Influence of plasma pretreatment on shear bond strength of self-adhesive resin cements to polyetheretherketone

Fracture strength of cad-cam milled polyetheretherketone (PEEK) post-cores vs conventional post-cores; an in vitro study

Background

The aim of this study was to compare the fracture strength and fracture modes of post-cores produced with CAD-CAM from modified polyetheretherketone (PEEK) materials with other custom-produced post-cores.

Methods

Sixty human mandibular first premolars with equal root sizes were used. The teeth were divided into six groups (n = 10), and root canal treatment was performed. The teeth were separated from the roots over 2 mm from the cemento-enamel junction. As a result of the decoronation process, a 1 mm wide shoulder line was obtained for all teeth. For the fracture strength test, 10 mm deep post spaces were created on the teeth with a 1.6 mm diameter driller. Post-core groups consisted: everStick® glass fiber post-core (Group GF), zirconia post-core (Group Z), metal (Cr-Co) post-core (Group M), PEEK post-core without filler (Group UP), PEEK post-core with 20% TiO2 Filler (Group TP), and post-core with 20% ceramic filler (Group CP). Following the application of posts to post spaces, copings were created and cemented on the samples. With the universal tester, a force was applied to the long axis of the tooth with a slope of 135°. The mean fracture strength (N) between the groups was statistically evaluated using one-way ANOVA, and pairwise mean differences were detected using post hoc Tukey's HSD test among the groups.

Results

According to the results of the statistical analysis, a significant difference was found between the groups in terms of mean fracture resistance (p < 0.05). Group Z (409.34 ± 45.72) was significantly higher than Group UP (286.64 ± 37.79), CP (298.00 ± 72.30), and TP (280.08 ± 67.83). Group M (376.17 ± 73.28) was significantly higher than Group UP (286.64 ± 37.79) and Group TP (280.08 ± 67.83). There were no statistically significant differences between the means of the other groups (p > 0.05). Among all the groups, Group Z exhibited a higher prevalence of repairable failure modes, while the rest of the groups predominantly experienced irreparable failure modes.

Conclusion

In our study, zirconia and metal post-core samples showed higher average fracture strength values than PEEK post-cores groups. Repairable failure modes were more common in the zirconia post-cores, whereas the opposite was observed in the other groups. Further experimental and clinical trial studies are needed before PEEK materials can be used as post materials in the clinic.

Effect of surface treatment and resin cement type on the bond strength of polyetheretherketone to lithium disilicate ceramic

BACKGROUND

This study aims to evaluate the effect of surface treatment and resin cement on the shear bond strength (SBS) and mode of failure of polyetheretherketone (PEEK) to lithium disilicate ceramic (LDC). This is suggested to study alternative veneering of PEEK frameworks with a ceramic material.

METHODS

eighty discs were prepared from PEEK blank and from lithium disilicate ceramic. Samples were divided into four groups according to surface treatment: Group (A) air abraded with 110 μm Al2O3, Group (AP) air abrasion and primer application, Group (S) 98% sulfuric acid etching for 60 s, Group (SP) Sulfuric acid and primer. Each group was subdivided into two subgroups based on resin cement type used for bonding LDC:1) subgroup (L) self- adhesive resin cement and 2) subgroup (B) conventional resin cement (n = 10). Thermocycling was done for all samples. The bond strength was assessed using the shear bond strength test (SBS). Failure mode analysis was done at 50X magnification with a stereomicroscope. Samples were chosen from each group for scanning electron microscope (SEM). The three-way nested ANOVA followed by Tukey's post hoc test were used for statistical analysis of results. Comparisons of effects were done utilizing one way ANOVA and (p < 0.05).

RESULTS

The highest mean of shear bond strength values was demonstrated in Group of air abrasion with primer application using conventional resin cement (APB) (12.21 ± 2.14 MPa). Sulfuric acid groups showed lower shear bond strength values and the majority failed in thermocycling especially when no primer was applied. The failure mode analysis showed that the predominant failure type was adhesive failure between cement and PEEK, while the remaining was mixed failure between cement and PEEK.

CONCLUSION

The air abrasion followed by primer application and conventional resin cement used for bonding Lithium Disilicate to PEEK achieved the best bond strength. Primer application did not have an effect when self-adhesive resin cement was used in air-abraded groups. Priming step is mandatory whenever sulfuric acid etching surface treatment is utilized for PEEK.

Effects of Nd: YAG LASER irradiation and O2 plasma on the adhesive performance of poly-ether-ether-ketone (PEEK)

PURPOSE

To evaluate the effects of neodymium-doped yttrium aluminum garnet (Nd: YAG) LASER irradiation and oxygen (O2) plasma on the adhesive performance of polyether ether ketone (PEEK) and resin adhesive.

METHODS

Nd: YAG LASERs of varying powers and O2 plasma for different durations were used to modify PEEK. A total of 168 PEEK specimens were randomly divided into seven groups (n = 24/group): (A) Control group: untreated PEEK, (B) L0.75 group: PEEK modified with 0.75 W Nd: YAG LASER, (C) L1 group: PEEK modified with 1.0 W Nd: YAG LASER, (D) L1.25 group: PEEK modified with 1.25 W Nd: YAG LASER, (E) P15 group: PEEK modified with 15 min of O2 plasma, (F) P25 group: PEEK modified with 25 min of O2 plasma, and (G) P35 group: PEEK modified with 35 min of O2 plasma. The surface characteristics of the materials were comprehensively analyzed using a scanning electron microscope (SEM), profilometer, energy-dispersive spectrometer (EDS), and contact angle tester. The adhesive specimens were bonded with Variolink N resin adhesive in all groups and each group was further divided into two subgroups (n = 12/group): (a) water storage for 56 h at 37 °C and (b) thermal cycling 5000 times. Shear bond strength (SBS) was tested using a universal testing machine, and the fracture modes were observed using an automated chemiluminescence analysis system to assess the effects of Nd: YAG LASER and O2 plasma on the bond strength of PEEK to resin adhesive.

RESULTS

Both Nd: YAG LASER and O2 plasma treatments altered the surface characteristics of PEEK and significantly increased the SBS between PEEK and Variolink N resin adhesive. The L0.75 group (Nd: YAG LASER) and the P35 group (O2 plasma) achieved the highest SBS, respectively. Furthermore, the SBS of the L0.75 group was higher than that of the P35 group. Following thermal cycling, SBS values decreased compared to the water storage subgroups. The fracture modes of the specimens in each group were predominantly interfacial and mixed, with no cohesive fractures observed.

CONCLUSIONS

Nd: YAG LASER irradiation and O2 plasma treatments can improve the SBS between PEEK and resin adhesive, with the 0.75 W Nd: YAG LASER being the preferred treatment method.

Conditioning of PEEK Implant Abutment Surfaces Using Photodynamic Therapy, Nd:YAG Laser, and Conventional Methods to Evaluate Shear Bond Strength

Objective: This study was done to evaluate shear bond strength (SBS) and modes of failures after different surface treatment modalities on polyetheretherketone (PEEK) implant abutments. Materials and methods: Seventy-five PEEK implant abutment specimens were randomly distributed into five groups based on surface treatment methods: Group I: No treatment, Group II: methylene blue-mediated photodynamic therapy (MB-PDT), Group III: neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, Group IV: Sulfuric acid (H2SO4), and Group V: Sandblasting (Sb). The measurements for SBS and failure modes for PEEK implant abutment specimens were evaluated via Universal Testing Machine and Stereomicroscope, respectively. Two-way analysis of variance and Tukey's post-hoc test (p > 0.05) were used for the statistical analysis. Moreover, the Shapiro-Wilk normality test was also performed for normality. Results: The SBS mean values and standard deviations in megapascals (MPa) for PEEK abutment specimens with different surface pretreatment groups are shown in Table 1 and Fig. 1. The control group had the lowest SBS (9.67 ± 2.1 MPa), while the highest SBS was observed in Group II (MB-PDT; 17.21 ± 1.32 MPa). SBS values for Group IV (H2SO4; 15.83 ± 0.63 MPa) and Group III (Nd:YAG laser; 16.91 ± 2.10 MPa) were similar to Group II (MB-PDT; p > 0.05). The SBS values for the sandblasted specimens (13.90 ± 1.87 MPa) were not significantly different from the control group (p > 0.05). Conclusions: The PEEK implant abutment surfaces treated with MB-PDT and Nd:YAG laser expressed significantly improved SBS.

Effect of laser engraving on shear bond strength of polyetheretherketone to indirect composite and denture-base resins

Background/purpose

Polyetheretherketone (PEEK) is a highly sought-after thermoplastic due to its exceptional mechanical properties and biocompatibility. However, bonding PEEK to indirect composite resin (ICR) or denture-based resin (DBR) can be challenging. Laser engraving technology has shown potential to improve bonding for other materials; thus, this study aims to evaluate its effectiveness for PEEK.

Materials and methods

The experiment involved preparing ingot-shaped PEEK samples, which were then categorized into four groups based on the treatment method employed: without treatment, air abrasion, sulfuric acid etching, and laser engraving (LS). Subsequently, the samples were bonded to ICR or DBR, and their shear bond strength (SBS) was tested with or without thermocycling using a universal testing machine. Furthermore, the failure mode was observed, with statistical analyses conducted to compare the results.

Results

The grid-like microslit structure of LS group displayed the highest SBS for bonding PEEK to ICR or DBR (P < 0.05). During the bonding of PEEK to ICR, resin residue and penetration into the microslits were frequently observed in the LS group, indicating cohesive failure. However, when PEEK was bonded to DBR, mixture failure was frequently observed without thermocycling. After thermocycling, only the LS group showed cohesive failure, while the majority of specimens exhibited mixture failure.

Conclusion

Laser engraving significantly improves the SBS between PEEK and both ICR and DBR. Furthermore, it was observed that resin had penetrated the microslits, indicating that laser engraving has great potential as a surface treatment method.

Poly-Ether Ether-Ketone Post Conditioned with Sulfuric Acid, Rose Bengal Activated by Photodynamic Therapy and Sandblasting on Pushout Bond Strength to Radicular Dentin Luted with Methyl Methacrylate and Composite-Based Cement

Objective: Assessment of post surface conditioners [sulfuric acid (SA), Rose Bengal (RB), and sandblasting (SB)] and different luting cements [methyl methacrylate (MMA)-based cement and composite-based cement] on pushout bond strength (PBS) of poly-ether ether-ketone (PEEK) post bonded to canal dentin. Materials and methods: Endodontic treatment was performed on 120 single-rooted human premolar teeth. The preparation of the post space was performed and 4 mm of gutta-percha was retained in the apical region of the root. One hundred and twenty PEEK posts were fabricated from a PEEK blank utilizing a Computer aided design-Computer aided manufacture (CAD-CAM) system. The PEEK posts were allocated randomly into four groups based on post surface conditioning (n = 30). Group A: SA, Group B: RB, Group C: SB, and Group D: No conditioning (NC). Each group was further divided into two subgroups based on the luting cement used for bonding (n = 15). Group A1, B1, C1, and D1 specimens were cemented using composite-based resin cement. However, Group A2, B2, C2, and D2 posts were luted with MMA-based resin cement. PBS assessment using a universal testing machine was performed. Failure modes were analyzed under a stereomicroscope. The data relating to the effects of surface treatment and luting types of cement were analyzed using one-way analysis of variance (ANOVA) and Tukey's post hoc test (p = 0.05). Results: Coronal section of Group B2: RB+Super-Bond C&B [9.61 ± 0.75 megapascals (MPa)] displayed the highest bond scores of PEEK after root dentin. Whereas it was also discovered that Group D1: NC+Panavia®V5 (2.05 ± 0.72 MPa) presented the lowest PBS scores. Intergroup comparison analysis revealed that Group A2: SA+Super-Bond C&B and Group B2: RB+Super-Bond C&B displayed no significant difference in their bond scores. Conclusions: RB and SA possess the potential to be used as a PEEK post conditioner. MMA-based cement displayed better performance than composite-based cement.

Using Peek as a Framework Material for Maxillofacial Silicone Prosthesis: An In Vitro Study

There are often bonding problems between acrylic resins and silicone. PEEK (polyetheretherketone), which is a high-performance polymer, has great potential for the implant, and fixed or removable prosthodontics. The aim of this study was to evaluate the effect of different surface treatments on PEEK to be bonded to maxillofacial silicone elastomers. A total of 48 specimens were fabricated from either PEEK or PMMA (Polymethylmethacrylate) (n = 8). PMMA specimens acted as a positive control group. PEEK specimens were divided into five study groups as surface treatments as control PEEK, silica-coating, plasma etching, grinding, or nano-second fiber laser. Surface topographies were evaluated by scanning electron microscopy (SEM). A platinum-primer was used on top of all specimens including control groups prior to silicone polymerization. The peel bond strength of the specimens to a platinum-type silicone elastomer was tested at a cross-head speed of 5 mm/min. The data were statistically analyzed (α = 0.05). The control PEEK group showed the highest bond strength (p < 0.05) among the groups. No statistical difference was found between control PEEK, grinding, or plasma etching groups (p > 0.05). The lowest bond strength was seen in the laser group, which was not statistically different from silica-coating (p > 0.05), and statistically different from control PEEK, grinding, or plasma groups (p < 0.05). Positive control PMMA specimens had statistically lower bond strength than either control PEEK or plasma etching groups (p < 0.05). All specimens exhibited adhesive failure after a peel test. The study results indicate that PEEK could serve as a potential alternative substructure for implant-retained silicone prostheses.

Determination of Shear Bond Strength between PEEK Composites and Veneering Composites for the Production of Dental Restorations

We studied the shear bond strength (SBS) of two PEEK composites (BioHPP, BioHPP plus) with three veneering composites: Visio.lign, SR Nexco and VITA VM LC, depending on the surface treatment: untreated, sandblasted with 110 μm Al₂O₃, sandblasted and cleaned ultrasonically in 80% ethanol, with or without adhesive Visio.link, with applied Visio.link and MKZ primer. For the BioHPP plus, differential scanning calorimetry (DSC) revealed a slightly lower glass transition temperature (T_g 150.4 ± 0.4 °C) and higher melting temperature (T_m 339.4 ± 0.6 °C) than those of BioHPP (T_g 151.3 ± 1.3 °C, T_m 338.7 ± 0.2 °C). The dynamical mechanical analysis (DMA) revealed a slightly higher storage modulus of BioHPP (E' 4.258 ± 0.093 GPa) than of BioHPP plus (E' 4.193 ± 0.09 GPa). The roughness was the highest for the untreated BioHPP plus, and the lowest for the polished BioHPP. The highest hydrophobicity was achieved on the sandblasted BioHPP plus, whereas the highest hydrophilicity was found on the untreated BioHPP. The highest SBSs were determined for BioHPP and Visio.lign, adhesive Visio.link (26.31 ± 4.17 MPa) or MKZ primer (25.59 ± 3.17 MPa), with VITA VM LC, MKZ primer and Visio.link (25.51 ± 1.94 MPa), and ultrasonically cleaned, with Visio.link (26.28 ± 2.94 MPa). For BioHPP plus, the highest SBS was determined for a sandblasted surface, cleaned ultrasonically, with the SR Nexco and Visio.link (23.39 ± 2.80 MPa).

Bond Strength of Sandblasted PEEK with Dental Methyl Methacrylate-Based Cement or Composite-Based Resin Cement

Poly-ether-ether-ketone (PEEK) is commonly employed in dental prostheses owing to its excellent mechanical properties; however, it is limited by its low bond strength with dental resin cement. This study aimed to clarify the type of resin cement most suitable for bonding to PEEK: methyl methacrylate (MMA)-based resin cement or composite-based resin cement. For this purpose, two MMA-based resin cements (Super-Bond EX and MULTIBOND II) and five composite-based resin cements (Block HC Cem, RelyX Universal Resin Cement, G-CEM LinkForce, Panavia V5, and Multilink Automix) were used in combination with appropriate adhesive primers. A PEEK block (SHOFU PEEK) was initially cut, polished, and sandblasted with alumina. The sandblasted PEEK was then bonded to resin cement with adhesive primer according to the manufacturer's instructions. The resulting specimens were immersed in water at 37 °C for 24 h, followed by thermocycling. Subsequently, the tensile bond strengths (TBSs) of the specimens were measured; the TBSs of the composite-based resin cements after thermocycling were found to be zero (G-CEM LinkForce, Panavia V5, and Multilink Automix), 0.03 ± 0.04 (RelyX Universal Resin Cement), or 1.6 ± 2.7 (Block HC Cem), whereas those of Super-Bond and MULTIBOND were 11.9 ± 2.6 and 4.8 ± 2.3 MPa, respectively. The results demonstrated that MMA-based resin cements exhibited stronger bonding to PEEK than composite-based resin cements.

Composite-veneering of polyether-ether-ketone (PEEK): evaluating the effects of different surface modification methods on surface roughness, wettability, and bond strength

This study aimed to evaluate the effects of different surface modification methods on the surface roughness, contact angle, and bond strength of composite-veneer materials of polyether-ether-ketone (PEEK). Fifty-five specimens (n = 11) with a size of 7 × 7 × 2 mm were cut out from PEEK discs. The specimens were divided into five groups with different surface treatments: no treatment (NO) (control group), sulfuric acid (SA), plasma (P), femtosecond laser (FS), and Nd-YAG laser (NY). After the surface treatments, the specimens were checked for roughness, contact angle, and bond strength of the composite-veneer material. Data were analyzed with the Welch test for roughness, contact angle, and bond strength parameters. Individual Pearson correlation tests were executed for all surface treatment groups to determine any significant correlations among roughness, contact angle, and bond strength parameters (P < .001). Roughness, contact angle, and bond strength values were affected by surface modification methods (P < .001). In comparison to the control group, NY and FS treatments increased the surface roughness and bond strength; they also provided bond strength values comparable to the SA group. When the relationship between the variables was examined, no correlation was seen between roughness, contact angle, and bond strength values for the NY, SA, and control groups (P > .05); however, significant correlations were determined between the contact angle and surface roughness values for the P and FS groups (P < .05). Femtosecond and Nd-YAG laser treatments are viable surface modification alternatives to the sulfuric acid treatment for the PEEK material.

Comparing the shear bond strength of veneering materials to the PAEKs after surface treatments

Background

This study aimed to evaluate the impact of various surface treatments on the shear bond strength (SBS) of polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) polymers to indirect laboratory composite (ILC) and lithium disilicate ceramic (LDC) veneering materials.

Methods

Polymer specimens (7 × 7x2 mm) were sectioned from PEEK and PEKK discs (N = 294) and randomly allocated to 7 groups (n = 20); untreated (Cnt), plasma (Pls), 98% sulfuric acid (Sa), sandblasting with 110 µm Al2O3 (Sb), tribochemical silica coating with 110 µm silica modified Al2O3 (Tbc), Sb + Sa, Tbc + Sa. Scanning electron microscopy assessments were performed on one sample of each treatment group, and veneering materials were applied to the remaining specimens (n = 10). The specimens were subjected to the SBS test after being soaked in distilled water (24 h, 37 °C). Three-way ANOVA, independent sample t-test, and Tukey HSD test were performed for statistical analyses (α = .05).

Results

The surface treatment, polymer, veneering material types, and their interactions were significant on SBS results according to the 3-way ANOVA (p < 0.001). The SBS values of ILC veneered groups were significantly higher than LDC groups, regardless of surface treatment and polymer type (p < 0.05). The highest SBS values were obtained for Sa-applied ILC veneered PEEK (21.55 ± 1.45 MPa) and PEKK (17.04 ± 1.99 MPa) polymer groups (p < 0.05).

Conclusion

The effect of surface treatment and veneering materials may be significant on the SBS values of PAEKs. Therefore, the application parameters of surface treatments should be more specified for the applied veneering material and polymer type.

PEEK in Fixed Dental Prostheses: Application and Adhesion Improvement

Polyetheretherketone (PEEK) has been widely applied in fixed dental prostheses, comprising crowns, fixed partial dentures, and post-and-core. PEEK’s excellent mechanical properties facilitate better stress distribution than conventional materials, protecting the abutment teeth. However, the stiffness of PEEK is not sufficient, which can be improved via fiber reinforcement. PEEK is biocompatible. It is nonmutagenic, noncytotoxic, and nonallergenic. However, the chemical stability of PEEK is a double-edged sword. On the one hand, PEEK is nondegradable and intraoral corrosion is minimized. On the other hand, the inert surface makes adhesive bonding difficult. Numerous strategies for improving the adhesive properties of PEEK have been explored, including acid etching, plasma treatment, airborne particle abrasion, laser treatment, and adhesive systems.

Nd:YVO4 laser groove treatment can improve the shear bond strength between dental PEEK and adhesive resin cement with an adhesive system

The purpose of this study was to investigate the effect of various surface treatments on the shear bond strength between dental polyetheretherketone (PEEK) and adhesive resin cement. Two hundred and forty specimens were randomly classified into four groups: no treatment, sandblasted, sulfuric-acid-etched, and laser-grooved treatment. Each group was classified into two adhesive resin cement subgroups. Surface roughness, water contact angle, shear bond strength, and failure mode were measured; SEM and XPS results were obtained. The data were statistically analyzed using one-way or two-way analysis of variance and Tukey's honest significant difference test (α=0.05). Laser-grooved PEEK surface showed regular grooves and carbonization by thermal degradation; the surface roughness as well as water contact angle of were the highest in all groups. Shear bond strength values were significantly higher in the laser-groove-treated and sulfuric-acid-etched groups. Laser-groove-treated specimens showed cohesive failure. Laser-grooved treatment can improve shear bond strength between PEEK and adhesive resin cement.

Digitally Fabricated Dentures for Full Mouth Rehabilitation with Zirconia, Polyetheretherketone and Selective Laser Melted Ti-6Al-4V Material

CAD/CAM technologies have been embedded into the fabrication of removable partial denture (RPD). Various materials such as zirconia and polyetheretherketone (PEEK) are developed for subtractive manufacturing. As for additive manufacturing, dental professionals have begun to use selective laser melting (SLM) techniques for fabricating metallic RPD frameworks. This report demonstrates a case rehabilitated with a maxillary telescopic crown-retained combining PEEK and zirconia material denture and a mandibular Kennedy Class I RPD fabricated with SLM techniques. First, a conventional impression was performed and the master cast was mounted with a centric relation record. Digital models were obtained using tabletop scanners and then the telescopic primary zirconia crowns were designed and milled. After transferring the intraoral distribution of primary crowns using pick-up impression, secondary PEEK crowns and framework were designed, milled, and veneered with composite resin. Mandibular framework was designed and constructed using SLM technique with Ti-6Al-4V. Definitive prostheses for both jaws were finished and delivered. Delivered prostheses functioned well for a one-year period. The was patient satisfied with the improvements in chewing function and esthetics. Both substrative and additive manufacturing techniques are suitable for framework fabrication. Further investigation is needed for improving the mechanical performance and long-term prognosis of digitally made prostheses.

Artifact expression of polyetheretherketone in cone beam computed tomography: An in vitro study

STATEMENT OF PROBLEM

Dental prosthetic materials can cause artifacts in cone beam computed tomography (CBCT) images, adversely affecting diagnostic quality, although the problem may be less with polyetheretherketone (PEEK). Studies evaluating the artifacts caused by frequently used prosthetic materials are lacking.

PURPOSE

The purpose of this in vitro study was to compare the artifacts in CBCT images caused by PEEK, zirconia, cobalt-chromium (Co-Cr) alloy, and titanium (Ti).

MATERIAL AND METHODS

A polymethylmethacrylate phantom (Ø4.0×4.0 cm) with a central cylindrical aperture (Ø0.5×0.5 cm) was produced. Co-Cr, Ti, zirconia, and PEEK cylinders (0.5×0.5 cm) were manufactured, and CBCT images of the empty phantom (control group) with the test cylinders inside were made 3 times. In all images, the axial sections passing through the middle of the materials were evaluated. Eight regions of interest (ROI) area were determined around the materials (0.5×0.5 cm). The presence of artifacts was evaluated by making gray value standard deviation (SD) calculations in these ROI areas. The average SD values of 8 ROI fields from the 3 CBCT scans were made, and the materials were compared with each other in terms of the presence of artifacts by using 1-way analysis of variance (α=.05).

RESULTS

The difference between the SD values of the control and the PEEK cylinder was not statistically significant (P>.05). The SD values of both the control and PEEK groups were significantly lower than those of the zirconia, Co-Cr, and Ti groups (P<.05).

CONCLUSIONS

Zirconia, Ti, and Co-Cr caused artifacts in CBCT images, but the artifacts with PEEK were similar to those in the control group, suggesting it was the optimal choice in terms of achieving diagnostic quality.

Influence of chairside surface treatments on the shear bond strength of PEKK polymer to veneering resin materials: An in vitro study

STATEMENT OF PROBLEM

High-performance thermoplastics have been adopted as an alternative restorative material to metal or ceramics. However, a straightforward surface modification process to provide a durable bond strength between the polymer and the veneering material is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the shear bond strength (SBS) of different veneering resin materials to polyetherketoneketone (PEKK) after different surface treatments.

MATERIAL AND METHODS

Rectangular (7×7×2 mm) PEKK specimens (N=120) were randomly allocated to the following 6 groups (n=20): untreated (Cnt); nonthermal plasma (NTP) treated; tribochemical silica airborne-particle abrasion with 30-μm silica-modified Al₂O₃ (Tbc); abraded with a coarse-grit diamond rotary instrument (Ab); tribochemical silica airborne-particle abrasion + plasma treated (Tbc_NTP); abraded + plasma treated (Ab_NTP). After a bonding agent (PEKK Bond) was applied to the specimens, each group was divided into 2 subgroups according to the applied veneering resin materials: polymethylmethacrylate (PMMA) and nanohybrid composite resin (NHC, n=10). The specimens were stored in water for 24 hours at 37 °C and subjected to the SBS test by using a universal testing machine, and failure modes were evaluated using a stereomicroscope. Two-way analysis of variance (ANOVA) was performed followed by the Tukey honestly significant difference (HSD) test to statistically analyze the data (α=.05).

RESULTS

The 2-way ANOVA showed that surface treatment methods, veneering material, and their interactions were significantly different on the SBS values (P<.001). The highest SBS values were determined for the Tbc and Tbc_NTP treatment groups not only for PMMA (10.71 to 11.63 MPa) but also for NHC (19.80 to 20.60 MPa) veneering resin materials (P<.05).

CONCLUSIONS

The bonding capacity of PEKK to the PMMA and NHC veneering resin materials can be significantly improved by using tribochemical silica airborne-particle abrasion alone or with nonthermal plasma surface treatment techniques. Furthermore, using NHC veneering resin material is recommended over PMMA.

Repair of resin-veneered polyetheretherketone after veneer fracture

STATEMENT OF PROBLEM

If a composite resin-veneered polyetheretherketone (PEEK) restoration chips or fractures, a repair may be indicated. However, the most appropriate repair protocol for a composite resin-veneered PEEK restoration is unclear.

PURPOSE

The purpose of this in vitro study was to determine the efficacy of airborne-particle abrasion and/or a primer in the repair of composite resin-veneered PEEK prostheses.

MATERIAL AND METHODS

PEEK specimens (N=80) were airborne-particle abraded with alumina before being conditioned with a methyl methacrylate-based primer. A thin layer of opaquer was applied, and a split mold was then filled with a veneering resin. The specimens underwent 5000 thermocycles, and then shear bond strength (SBS) was determined and used as the positive control group. Specimens that failed in either mixed or adhesive modes were contaminated with saliva and then exposed to 4 different repair treatment methods: no airborne-particle abrasion, bonded without a primer (negative control group); airborne-particle abrasion, bonded without a primer; no airborne-particle abrasion, bonded with a primer; and airborne-particle abrasion, bonded with a primer. All specimens had opaquer applied before being veneered. Repaired specimens then underwent thermocycling before SBS testing. Data were analyzed via ANOVA with a Newman-Keuls post hoc test (α=.05).

RESULTS

The SBS values for the negative control were significantly lower than those of all other repair groups and the control group (P<.018). No significant differences in the SBS values were found among these other repair groups or the positive control group (P>.05).

CONCLUSIONS

Composite resin-veneered PEEK restorations or prostheses repaired with airborne-particle abrasion and/or primer can provide SBS comparable with that of the initial SBS.

Effect of different surface treatments on the bond strength of milled polyetheretherketone posts

STATEMENT OF PROBLEM

Polyetheretherketone (PEEK) can be used as a framework material for removable and fixed dental prostheses. However, information about the use of PEEK as a post-and-core restoration is scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different surface treatments on the push-out bond strength of milled polyetheretherketone posts to resin cement.

MATERIAL AND METHODS

Sixty intact human maxillary central incisors were selected and endodontically treated, and standardized post spaces were prepared. Sixty PEEK posts were milled from a prefabricated PEEK blank by using a computer-aided design and computer-aided manufacturing (CAD-CAM) system and divided into 3 groups (n=15) according to the surface treatment: acid etching by using 98% sulfuric acid (AE); airborne-particle abrasion by using 50-μm Al₂O₃ (AA); nonthermal plasma treatment (NTP); in addition, PEEK posts (n=15) received no treatment (NT) and served as a control. All posts were bonded by using a self-adhesive resin cement. Three sections (coronal, middle, and apical) were obtained for each specimen. Push-out bond strength measurements (MPa) for each section were recorded by using a universal testing machine at a crosshead speed of 0.5 mm/min until failure occurred. The post-cement interfaces and failure modes were evaluated by using scanning electron microscopy. The data obtained were statistically analyzed by using 1-way ANOVA and the pair-wise Tukey (HSD) test to study the difference between group mean values (α=.05).

RESULTS

The overall mean ±standard deviation of the push-out bond strength was 11 ±2 MPa for AE group, 6 ±1 MPa for AA group, 5 ±1 MPa for NTP group, and 3 ±1 MPa for NT group. A statistically significant difference was found among all groups subjected to different surface treatments as indicated by the ANOVA test (P<.001). The pair-wise Tukey honestly significant difference (HSD) test showed a significant difference among the AE group and all groups (P<.001); however, no significant difference was observed between the AA and NTP groups (P>.05). Moreover, a significant difference was observed among all root sections (P<.001).

CONCLUSIONS

Surface treatment of PEEK posts with 98% sulfuric acid for 60 seconds showed significantly higher bond strength values than those in other groups. The bond strength of PEEK posts to resin cement was significantly higher in the coronal section than that in other sections.

Review on Development and Dental Applications of Polyetheretherketone-Based Biomaterials and Restorations

Polyetheretherketone (PEEK) is an important high-performance thermoplastic. Its excellent strength, stiffness, toughness, fatigue resistance, biocompatibility, chemical stability and radiolucency have made PEEK attractive in dental and orthopedic applications. However, PEEK has an inherently hydrophobic and chemically inert surface, which has restricted its widespread use in clinical applications, especially in bonding with dental resin composites. Cutting edge research on novel methods to improve PEEK applications in dentistry, including oral implant, prosthodontics and orthodontics, is reviewed in this article. In addition, this article also discusses innovative surface modifications of PEEK, which are a focus area of active investigations. Furthermore, this article also discusses the necessary future studies and clinical trials for the use of PEEK in the human oral environment to investigate its feasibility and long-term performance.

Effect of pre-coating with methyl methacrylate containing UV photoinitiators on the bond strength of poly(ether ether ketone)

This study investigates the effect of pre-coating with methyl methacrylate (MMA) containing ultraviolet (UV) photoinitiators on the bond strength of poly(ether ether ketone) (PEEK). Cylindrical PEEK blocks were irradiated with 365 nm UV light for 5-20 s after they were coated with MMA containing 0.4-3.0 wt% UV photoinitiators: [1-phenyl-1,2-propanedione (PPD)], [diphenyl(2,4,6-trimethylbenzoyl) (TMDPO)], and [phenyl bis(2,4,6-trimethylbenzoyl) phosphine oxide (BTMPO)]. Pre-coated PEEKs were bonded to PEEK blocks with a MMA-based adhesive resin. The shear bond strength was measured using a universal testing machine. Secondary electron images were captured to observe failure surfaces. The data were analyzed with one- and two-way ANOVA and Tukey's post hoc tests (p<0.05). The highest bond strength (20.7±5.1 MPa) was observed for pre-coating with MMA containing 0.4 wt% BTMPO, for 20 s of UV irradiation. Cohesive failure of the adhesive resin was observed. The use of this pre-coating led to improved bonding performance of PEEK.

Shear bond strength of veneering composite to high performance polymers

High performance polymers like PEEK (polyetheretherketone) and FRC (fiberreinforced composite) could substitute metallic alloys for removable partial dentures. However, these polymers require aesthetic veneering. This study was to determine the bond strength to direct composite. Specimens made of PEEK and FRC were produced and air-abraded (50 μm aluminum-oxide). Specimens were allocated to four experimental groups: Luxatemp Glaze & Bond, Scotchbond Universal, SR Nexco Connect and iBond Universal. Specimens were divided into three subgroups for short-term, long-term and no artificial aging and shear bond strength (SBS) was evaluated. SBS of specimens made of PEEK with no artificial aging showed values between 10.79-14.00 MPa, short-term artificial aging resulted in values between 3.78-13.85 MPa and after long-term artificial aging SBS decreased to 0-8.75 MPa. SBS measurement of FRC specimens resulted in values between 9.83-12.1 MPa without aging, after short-term artificial aging values decreased to 8.36-11.98 MPa and after long-term aging SBS showed a degradation to 4.52-7.82 MPa.

The impact of non-thermal plasma on the adhesion of polyetherketoneketone (PEKK) to a veneering composite system

The PEKK material can be used in prosthodontics for framework manufacturing and is commonly laminated with veneering composites to achieve a better esthetics. Various surface treatment methods including sandblasting, etching, laser and cold plasma treatments were reported to enhance the adhesive properties of dental polymers. Both tensile and shear bond test were employed to quantify the bond strength between PEKK and veneering composites. The present in vitro study aims to evaluate the influence of acetylene, argon, air, nitrogen and oxygen plasma on the shear bond strength between PEKK and one veneering composite. Firstly, to determine which bond test type should be applied, n = 40 PEKK specimens were treated with argon plasma. Both shear and tensile bond tests were performed and compared to the control group (n = 40). In shear bond testing, values were 8.14 ± 1.70 MPa for Argon plasma while 5.83 ± 1.42 MPa for control group. In tensile bond testing, Argon plasma 1.50 ± 0.51 MPa while control group 0.58 ± 0.50 MPa. Afterwards n = 160 PEKK specimens were treated with rocatec sandblasting (n = 20), adhesive (n = 20), acetylene (n = 20), argon (n = 20), air (n = 20), nitrogen (n = 20), oxygen (n = 20) plasma types and compared to the untreated control group (n = 20) using shear bond strength test (SBS). Additionally surface roughness and scanning electron microscopy analyses were performed. The following SBS values were revealed: 10.22 ± 1.06 MPa for rocatec; 9.89 ± 3.08 MPa for acetylene, 9.16 ± 1.48 MPa for adhesive, 7.54 ± 1.52 MPa for argon, 7.09 ± 1.99 MPa for air, 7.03 ± 1.48 MPa for nitrogen, 5.69 ± 1.59 MPa for oxygen plasma types and 4.71 ± 1.54 MPa for the control group. All groups, except control group, showed SBS over 5 MPa, which means that they are suitable for the clinical application, according to ISO 10477. Acetylene showed the highest SBS among all plasma types (p < 0.0001), which was on a level of rocatec sandblasting group. Rocatec and acetylene groups demonstrated Ra values significantly different to the reference group (p < 0.0001). Plasma treatment especially with acetylene gas can be an effective more convenient surface treatment method for strengthening the bond strength between PEKK and veneering composites than traditional sandblasting/adhesive treatment.

Evaluation of various denture cleansers on color stability and surface topography of polyetherketoneketone, polyamide, and polymethylmethacrylate

The aim of this study was to evaluate the effect of sodium perborate effervescent tablets and citric acid solution on the color stability and surface topography of a new generation of high-performance polymer polyetherketoneketone (PEKK), thermoinjection-molded polyamide, and polymethylmethacrylate (PMMA). Fifty disc-shaped specimens were fabricated (10 mm × 2 mm) from PEKK (P group), polyamide (D group), and PMMA (M group). These groups were divided into five subgroups (n = 10) according to the storage media. The test groups were immersed in the following solutions: distilled water (Control), Corega, Protefix, Perlodent, and Curaprox. The color stability values (ΔE) were measured using a spectrophotometer before and after immersion in distilled water and four different denture cleansers for 8 hr/day for 140 days. Topography alterations after treatments were assessed with scanning electron microscopy (SEM). Data were analyzed by one-way analysis of variance (ANOVA) followed by Tukey's Honest Significant Difference test. The p < .05 was considered significant. All denture cleansers increased the ΔE values relative to the baseline values in the M, D, and P groups (p < .05). The Perlodent denture cleanser demonstrated the highest ΔE value in all groups, which was unacceptable. Curaprox denture cleanser showed the lowest ΔE value in the M and D groups (p < .05). Curaprox in all groups showed a ∆E value less than 3.7. For patients who have PEKK- and polyamide-based prosthesis, the use of citric acid-based cleansers may be more recommended than sodium perborate-containing cleansers because of its clinically acceptable color changes on polymers in terms of color stability.

Suitability of the new Aryl-Ketone-Polymer indicated for removable partial dentures: Analysis of elastic properties and bond strength to denture resin

Elastic properties of Aryl-Ketone-Polymer (UAKP) and tensile bond strength (TBS) to denture resin (PalaXpress) were tested. Indentation modulus (E_IT) and indentation hardness (H_IT) were measured via Martens hardness (n=10 specimens) with 4.2±0.6 kN/mm² and 261±8 N/mm² respectively. TBS was tested in dependence of different adhesives (visio.link (VL), Adhese Universal (AU), All-Bond Universal (ABU), CLEARFIL UNIVERSAL BOND (CUB), G-Premio BOND (GPB), iBOND Universal (IBU), ONE COAT 7 UNIVERSAL (OCU), Scotchbond Universal (SBU) and without adhesive (CG), n=18/group) and the application of opaquer (n=9/group) after thermocycling (5°C/55°C, 10,000×). TBS was affected by the adhesive (η (P²=0.715, p<0.001) followed by the opaquer (η_P²=0.335, p<0.001). VL and CG showed highest TBS followed by AU and ABU. IBU and GPB resulted in lowest TBS. Opaquer increased TBS for all adhesives (p<0.05), except VL and CG (p<0.258). Elastic properties are well-suited for the indication of removable partial dentures. Bonding to denture resin is no limiting factor.

The use of PEEK in digital prosthodontics: A narrative review

Background

Advanced computer-aided design and computer-aided manufacturing (CAD-CAM) technology led to the introduction of an increasing number of machinable materials suitable for dental prostheses. One of these materials is polyetheretherketone (PEEK), a high performance polymer recently used in dentistry with favorable physical, mechanical and chemical properties. The purpose of this study was to review the current published literature on the use of PEEK for the fabrication of dental prostheses with CAD-CAM techniques.

Methods

Electronic database searches were performed using the terms “PEEK”, “CAD-CAM”, “dental”, “dentistry” to identify studies related to the use of PEEK for the fabrication of CAD-CAM prostheses. The search period spanned from January 1990 through February 2020. Both in vivo and in vitro studies in English were eligible. Review articles and the references of the included publications were searched to identify relevant articles.

Results

A great number of in vitro studies are available in the current literature pointing out the noticeable properties of PEEK. The use of PEEK has been recommended for a wide range of CAD-CAM fabricated fixed and removable dental prostheses. PEEK was additionally recommended for occlusal splints, intra-radicular posts, implant abutments, customized healing abutments and provisional restorations. However, only a few clinical studies were identified.

Conclusions

PEEK could be considered as a viable alternative for CAD-CAM fixed and removable dental prostheses to well-established dental materials. Due to the scarcity of clinical data, clinical trials are needed to assess the long-term performance of PEEK prostheses.

Effect of Surface Treatment With Er:YAG and CO2 Lasers on Shear Bond Strength of Polyether Ether Ketone to Composite Resin Veneers

Introduction: Polyether ether ketone (PEEK) has low surface energy and high resistance to chemical surface treatments. Therefore, different surface treatments such as laser conditioning should be investigated. There is a gap of information regarding the efficacy of laser irradiation in the surface treatment of PEEK, and the efficacy of several laser types needs to be evaluated for this purpose. This study aimed to assess the effect of surface treatment with erbium-doped yttrium aluminum garnet (Er:YAG) and carbon dioxide (CO2) lasers on shear bond strength (SBS) of PEEK to composite resin veneers. Methods: In this experimental study, 60 rectangular-shaped PEEK samples (7 x 7 x 2 mm) were used. The samples were mounted in auto-polymerizing acrylic resin in such a way that only one surface measuring 7x7 mm remained exposed. The samples were then randomly divided into 3 groups (n=20) of control, Er:YAG laser surface treatment (Power=1.5 W, energy density=119.42 J/cm² , irradiation time=20 s) and CO2 laser surface treatment (Power=4 W, energy density=159.22 J/cm² , irradiation time=50 s). The bonding agent and PEEK opaque were applied on the surface of samples and they were veneered with a composite resin using a hollow plastic cylinder with an internal diameter of 4 mm. The SBS was then measured and the data were analyzed using one-way ANOVA, Tukey HSD test and Dunnett's test at 0.05 level of significance. Results: The SBS of the 3 groups was significantly different (P<0.001). The Tukey HSD test revealed that the Er:YAG laser had higher SBS than the CO2 laser group (P<0.001). The Dunnett's test showed that both Er:YAG and CO2 laser groups yielded higher SBS than the control group (P<0.001). Conclusion: The Er:YAG and CO2 laser treatments can increase the SBS of PEEK to composite resin veneers, although the Er:YAG laser seems to be more effective for this purpose.

Adhesion to high-performance polymers applied in dentistry: A systematic review

OBJECTIVE

The aim of this systemic review, conducted in accordance with the PRISMA statement, was to investigate the impact of surface pretreatments on the bonding strength of high performance polymers (HPPs).

METHODS

Eight databases were searched through March 2019. Risk of bias was assessed and random effects meta-analyses were applied to analyze mean differences in shear bond strength (SBS) and tensile bond strength (TBS), considering surface pretreatments and bonding agents after 24h and thermocycling.

RESULTS

A total of 235 relevant titles and abstracts were found, yielding 11 final selections. Low risk of bias was observed in most studies. For polyetheretherketone (PEEK) specimens, random-effect models showed that, compared to non-treated controls, pretreatments associated with Visio.link® (Bredent, Senden, GE) increased TBS by 26.72MPa (95% confidence interval (CI), 19.69-33.76; p<0.00001) and increased SBS by 4.86MPa (95% CI, 2.61-7.10; p<0.00001). Air abrasion improved SBS by 4.90MPa (95% CI, 3.90-5.90; p<0.00001) (50μm alumina) and 4.51MPa (95% CI, 1.85-7.18; p=0.0009) (silica-coated CoJet). In comparison to non-treated controls, Visio.link® and Signum PEEK Bond® (Heraeus Kulzer, Hanau, GE) increased SBS by 33.76MPa (95% CI, 18.72-48.81; p<0.00001) and 33.28MPa (95% CI, 17.48-49.07; p<0.00001), respectively. No differences were found between Visio.link® and Signum PEEK Bond® or Monobond Plus/Heliobond® (Ivoclar Vivadent, Schaan, LH) (p>0.05). Similar results were observed for polyetherketoneketone (PEKK) specimens.

SIGNIFICANCE

This review shows improved HPP bonding following the application of various surface pretreatments, including air abrasion and bonding agents.

The Effect of Various Plasma Gases on the Shear Bond Strength between Unfilled Polyetheretherketone (PEEK) and Veneering Composite Following Artificial Aging

This study investigated the effect of different gaseous plasma surface treatments on the shear bond strength between unfilled polyetheretherketone (PEEK) and veneering composite resin. The study followed ISO 10477 guidelines in preparing, bonding, and testing the samples. Specimens of unfilled PEEK were distributed to one of the following six surface treatment groups: reference, adhesive, argon, nitrogen, oxygen, and air plasmas. After milling, the specimens were wet polished using (P320) polishing discs. Bonding procedures were done according to the manufacturer's instructions using (Opaquer + Dentine), except in the adhesive group (Visio.link + Opaquer + Dentine). Afterwards, thermal cycling for 5000 cycles between 5 and 55 °C in distilled water was conducted. Finally, the shear bond strengths of all groups were calculated, and mode of fracture was determined. Nitrogen surface treatment had the highest mean shear bond strength of 10.04 (±1.84) MPa, while the reference group showed the lowest value of 5.38 (±2.90) MPa. Regarding mode of fracture, all the specimens showed a 100% adhesive failure mode. Plasma surface treatment can be a reliable alternative method to the traditional protocol of bonding veneering composite resin to unfilled PEEK material.

Influence of SiO2 content of polyetheretherketone (PEEK) on flexural properties and tensile bond strength to resin cement

In the present study, the influence of the SiO₂ content of polyetheretherketone (PEEK) on the bonding between PEEK and resin cement, and the corresponding mechanical properties, were evaluated. Three experimental PEEK samples with varying amounts of SiO₂, and PEEK containing 20 wt% of TiO₂ (DK), were investigated. The tensile bond strength (TBS) was evaluated before and after 10,000 thermal cycles, upon polishing, sandblasting, and conditioning of the specimens with BONDMER lightless containing a silane coupling agent, and bonded with ESTECEM II. The crystallinity, flexural modulus, and flexural strength were determined after 10,000 thermal cycles. TBS values were analyzed by two-way ANOVA and a t-test with Bonferroni correction (α<0.05), while the crystallinity, flexural modulus, and flexural strength were analyzed with one-way ANOVA followed by a t-test with Bonferroni correction (α<0.05). The TBS improved with increasing SiO₂ content in PEEK; moreover, DK and the sample with 40 wt% SiO₂ exhibited the highest flexural strength.

Effect of non-thermal plasma on the shear bond strength of resin cements to Polyetherketoneketone (PEKK)

PURPOSE

This study aimed to assess the effect of non-thermal plasma on the shear bond strength of resin cements to polyetherketoneketone (PEKK) in comparison to other surface treatment methods.

MATERIALS AND METHODS

Eighty PEKK discs were subjected to different surface treatments: (1) Untreated (UT); (2) Non-thermal plasma (NTP); (3) Sandblasting with 50 µm Al₂O₃ particles (SB); and (4) Sandblasting + Non-thermal plasma (SB+NTP). After each surface treatment, the contact angle was measured. Surface conditioning with Visio.Link was applied in all groups after pre-treatment. RelyX Unicem resin cement was bonded onto the PEKK specimens. After fabrication of the specimens, half of each group (n=10) was initially tested, while the other half was subjected to thermocycling (5℃ to 55℃ at 10,000 cycles). Shear bond strength (SBS) testing was performed using a universal testing machine, and failure modes were assessed using stereomicroscopy. The SBS results were analyzed statistically using one-way ANOVA followed by Tukey's post hoc test. Independent t-test was used to examine the effect of thermocycling (P<.05).

RESULTS

The highest SBS values with or without thermocycling were observed with PEKK specimens that were treated with SB+NTP followed by the SB group. The lowest SBS results were observed in the UT groups.

CONCLUSION

The shear bond strength between PEKK and resin cements was improved using non-thermal plasma treatment in combination with sandblasting.

Effect of laser groove treatment on shear bond strength of resin-based luting agent to polyetheretherketone (PEEK)

PURPOSE

The mechanical properties of polyetheretherketone (PEEK) are ideally suited for fixed dental prostheses. However, PEEK typically has low adhesion strength to resin-based luting agent. This study assessed the shear bond strength between laser groove treated PEEK and resin-based luting agent.

METHODS

A total of 230 specimens were randomly divided into five groups (n=46): no-treatment, air abrasion treatment, 100μm-deep, 150μm-deep, and 200μm-deep laser groove treatments. The surface roughness was measured, scanning electron microscopy was used to observe the specimen surfaces, and X-ray photoelectron spectroscopy (XPS) was used to analyze the surfaces. Each group was divided into four resin-based luting agent subgroups: Panavia V5, RelyX Ultimate Resin Cement, G-CEM Link Force, and Super-Bond C&B. After the resin-based luting agent was bonded to the specimens, the bond strength was measured using shear tests and the failure modes were assessed by stereomicroscopy. The surfaces were also observed by scanning electron microscopy (SEM) after the shear bond strength measurements. The data were statistically analyzed using a two-way analysis of variance and Tukey's honest significant difference test (α=0.05).

RESULTS

The PEEK surface after laser groove treatment groups exhibited the highest mean Ra values. In the XPS analysis, the laser treated PEEK surface exhibited an effective surface composition for bonding with resin-based luting agent. The shear bond strengths for the laser groove treated samples were significantly higher (p<0.05) than those of the no-treatment and air abrasion treatment groups.

CONCLUSIONS

The shear bond strength between PEEK and resin-based luting agent was substantially improved by laser groove treatment.

Effects of sulfuric and vinyl sulfonic acid etchants on bond strength of resin composite to polyetherketoneketone

This study aims to evaluate the effects of etching with sulfuric acid (SA) and vinyl sulfonic acid (VSA) on the bond strength between a light-curing indirect resin composite and polyetherketoneketones (PEKK). PEKK specimens were ground with 600 silicon carbide papers, etched with 90% SA for 5 s (90-5 SA) or 95% VSA for 30 s (95-30 VSA), and then modified with a phosphate primer; afterward, a light-curing resin composite was veneered on the specimens. Two control groups were also prepared without etching (unetched/unprimed and unetched/primed). After 20,000 thermocycles in water at 4 and 60 °C, the shear bond strengths of the specimens were determined and subjected to a nonparametric (Steel-Dwass) test (α = 0.05, n = 8). The etched surfaces were observed by scanning electron microscopy (SEM) at 2000× magnification. Higher bond strengths were obtained when the PEKK surface was etched with 90-5 SA or 95-30 VSA (90-5 SA/unprimed 24.3 ± 4.3 MPa, 90-5 SA/primed 26.2 ± 3.2 MPa, 95-30 VSA/unprimed 23.7 ± 2.5 MPa, 95-30 VSA/primed 24.3 ± 4.1 MPa), and these values were not statistically different, whereas the two control groups exhibited significantly lower bond strengths (unetched/unprimed 12.2 ± 1.7 MPa, unetched/primed 9.5 ± 2.7 MPa). SEM observations revealed that 95-30 VSA led to a microporous (felt-like) surface, which was different from the surface structure etched with 90-5 SA. Etching the PEKK surface with SA or VSA significantly improved the bond strength between resin composite and PEKK in contrast with the application of the phosphate primer. Appropriate chemical etching could be a useful option when fabricating prostheses using PEKK-based materials and indirect resin composites.

Influence of different low-pressure plasma process parameters on shear bond strength between veneering composites and PEEK materials

OBJECTIVE

The aim of this study was to evaluate the impact of oxygen and argon/oxygen low-pressure plasma on the shear bond strength (SBS) between dental PEEK compounds and veneering composites as a function of plasma process time.

METHODS

Of an unfilled PEEK ("Juvora") and two pigment powder filled PEEK compounds ("DC4420", "DC4450"), 273 rectangular plates were prepared and polished up to 1200 grit. Afterwards the samples were sandblasted and randomly assigned to five different surface pre-treatment groups (1. No plasma (control); 2. O₂ plasma for 3min; 3. O₂ plasma for 35min; 4. Ar/O₂ plasma for 3min; 5. Ar/O₂ plasma for 35min). Surface roughness and water contact angles were recorded using three samples of each PEEK compound for each of the plasma treatment groups. 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 three different veneering composites (a) Vita VM LC, "Vita" (Vita Zahnfabrik, Bad Säckingen, Germany); (b) GC GRADIA, "Gradia" (GC Europe, Leuven, Belgium); (c) GC GRADIA DIRECT Flo, "Gradia Flo" (GC Europe, Leuven, Belgium)) into a cylindrical form on the sample surface before light curing. SBS was measured using a universal testing machine after 24h of incubation in distilled water at 37°C.

RESULTS

The two pigment filled PEEK compounds treated with O₂ plasma and veneered with Gradia Flo showed the highest SBS values (34.92±6.55MPa and 34.2±1.87MPa) followed by the combination of the unfilled PEEK material with Gradia Flo (29.57±3.71MPa). The SBS values of the samples veneered with Gradia were lower, but not significantly so. The SBS values of the specimens with Vita were for the most part associated with significantly lower results.

SIGNIFICANCE

A low-pressure plasma process using oxygen plasma for a duration of 35min, preceded by sandblasting, seems to be the most effective in increasing shear bond strength between veneering composites and PEEK materials.

Peek polymer in orthodontics: A pilot study on children

The purpose of the study has been making the orthodontic space maintainers in PEEK polymer (Polyetheretherketone) through a digital workflow. New digital technologies are taking hold in diagnosis, therapy and in dental laboratories. The digital world can help dentist in diagnosis and therapy: -diagnosis through the acquisition of radiographic images (CBCT) or scanners which allow the creation of 3D digital models – about therapy thanks to dental CAD CAM system. It consists of design devices through an dedicated software CAD and then realize devices through CAM system. We used digital system to improve the quality of the treatment and reduce costs. Peek polymer, subject of studies in recent years, thanking to its characteristics, resulted useful for this study. According to a nine month- follow up the devices were found comfortable, satisfying, personalized and minimally visible for the patients. These devices were found suitable to maintain the space. About material, thanks to its dimensional stability, mechanical strength but specially, thanks to its biocompatibility, PEEK was found as a very good material to build space maintainers. The workflow allowed a simulation of the treatment plan with a better collaboration and acceptance of the patient. Digital system reduced the systematic mistakes during the various phases and the production time. The digital system saved space creating a virtual plaster casts collection.

Key words:PEEK, CAD/CAM system, space maintainers, orthodontic prevention.

Bonding to Different PEEK Compositions: The Impact of Dental Light Curing Units

This study investigated the impact of different light curing units (LCUs) for the polymerization of adhesive system visio.link (VL) on the tensile bond strength (TBS) of different PEEK compositions. For TBS measurements, 216 PEEK specimens with varying amounts of TiO₂ (PEEK/0%, PEEK/20%, PEEK/>30%) were embedded, polished, air abraded (Al₂O₃, 50 µm, 0.4 MPa), conditioned using VL, and polymerized using either a halogen LCU (HAL-LCU) or a LED LCU (LED-LCU) for chairside or labside application, respectively. After thermocycling (5000×, 5/55 °C), TBS was measured, and fracture types were determined. Data was analyzed using a 2-way ANOVA followed by Tukey-HSD, Kruskal-Wallis H and Mann-Whitney U tests as well as a Chi²-test and a Ciba-Geigy table (p < 0.05). Globally, the light curing units, followed by PEEK composition, was shown to have the highest impact on TBS. The HAL-LCUs, compared to the LED-LCUs, resulted in a higher TBS for all PEEK compositions-without significant differences between chairside and labside units. Regarding the different PEEK compositions, PEEK/20%, compared to PEEK/0%, resulted in a higher TBS when both, HAL-LCUs or LED-LCUs were used for labside application. In comparison with PEEK/>30%, PEEK/20% resulted in a higher TBS after using HAL-LCU for labside application. No significant differences were found between PEEK/0% and PEEK/>30%. HAL-LCU with PEEK/20% for labside application showed a higher TBS than HAL-LCU with PEEK/20% for chairside application, whereas LED-LCU with PEEK/>30% for chairside application showed a higher TBS than LED-LCU with PEEK/>30% for labside application.

Bonding of the Polymer Polyetheretherketone (PEEK) to Human Dentin: Effect of Surface Treatments

Polyetheretherketone (PEEK) is a material suitable for frameworks of fixed dental prostheses. The effect of different surface treatments on the bond strength of PEEK bonded to human dentin was evaluated. One hundred PEEK cylinders (3 mm×3 mm) were divided into five groups according to surface treatment: silica coating, sandblasting with 45 μm Al2O3 particles, etching with 98% sulfuric acid for 5, 30 and for 60 s. These cylinders were luted with resin cement onto 50 human molars. First, each tooth was embedded in epoxy resin and the buccal dentin surface was exposed. Then, two delimited dentin areas (Æ:3 mm) per tooth were etched with 35% phosphoric acid and bonded with a two-step self-priming adhesive system. After the luting procedure the specimens were stored in water (24 h/37 °C). Shear bond strength (SBS) was tested using a universal testing machine (crosshead speed 0.5 mm/min; load cell 50 kgf) and failure types were assessed. Stress data (MPa) were analyzed using the Kruskal-Wallis test. Comparison of the proportions of different failure types was performed using the Bonferroni method (p<0.05). Kruskal-Wallis demonstrated that differences among groups were not significant (p=0.187). Mean SBS were as follows: silica coating, 2.12±1.12 MPa; sandblasting, 2.37±0.86 MPa; sulfuric acid 5 s, 2.28±1.75 MPa; sulfuric acid 30 s, 1.80±0.85 MPa; sulfuric acid 60 s, 1.67±0.94 MPa. Adhesive and mixed failures were predominant in all groups. Both physical and chemical surface treatments produced adhesion between PEEK, resin cement and dentin.