PEEK Material in the Reconstruction of Maxillofacial Defects: A Literature Review

Öz

Congenital or acquired maxillofacial defects cause aesthetic, phonetic, functional and psychological problems. These multiple problems create various treatment alternatives for the rehabilitation of the defect area. The success of the prosthetic treatment applied in the reconstruction of the defect directly affects patient satisfaction and quality of life. The main aim of prosthetic rehabilitation is to reconstruct the defects and eliminate the associated problems. Material selection in prosthetic treatment is important in terms of patient comfort and acceptability. The main properties desired in this selection are biocompatibility, durability, lightness, shaping capability, thermal resistance, radiolucency and low infectivity. Silicone-based materials, methyl methacrylate, titanium mesh and polyethylene are the materials commonly used in the reconstruction of defects with their advantages and disadvantages. As a result of the search for the ideal material, Polyetheretherketone (PEEK) is thought to be an alternative material. This review discusses the use of PEEK for prosthetic rehabilitation in patients with maxillofacial defects.

Anahtar Kelimeler

• Maxillofacial defect
• obturator
• PEEK
• polyetheretherketone

Maksillofasiyal Defektlerin Rekonstrüksiyonunda PEEK Materyalinin Yeri: Bir Literatür Derlemesi

Öz

Doğumsal veya kazanılmış maksillosiyal defektler estetik, fonetik, fonksiyonel bozukluklar ve psikolojik problemlere sebep olur. Çok yönlü problemler defekt bölgesinin rehabilitasyonu için çeşitli tedavi alternatifleri oluşturur. Defektin rekonstrüksiyonda uygulanan protetik tedavinin başarısı hasta memnuniyetini ve yaşam kalitesini doğrudan etkilemektedir. Protetik rehabilitasyonun primer amacı defektleri kapatmak ve buna bağlı problemleri ortadan kaldırmaktır. Protetik tedavide malzeme seçimi hasta konforu ve kabullenebilirlik açısından önemlidir. Bu seçimde istenilen başlıca özellikler biyouyumluluk, dayanıklılık, hafiflik, şekillendirilebilme imkanı, termal dayanım, radyolüsentlik ve düşük enfeksiyona sebebiyet verebilmesidir. Defektlerin rekonstrüksiyonunda silikon esaslı materyaller, metil metakrilat, titanyum ağ ve polietilen (PE) avantaj ve dezavantaları ile rutinde kullanılan materyallerdir. İdeal malzeme arayışının neticesinde Polietereterketonun (PEEK) alternatif bir materyal olabileceği düşünülmektedir. Bu derlemede maksillofasiyal defekte sahip hastalarda protetik rehabilitasyon amaçlı kullanılan PEEK’in avantaj ve dezavantajlarından bahsedilecektir.

Anahtar Kelimeler

• Maksillofasiyal defekt
• obturatör
• PEEK
• polietereterketon

Kaynakça

1. 1. Zafar MS. Prosthodontic Applications of Polymethyl Methacrylate (PMMA): An Update. Polymers. 2020 Oct 8;12(10):2299.
2. 2. Beumer, John, Curti̇s TA, ADNF Maxillofacial rehabilitation: prosthodontic and surgical considerations. St. Louis;1996
3. 3. Haraguchi M, Mukohyama H, Taniguchi H. A simple method of fabricating an interim obturator prosthesis by duplicating the existing teeth and palatal form. The Journal of Prosthetic Dentistry. 2006 Jun;95(6):469-72.
4. 4. Ghulam, A. H., & Abdualhadi, N. F Maxillofacial Obturator and Materials. Baghdad: Universityof Baghdad;2022
5. 5. Gay WD, King GE. Applying basic prosthodontic principles in the dentulous maxillectomy patient. The Journal of Prosthetic Dentistry. 1980 Apr;43(4):433-5.
6. 6. Kouyoumdjian J, Chalian V. An interim obturator prosthesis with duplicated teeth and palate. The Journal of Prosthetic Dentistry. 1984 Oct;52(4):560-2.
7. 7. Loibi E, Elangovan S. Two-piece hollow bulb obturator. Indian J Dent Res. 2011;22(3):486.
8. 8. Habib BH, Driscoll CF. Fabrication of a closed hollow obturator. The Journal of Prosthetic Dentistry. 2004 Apr;91(4):383-5.

9. 9. Caculo SP, Aras MA, Chitre V. Hollow Dentures: Treatment Option for Atrophic Ridges. A Clinical Report. Journal of Prosthodontics. 2013 Apr;22(3):217-22.
10. 10. Maas CS, Merwin GE, Wilson J, Frey MD, Maves MD. Comparison of Biomaterials for Facial Bone Augmentation. Archives of Otolaryngology - Head and Neck Surgery. 1990 May 1;116(5):551-6.
11. 11. Kim MM, Boahene KDO, Byrne PJ. Use of Customized Polyetheretherketone (PEEK) Implants in the Reconstruction of Complex Maxillofacial Defects. Archives of Facial Plastic Surgery. 2009 Jan 1;11(1):53-7.
12. 12. Ali U, Karim KJBA, Buang NA. A Review of the Properties and Applications of Poly (Methyl Methacrylate) (PMMA). Polymer Reviews. 2015 Oct 2;55(4):678-705.
13. 13. Shimodaira K, Yoshida H, Mizukami M, Funakubo T. Obturator prosthesis conforming to movement of the soft palate: A clinical report. The Journal of Prosthetic Dentistry. 1994 Jun;71(6):547-51.
14. 14. Aladağ Lİ̇. Sonradan kazanılmış bir maksiller defektin protetik obturasyonu. Atatürk Üni̇versi̇tesi̇ Di̇ş Heki̇mli̇ği̇ Fakültesi̇ Dergi̇si̇ . 2011;(4):122-127.
15. 15. High performance thermoplastic resins and their composites. Ottowa Canada:Sylvie Beland;1990.
16. 16. Kurtz SM, Devine JN. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials. 2007 Nov;28(32):4845-69.
17. 17. Jones D, Leach D, Moore D. Mechanical properties of poly(ether-ether-ketone) for engineering applications. Polymer. 1985 Aug;26(9):1385-93.
18. 18. Qin L, Yao S, Zhao J, Zhou C, Oates TW, Weir MD, et al. Review on Development and Dental Applications of Polyetheretherketone-Based Biomaterials and Restorations. Materials. 2021 Jan 15;14(2):408.
19. 19. Skirbutis, G, Dzingutė, A, Masiliūnaitė, V, Šulcaitė, G, Žilinskas, J. A review of PEEK polymer’s properties and its use in prosthodontics. Stomatologija 2017;19:19-23
20. 20. Nieminen T, Kallela I, Wuolijoki E, Kainulainen H, Hiidenheimo I, Rantala I. Amorphous and crystalline polyetheretherketone: Mechanical properties and tissue reactions during a 3‐year follow‐up. J Biomedical Materials Res. 2008 Feb;84A(2):377-83.
21. 21. Rahmitasari F, Ishida Y, Kurahashi K, Matsuda T, Watanabe M, Ichikawa T. PEEK with Reinforced Materials and Modifications for Dental Implant Applications. Dentistry Journal. 2017 Dec 15;5(4):35.
22. 22. Hearle, Ws J, E. High-performance fibres. England Cambridge: 2001
23. 23. Najeeb S, Zafar MS, Khurshid Z, Siddiqui F. Applications of polyetheretherketone (PEEK) in oral implantology and prosthodontics. Journal of Prosthodontic Research. 2016 Jan;60(1):12-9.
24. 24. Çulhaoğlu Ak, Özkır Se, Türkkal F. Polieter Eter Keton (Peek) Ve Dental Kullanımı. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2019 29(4), 711-718.
25. 25. Ma R, Tang T. Current Strategies to Improve the Bioactivity of PEEK. IJMS. 2014 Mar 28;15(4):5426-45.
26. 26. Lethaus B, Safi Y, ter Laak-Poort M, Kloss-Brandstätter A, Banki F, Robbenmenke C, et al. Cranioplasty with Customized Titanium and PEEK Implants in a Mechanical Stress Model. Journal of Neurotrauma. 2012 Apr 10;29(6):1077-83.
27. 27. Godara A, Raabe D, Green S. The influence of sterilization processes on the micromechanical properties of carbon fiber-reinforced PEEK composites for bone implant applications. Acta Biomaterialia. 2007 Mar;3(2):209-20.
28. 28. Khonsari RH, Berthier P, Rouillon T, Perrin J, Corre P. Severe infectious complications after PEEK-derived implant placement: Report of three cases. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2014 Oct;26(4):477-82
29. 29. Gorth DJ, Puckett S, Ercan B, Webster TJ, Rahaman M, Bal BS. Decreased bacteria activity on Si3N4 surfaces compared with PEEK or titanium. International journal of nanomedicine. 2012:4829-40.
30. 30. Barton , J. A, Sagers , D. R, Pi̇tt &, WG. Bacterial adhesion to orthopedic implant polymers.. Journal Of Bi̇omedi̇cal Materi̇als Research: An Offi̇ci̇al Of The Soci̇ety For Bi̇omateri̇als And The Japanese Soci̇ety For Bi̇omateri̇als, . 1996;30(3):403-410.
31. 31.Noiset O, Schneider YJ, Marchand–Brynaert J. Surface modification of poly (aryl ether ether ketone)(PEEK) film by covalent coupling of amines and amino acids through a spacer arm. Journal of Polymer Science Part A: Polymer Chemistry. 1997;35(17):3779-90.
32. 32. Stawarczyk B, Beuer F, Wimmer T, Jahn D, Sener B, Roos M, vd. Polyetheretherketone a suitable material for fixed dental prostheses? J Biomed Mater Res B Appl Biomater. 2013;101(7):1209–1216.
33. 33. Schmidlin PR, Stawarczyk B, Wieland M, Attin T, Hämmerle CHF, Fischer J. Effect of different surface pre-treatments and luting materials on shear bond strength to PEEK. Dent Mater. 2010;26(6):553-9.
34. 34. Najeeb S, Khurshid Z, Matinlinna JP, Siddiqui F, Nassani MZ, Baroudi K. Nanomodified Peek Dental Implants: Bioactive Composites and Surface Modification—A Review. International Journal of Dentistry. 2015;2015:1-7.
35. 35. Katzer A, Marquardt H, Westendorf J, Wening J, von Foerster G. Polyetheretherketone—cytotoxicity and mutagenicity in vitro. Biomaterials. 2002 Apr;23(8):1749-59.
36. 36. Rivard CH, Rhalmi S, Coillard C. In vivo biocompatibility testing of PEEK polymer for a spinal implant system: a study in rabbits. J Biomed Mater Res 2002;62:488-98.
37. 37. Scolozzi P, Martinez A, Jaques B. Complex orbito-fronto-temporal reconstruction using computer-designed PEEK implant. J Craniofac Surg. 2007;18:224–228.
38. 38. Kim MM, Boahene KD, Byrne PJ. Use of customized polyetheretherketone (PEEK) implants in the reconstruction of complex maxillofacial defects. Arch Facial Plast Surg. 2009;11:53–57.
39. 39. Sharaf MY, Eskander AE, Ibrahim SI. Evaluation of patients satisfaction of attachment retained PEEK versus clasp retained obturators in unilateral total maxillectomy (RCT). Egypt Dent J. 2018; 64 (01) 93-102
40. 40. Vaddamanu SK, Alhamoudi FH, Chaturvedi S, Alqahtani NM, Addas MK, Alfarsi MA, Elmahdi AE. Retentive Forces and Deformation of Fitting Surface in RPD Clasp Made of Polyether-Ether-Ketone (PEEK). Polymers. 2023;15(4), 956.
41. 41. Hama Suleiman S, Vult von Steyern P. Fracture strength of porcelain fused to metal crowns made of cast, milled or laser-sintered cobalt-chromium. Acta Odontologica Scandinavica. 2013 Sep;71(5):1280-9.
42. 42. Elias CN, Fernandes DJ, Souza FMd, Monteiro EdS, Biasi RSd. Mechanical and clinical properties of titanium and titanium-based alloys (Ti G2, Ti G4 cold worked nanostructured and Ti G5) for biomedical applications. Journal of Materials Research and Technology. 2019 Jan;8(1):1060-9.
43. 43. Tanoue M, Kanazawa M, Takeshita S, Minakuchi S. Effects of clip materials on stress distribution to maxillary implant overdentures with bar attachments. The Journal of Prosthetic Dentistry. 2016 Mar;115(3):283-9.
44. 44. Frost , HM. A 2003 update of bone physiology and wolff\'s law for clinicians. The Angle Orthodonti̇st. 2004;74.1:3-15.
45. 45. Abdraboh A, Elsyad M, Mourad S, Alameldeen H. Milled Bar with PEEK and Metal Housings for Inclined Implants Supporting Mandibular Overdentures: 1-Year Clinical, Prosthetic, and Patient-Based Outcomes. Int J Oral Maxillofac Implants. 2020 Sep;35(5):982-9.
46. 46. Villefort RF, Tribst JPM, Dal Piva AMDO, Borges AL, Binda NC, Ferreira CEDA. Stress distribution on different bar materials in implant-retained palatal obturator. PLOS ONE. 2020 Oct 30;15(10):e0241589.
47. 47. Meningaud J, Spahn F, Donsimoni J. After titanium, peek? Revue de Stomatologie et de Chirurgie Maxillo-faciale. 2012;113(5):407-10.
48. 48. Schwitalla AD, Spintig T, Kallage I, Müller W. Flexural behavior of PEEK materials for dental application. Dental Materials. 2015 Nov;31(11):1377-84.
49. 49. Johansson P, Jimbo R, Kozai Y, Sakurai T, Kjellin P, Currie F, et al. Nanosized Hydroxyapatite Coating on PEEK Implants Enhances Early Bone Formation: A Histological and Three-Dimensional Investigation in Rabbit Bone. Materials. 2015 Jun 25;8(7):3815-30.
50. 50. Johansson P, Barkarmo S, Hawthan M, Peruzzi N, Kjellin P, Wennerberg A. Biomechanical, histological, and computed X‐ray tomographic analyses of hydroxyapatite coated PEEK implants in an extended healing model in rabbit. J Biomedical Materials Res. 2018 May;106(5):1440-7.
51. 51. Li̇ng-Yu , I. L, Cong-Yi̇ng , U. ZHO, Ji̇e , I. WE, ve ark. Quantitative analysis of nfa/PEEK implant interfaces in beagle dogs.. Shanghai̇ Journal Of Stomatology. 2014;23(2):166-171
52. 52. Schwitalla AD, Spintig T, Kallage I, Müller W. Pressure behavior of different PEEK materials for dental implants. Journal of the Mechanical Behavior of Biomedical Materials. 2016 Feb;54:295-304.
53. 53. Mishra S, Chowdhary R. PEEK materials as an alternative to titanium in dental implants: A systematic review. Clin Implant Dent Rel Res. 2019 Feb;21(1):208-22.
54. 54. Honigmann P, Sharma N, Okolo B, Popp U, Msallem B, Thieringer FM. Patient-Specific Surgical Implants Made of 3D Printed PEEK: Material, Technology, and Scope of Surgical Application. BioMed Research International. 2018;2018:1-8.
55. 55. Brandão TB, Vechiato Filho AJ, de Souza Batista VE, de Oliveira MCQ, Santos-Silva AR. Obturator prostheses versus free tissue transfers: A systematic review of the optimal approach to improving the quality of life for patients with maxillary defects. The Journal of Prosthetic Dentistry. 2016 Feb;115(2):247-253.e4.
56. 56. Semple CJ, Rutherford H, Killough S, Moore C, McKenna G. Long-term impact of living with an obturator following a maxillectomy: A qualitative study. Journal of Dentistry. 2019 Nov;90:103212.
57. 57. Omondi B, Guthua S, Awange D, Odhiambo W. Maxillary obturator prosthesis rehabilitation following maxillectomy for ameloblastoma: Case series of five patients. The Journal of Prosthetic Dentistry. 2005 Mar;93(3):244.
58. 58. Keyf F. Obturator prostheses for hemimaxillectomy patients. J of Oral Rehabilitation. 2001 Sep;28(9):821-9.
59. 59. Bhargav A, Sanjairaj V, Rosa V, Feng LW, Fuh YH J. Applications of additive manufacturing in dentistry: A review. J Biomed Mater Res. 2018 Jul;106(5):2058-64.
60. 60. Zhang Y, Luo J, Zhang Y, Wu J. Rehabilitation for a scleroderma patient with severe microstomia using digital and conventional methods. The Journal of the American Dental Association. 2020 Sep;151(9):684-90.
61. 61. Hiyasad AS, Darmani H. The effects of recasting on the cytotoxicity of base metal alloys. J Prosthet Dent 2005; 93:158-163.
62. 62. Costa-Palau S, Torrents-Nicolas J, Brufau-de Barberà M, Cabratosa-Termes J. Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: A clinical report. The Journal of Prosthetic Dentistry. 2014 Sep;112(3):680-2.
63. 63. Kang J, Zhang J, Zheng J, Wang L, Li D, Liu S. 3D-printed PEEK implant for mandibular defects repair - a new method. Journal of the Mechanical Behavior of Biomedical Materials. 2021 Apr;116:104335.
64. 64. Ahmed KS, Ibad H, Suchal ZA, Gosain AK. Implementation of 3D Printing and Computer-Aided Design and Manufacturing (CAD/CAM) in Craniofacial Reconstruction. Journal of Craniofacial Surgery. 2022 Sep;33(6):1714-9.
65. 65. Owusu JA, Boahene K. Update of patient-specific maxillofacial implant. Current Opinion in Otolaryngology & Head and Neck Surgery. 2015 Aug;23(4):261-4.
66. 66. Rubi̇n , J. P, AMJY. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plasti̇c And Reconstructi̇ve Surgery. 1997;1:1336-1353.
67. 67. Aydin S, Kucukyuruk B, Abuzayed B, Aydin S, Sanus GZ. Cranioplasty: Review of materials and techniques. Journal of Neurosciences in Rural Practice. 2011 Jul;02(02):162-7.
68. 68. Ridwan-Pramana A, Wolff J, Raziei A, Ashton-James CE, Forouzanfar T. Porous polyethylene implants in facial reconstruction: Outcome and complications. Journal of Cranio-Maxillofacial Surgery. 2015 Oct;43(8):1330-4.
69. 69. Punchak M, Chung LK, Lagman C, Bui TT, Lazareff J, Rezzadeh K, et al. Outcomes following polyetheretherketone (PEEK) cranioplasty: Systematic review and meta-analysis. Journal of Clinical Neuroscience. 2017 Jul;41:30-5.
70. 70. Tesavibul P, Chantaweroad S, Laohaprapanon A, Channasanon S, Uppanan P, Tanodekaew S, et al. Biocompatibility of hydroxyapatite scaffolds processed by lithography-based additive manufacturing. BME. 2015 Oct 21;26(1-2):31-8.
71. 71. Garagiola U, Grigolato R, Soldo R, Bacchini M, Bassi G, Roncucci R, et al. Computer-aided design/computer-aided manufacturing of hydroxyapatite scaffolds for bone reconstruction in jawbone atrophy: a systematic review and case report. Maxillofac Plast Reconstr Surg. 2016 Dec;38(1)
72. 72. Zhang L, Shen S, Yu H, Shen SG, Wang X. Computer-Aided Design and Computer-Aided Manufacturing Hydroxyapatite/Epoxide Acrylate Maleic Compound Construction for Craniomaxillofacial Bone Defects. Journal of Craniofacial Surgery. 2015 Jul;26(5):1477-81.
73. 73. Figliuzzi M, Mangano FG, Fortunato L, De Fazio R, Macchi A, Iezzi G, et al. Vertical Ridge Augmentation of the Atrophic Posterior Mandible With Custom-Made, Computer-Aided Design/Computer-Aided Manufacturing Porous Hydroxyapatite Scaffolds. Journal of Craniofacial Surgery. 2013 May;24(3):856-9.
74. 74. Xue AS, Koshy JC, Weathers WM, Wolfswinkel EM, Kaufman Y, Sharabi SE, et al. Local Foreign-Body Reaction to Commercial Biodegradable Implants: An in Vivo Animal Study. Craniomaxillofacial Trauma & Reconstruction. 2014 Mar;7(1):27-33.
75. 75. Alonso-Rodriguez E, Cebrián J, Nieto M, Del Castillo J, Hernández-Godoy J, Burgueño M. Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature. Journal of Cranio-Maxillofacial Surgery. 2015 Sep;43(7):1232-8.
76. 76. Gerbino G, Zavattero E, Zenga F, Bianchi FA, Garzino-Demo P, Berrone S. Primary and secondary reconstruction of complex craniofacial defects using polyetheretherketone custom-made implants. Journal of Cranio-Maxillofacial Surgery. 2015 Oct;43(8):1356-63.
77. 77. Chepurnyi Y, Chernogorskyi D, Kopchak A, Petrenko O. Clinical efficacy of peek patient-specific implants in orbital reconstruction. Journal of Oral Biology and Craniofacial Research. 2020 Apr;10(2):49-53.