DOI: 10.7860/JCDR/2019/41965.

13103
Review Article

Polyetheretherketone (PEEK) in Dentistry

Dentistry Section
veena b benakatti1, jayashree A sajjanar2, aditya acharya3

ABSTRACT
There has been a constant research in identifying ideal restorative materials to replace lost dentofacial structures. Material such as
wood, shell, ivory, rubbers to metals and plastics have been tried in the past. Advancements in dental materials have given dentistry
more promising materials, yet each material remains short of being the ideal one. Oral conditions demand a material with good
mechanical and biologic properties in addition to aesthetics. At present Polyetheretherketone (PEEK) is one of the viable materials
among scientifically approved and safe materials in restoring the lost orofacial tissues. Due to its excellent properties peek has
several applications in field of dentistry like implants, removable and fixed partial dentures, and orthodontic wires.

Keywords: Aesthetic dentistry, Implant, Surface treatment

Introduction PEEK is widely used not only in engineering applications but also
In view of aesthetic concerns, metal free restorations are gaining in medical applications because of its excellent thermal properties,
popularity in current dental therapies. PEEK is one among the metal superior wear resistance, great processability, inertness, corrosion
free restorations that has many potential uses in dentistry. Due to its resistance, high strength and modulus of elasticity [5]. PEEK
excellent properties PEEK is gaining importance in oral implantology has elastic modulus that in close to human bone suggesting
and prosthodontics [1]. Titanium (Ti) and its alloys have been used homogeneous stress distribution to surrounding tissues.
as dental implants since its introduction by Brånemark. Ti materials Radiographic radiolucency and low density (1.32 g/cm3) makes it
have certain clinical issues, such as occasional metal hypersensitivity suitable for medical applications [1,7,8]. Radio pacifiers like barium
and allergies, surface degradation and contamination related to peri- sulfate can be added to improve visualisation and contrast in
implantitis, high modulus of elasticity and the metallic color which medical imaging [5].
is less acceptable in aesthetic regions. PEEK-based materials can PEEK is an inert material highly compatible with surrounding tissues
overcome these problems and can be a viable substitute to titanium and do not exhibit any toxic or mutagenic effects. Therefore, it can
[2]. Due to its excellent mechanical and aesthetic properties PEEK be an ideal substitute for patients allergic to titanium and other
can also be used as framework for removable and fixed dental metals. PEEK does not have metallic color; it is beige with a touch
prosthesis, orthodontic wires [3]. This paper summarises the of grey and has more aesthetic appearance [9].
properties and application of PEEK for dental purposes.
PEEK Processing and Manufacturing
History of PEEK PEEK implant components are manufactured using injection
PEEK is a polyaromatic semi crystalline thermoplastic polymer molding, extrusion and compression molding techniques [5].
originally introduced by victrex PLC then ICI (imperial chemical As an alternate to these techniques Rapid Prototyping and CAD
industries) in early 1980s for engineering applications. It was CAM milling produces quick, highly precise prostheses without
first commercialised for industrial applications in manufacture of compromising quality of material [10].
aircraft, turbine blades, piston parts, cable insulation, bearings
and compressor plate valves [1]. Later in 1998 it was proposed for Applications of PEEK in Dentistry
biomedical application by Invibio Ltd (Thornton-Cleveleys, UK). In Owing to its excellent properties, PEEK succeeded as a biomaterial
the same year Victrex PEEK business (Imperial Chemical Industry, in medicine; soon it found its application in dentistry. Different
London UK) launched PEEK-OPTIMA for long-term implantable surface modifications have allowed PEEK to bond with various luting
applications [4]. agents. Tensile properties of PEEK are comparable to bone, enamel
and dentin, which makes it a suitable dental restorative material.
Structure and Properties of PEEK With good biocompatibility and afore mentioned properties PEEK is
PEEK is a colorless organic thermoplastic polymer a member successfully used in dentistry as implants, framework for removable
of PAEK family. It is a homopolymer having a single monomer. and fixed prosthesis [3].
It is a semicrystalline thermoplastic with exceptional chemical
and mechanical properties that are retained even at higher a. As Implant Material
temperatures. Length, chemical composition, structure (branching Dental implants make one of the most viable replacements for missing
of polymer) of PEEK renders it stable at high temperatures making tooth. Titanium has been the material of choice for dental implants
processing of peek implant components easy [5]. PEEK shows since its introduction by Branemark. However, titanium lacks certain
resistance to deterioration during various sterilisation procedures; important properties. There are reported cases of hypersensitivity to
hence it can be sterilised with heat sterilisation methods without material. The difference in elastic moduli of Titanium and surrounding
affecting its properties [6]. Its chemical structure makes it highly bone, leads to stress shielding and bone resorption. Major benefit
resistant to chemical and radiation damage, compatible with of PEEK as an implant material is its Youngs modulus which is
reinforcing agents such as glass and carbon fibers, greater close to human bone, thus it can generate favorable stress and
strength than metals. These properties make it highly suitable of deformations minimising stress shielding effect and bone resorption.
industrial applications [5]. Unfilled PEEK exhibits an elastic moduli of 3-4Gpa. The addition of
10 Journal of Clinical and Diagnostic Research. 2019 Aug, Vol-13(8): ZE10-ZE12
www.jcdr.net Veena B Benakatti et al., Polyetheretherketone (PEEK) in Dentistry

reinforcing agents like carbon fibers increases elastic modulus of Composite preparation, bioactivity of PEEK can be improved by
PEEK up to 18Gpa which matches elastic moduli of bone (14Gpa). impregnating it with bioactive materials. Depending on the size of
Titanium provokes a dark shimmer of periimplant tissue in cases with these materials, PEEK composites are classified as conventional
thin biotype and mucosal recession which produces unaesthetic PEEK and nanosized (<100 nm) PEEK composites. One conventional
appearance in patients, especially with high lip line. PEEK can be PEEK composite, that is hydroxyapatite, has good biocompatibility,
alternative to titanium in such cases [2,11]. The long-term presence bioactivity, osteoconduction, and can be used as a filler material
of metals results in tissue reactions and osteolysis [12]. to prepare PEEK composites. The increase in the amount of
Corrosion-resistance, bioactivity and biocompatibility, non-toxicity, HA content improves tensile modulus and micro hardness, but
all are shown by Bioactive ceramics. However, the demands for load- decreases tensile strength and strain to fracture [1].
bearing applications cannot be fulfilled because of the mechanical Bioactive inorganic particles have been inserted to PEEK with
properties of ceramics, like their ductility, low fracture toughness, melt blending and compression molding techniques in order to
brittleness and high elastic modulus [12]. Elastic modulus of zirconia enhance its bioactivity. These bioactive nanocomposites also
is 210 gpa which is about 14 times greater than compact bone have improved mechanical properties. Hydroxyfluoroapatite
(14gpa). These stiff implants do not adequately strain the bone, has been suggested to impart antimicrobial properties against
resulting in disuse atrophy and bone resorption [9]. PEEK makes an streptococcus mutans and also enhance osseointegration.
alternative to ceramics in terms of mechanical properties. Bioactive PEEK nanocomposites can also be used as indirect
Although unmodified PEEK is considered a bioinert material, there intracoronal and extracoronal restorations, as they have
is no conclusive evidence of osseoconductive effects; hence advantage of antibacterial properties in addition to better
unmodified peek implants survival is questionable. Inadequate mechanical properties [3].
osseoconductivity and bioactivity of the dental implant may lead to PEEK can be used as implant abutments as they exhibit comparable
severe implantitis and implant failure [13]. bone resorption and soft tissue inflammation to titanium abutments.
These are some of the current strategies to improve the bioactivity In addition closely matching elastic modulus of bone and PEEK
of PEEK [12]. reduces stress shielding effect and encourage bone remodeling.
• Physical treatment Thus PEEK can be viable alternative to titanium abutments [3].
However, because of its lower fracture resistance PEEK is not used
• Chemical treatment
as a definitive abutment material [1].
• Surface coating
• Composite preparation b. In Removable Prosthesis and its Components
To improve bioactivity of PEEK several surface modifications have Owing to its light weight, superior biologic, aesthetic and mechanical
been tried, physical treatment like plasma modifications (such as properties PEEK can be used to construct clasps and dentures
nitrogen and oxygen plasma, ammonia/argon plasma, oxygen by CAD CAM systems. Another application would be to make
plasma, methane and oxygen plasma, ammonia plasma, oxygen removable obturators [1,3]. Biocompatibility, resistance to cracking,
and argon plasma, and hydrogen/argon plasma) and Accelerated flexural bone modulus, machinability and ease of polishing of
neutral atom beam (ANAB). Plasma modification resulted into PEEKOPTIMA (reinforced poly-ether-etherketone) allows material
increase adhesion, proliferation and osteogenic differentiation [1]. to be used in the palatal section of maxillary obturator prostheses.
Costa-Palau S et al., fabricated maxillary obturator prosthesis using
Chemical treatment like wet chemistry and sulfonation, surface
PEEK and found that the use of PEEK simplified the fabrication of
coating by titanium, gold, titanium dioxide, diamond-like carbon,
the antral section of the obturator and resulted in significantly lighter
tert-butoxides, and hydroxyapatite have been considered.
obturator prosthesis. Retention, aesthetics and patient comfort
The hydroxyapatite is the most widely used material due to its
were greatly improved. Constructing obturator prosthesis with
biocompatibility, bioactivity, and osteoconductivity in vivo. Surface
PEEK-OPTIMA is a good alternative to conventional materials and
coatings can be applied using the following techniques: aerosol
methods for patients with large oral-nasal defects [15]. In a partial
deposition, vacuum plasma spraying, arc ion plating, plasma
denture framework made of PEEK, patient comfort is improved
immersion ion implantation and deposition, physical vapor
deposition, cold spray technique, electron beam deposition, ionic because of its strength and lightweight, digital design customises
plasma deposition, radio-frequency magnetron sputtering, and spin individual anatomy, absence of metal taste), no thermal and
coating [1]. Devine et al compared bioactivity of titanium coated and electrical conductivity, scanner and x-ray friendly, non-allergenic.
uncoated implants and concluded that Ti coating of Carbon fiber PEEK frameworks are shock absorbent during mastication, have an
PEEK screws significantly improve bone apposition and removal excellent resistance to decay and abrasion. Although metals exhibit
torque compared with uncoated Carbon fiber PEEK screws. Author good strength but resiliency and patient comfort are also of great
also compared the titanium coating by physical vapor deposition and concern [16].
vaccum plasma spraying and concluded that VPS-coated screws had Despite good fracture resistance, PEEK is weak mechanically
a screw removal torque which was statistically greater than uncoated in homogenic form. Tannous F et al., in vitro research showed
and PVD-coated screws [14]. Thin layer of nanoscale calcium that PEEK clasps have lower resistance forces in comparison to
hydroxyapatite has been tried as a coating on PEEK by a process cobaltchrome [17]. Hence lead to the development of modified
called spin coating. In this process apatite is dissolved in organic PEEK containing 20% ceramic fillers known as BioHPP (Bredent
solvents and dropped onto implant surface rotating at high speeds. GmbH Senden, Germany). Possibility of corrections, good stability,
These spin coated implants showed higher bone implant contact in optimal polish ability and aesthetics of BioHPP produce high-quality
comparison to unmodified PEEK. Alternatively plasma gas etching is prosthesis. BioHPP with a great potential as framework material,
another procedure to produce nanoscale surface modifications for makes good alternative to Cr-Co frameworks in patients with high
PEEK in which low pressure gases are used to introduce nanolevel aesthetic requirements [18].
surface roughness and functional groups on PEEK. This induces more
hydrophilicity for better material tissue interaction. These gas plasma c. As a Framework in Fixed Prosthesis
modified implants showed improved proliferation and differentiation Since PEEK is opaque it should be veneered with composites
of mesenchymal cells on implant surface. Various other methods of to attain aesthetics. The colour of PEEK which is grey in unfilled
surface deposition like electron beam deposition has been tried to material can be ad-justed by incorporating appropriate pigments.
enhance hydrophilicity and cellular proliferation [3]. Since PEEK is chemically inert different methods have been tried to
Journal of Clinical and Diagnostic Research. 2019 Aug, Vol-13(8): ZE10-ZE12 11
 Veena B Benakatti et al., Polyetheretherketone (PEEK) in Dentistry www.jcdr.net

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PARTICULARS OF CONTRIBUTORS:
1. Lecturer, Department of Prosthodontics, KAHERS, Klevkids, Belagavi, Karnataka, India.
2. Senior Lecturer, Department of Prosthodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India.
3. Lecturer, Department of Prosthodontics, KAHERS, Klevkids, Belagavi, Karnataka, India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:

Veena B Benakatti,
Lecturer, Department of Prosthodontics, KLEVK Institute of Dental Sciences, Nehru Nagar, Belagavi, Karnataka, India. Date of Submission: May 10, 2019
E-mail: veenak20021@rediffmail.com Date of Peer Review: May 27, 2019
Date of Acceptance: Jun 29, 2019
Financial OR OTHER COMPETING INTERESTS: None. Date of Publishing: Aug 01, 2019

12 Journal of Clinical and Diagnostic Research. 2019 Aug, Vol-13(8): ZE10-ZE12