In Vitro Assessment of the Cell Metabolic Activity, Cytotoxicity, Cell Attachment, and Inflammatory Reaction of Human Oral Fibroblasts on Polyetheretherketone (PEEK) Implant-Abutment

The purpose of this research is to compare the cytotoxicity of polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) with conventional dental implant–abutment materials, namely titanium alloy (Ti-6Al-4V) and yttria-stabilized tetragonal zirconia polycrystal (Y-TZP), to evaluate the cell metabolic activity, cytotoxicity, and inflammation potential of human oral fibroblasts (HOF) on these materials. Disk-shaped specimens were designed and prepared via a dental computer-aided manufacturing technology system. Surface topography, roughness, and free energy were investigated by atomic force microscope and contact angle analyzer; cell metabolic activity and cytotoxicity by MTT assay; and morphological changes by scanning electron microscopy (SEM). The effect of pro-inflammatory gene expression was evaluated by RT-qPCR. The obtained data were analyzed with one-way analysis of variance and post-hoc Tukey’s honest significant difference tests. PEEK and PEKK exhibited higher submicron surface roughness (0.04 μm) and hydrophobicity (>80°) than the control. Although the cell activity of PEEK was lower than that of Ti-6Al-4V and Y-TZP for the first 24 h (p < 0.05), after 48 h there was no difference (p > 0.05). According to the cell cytotoxicity and the pro-inflammatory cytokine gene expression assays, there was no difference between the materials (p > 0.05). SEM observations indicated that HOF adhered poorly to PEKK but properly to Ti-6Al-4V, Y-TZP, and PEEK. PEEK and PEKK show comparable epithelial biological responses to Ti-6Al-4V and Y-TZP as implant–abutment materials. Between the two polymeric materials, the PEEK surface, where the HOF showed better cell metabolic activity and cytotoxicity, was a more promising implant–abutment material.

Retentive Forces of Removable Partial Denture Clasp Assemblies Made from Polyaryletherketone and Cobalt-Chromium: A Comparative Study

PURPOSE

To compare retentive forces of removable partial denture clasps traditionally fabricated with cobalt-chromium (CoCr) material and two computer-aided design and computer-aided manufactured (CAD/CAM) thermoplastic polymers.

MATERIALS AND METHODS

Forty-eight clasp assemblies (16 CoCr, 16 polyetheretherketone (PEEK) and 16 polyetherketoneketone (PEKK) thermoplastic polymer) were fabricated for 48 mandibular tooth analogs. Individual clasps were inserted and removed on the tooth analogs utilizing a chewing simulator for 15,000 cycles to simulate 10 years of use. Retentive forces were measured utilizing a mechanical load tester at baseline and intervals of 1500 cycles. Data were analyzed with one-way Analysis of Variance, Tukey post-hoc, and paired T tests.

RESULTS

Mean retentive forces between all groups were significantly different (p < 0.001). Retentive forces of CoCr clasps were significantly higher than both polymers (p < 0.001). The mean retentive forces for PEEK were not significantly different from PEKK (p = 0.23). A significant increase in retentive forces was observed for all three clasps after the first period of cycling, followed by continual decrease for the remaining cycles. At the endpoint of 15,000 cycles, no clasp assemblies showed lower retentive forces than at initial baseline.

CONCLUSION

Thermoplastic polymer clasps demonstrated lower retentive forces compared to CoCr clasps. All three groups displayed a similar pattern of initial increase, followed by a gradual decrease, of retentive force. Despite this observation, the clasps maintained similar or higher retentive forces than measured at baseline. This resistance to fatigue and ability to fabricate with CAD/CAM technologies provides support for clinical use of these high-performance polymer (HPP) materials.

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.

Investigation of the retention forces of secondary telescopic crowns made from Pekkton® ivory in combination with primary crowns made from four different dental alloys: an in vitro study

The aim of this study was to investigate the retention forces of secondary telescopic crowns made of polyetherketoneketone (PEKK) in combination with primary crowns made of four different dental alloys and to determine whether the retention forces change in the course of up to 5000 simulated wear cycles. A total of four groups of telescopic crowns were investigated: group 1: 10 primary crowns made of a gold alloy (NEOCAST®3), group 2: 10 primary crowns made of a non-precious metal alloy (Girobond NB), group 3: 10 primary crowns made of zirconium (Cercon®base) and group 4: 10 primary crowns made from PEKK (Pekkton®ivory). The corresponding secondary crowns were made from PEKK in all the four groups. Each pair was fixed axially in a wear simulator specifically designed for the study. Overall, 10,000 joining and separating cycles were performed for each group. To simulate intraoral conditions, a saliva substitute served as a lubricant. Force transducers were used to record the retention forces and after completing 10,000 cycles, the surface of each primary crown was examined using a scanning electron microscope (SEM). All groups showed an increase in the retention force for the first 2000 cycles which stayed constant for the remaining 8000 cycles. The Pekkton®ivory/Pekkton®ivory and NEOCAST®3/Pekkton®ivory combinations displayed mean retention force values of 16 N after a slight increase in the retention force. The Cercon®base/Pekkton®ivory and Girobond NB/Pekkton®ivory combinations displayed an initially high increase in the retention force and then showed a mean retention force of up to 29 N. All primary crowns displayed surface wear. Zirconium primary crowns showed the least wear compared to PEKK and the gold and non-precious metal alloys.

Bonding and Thermal Cycling Performances of Two (Poly)Aryl-Ether-Ketone (PAEKs) Materials to an Acrylic Denture Base Resin

Poly(aryl–ether–ketone) materials (PAEKs) are gaining interest in everyday dental practices because of their natural properties. This study aims to analyze the bonding performance of PAEKs to a denture acrylic. Testing materials were pretreated by grinding, sandblasting, and priming prior to polymerization with the denture acrylic. The surface morphologies were observed using a scanning electron microscope and the surface roughness was measured using atomic force microscopy. The shear bond strength (SBS) values were determined after 0 and 2500 thermal cycles. The obtained data were analyzed using a paired samples t-test and Tukey’s honestly significant difference (HSD) test (α = 0.05). The surface characteristics of testing materials after different surface pretreatments showed obvious differences. PAEKs showed lower surface roughness values (0.02–0.03 MPa) than Co-Cr (0.16 MPa) and zirconia (0.22 MPa) after priming and sandblasting treatments (p < 0.05). The SBS values of PAEKs (7.60–8.38 MPa) met the clinical requirements suggested by ISO 10477 (5 MPa). Moreover, PAEKs showed significantly lower SBS reductions (p < 0.05) after thermal cycling fatigue testing compared to Co-Cr and zirconia. Bonding performance is essential for denture materials, and our results demonstrated that PAEKs possess good resistance to thermal cycling fatigue, which is an advantage in clinical applications. The results imply that PAEKs are potential alternative materials for the removable of prosthetic frameworks.

Characterization and Antibacterial Properties of Polyetherketoneketone Coated with a Silver Nanoparticle-in-Epoxy Lining

Polyetherketoneketone (PEKK) is an alternative material for use in removable partial denture frameworks; these frameworks must exhibit antibacterial properties to reduce the risk of periodontal disease. In the present study, silver nanoparticles (AgNPs) were synthesized via the reduction of silver nitrate with sodium borohydride in a solution containing polyvinyl pyrrolidone (PVP). Transmission electron microscope images and dynamic light scattering confirmed that metallic nanoparticles had been created with an average size of 32 nm. Furthermore, the coating of the PEKK polymeric substrate with 0.5% AgNPs was carried out using an epoxy resin lining at room temperature. Fourier transform infrared (FTIR) spectra confirmed the successful transfer of the AgNP-in-resin lining onto the polymeric substrate. Scanning electron microscopy and atomic force microscopy confirmed that the AgNPs had been uniformly deposited onto the PEKK specimens. Finally, the antibacterial activity of the specimens was tested against Porphyromonas gingivalis. An inhibition zone of 22.5 mm and an antibacterial rate of 83.47% were found for the PEKK coated with 0.5% AgNPs (0.5% Ag-PEKK) compared to an untreated polyetheretherketone (PEEK) substrate, evidencing that 0.5% Ag-PEKK has potential antibacterial properties for implant applications.

Mechanical Fatigue Performance of Patient-Specific Polymer Plates in Oncologic Mandible Reconstruction

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.

Preparation and Characterization of a Polyetherketoneketone/Hydroxyapatite Hybrid for Dental Applications

Here, we developed a new synthetic method for the production of a new class of polymeric inorganic hybrid biomaterial that has potential for dental implant applications and, in general, other orthopedic applications owing to its excellent mechanical properties and biomechanical compatibility. The new hybrid biomaterial is a composite consisting of polyetherketoneketone (PEKK) and hydroxyapatite (HA). This hybrid material boasts several unique features, including its high HA loading (up to 50 wt%), which is close to that of natural human bone; the homogeneous HA distribution in the PEKK matrix without phase separation; and the fact that the addition of HA has no effect on the molecular weight of PEKK. Nanoindentation analysis was used to investigate the mechanical properties of the composite, and its nano/microstructure variations were investigated through a structural model developed here. Through nanoindentation technology, the newly developed PEKK/HA hybrid biomaterial has an indentation modulus of 12.1 ± 2.5 GPa and a hardness of 0.42 ± 0.09 GPa, which are comparable with those of human bone. Overall, the new PEKK/HA biomaterial exhibits excellent biomechanical compatibility and shows great promise for application to dental and orthopedic devices.

Strain gauge analysis and fracture resistance of implant-supported PEKK hybrid abutments restored with two crown materials: An in vitro study

BACKGROUND

Polyetherketoneketone (PEKK) was recently introduced as an alternative to titanium and ceramic implant abutments due to its apparent ability to dissipate excessive strain around dental implants. However, the biomechanical behaviors of implant abutment crown systems may change depending on the crown and abutment material combinations used.

OBJECTIVES

This study aimed to assess how the crown material affects strain generation and fracture resistance of PEKK hybrid abutment crowns.

MATERIAL AND METHODS

Sixteen dummy implants (Ø 3.7 x 11 mm), simulating maxillary first premolars, were restored with 16 milled PEKK hybrid abutments and randomly categorized into two groups according to the crown material (n = 8): Group C, milled composite crowns cemented on PEKK hybrid abutments; and Group Z, ultra-translucent zirconia crowns cemented on PEKK hybrid abutments. Before thermocycling, a cyanoacrylate-base adhesive was used to position two strain gauges on buccal and lingual crestal bone surfaces, and a vertical load (100 N) was applied to the central fossa to record the strain generated. Then, all samples were thermocycled between 5°C and 55°C before being loaded to fracture on a universal testing machine. Modes of failure were observed under an optical microscope, and representative samples were examined using a scanning electron microscope. Independent t-tests were used for intergroup comparisons. The significance level was set at (p < 0.05) for all tests..

RESULTS

The results showed a significant difference between both groups. The zirconia group recorded significantly higher strain and fracture resistance values than the composite group (p < 0.001). There was a positive correlation between the strain developed in peri-implant crestal bone and fracture resistance of the abutment crown complex.

CONCLUSIONS

Strains developed in both groups were within the acceptable clinical range. The crown material substantially impacted the strain and fracture of the PEKK hybrid abutment crown system.

Stress behavior of an anterior single implant restored with high-performance polymer abutments under immediate and delayed loading: A 3D FEA study

PURPOSE

To evaluate the stress generated on peripheral bone, implant, and prosthetic components while using polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) hybrid abutments in two different loading situations with nonlinear 3D finite element analysis.

MATERIALS AND METHODS

Standard tessellation language (STL) files of original components were used for the in-silico modeling of implant, standard titanium abutment, and hybrid abutments (PEEK and PEKK). The implant was placed in the bone block to imitate immediate loading, in which a friction coefficient of 0.3 was set between the bone and the implant interface, or delayed loading, where the bone-implant interface was assumed to be perfect. In all models, both a horizontal force (25.5 N) and a 30-degree oblique force (178 N) were applied to the long axis of the implant to the palatal surface of the restoration. The stress distribution was evaluated.

RESULTS

While more stress was observed in the prosthetic structures in the PEEK and PEKK models, the stresses on the implant and bone were similar in all models, regardless of the loading situation. Under immediate loading, PEEK hybrid abutments caused excessive stress accumulation on the titanium base abutment.

CONCLUSIONS

Even though abutment type did not affect the stresses on peripheral bone, PEEK and PEKK abutments generated greater stresses on the implant and the standard titanium abutment accumulated higher stresses. Oblique forces mostly generated greater stress than horizontal forces. Oblique forces on an immediately loaded implant led to stresses higher than the yield strength of a titanium implant when restored with PEEK hybrid abutment.

The influence of framework material on stress distribution in maxillary complete-arch fixed prostheses supported by four dental implants: a three-dimensional finite element analysis

The purpose of the present study was to compare the stress distribution patterns of four materials used for the framework of All-on-4 prostheses. Following framework materials were evaluated: PEKK, PEEK, titanium, and monolithic zirconia. Bilateral 150 N axial and oblique loads were applied in the first molar region and analyzed using FEA. The highest maximum principal stress and minimum principal stress values in cortical bone were found to appear with PEKK and PEEK frameworks around the posterior dental implants upon oblique loading. The fabrication of frameworks from rigid materials in All-on-4 prostheses reduces stress in dental implants and peri-implant bone when the distal implants are tilted 30°.

Evaluating the Effect of Different Polymer and Composite Abutments on the Color Accuracy of Multilayer Pre-Colored Zirconia Polycrystal Dental Prosthesis

With increasing aesthetic awareness and emphasis on time costs in today’s society, monolithic multilayer precolored zirconia ceramics (M-Zr) facilitate aesthetic restorations in a convenient and straightforward manner without the need for veneering porcelain to modify the color. However, the effect of abutment materials on the final color of M-Zr remains unclear. Herein, we placed Vita A1 Shade M-Zr on six different abutment materials, zirconia (Y-TZP), 3D printed composite resin (CR), dental model resin (MR), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), and cobalt−chromium alloy (Co−Cr), to evaluate their effect on the color accuracy of M-Zr. The color attributes (L*, a*, and b*) were measured using a dental spectrophotometer. The translucency parameter (TP), contrast ratio, color difference (ΔE) between each background substrate and the Vita A1 Shade Guide, and chroma values (C) were calculated to evaluate the color accuracy of M-Zr. A statistical analysis was performed using one-way analysis of variance and post hoc Tukey’s HSD tests (α = 0.05). The experimental results indicate that the TP values and contrast ratio of the M-Zr samples were 14.85 and 0.83, respectively. Co−Cr had the highest ΔE (6.08) and lowest C value (7.52); PEKK had the lowest ΔE (2.60), and PEEK had the highest C value (12.23) (p < 0.05). Notably, the ΔE values of CR (3.13), PEEK (2.86), and PEKK were within clinical indicators (ΔE < 3.7). Based on these results, it can be concluded that the abutment material has a significant effect on the final color of the M-Zr, and PEEK or PEKK resulted in good color accuracy. When choosing the dental MR, traditional zirconia, or metals as abutment materials, colored or opaque cement might be required to eliminate color distortion and achieve desirable optical properties.

Biological, Biomechanical, and Histopathological Evaluation of Polyetherketoneketone Bioactive Composite as Implant Material

While polyetherketoneketone is a high-performance thermoplastic polymer, its hydrophobicity and inertness limit bone adhesion. This study aimed to evaluate a novel PEKK/CaSiO3/TeO2 nanocomposite, comparing it to PEKK/15 wt.% CaSiO3 and PEKK groups. The in vitro study, involving 90 discs (n = 30), assessed the cytotoxicity of all groups after 24, 72, and 168 h. The in vivo animal study, using cylinder-type implants (n = 30), evaluated osseointegration through biomechanical push-out tests, descriptive histopathological examinations of decalcified sections stained with hematoxylin and eosin, and histomorphometric analysis of new bone formation area after 2- and 6-week healing intervals. The cytocompatibility of PEKK/15 wt.% CaSiO3/1 wt.% TeO2 composite confirmed its acceptance as a biomedical material. Additionally, in vivo study results showed that the PEKK/15 wt.% CaSiO3/1 wt.% TeO2 had the highest shear strength value and the highest new bone formation area compared to other experimental groups. The multimodal concept of adding CaSiO3 micro fillers and TeO2 nanofillers to PEKK produces a cytocompatible composite that enhances osseointegration and new bone formation in a rabbit's femur after 2- and 6-week healing intervals.

Surface Characteristics and Adhesion of Veneering Composite Resin to PAEK-Based Substructure Restorative Materials

PURPOSE

To evaluate and compare the shear bond strength (SBS) of composite veneering material to polyetherketoneketone (PEKK), polyetheretherketone (PEEK), zirconia (YZ), and nickel-chromium alloy (NiCr) substructure restorative materials.

MATERIALS AND METHODS

Forty samples (12 × 2 mm) were prepared from four materials: PEKK, PEEK, zirconia, and NiCr alloy (n = 10). The Vickers hardness was evaluated before preparing the surface for bonding by shot-blasting using 110 μm Al₂ O₃ particles. The surface roughness (Ra) of each sample was determined using a noncontact optical profilometer. The veneering resin was bonded onto each sample following primer application. The prepared samples were then subjected to an SBS test using a universal testing machine at 0.5 mm/min crosshead speed. Failure modes and surface topography following debonding were assessed. The data were statistically analyzed using ANOVA and Tukey's post-hoc comparison test (p < 0.05).  RESULTS: The highest and lowest mean surface roughness was observed in PEEK (3.45 ±0.13 μm) and NiCr (1.87 ±0.07 μm) materials, respectively. A significant difference in roughness values was observed between the materials except for NiCr and YZ (p = 0.547). Concerning SBS, PEEK and NiCr exhibited the highest (16.23 ±0.96 MPa) and lowest (10.1 ±0.63 MPa) values. The mean difference in SBS indicated a statistically significant difference between the material groups (p < 0.01).

CONCLUSIONS

PEKK materials demonstrated significantly lower SBS than PEEK and significantly higher SBS values than conventional zirconia and alloy materials. A positive and significant correlation between mean roughness and SBS was observed, but the causality could be either intrinsic to the material or the roughness.

The Tensile, Thermal and Flame-Retardant Properties of Polyetherimide and Polyetherketoneketone Processed via Fused Filament Fabrication

Polymer materials are increasingly widely used in high-fire-risk applications, such as aviation interior components. This study aimed to compare the tensile, thermal, and flame-retardant properties of test samples made from ultra-performance materials, polyetherimide (PEI) and polyetherketoneketone (PEKK), using the fused filament fabrication process (FFF). The tensile tests were performed for these materials at different raster angles (0, 45, and 90°). The thermomechanical tests were done in the axial, perpendicular, and through-thickness directions to the extruded filaments. The impact of printing parameters on the flame retardancy of 3D-printed samples was investigated in vertical burn tests with varying specimen thicknesses and printing directions. Experimentally, it was testified that PEKK had better isotropic behaviour than PEI for mechanical performance, thermal expansion, and fire-resistant properties, which are essential in fabricating intricately shaped products.

Stereomicroscope-Based in Vitro Study Evaluating the Marginal and Internal Fit of PEEK and PEKK Crowns

Purpose

The aim of the in vitro study was to compare the internal merge and marginal perfection of polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) crowns under a stereomicroscope.

Methods

All-ceramic preparation is done on the maxillary first premolar which is mounted on the wax block which was scanned using 3Shape scanner and duplicated into 30 acrylic CAD/CAM dies (n = 15) for the placement of PEEK and PEKK crowns. The YENADENT milling system was used to fabricate 15 samples from Group A PEEK crowns and to fabricate 15 samples from Group B PEKK crowns. According to the manufacturer's instructions, an equal amount of the dual-cure resin luting agent (Rely X U200 Self-Adhesive resin, 3M, Germany) was dispensed on the mixing pad before being mixed with cement and painted on the internal surfaces of the copings with the finger pressure crowns which were luted. The values were then analyzed using one-way ANOVA (post hoc) followed by Dunnett's t-test.

Results

Among those two groups, PEEK group materials showed the lowest mean value of (28.73.3 ± 4.01) for marginal fit and (26.72 ± 2.53) for internal gap, whereas PEKK group showed a mean value of (32.85 ± 4.63) and (33.06 ± 4.14), respectively.

Conclusion

Among these two groups, comparatively less marginal fit and internal adaptation is seen in PEKK when compared to the PEEK crowns. While the marginal fit and internal adaptation of both PEEK and PEKK copings were in acceptable clinical range.

Advanced 3D Printing of Polyetherketoneketone Hydroxyapatite Composites via Fused Filament Fabrication with Increased Interlayer Connection

Additively manufactured implants, surgical guides, and medical devices that would have direct contact with the human body require predictable behaviour when stress is applied during their standard operation. Products built with Fused Filament Fabrication (FFF) possess orthotropic characteristics, thus, it is necessary to determine the properties that can be achieved in the XY- and Z-directions of printing. A concentration of 10 wt% of hydroxyapatite (HA) in polyetherketoneketone (PEKK) matrix was selected as the most promising biomaterial supporting cell attachment for medical applications and was characterized with an Ultimate Tensile Strength (UTS) of 78.3 MPa and 43.9 MPa in the XY- and Z-directions of 3D printing, respectively. The effect of the filler on the crystallization kinetics, which is a key parameter for the selection of semicrystalline materials suitable for 3D printing, was explained. This work clearly shows that only in situ crystallization provides the ability to build parts with a more thermodynamically stable primary form of crystallites.

Designing Superhydrophilic 3D Porous Surfaces on Polyetherketoneketone Surfaces to Promote Biocompatibility

Polyetherketoneketone (PEKK) exhibits satisfactory mechanical properties and biocompatibility, with an elastic modulus closely resembling that of natural bone. This property reduces the stress-shielding effect associated with bone implants. However, the biological inertness of the PEKK surface remains a significant limitation for its application in bone tissue engineering. The objective of this study was to create a superhydrophilic 3D porous structure on the surface of PEKK to enhance biocompatibility, in terms of vascularization and bone remodeling. A combination of mechanical, chemical, and physical surface treatments was employed to modify the PEKK surface. Initially, mechanical sandblasting was used to create a rough surface to promote mechanical interlocking with bone tissue. Subsequently, chemical acid etching and physical low-temperature atmospheric plasma cleaning were applied to develop a superhydrophilic 3D porous surface. The modified surfaces were characterized for morphology, roughness, hydrophilicity, and functional groups. Cellular responses, including vascularization and bone remodeling, were evaluated to assess the potential for improved biocompatibility. The combination of acid etching and low-temperature atmospheric plasma cleaning, with or without prior sandblasting, successfully created a superhydrophilic 3D porous structure on the PEKK surface. This modified surface enhanced the tube formation in human umbilical vein endothelial cells. It also promoted the adhesion and mineralization of human bone marrow mesenchymal stem cells and slightly reduced tartrate-resistant acid phosphatase expression and F-actin ring size in mouse macrophage cells. This study introduces an innovative and effective surface modification strategy for PEKK surface, combining mechanical, chemical, and physical treatments to enhance biocompatibility. The modified PEKK surface promotes angiogenic and osteogenic responses while slightly inhibiting osteoclastic activity, making it a potential alternative for dental and orthopedic PEKK implant applications.

Bio-functional hydroxyapatite-coated 3D porous polyetherketoneketone scaffold for enhanced osteogenesis and osteointegration in orthopedic applications

Polyetherketoneketone (PEKK), a high-performance thermoplastic special engineering material, maintains bone-like mechanical properties and has received considerable attention in the biomedical field. The 3D printing technique enables the production of porous scaffolds with a honeycomb structure featuring precisely controlled pore size, porosity and interconnectivity, which holds significant potential for applications in tissue engineering. The ideal pore architecture of porous PEKK scaffolds has yet to be elucidated. Porous PEKK scaffolds with five pore sizes P200 (225 ± 9.8 μm), P400 (411 ± 22.1 μm), P600 (596 ± 23.4 μm), P800 (786 ± 24.2 μm) and P1000 (993 ± 26.0 μm) were produced by a 3D printer. Subsequently, the optimum pore size, the P600, for mechanical properties and osteogenesis was selected based on in vitro experiments. To improve the interfacial bioactivity of porous PEKK scaffolds, hydroxyapatite (HAp) crystals were generated via in situ biomimetic mineralization induced by the phase-transited lysozyme coating. Herein, a micro/nanostructured surface showing HAp crystals on PEKK scaffold was developed. In vitro and in vivo experiments confirmed that the porous PEKK-HAp scaffolds exhibited highly interconnected pores and functional surface structures that were favorable for biocompatibility and osteoinductivity, which boosted bone regeneration. Therefore, this work not only demonstrates that the pore structure of the P600 scaffold is suitable for PEKK orthopedic implants but also sheds light on a synergistic approach involving 3D printing and biomimetic mineralization, which has the potential to yield customized 3D PEKK-HAp scaffolds with enhanced osteoinductivity and osteogenesis, offering a promising strategy for bone tissue engineering.

Liver-Inspired Polyetherketoneketone Scaffolds Simulate Regenerative Signals and Mobilize Anti-Inflammatory Reserves to Reprogram Macrophage Metabolism for Boosted Osteoporotic Osseointegration

Tissue regeneration is regulated by morphological clues of implants in bone defect repair. Engineered morphology can boost regenerative biocascades that conquer challenges such as material bioinertness and pathological microenvironments. Herein, a correlation between the liver extracellular skeleton morphology and the regenerative signaling, namely hepatocyte growth factor receptor (MET), is found to explain the mystery of rapid liver regeneration. Inspired by this unique structure, a biomimetic morphology is prepared on polyetherketoneketone (PEKK) via femtosecond laser etching and sulfonation. The morphology reproduces MET signaling in macrophages, causing positive immunoregulation and optimized osteogenesis. Moreover, the morphological clue activates an anti-inflammatory reserve (arginase-2) to translocate retrogradely from mitochondria to the cytoplasm due to the difference in spatial binding of heat shock protein 70. This translocation enhances oxidative respiration and complex II activity, reprogramming the metabolism of energy and arginine. The importance of MET signaling and arginase-2 in the anti-inflammatory repair of biomimetic scaffolds is also verified via chemical inhibition and gene knockout. Altogether, this study not only provides a novel biomimetic scaffold for osteoporotic bone defect repair that can simulate regenerative signals, but also reveals the significance and feasibility of strategies to mobilize anti-inflammatory reserves in bone regeneration.

Comparison of marginal and internal adaptation of three-unit fixed dental prostheses made using CAD/CAM metal-free materials

The aim of this study was to compare the marginal and internal adaptation of three-unit fixed dental prostheses (FDPs) fabricated from different metal-free materials using CAD/CAM methods. A total of 100 three-unit FDPs were produced from a cubic zirconia, a fiber-reinforced resin composite, a polyetheretherketone (PEEK), a polyetherketoneketone (PEKK), and a polymer composite material by the CAD/CAM method (n = 20 per material). The zirconia group was considered the control/reference material. Marginal and internal gap values of the produced FDPs were measured using the silicone replica method at ×40 magnification under a stereomicroscope. The obtained data were analyzed using one-way ANOVA and Tukey's HSD tests. The marginal and internal gap values for the cubic zirconia material were found to be statistically significantly lower than those seen for the PEEK, polymer composite, PEKK, and fiber-reinforced resin composite materials. While the marginal and internal adaptation of the cubic zirconia material was found to be better than the others, it should be noted that the marginal and internal gap values for all other materials tested were found to be within the clinically acceptable range.

Shock Absorption Capacity of High-Performance Polymers for Dental Implant-Supported Restorations: In Vitro Study

BACKGROUND

Restorative materials might significantly affect load transmission in peri-implant bone. The aim of the present study is to evaluate the shock absorption capacity of two different polymeric materials to be used for implant-supported prostheses.

METHODS

A masticatory robot was used to compare the shock absorption capacity of veneered and non-veneered polyetherketoneketone (PEKK), Pekkton®ivory (Cendres+Mètaux), and the glass fiber-reinforced composite (GFRC), TRINIATM (Bicon). Five identical sample crowns for each of the three groups were tested. Forces transmitted at the simulated peri-implant bone were recorded and statistically analyzed.

RESULTS

The statistical analysis of forces transmitted at the simulated dental implant revealed significant differences between the materials tested and between these materials and zirconia, glass ceramic, composite resin, and acrylic resin. Only differences between PEKK and veneered PEKK and between PEKK and one of the previously tested composite resins were not statistically significant. PEKK samples demonstrated significantly greater shock absorption capacity compared to GFRC.

CONCLUSIONS

PEKK revealed optimal shock absorption capacity. Further studies are needed to evaluate its efficacy in the case of long-span prostheses with reduced prosthetic volume.