Polyetheretherketone (PEEK) is a polyaromatic compound which is a polyaryleterketone

group . It is promising thanks to the appropriate physical and mechanical properties in the
fields of medicine and dentistry. There are many uses of PEEK:
• maxillofacial and cranial implant,
• Spinal surgery,
• Orthopaedic surgery,
• A dental implant, root canal material
carbon fiber reinforced PEEK(CFR-
PEEK),
• Cardiac surgery
The areas of use in dentistry are :
I. implants
a) implant
b) implant supported bar
c) abutment
d) temporary abutment
e) healing cap
II. fixed prostheses
III. endocrowns
IV. removable dentures
V. maxillofacial prostheses
VI. orthodontic wire
PEEK is synthesized by an alkylation reaction that combines 4’40- difluoro benzophenone with
hydroquinone salt Ether bond gives the molecule an axial displacement, while the benzene
ring gives stiffness. The molecule has two microstructures:
1. Crystalline phase
2. Amorphous phase (surrounds crystals)

Chemical formula of PEEK which has a close modulus of elasticity to the bone , it can be
used as an alternative to metal implants . PEEK is an inert material and it’s thermal
properties remain stable in the human body . According to Katzer et al, PEEK and CFR-
PEEK do not exhibit cytotoxic, mutagenic reaction
. Similarly, PEEK does not show an allergic reaction according to the study of Wenz et al. .
PEEK has high thermal degradation resistance, melting temperature is 334˚C . It provides
radiolucent imaging, so it is compatible with imaging techniques such as magnetic
resonance imaging (MRI), computerized tomography (CT), and X-RAY . Combination with
barium sulfate can increase the radioopacity . It has resistance to gamma radiation . One of
the disadvantages is unable to osseointegration This restricts its use on the
implant surface or biomedically Another disadvantage is that the bond strength is low during
the veneering process with the composite since the wettability is insufficient . In addition,
PEEK may be appropriate for individuals with metal allergies. It can also be reinforced with
carbon or glass fibers and modified with nanoparticles . Carbon fiber-reinforced PEEK turns
into black . Reinforced PEEK provides a more aesthetic appearance due to its white color on
the gingiva, which has a fine biotype
.
Advantages of PEEK:
1. Resistant to radiation,
2. Resistant to various chemicals,
3. Insoluble in solvents in the mouth and at
room temperature,
4. Stable over 300˚C,
5. More durable than many metal
restorations,
6. Can be reinforced with carbon fiber,
7. Tolerable in allergic patients,
8. Can be sterilized repeatedly without
degradation
Disadvantages:
• Lack of osseointegration,
• Low wettability,
• Not aesthetic due to metallic gray,
• Difficult to manufacture implants,
• Radiolucent imaging.
PEEK with Fixed Prosthesis
PEEK is a recommended material for fixed prostheses . PEEK has been modified by
techniques such as mixing, filling, fiber reinforcement to obtain a material that is more rigid
and suitable for dental use PEEK can be used in fixed prostheses because of
its suitable mechanical properties thanks to inorganic chemicals in it . It can be produced by
methods such as vacuum pressing, milling (Computer aided milling-computer aided
manufacturing) Also, PEEK is recommended as a framework material for a fixed dental
prosthesis due to its hardness According to Lieberman et al. PEEK has low solubility
and water absorption values when compared materials such as polymethylmethacrylate
(PMMA) and can be considered for long term restorations
.
PEEK is a white-gray non-aesthetic material and requires veneering for anterior use
Veneering methods are effective on fracture load. When digital veneering is performed, the
fracture load is higher, regardless of the aging level

Many studies have been done on strengthening the connection between PEEK and
composite. Since conventional composite veneering applications were not sufficient for
PEEK, different methods were applied. In studies with sulfuric acid and piranha solution, it
has been observed that sulfuric acid increases the bond strength . Airborne-particle
abrasion, etching and plasma treatment are known as methods to increase wettability
According to the study by Uhrenbaher et al, airborne-particle abrasion (50µm alumina
particles) and sulfuric acid etching (60 seconds) should be applied before bonding PEEK
crowns. It was also concluded that retention was increased by the use of various bonding
systems (Signum PEEK Bond, visio.link) According to the results on research conducted
on the surface of PEEK, microwave supported coating technology can be used more quickly
and reliably than conventional methods

Load bearing capacity was evaluated in a laboratory study on a three-unit inlay retained
bridge. The restorations with PEEK showed high load-bearing capacity and the fractures
were mostly seen in the connector region Modified PEEK materials with ceramic fillers are
preferred for temporary purposes in resin bonded fixed dental prosthesis(RBFDP) since they
are more aesthetic in appearance compared to metal substructures Similarly, veneered
PEEK can be used as the interim framework of RBFDP in the anterior region as an
alternative to materials such as metal-ceramic, glass infiltrated alumina, zirconia,
and lithium disilicate

PEEK in Implants
Implant treatment is one of the most accepted indications in terms of success and
satisfaction in treating missing teeth in today's dentistry.PEEK was used in spinal and hip
surgeries at the beginning and can now be used as computer designed craniofacial
implants . It can be used in the reconstruction of facial deformities with interlocking
systems in jaw and zygoma deformities . In addition, the data of a review study shows that
there are many positive properties compared to titanium alloys

PEEK is a promising material that can be used as an implant with its low elasticity modulus
(Young's modulus) and easily modified and strengthened carbon fiber-reinforced PEEK
(CFR-PEEK) and glass fiber-reinforced PEEK(GFR-PEEK) Since the osseointegration of
PEEK is limited, osteoblast activity is tried to be increased by various surface modifications
Surface properties and chemistry, increasing wettability are decisive for cell adhesion and
proliferation A number of studies have been carried out to improve the wettability of
the material by changing the surface properties. Alumina-coated PEEK samples were
examined by Akkan et al. with oxygen plasma etching and laser modification, according to
the data obtained, wettability is increased for implantation . PEEK is coated with
hydroxyapatite and promising results were obtained Plasma immersion ion implantation
(PIII) technique can be applied by using water-H2O and ammonia-NH3 to improve the bone
interface properties of PEEK implants. With this application, effects on cell interaction,
surface adhesion, proliferation, osteogenic differentiation have been increased CFR-PEEK,
pure PEEK and titanium implants were compared using finite element analysis. In this
study, stress, deformation, and contact pressures were investigated by applying force on
these implant materials with 100 N parallel and 30˚angle from the buccal surface.
Accordingly, CFR-PEEK implants achieved almost the same values as titanium, but
more work was needed for pure PEEK The internal spline mechanism has been
developed as an alternative to the hexagonal
mechanism commonly used in the implant abutment interface. In order to measure the
average insertion torque and the suitability for immediate loading, a 32 N cm torque was
applied to titanium, PEEK and CFR-PEEK dental implants. Titanium implants were found to
be more resistant in this study . Several methods have been developed to alter
surface properties of PEEK to improve bioactivity . The change in surface properties after
sandblasting with aluminum oxide was investigated. Reinforced (CFR-PEEK) and filler
(ceramic filled PEEK) were found to be suitable surface roughness for osseointegration after
blasting PEEK surface development processes are summarized in Table 1 According to
Khonsari et al, although PEEK is a promising material in dentistry and implantology,
there are cases with failure when used as an implant. Therefore, further research is needed
Histological examinations revealed different tissue behavior and inflammatory cytokines
around different implant materials. The level of DNA is less pronounced around PEEK
implants, with alkaline phosphatase and osteocalcin levels are higher around
Titanium-Aluminum-Vanadium alloys. However, IL1-ß, IL-6, IL-8 levels, which are
proinflammatory cytokines, have been observed higher around PEEK implants and at least
around Ti alloys. Antiinflammatory cytokine IL -10 level was higher in Ti alloys than PEEK.
The cause of fibrosis tissue formation around PEEK implants can be attributed to
the formation of these proinflammatory cytokines. However, Ti alloy surfaces provide a more
favorable environment for osteogenic activity Various materials are used in as implant
abutments, such as titanium, gold, zirconia, alumina, and glass. High-strength polymer
materials such as PEEK are also recommended as abutments in many implant-supported
restorations . Less bacterial biofilms are observed compared to titanium and zircon
abutments. Research has shown that PEEK can be used as an immediate definitive
abutment and framework material . A study conducted by Kaleli et al. noted that the
use of custom PEEK abutments increases stress and is not suitable for posterior use in
individuals with parafunctional habits According to Neumann et al. when used as an
abutment, PEEK exhibits lower fracture resistance than titanium alloys It was concluded that
reinforced PEEK abutments are a good alternative to titanium abutments in an animal study
evaluating the effect of PEEK and titanium abutments on biological width and soft tissue
stability . Similarly, in an animal study that examined the effect of pure PEEK, roughened
PEEK, titanium bonded PEEK and titanium healing abutments on hard and soft tissue
healing, it was concluded that PEEK healing abutments were an alternative to titanium
In the all-on-four treatment protocol, PEEK framework can be used in the production of
implant-supported fixed prostheses during the permanent loading. According to Zoidis, when
PEEK is produced by veneering with PMMA, considering the aesthetic and biomechanical
advantages of PEEK, it’s been a good alternative to conventional ceramic and metal-
ceramic prostheses In a study comparing tensile strength between PEEK and Titanium
abutment screws, titanium screws were found to be significantly resistant. However, PEEK
reinforced by > 50% continuous carbon fibers can be considered as abutment screw
In 10 patients with maxilla anterior defect, fixed acrylic restoration study was performed
using PEEK and titanium subperiosteal implants. PEEK implants produced by CAD-CAM
have positive results despite limited osseointegration properties