Dental News - Interview: “Research on PEEK implants is both challenging and motivating”

Dental Tribune International

Mon. 18. September 2017

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MADRID, Spain: In 2010, Dr Pär Johansson received his dentistry degree at Malmö University in Sweden, where he submitted a master thesis on implant surfaces. A few years later, he joined a research team at the same department as they were launching an interesting project on a new implantable material, PEEK (polyether ether ketone). In an interview with Dental Tribune Online, Johansson spoke about the advantages and challenges of PEEK implants and what the new material could mean for the future of implantology.

What, in your opinion, has been the greatest development in dental implantology throughout the decades?

Since the discovery of osseointegration, the development of dental implantology has been extraordinary and extremely fast. The advancement began by experimenting with different implant materials and inventive shapes and forms. Thereafter, the implant surface was modified using several subtractive and additive methods to shorten the healing time and increase the success rate. Today, researchers are attempting to improve osseointegration by loading the implant surface with pharmaceuticals or proteins. As a researcher, I would say that the most important developments in dental implantology have been the surface improvements and, to some extent, our understanding of bone and implant interaction. As a clinician, the greatest developments have been improved treatment protocols and the implementation of digital appliances.

At the 2017 European Association for Osseointegration (EAO) congress, you will be giving a lecture about PEEK implants. What was your motivation behind specialising in this implant material?

The project became my PhD project, which I am defending later this year. PEEK is a highly advanced polymer with properties that could improve the treatment outcomes of several procedures. The challenge is that PEEK is not optimal as a loadbearing implant because of the bio-inert surface which does not osseointegrate without modification. Therefore, research on PEEK implants is both challenging and motivating, particularly since the arena of applications, especially in dentistry, is so unexplored.

It has been argued that implantable PEEK polymers are a next-generation biomaterial. Is that fact or fantasy?

I would say that PEEK has come a long way to becoming the next-generation biomaterial in the orthopaedic field. Today, PEEK is the standard implant material in several spinal procedures and ongoing research has introduced more applications. In dentistry, the introduction of PEEK has been slow, but the material may well be functional in healing abutments, temporary cylinders and dental frameworks. Introduction of new biomaterials is a slow process which require a comprehensive evaluation by the US Food and Drug Administration before it can be implemented for clinical trials. PEEK-OPTIMA (Invibio) is currently the only commercial PEEK polymer approved by the FDA as a medical device.

What are the main advantages of PEEK in comparison with conventional implant materials like titanium? What are its limitations?

The main advantage in spine and trauma surgery is its superior biomechanical properties compared with metals. PEEK has an elastic modulus similar to that of human bone, while that of titanium is almost eightfold higher. Differences in elastic modulus between the implant and the surrounding tissue may promote stress shielding and inhibit bone growth or lead to bone resorption. Furthermore, titanium and metal alloys have, in some documented cases, caused signs of hypersensitivity and allergy. These days, there is also an increasing demand for non-metallic restorations and biomaterials. PEEK is bio-inert, has a non-reactive surface and, according to current literature, has never shown any signs of provoking hypersensitivity. The colour of PEEK is more natural, and this enables the manufacturing of aesthetic implants for thin biotypes and diverse dental components. Finally, PEEK is transparent to X-rays, which is a feature highly useful after spine surgery, allowing the postoperative radiograph to be viewed and analysed without any disturbing artefacts.

The results of a study in rabbit bone you conducted in 2016 proved that the addition of a nanosized hydroxyapatite coating to PEEK surfaces improved the bone–implant contact and demonstrated strong osteoconductive properties at the perforation. How important are these findings to advancing research on PEEK implants?

This aforementioned study is the third by our research group on PEEK. There were two main areas of investigation regarding the material used in this study, the use of PEEK as a biomaterial and the innovative coating technique by which a nanosized hydroxyapatite coating is applied to the implant surface. Further, this study evaluated a PEEK implant with a unique design: the implant is manufactured with an apical perforation to enable evaluation of the bone fusion. The design is mainly aimed to be correlated to spinal applications where PEEK implants are currently used as cages between the vertebrae to facilitate bone fusion. The results of this study show the significant effect of surface modification using nano-hydroxyapatite. These outcomes are important in inspiring and facilitating future research on PEEK and nano-hydroxyapatite. This coating technique can further be applied to PEEK implants with other design and surface properties of the core material.

Do PEEK implants have a good success rate in human patient cases that would allow them to be used in all clinical situations?

PEEK implants used in spinal surgery have in retrospective studies showed equal or more successful outcomes in terms of treatment success and bone formation compared with titanium. Recently, the FDA has given clearance for hydroxyapatite-coated and -impregnated PEEK implants. However, the approval only applies to PEEK as an inter-body spine implant. It is difficult to relate the outcomes as a spine implant to other applications, since the design, loading and surrounding tissue are different. However, if hydroxyapatite-modified PEEK can reach comparable levels of osseointegration to titanium, there will be a manifold increase in applications.

How likely do you think it is that PEEK dental implants will replace conventional ones in the near future?

Replacing titanium in oral implantology will require more research including experimental studies and clinical trials. According to the current literature on PEEK and its various bioactive improvements, the level of osseointegration does not seem sufficient to withstand the load from masticatory forces. However, an introduction into the dental field could be as an orthodontic implant implanted for a relatively short period of function and with less and more controlled applied force.

Dr Pär Johansson will be presenting his lecture titled “PEEK implants. Ready for clinical use?” at EAO Madrid 2017 on 7 October in Arena 5.

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