Journal of Oral Implantology December 2013 - (Page 743)

LITERATURE REVIEW PEEK Dental Implants: A Review of the Literature Andreas Schwitalla, DDS1* ¨ Wolf-Dieter Muller, PhD2 The insertion of dental implants containing titanium can be associated with various complications (eg, hypersensitivity to titanium). The aim of this article is to evaluate whether there are existing studies reporting on PEEK (polyetheretherketone) as an alternative material for dental implants. A systematic literature search of PubMed until December 2010 yielded 3 articles reporting on dental implants made from PEEK. One article analyzed stress distribution in carbon fiber-reinforced PEEK (CFR-PEEK) dental implants by the 3-dimensional finite element method, demonstrating higher stress peaks due to a reduced stiffness compared to titanium. Two articles reported on investigations in mongrel dogs. The first article compared CFR-PEEK to titanium-coated CFRPEEK implants, which were inserted into the femurs and evaluated after 4 and 8 weeks. The titanium-coated implants showed significantly higher bone-implant contact (BIC) rates. In a second study, implants of pure PEEK were inserted into the mandibles beside implants made from titanium and zirconia and evaluated after 4 months, where PEEK presented the lowest BIC. The existing articles reporting on PEEK dental implants indicate that PEEK could represent a viable alternative material for dental implants. However, further experimental studies on the chemical modulation of PEEK seem to be necessary, mainly to increase the BIC ratio and to minimize the stress distribution to the peri-implant bone. Key Words: PEEK, dental implants, finite element method, animal experiments, osseointegration INTRODUCTION D ental implants increase the quality of life for many patients with tooth loss.1 The material of choice for oral endosseous implants is pure titanium, introduced at the end of the 1960s by Branemark.2 Although implants based on titanium and titanium alloys, such as Ti-6Al-7Nb and Ti- 6Al-4V,3,4 are well evidence-based, it was demonstrated that their use can be correlated with a range of problems. One problem is a potential hypersensitivity to titanium.5-9 Another problem could occur due to the gradient difference in the elastic moduli of a titanium implant and its surrounding bone. This may cause stress in the implant-bone interface during load transfer,10,11 probably resulting in peri1 Department of Oral and Maxillofacial Surgery, Clinical Naviga´ tion and Robotics, Charite -Campus Virchow Clinic, Berlin, Germany. 2 Department for Dental Materials and Biomaterial Research, ´ School of Dentistry, Charite-Campus Benjamin Franklin, Berlin, Germany. * Corresponding author, e-mail: andreas.schwitalla@charite.de DOI: 10.1563/AAID-JOI-D-11-00002 implant bone loss.12,13 Also, titanium can cause esthetic problems due to its lack of light transmission.14 This can provoke a dark shimmer of the periimplant soft tissue in cases of thin biotype mucosa and/or mucosa recession around a titanium implant. This can be problematic especially in the presence of a high smile line.15,16 Additionally, an increasing number of patients are demanding dental reconstructions of completely metal-free materials.15 As an alternative to titanium, ceramic implants are proposed, which were first introduced about 40 years ago and were made from aluminum oxide.17-22 Due to frequent fracture incidence, this material was substituted by titanium.23 Nowadays, ceramic dental implants are made of zirconia, which seems to be a better suitable alternative to titanium because of its tooth-like color, mechanical properties, biocompatibility, and low plaque affinity.24 But a systematic review of the literature by Andreiotelli et al15 from 2009 concludes that the scientific clinical data are not yet sufficient to recommend ceramic implants for routine clinical use. This corresponds to a grade C recommendation of the definitions of types of evidence originating from the US Agency for Health Journal of Oral Implantology 743

Table of Contents for the Digital Edition of Journal of Oral Implantology December 2013

Blade-Form Dental Implants: FDA Reclassification as a Class II Dental Implant Device
Effect of Different Storage Media on the Regenerative Potential of Autogenous Bone Grafts: A Histomorphometrical Analysis in Rabbits
Tensile Resistance of Mineralized and Demineralized Rat Bones in Different Regions (Calvarial and Femur)
Microbial Diversity of Peri-Implant Biofilms on Implant Fixed Bar and Telescopic Double Crown Attachments
Evidence-Based Techniques to Assess the Performance of Dental Implants
Influence of Platform and Abutment Angulation on Peri-Implant Bone. A Three- Dimensional Finite Element Stress Analysis
Direct Current Electric Stimulation in Implant Osseointegration: An Experimental Animal Study With Sheep
Prevalence of Sinus Augmentation Associated With Maxillary Posterior Implants
The Bactericidal Effects of an Acidified Sodium Chlorite-Containing Oral Moisturizing Gel: A Pilot Study
Influence of Fine Threads and Platform-Switching on Crestal Bone Stress Around Implant— A Three-Dimensional Finite Element Analysis
An Evaluation of the Resonance Frequency Analysis Device: Examiner Reliability and Repeatability of Readings
Histologic and Histomorphometric Assessment of Implants and Periapical Tissues When Placed in the Sockets of Extracted Teeth, Teeth With Periapical Lesions, and Healed Lesions: A Canine Study
Microbiological Aspects of Human Mandibular Subperiosteal Dental Implants
A Technique for Removal of a Fractured Implant Abutment Screw
Eight-Year Results of Site Retention of Anorganic Bovine Bone and Anorganic Bovine Matrix
A Reactive Lesion (Pyogenic Granuloma) Associated With Dental Implant: A Case Report
Twelve-Year Clinical and Radiological Results of Maxillary and Mandibular Implant- Retained Bar Overdentures Carried out on Oxidized (TiUnite) Replace Select Implants: A Clinical Case
PEEK Dental Implants: A Review of the Literature

Journal of Oral Implantology December 2013