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Gama LT, Bezerra AP, Schimmel M, Rodrigues Garcia RCM, de Luca Canto G, Gonçalves TMSV. Clinical performance of polymer frameworks in dental prostheses: A systematic review. J Prosthet Dent 2024; 131:579-590. [PMID: 35422333 DOI: 10.1016/j.prosdent.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 12/11/2022]
Abstract
STATEMENT OF PROBLEM High-performance polymers including polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) have been used as substitutes for metal frameworks in dental prostheses. However, the clinical performance of polymer-based frameworks is still uncertain. PURPOSE The purpose of this systematic review was to compare the clinical performance of PEEK and PEKK with that of metal frameworks for different dental prostheses. MATERIAL AND METHODS This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases and non-peer-reviewed literature (without language or follow-up restrictions) were searched for studies conducted before February 2022. Only clinical studies, either randomized clinical trials (RCTs) or nonrandomized clinical trials (N-RCTs), comparing the clinical performance of polymer and metal frameworks were included. The risk of bias and certainty of the evidence were assessed with the RoB 2.0, ROBINS-I, and GRADE. Biologic (plaque and gingival indices, probing depth, bleeding scores, implant stability quotient, marginal bone loss) and mechanical outcomes (ridge base relation, prosthetic marginal gap, and fracture) were assessed. RESULTS Only 9 studies (7 RCTs and 2 N-RCTs) were included, all with moderate to serious risk of bias and low to very low certainty of evidence. No meta-analysis was possible, but qualitative analysis revealed lower plaque and gingival indices, probing depth, and marginal bone loss, with higher survival rates for implant-supported fixed prostheses and overdentures fabricated with PEEK than for metal frameworks. No significant differences were found between groups for removable partial dentures. The marginal fit of PEEK frameworks was also better for single crowns. Three fractures were reported in the 3 PEKK fixed dental prostheses with cantilevers. CONCLUSIONS PEEK and PEKK seem to be promising materials for dental prostheses, with acceptable response from the periodontal tissue. However, further well-designed studies are necessary to better understand their clinical and long-term limitations.
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Affiliation(s)
- Lorena Tavares Gama
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Adriana Pinto Bezerra
- PhD student, Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Martin Schimmel
- Full Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern (UNIBE), Bern, Switzerland; Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Renata Cunha Matheus Rodrigues Garcia
- Full Professor, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Graziela de Luca Canto
- Full Professor, Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
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Liu Y, Fang M, Zhao R, Liu H, Li K, Tian M, Niu L, Xie R, Bai S. Clinical Applications of Polyetheretherketone in Removable Dental Prostheses: Accuracy, Characteristics, and Performance. Polymers (Basel) 2022; 14:polym14214615. [PMID: 36365609 PMCID: PMC9654455 DOI: 10.3390/polym14214615] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
The high-performance thermoplastic polyetheretherketone (PEEK) has excellent mechanical properties, biocompatibility, chemical stability, and radiolucency. The present article comprehensively reviews various applications of PEEK in removable dental prostheses, including in removable partial dentures (RPDs) (frameworks and clasps), double-crown RPDs, and obturators. The clinical performance of PEEK in removable dental prostheses is shown to be satisfactory and promising based on the short-term clinical evidence and technical complications are scarce. Moreover, the accuracy of RPDs is a vital factor for their long-term success rate. PEEK in removable dental prostheses is fabricated using the conventional lost-wax technique and CAD/CAM milling, which produces a good fit. Furthermore, fused deposition modeling is considered to be one of the most practical additive techniques. PEEK in removable prostheses produced by this technique exhibits good results in terms of the framework fit. However, in light of the paucity of evidence regarding other additive techniques, these manufacturers cannot yet be endorsed. Surface roughness, bacterial retention, color stability, and wear resistance should also be considered when attempting to increase the survival rates of PEEK removable prostheses. In addition, pastes represent an effective method for PEEK polishing to obtain a reduced surface roughness, which facilitates lower bacterial retention. As compared to other composite materials, PEEK is less likely to become discolored or deteriorate due to wear abrasion.
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Affiliation(s)
- Yuchen Liu
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Ming Fang
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Correspondence: (M.F.); (S.B.)
| | - Ruifeng Zhao
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Hengyan Liu
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Kangjie Li
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Min Tian
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Lina Niu
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Rui Xie
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
| | - Shizhu Bai
- State Key Laboratory of Military Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- National Clinical Research Center for Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
- Correspondence: (M.F.); (S.B.)
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Khurshid Z, Nedumgottil BM, Ali RMM, Bencharit S, Najeeb S. Insufficient Evidence to Ascertain the Long-Term Survival of PEEK Dental Prostheses: A Systematic Review of Clinical Studies. Polymers (Basel) 2022; 14:polym14122441. [PMID: 35746022 PMCID: PMC9231096 DOI: 10.3390/polym14122441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Polyetheretherketone (PEEK) is a polymer that is used in the construction of orthopaedic and dental implants. It is also used to construct removable and fixed dental prostheses due to its superior mechanical and esthetic properties compared to conventional materials. This systematic review aims to analyse and appraise the literature concerning PEEK dental prostheses critically. Methods: The following focused question was constructed ‘Are dental prostheses made of PEEK inferior to those made of other materials in terms of clinical- and patient-reported outcomes?’. The CONSORT (Consolidated Standards of Reporting Trials) tool was used for the quality assessment of the randomised clinical trials. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) quality assessment tool was used to assess the quality of observational studies and the case reports were evaluated using the CARE (Case Report) guidelines. Results: A total of 12 studies were included in this review. Two case studies received an overall grade of medium and the overall quality of six studies was graded as ‘low’. All three observational studies and the only randomised controlled trial received scores of ‘medium’. Conclusion: PEEK-based dental prostheses may provide a viable and more esthetic alternative to conventional prosthodontic appliances. However, within the limitations of this study is the evidence to ascertain the long-term viability of PEEK-based dental prostheses. Future studies should focus on conducting large-scale, multicenter trials to compare the survival rate of PEEK prostheses to that of conventionally available prosthodontic appliances.
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Affiliation(s)
- Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.M.N.); (R.M.M.A.)
- Correspondence:
| | - Binoy Mathews Nedumgottil
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.M.N.); (R.M.M.A.)
| | - Ramy Moustafa Moustafa Ali
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.M.N.); (R.M.M.A.)
- Department of Removable Prosthodontics, Faculty of Dentistry, Fayoum University, Fayoum 2933110, Egypt
| | - Sompop Bencharit
- VCU Philips Institute for Oral Health Research, Department of Biomedical Engineering, School of Dentistry, College of Engineering, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Shariq Najeeb
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 3K7, Canada;
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