Wolf-Dieter Müller

PEEK Dental Implants: A Review of the Literature

The insertion of dental implants containing titanium can be associated with various complications (eg, hypersensitivity to titanium). The aim of this article is to evaluate whether there are existing studies reporting on PEEK (polyetheretherketone) as an alternative material for dental implants. A systematic literature search of PubMed until December 2010 yielded 3 articles reporting on dental implants made from PEEK. One article analyzed stress distribution in carbon fiber-reinforced PEEK (CFR-PEEK) dental implants by the 3-dimensional finite element method, demonstrating higher stress peaks due to a reduced stiffness compared to titanium. Two articles reported on investigations in mongrel dogs. The first article compared CFR-PEEK to titanium-coated CFR-PEEK implants, which were inserted into the femurs and evaluated after 4 and 8 weeks. The titanium-coated implants showed significantly higher bone-implant contact (BIC) rates. In a second study, implants of pure PEEK were inserted into the mandibles beside implants made from titanium and zirconia and evaluated after 4 months, where PEEK presented the lowest BIC. The existing articles reporting on PEEK dental implants indicate that PEEK could represent a viable alternative material for dental implants. However, further experimental studies on the chemical modulation of PEEK seem to be necessary, mainly to increase the BIC ratio and to minimize the stress distribution to the peri-implant bone.

The impact of argon/oxygen low-pressure plasma on shear bond strength between a veneering composite and different PEEK materials

OBJECTIVE The aim of the study was to evaluate the impact of low-pressure argon/oxygen plasma with and without previous sandblasting on the shear bond strength (SBS) between dental PEEK compounds and a veneering composite. METHODS Of one type of unfilled PEEK and two pigment powder filled PEEK compounds, forty rectangular plates each were prepared and polished up to 4000 grit. The samples were randomly assigned to four surface pre-treatment groups, each consisting of ten specimens (1. Untreated; 2. Plasma treatment; 3. Sandblasting; 4. Sandblasting+plasma treatment). Plasma treatment was performed for 35min using a low-pressure plasma system with a 1:1 mixture of the process gases argon and oxygen. Surface roughness and water contact angles were recorded. An adhesive (Visio.link, Bredent GmbH & Co KG, Senden, Germany) was applied onto the specimen surfaces and light cured. A mold was used to shape the veneering composite (Vita VM LC, Vita Zahnfabrik, Bad Säckingen, Germany) into a cylindrical form on the sample surface before light curing. SBS was measured after 24h incubation at 37°C in distilled water using a universal testing machine. RESULTS The samples pre-treated according to group 4 (sandblasting and plasma treatment) showed the highest SBS overall, whereas the unfilled PEEK showed the highest SBS (19.8±2.46MPa) compared to the other PEEK materials (15.86±4.39MPa and 9.06±3.1MPa). SIGNIFICANCE Sandblasting and surface activation with low-pressure argon/oxygen plasma in combination with an adhesive causes a favorable increase in shear bond strength, especially on unfilled PEEK material.

Hydrophilicity, Viscoelastic, and Physicochemical Properties Variations in Dental Bone Grafting Substitutes

The indication-oriented Dental Bone Graft Substitutes (DBGS) selection, the correct bone defects classification, and appropriate treatment planning are very crucial for obtaining successful clinical results. However, hydrophilic, viscoelastic, and physicochemical properties’ influence on the DBGS regenerative potential has poorly been studied. For that reason, we investigated the dimensional changes and molecular mobility by Dynamic Mechanical Analysis (DMA) of xenograft (cerabone®), synthetic (maxresorb®), and allograft (maxgraft®, Puros®) blocks in a wet and dry state. While no significant differences could be seen in dry state, cerabone® and maxresorb® blocks showed a slight height decrease in wet state, whereas both maxgraft® and Puros® had an almost identical height increase. In addition, cerabone® and maxresorb® blocks remained highly rigid and their damping behaviour was not influenced by the water. On the other hand, both maxgraft® and Puros® had a strong increase in their molecular mobility with different damping behaviour profiles during the wet state. A high-speed microscopical imaging system was used to analyze the hydrophilicity in several naturally derived (cerabone®, Bio-Oss®, NuOss®, SIC® nature graft) and synthetic DBGS granules (maxresorb®, BoneCeramic®, NanoBone®, Ceros®). The highest level of hydrophilicity was detected in cerabone® and maxresorb®, while Bio-Oss® and BoneCeramic® had the lowest level of hydrophilicity among both naturally derived and synthetic DBGS groups. Deviations among the DBGS were also addressed via physicochemical differences recorded by Micro Computed Tomography, Scanning Electron Microscopy, Fourier Transform Infrared Spectroscopy, X-ray powder Diffractometry, and Thermogravimetric Analysis. Such DBGS variations could influence the volume stability at the grafting site, handling as well as the speed of vascularization and bone regeneration. Therefore, this study initiates a new insight into the DBGS differences and their importance for successful clinical results.

A Novel Approach to Prove Bacterial Leakage of Implant-Abutment Connections In Vitro

Bacterial leakage from the implant-abutment-interface (IAI) is suspected of contributing to the development of peri-implantitis. The aim of the study was to develop a straightforward test setup to evaluate the bacterial leakage of the IAI of 2-piece implant systems under laboratory conditions. A test suspension of Enterococcus faecium was injected into 7 implants (PerioType Rapid Implants) prior to abutment fixation. The IAI was covered by kanamycin aesculn azide agar (KAAA), which serves as an optical indicator for E. faecium . The specimens were cyclically loaded with a force of 120 N for up to 1 000 000 cycles in a universal testing machine in accordance with the ISO 14801:2007 standard. The color change of the KAAA was recorded. Three of the 7 implants showed bacterial leakage before the cyclic loading test started. The bacterial tightness of the IAIs of the 4 remaining implants lasted for 35 680 ± 22 467 cycles on average. The experimental setup at hand provides the means for a straightforward evaluation of the bacterial tightness of the IAI of 2-piece dental implants.

In vitro degradation of a biodegradable polylactic acid/magnesium composite as potential bone augmentation material in the presence of titanium and PEEK dental implants

OBJECTIVE The aim of this study was to assess the degradation behavior by measuring the H2 release of a biodegradable composite consisting of a polylactic acid matrix reinforced with 30% wt. spherical magnesium microparticles (PLA/Mg) as potential bone augmentation material in combination with dental implants of either titanium or polyetheretherketone (PEEK) in order to evaluate the potential influence of the titanium dental implants on the corrosion behavior of the Mg particles within the PLA matrix. METHODS Three PEEK dental implants and three titanium dental implants were put into a central perforation of six PLA/Mg-discs. These samples were incubated at 37°C for 30days in McCoys 5A modified medium and the H2 release was evaluated. RESULTS Between day 7 and day 16 the average H2 release per cm2 of the surface of the PLA/Mg-samples in combination with the titanium implants was significantly higher than that of the sample group combined with the implants of PEEK (3.1±0.4ml vs. 2.8±0.4ml). This significant difference disappeared afterwards, whereas the H2 release was highest at day 30 and amounted 3.5±0.7ml/cm2 for the group with the titanium implants and 3.2±0.8ml/cm2 for the group with the PEEK implants. SIGNIFICANCE Regarding the similar values of the degradation depending H2 release of the two implant material groups, the co-implantation of a PLA/Mg composite is not only possible with new metal-free implant materials such as PEEK, but also with conventional implants of titanium.