revealed a significantly higher retention after 3 weeks (P=0.05) and 12 weeks (P=0.028) compared to controls. The result of the present study proves that the addition of nanocrystalline hydroxyapatite coating to PEEK surfaces significantly increases its removal torque and biocompatibility.