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Polyetheretherketone (PEEK) for medical applications

DOI:10.1007/s10856-016-5731-4
Authors:
Ivan Panayotov at Université de Montpellier
Ivan Panayotov
Orti Valerie at Université de Montpellier
Orti Valerie
Frédéric Cuisinier at Université de Montpellier
Frédéric Cuisinier
Jacques Yachouh at Centre Hospitalier Universitaire de Montpellier
Jacques Yachouh
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Abstract and Figures

Polyetheretherketone (PEEK) is a polyaromatic semi-crystalline thermoplastic polymer with mechanical properties favorable for bio-medical applications. Polyetheretherketone forms: PEEK-LT1, PEEK-LT2, and PEEK-LT3 have already been applied in different surgical fields: spine surgery, orthopedic surgery, maxillo-facial surgery etc. Synthesis of PEEK composites broadens the physicochemical and mechanical properties of PEEK materials. To improve their osteoinductive and antimicrobial capabilities, different types of functionalization of PEEK surfaces and changes in PEEK structure were proposed. PEEK based materials are becoming an important group of biomaterials used for bone and cartilage replacement as well as in a large number of diverse medical fields. The current paper describes the structural changes and the surface functionalization of PEEK materials and their most common biomedical applications. The possibility to use these materials in 3D printing process could increase the scientific interest and their future development as well.
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CLINICAL APPLICATIONS OF BIOMATERIALS Review Article
Polyetheretherketone (PEEK) for medical applications
Ivan Vladislavov Panayotov
1
•Vale
´rie Orti
1
•Fre
´de
´ric Cuisinier
1
•
Jacques Yachouh
1
Received: 5 April 2016 / Accepted: 24 May 2016 / Published online: 3 June 2016
ÓSpringer Science+Business Media New York 2016
Abstract Polyetheretherketone (PEEK) is a polyaromatic
semi-crystalline thermoplastic polymer with mechanical
properties favorable for bio-medical applications.
Polyetheretherketone forms: PEEK-LT1, PEEK-LT2, and
PEEK-LT3 have already been applied in different surgical
fields: spine surgery, orthopedic surgery, maxillo-facial
surgery etc. Synthesis of PEEK composites broadens the
physicochemical and mechanical properties of PEEK
materials. To improve their osteoinductive and antimicro-
bial capabilities, different types of functionalization of
PEEK surfaces and changes in PEEK structure were pro-
posed. PEEK based materials are becoming an important
group of biomaterials used for bone and cartilage
replacement as well as in a large number of diverse med-
ical fields. The current paper describes the structural
changes and the surface functionalization of PEEK mate-
rials and their most common biomedical applications. The
possibility to use these materials in 3D printing process
could increase the scientific interest and their future
development as well.
1 Introduction
Polyetheretherketone (PEEK) is a polyaromatic semi
crystalline thermoplastic polymer with chemical formula
(–C
6
H
4
–O–C
6
H
4
–O–C
6
H
4
–CO–)
n
[1]. PEEK was com-
mercialized for the industry in the 1980s [2]. It was pro-
posed as a material for biomedical application in 1998 by
Invibio Ltd. (Thornton-Cleveleys, UK). In the same year
Victrex PEEK business (Imperial Chemical Industry,
London UK) launched PEEK-OPTIMA for long-term
implantable applications [2,3]. Describing the properties of
PEEK-optima LT1 materials we should differentiate the
unfilled PEEK biomaterial from PEEK-composites.
Implants based on the PEEK composites have been devel-
oped as an alternative to conventional metallic or ceramic
devices [4]. PEEK-LT1 can contain varying amounts of
bioactive materials like hydroxyapatite (HA) and b-trical-
cium phosphate. PEEK polymer devices were first reported
for fracture fixation, using carbon reinforcement in a PEEK
matrix [5]. All structural changes in PEEK materials are
developed to increase their biomechanical and biological
properties. Today the medical application of PEEK materials
is common in several surgical fields. One possible classifi-
cation based on clinical application of PEEK materials i.e.
PEEK based implants is presented below.
1.1 Clinical classification of PEEK implants
(1) PEEK for bone replacement-maxillo-facial and cra-
nial implants.
(2) PEEK for spine surgery-spinal cages.
(3) PEEK for orthopedic surgery.
(a) for bone and hip-replacement-articulation
implants.
&Ivan Vladislavov Panayotov
ivan.panayotov@gmail.com
Vale
´rie Orti
valerie.orti@umontpellier.fr
Fre
´de
´ric Cuisinier
frederic.cuisinier@umontpellier.fr
Jacques Yachouh
jacquesyachouh@free.fr
1
Laboratoire de Bioinge
´nierie et Nanosciences EA 4203, UFR
Odontologie, Universite
´de Montpellier, 545 Avenue du
Professeur Jean-Louis Viala, 34193 Montpellier Cedex 5,
France
123
J Mater Sci: Mater Med (2016) 27:118
DOI 10.1007/s10856-016-5731-4
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... A reference to the attenuation coefficients as a function of photon energy are shown in the Supplementary material A ( Figure A). PEEK is of particular interest, as it is biocompatible, has a higher elastic modulus than most polymers (3)(4) GPa), lying between the modulus for cancellous (1 GPa) and trabecular (14 GPa) bone [13][14][15][16][17][18]. PEEK can also be 3D printed, enabling implants to be quickly customised for individual patients and manufactured with porosity to facilitate osseointegration. ...
Monte Carlo calculations of radiotherapy dose distributions within and around orthopaedic implants
Article
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  • Apr 2022
Background and purpose Cancer patients often require a titanium orthopaedic implant to support or replace lost bone. In radiation treatment, the dose distribution is perturbed causing regions of high and low dose at material interfaces. Since the survival of integrating bone tissue is critical to implant success, the aim of this study was to determine the dose distribution in and around the scaffold, when constructed from titanium or Poly-ether-ether-ketone (PEEK). Materials and methods The dose distributions in the pores and along boundaries for three implant scaffold designs were calculated using Monte-Carlo methods in Geant4/GATE, with the material taken as titanium or PEEK. The 3D dose distributions were analysed in MATLAB and segmented using image masks, yielding the dose distributions in key regions of interest. To evaluate the effect of the predicted dose perturbations, the cell survival was calculated using the linear-quadratic model for SAOS-2 cells (bone) using experimentally determined radiation response data. Results High dose gradients were found along the boundaries of the titanium implants, but not for the corresponding PEEK implants. The dose to the internal cavities of the titanium implants was enhanced by 10–15% near the proximal interface whereas for PEEK, there was no significant dose perturbation. The predicted perturbation caused by the titanium implant was shown to decrease the survival for SAOS-2 cells by 7% which was not found for the PEEK implants. Conclusion PEEK was shown to be a more favourable orthopaedic implant material over titanium for cancer patients considering radiation therapy.
... These high-quality properties make PEEK one of the most suitable advanced polymers used in many high-performance applications in aerospace, automotive, military, oil and gas, and chemical industries [2]. In addition, PEEK is a preferred biomaterial for making craniofacial, maxillofacial, orthopedic, and spinal implants because of its biocompatibility, radiolucency, chemical stability inside the body, and a close match to the mechanical properties of bone [3][4][5]. ...
In-house processing of 3D printable polyetheretherketone (PEEK) filaments and the effect of fused deposition modeling parameters on 3D-printed PEEK structures
Article
Full-text available
3D printing, specifically fused deposition modeling (FDM) of poly-ether-ether-ketone (PEEK), is one of the most powerful and efficient state-of-the-art manufacturing techniques. However, FDM of PEEK is challenging. Indeed, it is critical to consider specific 3D printing parameters and filament feedstock quality to achieve optimum mechanical properties in the 3D-printed PEEK parts. In this paper, we investigate the effect of specific 3D printing parameters such as nozzle and chamber temperature, print speed, and layer height on the mechanical properties of 3D-printed PEEK. Moreover, we explore the effect of filament quality on the structures’ mechanical properties. In that regard, we developed PEEK filaments using a customized extruder setup in-house and used those laboratory-developed filaments (LD) to 3D print PEEK structures suitable for mechanical testing (tensile, compression, and flexural testing) and compared them to the mechanical properties of 3D-printed parts that were developed using commercially available (CA) filaments. Results indicate that an optimum combination of a nozzle and chamber temperature, print speed, and layer height is appropriate to achieve 3D-printed parts with optimum mechanical properties. Notably, results confirmed no significant differences between the specimen groups developed using LD and CA filaments, highlighting that the LD filaments were of comparable quality to the CA ones. The highest mean strengths recorded for the parts printed with the LD filaments were 106.45 MPa (compressive), 85.43 MPa (tensile), and 102.63 MPa (flexural). This paper confirms that high-quality PEEK-based filaments can be developed in-house to yield 3D-printed PEEK parts with optimum mechanical properties.
Polyether ether ketone high-performance composites and blends present trends: A review
Chapter
  • Jan 2022
Engineering thermoplastics are highly crucial for various developments and applications. It is much in demand due to its low cost, durability, and ease of productivity. It is shapeable in desired dimensions. Among the various thermoplastics, polyether ether ketone is well known as an engineering thermoplastic. It is possible to obtain desirable mechanical, tribological, chemical, thermal, and electrical engineering properties by deploying polyether ether ketone as the host system. It is the first choice for aerospace, electrical, marine, automotive, and medical applications as a target host system. In this chapter, we report on the various composites and blends of polyether ether ketone, grades, factors affecting its chemical moiety, recycling, and interfacial issues corelated to its properties, followed by future prospectus.
Customized Barrier Membrane (Titanium Alloy, Poly Ether-Ether Ketone and Unsintered Hydroxyapatite/Poly-l-Lactide) for Guided Bone Regeneration
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Sufficient bone volume is indispensable to achieve functional and aesthetic results in the fields of oral oncology, trauma, and implantology. Currently, guided bone regeneration (GBR) is widely used in reconstructing the alveolar ridge and repairing bone defects owing to its low technical sensitivity and considerable osteogenic effect. However, traditional barrier membranes such as collagen membranes or commercial titanium mesh cannot meet clinical requirements, such as lack of space-preserving ability, or may lead to more complications. With the development of digitalization and three-dimensional printing technology, the above problems can be addressed by employing customized barrier membranes to achieve space maintenance, precise predictability of bone graft, and optimization of patient-specific strategies. The article reviews the processes and advantages of three-dimensional computer-assisted surgery with GBR in maxillofacial reconstruction and alveolar bone augmentation; the properties of materials used in fabricating customized bone regeneration sheets; the promising bone regeneration potency of customized barrier membranes in clinical applications; and up-to-date achievements. This review aims to present a reference on the clinical aspects and future applications of customized barrier membranes.
American Society of Maxillofacial Surgeons: The Last 25 Years and the Next 25 Years
Article
  • Jun 2022
Professional organizations, like most complex human entities in the world including companies and countries, undergo periodic changes. Sometimes, these changes happen in years, while others may take decades or more. This year is the 75th anniversary of the American Society of Maxillofacial Surgeons (ASMS), a society born of necessity after World War II, even though its inception goes further back several decades. This brief article commemorates this important landmark and summarizes some key events of the last 25 years from 1997 to 2022, as others have nicely summarized the earlier periods. In addition to changes in clinical, research, and education in the context of craniofacial surgery, the review also examines from the national and global perspectives within which exists ASMS. These historical comparisons allow for appreciation of changes and, more importantly, permits the educated forecast of the future. It is our hope that from the lessons learned from the past will emerge a brighter, better tomorrow.
The safety and efficacy of biceps tenodesis performed using a novel suture anchor
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Mechanical Fatigue Performance of Patient-Specific Polymer Plates in Oncologic Mandible Reconstruction
Article
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Mandible defects are conventionally reconstructed using titanium plates. However, titanium causes metallic artifacts which impair radiological imaging. This study aims at evaluating mechanical fatigue of radiolucent fiber-reinforced polyetheretherketone (f-PEEK), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and polyphenylsulfone (PPSU) polymer plates for mandible reconstruction. A total of 30 plates (titanium [n = 6], f-PEEK [n = 6], PEEK [n = 6], PEKK [n = 6], PPSU [n = 6]) were implanted in synthetic mandibulectomized polyurethane mandibles. Servo-pneumatic mechanical testing with cyclic application of 30–300 N at 3 Hz was conducted. Bite forces were 70% on the unresected and 30% on the resected side. Total number of cycles was set to 250,000. Testing was aborted in case of plate or screw failure. Axial load to failure was tested with a speed of 1 mm/s. Kruskal–Wallis and Dunn’s post hoc tests were used. Titanium, f-PEEK, and PEEK showed no failure in fatigue testing and PPSU (p < 0.001) failed against titanium, f-PEEK, PEEK, and PEKK. Titanium allowed the highest load to failure compared to f-PEEK (p = 0.049), PEEK (p = 0.008), PEKK (p < 0.001), and PPSU (p = 0.007). f-PEEK, PEEK, and PEKK withstood expected physiological bite force. Although titanium plates provided the highest fatigue strength, f-PEEK and PEEK plates showed no failure over 250,000 chewing cycles indicating sufficient mechanical strength for mandible reconstruction.
The Process of Custom Designing Replacement Cranial Bone Patches in Human Body
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Phototethering of Collagen onto Polyetheretherketone Surfaces to Enhance Osteoblastic and Endothelial Performance
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  • May 2022
Polyetheretherketone (PEEK) is a candidate material for bone implants as an alternative to metals. However, PEEK exhibits poor osseointegration and low endothelial compatibility. In the present study, we demonstrated the photo‐tethering of collagen onto PEEK surfaces to facilitate osteoblastic and vascular endothelial performance. In particular, collagen with methacryloyl groups was covalently tethered to the PEEK surface via surface‐initiated photopolymerization. This process is simpler than the conventional method of collagen‐tethering and can be extended to the surface‐patterning treatment of collagen. The Collagen was confirmed to be tethered to the PEEK surface using attenuated total reflection Fourier transform infrared measurements, bicinchoninic acid assays, and atomic force microscopic observations. When human bone marrow‐derived mesenchymal stem cells (HbmMSCs) were cultured on collagen‐tethered PEEK (COL‐PEEK) surfaces, the cells favorably adhered and proliferated. After inducing osteogenic differentiation, the cells on the COL‐PEEK surfaces showed higher expression levels of osteoblast‐related genes and mineralization than those on the PEEK surface. Moreover, the tethering of collagen greatly improved endothelial proliferation. The COL‐PEEK surfaces promoted endothelial networking in co‐culture with HbmMSCs. These results suggest that COL‐PEEK is highly compatible with both osteoblasts and vascular endothelial cells. COL‐PEEK is a promising implant that induces osteogenesis and angiogenesis to repair bone tissues. This article is protected by copyright. All rights reserved
Preservation of Infraorbital Nerve in Orbital Floor and Maxillary Defect Reconstruction With Patient-Specific Three-Dimensional Implant: A Case Report
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Reconstruction of orbitomaxillary defects poses many operative challenges because it requires consideration of cosmetic as well as functional elements: reestablishing facial symmetry while constituting the orbital volume and preserving involved neurovascular structures. The development of patient-specific polyetheretherketone implants have revolutionized complex craniofacial reconstruction due to its adaptability to anatomic constraints and accommodation of vital structures. Herein, we described 2 cases of orbitomaxillary reconstruction using PEEK implant with novel modifications to preserve the infraorbital nerve with optimal cosmetic outcomes and minimal postoperative morbidity.
Applications of PEEK in oral implantology and prosthodontics
Article
Full-text available
  • Oct 2015
Purpose: Polyetheretherketone (PEEK) is a polymer that has many potential uses in dentistry. The aim of this review was to summarize the outcome of research conducted on the material for dental applications. In addition, future prospects of PEEK in the field of clinical dentistry have been highlighted. Study selection: An electronic search was carried out via the PubMed (Medline) database using keywords 'polyetheretherketone', 'dental' and 'dentistry' in combination. Original research papers published in English language in last fifteen year were considered. The studies relevant to our review were critically analyzed and summarized. Results: PEEK has been explored for a number of applications for clinical dentistry. For example, PEEK dental implants have exhibited lesser stress shielding compared to titanium dental implants due to closer match of mechanical properties of PEEK and bone. PEEK is a promising material for a number of removable and fixed prosthesis. Furthermore, recent studies have focused improving the bioactivity of PEEK implants at the nanoscale. Conclusion: Considering mechanical and physical properties similar to bone, PEEK can be used in many areas of dentistry. Improving the bioactivity of PEEK dental implants without compromising their mechanical properties is a major challenge. Further modifications and improving the material properties may increase its applications in clinical dentistry.
The Use of Carbon-Fiber-Reinforced (CFR) PEEK Material in Orthopedic Implants: A Systematic Review
Article
Full-text available
  • Feb 2015
Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) has been successfully used in orthopedic implants. The aim of this systematic review is to investigate the properties, technical data, and safety of CFR-PEEK biomaterial and to evaluate its potential for new innovation in the design of articulating medical devices. A comprehensive search in PubMed and EMBASE was conducted to identify articles relevant to the outcomes of CFR-PEEK orthopedic implants. The search was also expanded by reviewing the reference sections of selected papers and references and benchmark reports provided by content experts. A total of 23 articles were included in this review. There is limited literature available assessing the performance of CFR-PEEK, specifically as an implant material for arthroplasty systems. Nevertheless, available studies strongly support CFR-PEEK as a promising and suitable material for orthopedic implants because of its biocompatibility, material characteristics, and mechanical durability. Future studies should continue to investigate CFR-PEEK's potential benefits.
Apatite-forming PEEK with TiO2 surface layer coating
Article
Full-text available
Polyetheretherketone (PEEK) is widely used in orthopedic implants, such as spinal fusion devices, because of its moderate elastic modulus, as well as relatively high mechanical strength. However, it does not bond to living bone, and hence it needs autograft to be fixed to the bone. In this study, we attempted to add bone-bonding properties to PEEK by coating with TiO2 synthesized by the sol-gel process. When a TiO2 sol solution consisting of titanium isopropoxide, water, ethanol, and nitric acid was deposited on a PEEK substrate without any pretreatment, the formed TiO2 gel layer was easily peeled off after subsequent treatments. However, when the same solution was deposited on PEEK that was preliminarily subjected to UV or O2 plasma treatment, the deposited TiO2 gel layer strongly adhered to the substrate even after subsequent treatments. The strong adhesion was attributed to the interaction among the C-O, C=O, and O-C=O groups on the PEEK owing to the UV or O2 plasma treatment and the Ti-O bond of the TiO2 gel. Apatite did not form on the as-formed TiO2 gel layer in a simulated body fluid (SBF) even within 3 days; however, apatite formed after soaking in 0.1 M HCl solution at 80 °C for 24 h. This apatite formation was attributed to positive surface charge of the TiO2 gel layer induced by the acid treatment. The PEEK with the TiO2 gel layer coating formed by the proposed process is expected to bond to living bone, because a positively charged titanium oxide which facilitates the formation of apatite in SBF within a short period is known to bond to living bone.
Finite element analysis of the biomechanical Effects of PEEK dental Implants on the peri-implant bone
Article
Full-text available
Dental implants are mostly fabricated of titanium. Potential problems associated with these implants are discussed in the literature, for example, overloading of the jawbone during mastication due to the significant difference in the elastic moduli of titanium (110 GPa) and bone (≈ 1–30 GPa). Therefore poly-ether-ether-ketone (PEEK) could represent an alternative biomaterial (elastic modulus 3–4 GPa). Endolign® represents an implantable carbon fiber reinforced (CFR)-PEEK including parallel oriented endless carbon fibers. According to the manufacturer it has an elastic modulus of 150 GPa. PEEK compounds filled with powders show an elastic modulus around 4 GPa.The aim of the present finite element analysis was to point out the differences in the biomechanical behavior of a dental implant of Endolign® and a commercial powder-filled PEEK. Titanium served as control.These three materials were used for a platform-switched dental implant-abutment assembly, whereas Type 1 completely consisted of titanium, Type 2 of a powder-filled PEEK and Type 3 of Endolign®. A force of 100 N was applied vertically and of 30° to the implant axis.All types showed a minimum safety factor regarding the yield strength of cortical bone. However, within the limits of this study the Type 2 implant showed higher stresses within the adjacent cortical bone than Type 1 and Type 3. These implant assemblies showed similar stress distributions.Endless carbon fibers give PEEK a high stability. Further investigations are necessary to evaluate whether there is a distinct amount of endless carbon fibers causing an optimal stress distribution behavior of CFR-PEEK.
Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease
Article
  • Dec 2002
OBJECTIVE: We investigated the effectiveness of a new material, polyetheretherketone (PEEK), in a spinal cage used in performing cervical spinal fusion for the correction of cervical kyphosis. METHODS: A total of 80 patients with various cervical diseases were divided into two groups. Patients in Group A (40 patients) underwent microdiscectomy and PEEK cage fusion, and patients in Group B (40 patients) were treated with microdisectomy and autogenous iliac crest graft (AICG) fusion. We evaluated the patients for cervical lordosis, the height of the foramina, the cross sectional area of the foramina, and fusion status on the basis of x-rays. The patients' neurological and functional outcomes were assessed on the basis of the Prolo scale. Magnetic resonance imaging was also performed for spinal cord evaluation. RESULTS: The use of the PEEK cage in patients who undergo spinal fusion may increase cervical lorclosis (mean, 2.33 +/- 3.00 mm; P = 0.03), whereas AICG fusion may not (mean, -0.84 +/- 6.69 mm; P = 0.49). The use of the PEEK cage was found to increase the height of the foramina (mean, 2.54 +/- 1.40 mm; P = 0.00) and increase its cross sectional area 2 (mean, 40.36 +/- 23.53 mm; P = 0.00). The height of the foramina increased only in the PEEK group postoperatively. The cross sectional area of the foramina increased in both groups postoperatively. The complication rate in patients who underwent fusion proceclures with the PEEK cage was less than that in patients who underwent fusion with AICG fusion (2.50 versus 17.50%; P = 0.03). Both groups had a satisfactory fusion rate (100 versus 93.1%). The patients' postoperative Prolo scale scores were statistically better in the PEEK group (8.50 +/- 1.49 versus 7.17 +/- 2.13; P = 0.00), and more patients in the PEEK group than in the AICG group achieved excellent outcomes (66.63 versus 28.57%; P 0.00). Because PEEK is radiotransparent on x-rays and few artifacts are seen on magnetic resonance imaging scans, it is better suited than autogenous iliac crest donor material for postoperative radiographic evaluation. CONCLUSION: The PEEK cage provides solid fusion, increased cervical lordosis, and increased height and cross sectional area of the foramina. There are few complications associated with the use of this cage, and the functional and neurological outcomes are satisfactory. It also facilitates postoperative x-ray and magnetic resonance imaging evaluation.. The PEEK cage is therefore a good substitute for AICG fusion in patients with cervical disc disease.
A New Rat Model for Translational Research in Bone Regeneration
Article
  • Oct 2015
The EU directive 2010/63/EU on the protection of animals used for scientific purpose focused on reducing the number of animals and refinement of breeding. Animal studies are necessary to protect human health. Lots of animal models exist to study bone regeneration but a reliable, well reproducible and relatively inexpensive model with the possibility for multiple testing in the same animal is still missing. Rats may serve as good models for this due to the small animal size, good cost/benefit ratio. The present study aimed to develop a novel rat caudal vertebrae critical size defect model for bone regeneration and implant osseointegration studies The study was performed using Wistar rats with weight from 380 to 450 gr. An incision was made on the dorsal side of the tail. After skin and muscles retractions, the vertebrae were exposed. Critical size defects for bone tissue engineering, or implant placements for titanium body experiments were possible in each of the first four caudal vertebrae. MicroCT and histology were used to detect bone growth. There was no bone formation in the defects after one month or two months of healing. When a calcium phosphate biomaterial was used (Bio-Oss®, Geistlich Pharma AG, Wolhusen, Switzerland), a good stability of the material in the defect was noted and bone growth was visible after one or two months. Results based on implant placement showed good primary stability after three month of healing. MicroCT showed integrated implant position through the vertebra. These results suggest that the rat caudal vertebrae may serve as a good new model for studying bone regeneration and implant osseointegration with the possibility of multiple testing within the same experimental animal and the potential to decrease number of experimental animals. .
Effect of different surface pretreatments and adhesives on the load-bearing capacity of veneered 3-unit PEEK FDPs
Article
  • Sep 2015
Statement of problem Polyetheretherketone (PEEK) can be used as a framework material for fixed dental prostheses (FDPs). However, information about the fracture load of veneered PEEK FDPs is still scarce. Purpose The purpose of this in vitro study was to investigate the influence of different PEEK surface pretreatments and adhesive systems on the fracture load of 2 differently veneered FDPs. Material and methods Four hundred eighty anatomically shaped 3-unit PEEK frameworks were milled, airborne-particle abraded with 50 μm alumina powder, and divided into 4 groups according to the following surface pretreatment (n=120): plasma treatment, etching with either sulfuric acid or piranha solution, and no further treatment. All groups were then allocated to 4 conditioning groups: visio.link, Ambarino P60, Signum PEEK Bond, or no conditioning. They were veneered with Signum Composite (n=15) or Signum Ceramis (n=15). Upon completion, the FDPs were thermally aged, and fracture loads and failure types were determined. Statistical analysis was performed with 3/2/1-way ANOVA with the post hoc Tukey HSD test (α=.05). Results The highest fracture loads were achieved without treatment in combination with visio.link (737 ±138 N). The lowest values were obtained after piranha acid etching and conditioning with visio.link (277 ±71 N); both groups were veneered with Signum Composite. The results, however, indicated no clear influence of either pretreatment or conditioning. With few exceptions, FDPs veneered with Signum Composite showed higher fracture load values compared to Signum Ceramis. After thermocycling, all FDPs showed cracks in the veneering composite resin material in the pontic region, regardless of the PEEK pretreatment or the adhesive system used. After loading, no fractures of the PEEK frameworks were evident in any FDPs, but chipping of the veneering material was observed. Conclusions With respect to the fracture types after thermocycling, pretreatment, conditioning, or veneering resin cement did not affect the fracture results.
Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty
Article
Traditional cranioplasty methods focus on pre-operative or intraoperative hand molding. Recently, CT guided polyether ether ketone (PEEK) plate reconstruction enables precise, time-saving reconstruction. This case series aims to show a single institution experience with use of PEEK cranioplasty as an effective, safe, precise, reusable, and time-saving cranioplasty technique in large, complex cranial defects.Methods We performed a 6-year retrospective review of cranioplasty procedures performed at our affiliated hospitals using PEEK implants. A total of nineteen patients underwent twenty-two cranioplasty procedures. Pre-operative, intra-operative, and post-operative data was collected.ResultsNineteen patients underwent twenty-two procedures. Time interval from injury to loss of primary cranioplasty averaged 57.7 months (0-336 mo); 4.0 months (n=10, range 0-19) in cases of trauma. Time interval from primary cranioplasty loss to PEEK cranioplasty was 11.8 months for infection (n=11, range 6-25 mo.), 12.2 months for trauma (n=5, range 2-27 mo.), and 0.3 months for cosmetic or functional reconstructions (n=3, range 0-1). Similar surgical techniques were used in all patients. Drains were placed in 11/22 procedures. Varying techniques were used in skin closure, including adjacent tissue transfer (4/22) and free tissue transfer (1/22). The PEEK plate required modification in four procedures. Three patients had reoperation following PEEK plate reconstruction.Conclusion Cranioplasty utilizing CT-guided PEEK plate allows easy inset, anatomic accuracy, mirror image aesthetics, simplification of complex 3D defects, and potential time savings. Additionally, it’s easily manipulated in the operating room, and can be easily re-utilized in cases of intraoperative course changes or infection.
Polymeric heart valves for surgical implantation, catheter-based technologies and heart assist devices
Article
  • Jan 2015
Efficient function and long-term durability without the need for anticoagulation, coupled with the ability to be accommodated in many different types of patient, are the principal requirements of replacement heart valves. Although the clinical use of valves appeared to have remained steady for several decades, the evolving demands for the elderly and frail patients typically encountered in the developed world, and the needs of much younger and poorer rheumatic heart disease patients in the developing world have now necessitated new paradigms for heart valve technologies and associated materials. This includes further consideration of durable elastomeric materials. The use of polymers to produce flexible leaflet valves that have the benefits of current commercial bioprosthetic and mechanical valves without any of their deficiencies has been held desirable since the mid 1950s. Much attention has been focused on thermoplastic polyurethanes in view of their generally good physico-chemical properties and versatility in processing, coupled with the improving biocompatibility and stability of recent formulations. Accelerated in vitro durability of between 600 and 1000 million cycles has been achieved using polycarbonate urethanes, and good resistance to degradation, calcification and thrombosis in vivo has been shown with some polysiloxane-based polyurethanes. Nevertheless, polymeric valves have remained relegated to use in temporary ventricular assist devices for bridging heart failure patients to transplantation. Some recent studies suggest that there is a greater degree of instability in thermoplastic materials than hitherto believed so that significant challenges remain in the search for the combination of durability and biocompatibility that would allow polymeric valves to become a clinical reality for surgical implantation. Perhaps more importantly, they could become candidates for use in situations where minimally invasive transcatheter procedures are used to replace diseased valves. Being amenable to relatively inexpensive mass production techniques, the attainment of this goal could benefit very large numbers of patients in developing and emerging countries who currently have no access to treatment for rheumatic heart disease that is so prevalent in these areas. This review discusses the evolution and current status of polymeric valves in wide-ranging circumstances.
Comparison of Polyetheretherketone (PEEK) and Titanium Cranioplasty after Decompressive Craniectomy.
Article
  • Jun 2014