Polyetheretherketone Research Articles

Enhanced osteogenesis and antibacterial activity of dual-functional PEEK implants via biomimetic polydopamine modification with chondroitin sulfate and levofloxacin

Polyetheretherketone (PEEK) implants have emerged as a clinically favored alternative to titanium alloy implants for cranial bone substitutes due to their excellent mechanical properties and biocompatibility. However, the biological inertness of PEEK has hindered its clinical application. To address this issue, we developed a dual-functional surface modification method aimed at enhancing both osteogenesis and antibacterial activity, which was achieved through the sustained release of chondroitin sulfate (CS) and levofloxacin (LVFX) from a biomimetic polydopamine (PDA) coating on the PEEK surface. CS was introduced to promote cell adhesion and osteogenic differentiation. Meanwhile, incorporation of antibiotic LVFX was essential to prevent infections, which are a critical concern in bone defect repairing. To our delight, experiment results demonstrated that the SPKD/CS-LVFX specimen exhibited enhanced hydrophilicity and sustained drug release profiles. Furthermore, in vitro experiments showed that cell growth and adhesion, cell viability, and osteogenic differentiation of mouse calvaria-derived osteoblast precursor (MC3T3-E1) cells were significantly improved on the SPKD/CS-LVFX coating. Antibacterial assays also confirmed that the SPKD/CS-LVFX specimen effectively inhibited the growth of Escherichia coli and Staphylococcus aureus, attributable to the antibiotic LVFX released from the PDA coating. To sum up, this dual-functional PEEK implant showed a promising potential for clinical application in bone defects repairing, providing excellent osteogenic and antibacterial properties through a synergistic approach.

A Stable Polymer-Blended Anion-Exchange Membrane for Enhanced Performance in Redox Flow Batteries

Redox flow batteries (RFBs) operate with a membrane, responsible for the separation of cationic active species and allowing the passage of counter-ions, to preserve electroneutrality on each side of RFBs. Commercial cation-exchange membranes (CEMs), such as Nafion®, possess excellent ionic conductivity and chemical stability. However, they face challenges in blocking cationic active species common in RFBs, leading to significant capacity loss over time. Anion-exchange membranes (AEMs) efficiently block active species with the assistance of the Donnan effect. Nevertheless, commercial AEMs lack acid stability and conductivity compared to their cationic counterparts.Polytetrafluoroethylene (PTFE)-reinforced quaternary ammonium cardo poly(ether)ketone (QPEK-C)-based membranes with Al2O3 additives (PQPAM), a heterogeneous AEM developed in our lab1, possess excellent ionic conductivity with low permeability of active species and good mechanical properties. PQPAM has demonstrated better acid stability than commercial AEMs. However, its acidic and oxidative stability require improvement, as evidenced by degradation after 250 hours of in-situ harsh RFB cycling due to the heterogeneous nature of PQPAM and the exposure of the susceptible QPEK-C-rich side to the electrolytes2. To address this issue, we propose a strategy to enhance the chemical stability of QPEK-C-based membranes by inhibiting the exposure of QPEK-C to oxidation agents through blending with a hydrophobic engineering thermoplastic like polybenzimidazole (PBI)3,4. Furthermore, PBI's known ability to protonate in acidic media will reinforce ionic conductivity and the separation of active species, thus improving the Donnan effect, in addition to enhancing chemical and mechanical stability.Elemental analyses and microscopy images confirm a homogeneous blending of PBI and QPEK-C, promising stability improvement. The results of ex-situ tests on ionic conductivity, cation permeability, and chemical stability align with the mentioned hypotheses, showcasing that blend of PBI/QPEK-C outperforms pure PBI and QPEK-C AEMs. Additionally, the mechanical properties of the PBI/QPEK-C blended AEMs are improved compared to pure QPEK-C AEMs and PBI/QPEK-C blended AEMs outperform pure PBI and QPEK-C AEMs in in-situ cycling tests with our patented titanium-cerium RFBs5. Moreover, this work will explore other strategies to improve the blended AEM properties, such as utilizing inorganic fillers or PTFE reinforcement.

Can mechanical heart valves perform similarly to tissue valves? An in vitro study

Current surgical aortic valve (AV) replacement options include bioprosthetic and mechanical heart valves (MHVs), each with inherent limitations. Bioprosthetic valves offer superior hemodynamics but suffer from durability issues, typically initiating deterioration within 7–8 years. MHVs, while durable, necessitate lifelong anticoagulation therapy, presenting risks such as severe bleeding and thromboembolic events. The need for anticoagulants is caused by non-physiological flow through the hinge area during the closed phase and large spikes of regional backflow velocity (RBV) during the closing phase that produces high shear events. This study introduces the iValve, a novel MHV designed to combine the hemodynamic benefits of bioprosthetic valves with the durability of MHVs without requiring anticoagulation. The iValve features eye-like leaflets, a saddle-shaped housing, and an optimized hinge design to enhance blood flow and minimize thrombotic risk. Fabricated using 6061-T6 aluminum and polyether ether ketone (PEEK), twelve iValve iterations were evaluated for their opening and closing dynamics. The reported top-performing prototypes demonstrated competitive performance against industry standards. The proposed iValve prototype exhibited a mean RBV of −4.34 m/s with no spikes in RBV, performing similarly to bioprosthetic valves and significantly outperforming existing MHVs. The iValve’s optimized design showed a 7–10% reduction in closing time and a substantial decrease in RBV spikes, potentially reducing the need for anticoagulation therapy. This study highlights the iValve’s potential to revolutionize prosthetic heart valve technology by offering a durable, hemodynamically superior solution that mitigates the drawbacks of current MHVs.

Morphology analysis of PEEK 450G using scanning electron microscopy directly on fast scanning calorimetry chips

To explore the morphology of polyetheretherketone (PEEK), this study employed fast scanning calorimetry (FSC) and scanning electron microscopy (SEM). The objective was to observe the PEEK microstructure under various thermal profiles replicating the additive manufacturing material extrusion process. Samples were observed using SEM directly from the FSC chips, allowing high-accuracy evaluation of the microstructure relative to the thermal profiles. This approach allowed for the evaluation of the microstructure with high accuracy concerning the thermal profiles to which the samples were previously exposed. Each sample was coated with a 10 nm layer of gold–palladium (20–80% ratio), and no etching was necessary to observe the micro features of the microstructure. The approach enabled successful observation and quantification of PEEK microstructure, linking substrate temperature and temperature peaks to microstructural outcomes. Notably, temperature peaks during the process enhanced the formation of well-developed, thick lamellae due to increased chain mobility. Additionally, embryos formed post-remelting of the substrate structure were observed.

Additive manufacturing and mechanical performance of short fiber reinforced PEEK (polyether ether ketone) thermoplastic composites in a vacuum environment

Short fiber reinforced thermoplastic composites (SFRTC) have gained popularity in the material extrusion (MEX) method, which is an additive manufacturing (AM) technology, allowing for the simpler and more cost-effective production of polymer composites. However, parts produced using MEX 3D printing technology often exhibit poor mechanical properties and surface quality compared to products manufactured using injection molding, which is one of the main disadvantages of this method. Various methods are used to overcome these challenges, such as production in a vacuum environment, heat-based processes, ultrasonic vibrations, and others. The objective of this study was to achieve parts with lower porosity and improved mechanical properties when printed in a vacuum environment compared to an atmospheric environment. Additionally, an investigation into the optimization of printing parameters was conducted to determine the parameters that yield the highest mechanical properties. For this purpose, SFRTC parts were printed at different vacuum levels (0.5, 10, 100 mbar), and they were subjected to flexural tests to determine their mechanical properties. The results showed that the flexural stress and elastic modulus of the samples produced in a 0.5 mbar vacuum environment increased by 79.75% and 39.41%, respectively, compared to samples produced in an atmospheric environment. Furthermore, the cross-sectional images of the samples were examined using an optical microscope, revealing the lowest porosity in the samples printed in 0.5 mbar vacuum environment.

Polyetheretherketone split post and core for restoration of multirooted molar with insufficient dental tissue remnants by digital techniques: a case report and 3-year follow up

BackgroundMulti-rooted teeth with extensive dental defects often face challenges in stability and biomechanical failure. High-performance polymer PEEK materials, with properties closer to dentin, show promise in reducing stress concentration and preserving tooth structure. This report aimed to explore the use of a highly retentive polyetheretherketone (PEEK) for manufacturing custom-made split post and core for the restoration of grossly destroyed endodontically treated molars.Clinical considerationsA 40-year-old female patient presented with complaints of loss of tooth substance in the posterior mandibular tooth. This case involved the digital design and fabrication of PEEK split post and core to restore multirooted molar with insufficient dental tissue remnants. The restorations were evaluated over a 3-year follow-up using the World Federation criteria (FDI). The restoration was clinically evaluated through intraoral examination, radiographic assessment, and subjective patient satisfaction, and was deemed clinically good according to FDI criteria.ConclusionThe outstanding mechanical properties of PEEK, coupled with the structure of the split post, provide an effective treatment option for weakened multirooted teeth. Simultaneously, the restoration configuration effectively addressed the challenge of varying postinsertion directions, and the interlocking mechanism between the primary and auxiliary posts enhanced the stability of the post and core.

Study on ultra-precision diamond cutting of polymers: Factors affecting dimensional accuracy and material removal mechanism

Polymers with surface microstructure have promising prospects for applications in the domains of aerospace, integrated circuits, and optical engineering. Ultra-precision cutting has unique advantages in the preparation of microstructure with high precision and complex shape. However, the inherent characteristics of polymers such as high elasticity, strong toughness, and poor thermal conductivity bring ultra-precision cutting a great challenge. In this study, the rectangular groove microstructures on polymers were fabricated by ultra-precision diamond cutting, and the influence of matrix material, feedrate and cutting depth on cutting performance and dimensional accuracy was quantitatively evaluated. The results indicate that the polyimide (PI) exhibits a good machinability compared with polyetheretherketone (PEEK) and polytetrafluoroethylene (PTFE). In addition, the feedrate have a negligible influence on the morphologies and dimensional accuracy of groove structure, while the groove width decreases and the ridge width increases as the cutting depth increases from 10 μm to 100 μm. The groove structure has the best dimensional accuracy when the cutting depth is 10 μm. Furthermore, the material removal mechanism of PI was discussed detailedly based on the results of numerical simulation and experiment.

Developing PEEK composites with exceptional thermal conductivity and electromagnetic shielding properties by constructing a dense dual-continuous filler network

Polyether ether ketone (PEEK) has regular and rigid molecular chain and is insoluble in most organic solvents. Therefore, it is challenging to use PEEK matrix composites for thermal conductivity (TC) and electromagnetic interference (EMI) shielding applications. Herein, PEEK composites with hybrid fillers were fabricated by solution blending and non-solvent-induced phase separation (NIPS) methods based on a chemical conversion reaction between soluble precursor PEEK-dithiolane and PEEK. Synergistic interaction between hybrid fillers (graphene nanosheets and multiwalled carbon nanotubes) improves the thermal and electrical conductivity of the composites. The effect of the hot-pressing pressure on the conductive/thermal network densification was investigated. The composites performed optimally at a hot pressure of 200 MPa and a filler content of 20.08 vol%. The maximum in-plane and out-of-plane TC reached 10.46 W·m–1·K–1 and 4.8 W·m–1·K–1, respectively, which were 4619 % and 2414 % higher than the corresponding TC of PEEK. Simultaneously, the optimised composite demonstrated significantly improved electrical conductivity (3517 S/m) and EMI shielding effectiveness (66.1 dB). These excellent characteristics are attributed to the solution blending–NIPS method, which improves the dispersion of hybrid fillers in the matrix and forms an internal and external dual-continuous thermal conductive network. The dual-continuous network creates effective channels for phonon and electron transport and enhances EM wave loss. This work provides inspiration for the preparation of PEEK composites as advanced EMI protection and thermal management materials.

Electromechanical coupling in polyetheretherketone through flexoelectricity

The electrical signals generated by an electromechanical coupling mechanism in biomaterials have significant potential applications in the field of biomedical engineering. For example, the piezoelectric- or flexoelectric-induced electrical signals in bone biomaterials play an important role in facilitating self-repair, remodeling, and reshaping processes. Polyetheretherketone (PEEK) has been found to possess excellent mechanical properties and biocompatibility with bone, making it an outstanding choice as an implantable polymer material. It is particularly important to investigate the electromechanical response performance of PEEK materials. In this study, we experimentally examine the flexoelectricity of PEEK and evaluate its effective out-of-plane direct and converse flexoelectric coefficients. Using the piezoresponse force microscopy module of atomic force microscopy, we observe a clear converse flexoelectric effect in a PEEK disk-shaped sample. The effective out-of-plane converse flexoelectric coefficient of the PEEK disk-shaped sample is about μ3333eff=0.21 ± 0.02 nN/V. The effective out-of-plane direct flexoelectric coefficient, determined through the bending experiment of a PEEK cantilever, is f3113eff = 17.61 nC/m, which is larger than that of polyvinylidene fluoride and is nearly two orders of magnitude superior over other biomaterials such as bone and hydroxyapatite. This indicates that PEEK materials have even greater potential for development and research in biomedical engineering applications such as intervertebral fusion, bone joint replacement, bone rehabilitation and regeneration, etc.

Three-Dimensional Finite Element Analysis of Stress Distribution in Dental Implant Prosthesis and Surrounding Bone Using PEEK Abutments.

(1) Background: Polyetheretherketone (PEEK) has been used as an alternative to titanium in implant prosthetic systems, but its impact on stress distribution in implant systems needs to be investigated. This study aimed to compare the effect of polyetheretherketone (PEEK) and titanium abutments on implant prosthetic systems and the supporting bone using three-dimensional finite element analysis (FEA). (2) Methods: Three-dimensional finite element analysis was conducted using CATIA V5 and Abaqus V6.12 software to model mandibular first-molar implant systems with titanium and PEEK abutments. Under external loading conditions, finite element analysis was conducted for the stresses in the implant components and surrounding bones of each group. (3) Results: The implant fixture of the PEEK model exhibited the highest von Mises stress (VMS). The lowest VMS was observed in the abutment screw of the titanium model. Both implant systems demonstrated similar stress distributions and magnitudes in cortical and cancellous bones. (4) Conclusion: PEEK abutments show a similar stress distribution in the surrounding bone compared to titanium. However, PEEK absorbs the stresses within the implant system and exhibits the highest VMS values due to its low mechanical and physical properties. Therefore, PEEK abutments need improved mechanical properties for better clinical application.

3D-printed porous polyether-ether-ketone composite scaffolds for better osteogenic activity

Due to excellent biocompatibility and favorable mechanical properties, polyether-ether-ketone (PEEK) scaffolds are becoming the next-generational orthopaedic implants, but the bioinertness limits their application. In this study, to improve the osteogenic activity of PEEK scaffolds, porous composite scaffolds containing PEEK and biphasic calcium phosphate (BCP) were achieved by 3D printing, which exhibited equilateral triangular profile with the porosity of 69.4 ± 6.3 % and elastic modulus of 186.2 ± 10.9 MPa. The EDS mapping images and XPS spectra indicated increased P and Ca elements in PEEK-BCP scaffolds. The results of in vitro and in vivo evaluations demonstrated that the introduction of BCP significantly increased the osteogenic capacity of PEEK scaffolds and the obvious bone ingrowth could be observed. In conclusion, compared with pure PEEK scaffolds, PEEK-BCP scaffolds with better osteogenic activity are more promising in the orthopaedic and craniofacial field.

Thermo-oxidative crosslinking of carbon fiber reinforced PEEK (Polyetheretherketone) for additive manufactured ceramic matrix composites

Carbon fiber reinforced polyetheretherketone (CF-PEEK) samples were fabricated using material extrusion. These additive manufactured green bodies are later processed to their final application as ceramic matrix composites (CMC) by the liquid silicon infiltration (LSI) route. Past studies showed that the application of material extrusion for the fabrication of CMC requires an additional stabilization-step after 3D-printing in order to prevent the remelting of CF-PEEK during the high temperature process of pyrolysis. The thermally induced crosslinking of the CF-PEEK parts ensured shape accuracy and avoided remelting during the pyrolysis afterwards but is limited by the melting temperature of PEEK (T m ∼ 343 °C). The study revealed a correlation between the annealing conditions time and temperature and the degree of crosslinking. Based on the analytical results from differential scanning calorimetry (DSC), a kinetic model was calculated, allowing predictions in dependence of the annealing temperature and time. Rheological and shape stability investigations of thermally annealed specimens verified the analytic results. The main findings of the study highlight an increasing degree of crosslinking with increasing annealing temperature and time.

Increasing the toughness while reducing the viscosity of carbon nano-tube/polyether imide/polyether ether ketone nanocomposites

Polyether ether ketone (PEEK) has good mechanical properties. However, its high viscosity when molten limits its use because it is hard to process. PEEK nanocomposites containing both carbon nanotubes (CNTs) and polyether imide (PEI) were prepared by a direct wet powder blending method using a vertical injection molding machine. The addition of an optimum amount of PEI lowered the viscosity of the molten PEEK by approximately 50% while producing an increase in the toughness of the nanocomposites, whose strain to failure increased by 129%, and fracture energy increased by 97%. The uniformly dispersed CNT/PEI powder reduced the processing difficulty of PEEK nanocomposites without affecting the thermal resistance. This improvement of the strength and viscosity of PEEK facilitate its use in the preparation of thermoplastic composites.

Polyetherketoneketone/carbon fiber composites with an amorphous interface prepared by solution impregnation

Interfacial adhesion between carbon fibers (CF) and polyetherketoneketone (PEKK) is a key factor that affects the mechanical performances of their composites. It is therefore of great importance to impregnate the CF bundles with PEKK as efficiently as possible. We report that PEKK with a good dispersion in a mixed solution of 4-chlorophenol and 1,2-dichloroethane can be introduced onto CF surfaces by solution impregnation and curing at 280, 320, 340 and 360 °C. The excellent wettability or infiltration of the PEKK solution guarantees a full covering and its tight binding to CFs, making it possible to evaluate the interfacial shear strength (IFSS) with the microdroplet method. The interior of the CF bundles is completely and uniformly filled with PEKK by solution impregnation, leading to a high interlaminar shear strength (ILSS). The maximum IFSS and ILSS reached 107.8 and 99.3 MPa, respectively. Such superior shear properties are ascribed to the formation of amorphous PEKK in the small spaces between CFs.

Simulating the Morphological Changes of Facial Deformities after Using 3D-printed Polyether Ether Ketone Facial Implants.

Patient-specific implants (PSIs) have been presented as an effective solution for diseases that require reconstruction. PSIs are designed to precisely fit anatomical defects or deformities in terms of shape and size. In addition to the possibility of predicting the results of surgery regarding soft tissue changes. A research sample consisting of 10 patients with facial deformities underwent maxillofacial reconstructive surgery between 2020 and 2021 in the Tishreen University Hospital, Syria. All patients underwent computed tomography scans; then, the design of the required facial implant was carried out, and the three-dimensional soft tissues were reconstructed using the ExoCad 3.0 program based on the computed tomography. The final form of the facial implant was printed from polyether ether ketone, and then surgical work was performed. The patients were followed up after 6 months. Then, a comparison was made between the virtual design and the real result. The absolute difference between the expected soft tissue changes result and the actual result did not exceed three-tenths for all patients, and only two of 10 patients had measurements higher than 20%. This technique can be relied upon with the placement of implants to predict the outcome of the surgical procedure in terms of morphological changes in the facial soft tissues covering PSI polyether ether ketone. Therefore, it is possible to make a virtual design based on the cosmetic requirements of the patient.

Study of structural, surface energies, and tribomechanical properties of thermoplastics irradiated by electron beam

This study investigates the effects of electron irradiation on the structural, surface energy, and tribomechanical properties of two key thermoplastics: polyetheretherketone (PEEK) and polytetrafluoroethylene (PTFE). The experimental methods included electron beam irradiation using the ILU-10 pulsed linear accelerator, Fourier transform infrared spectroscopy (FT-IR), x-ray diffraction (XRD), microhardness testing, surface roughness assessment, tribology tests, and contact angle measurements.The FT-IR analysis revealed significant chemical changes on the surfaces of the polymers, including oxidation processes and the breaking of molecular bonds. XRD analysis showed an increase in the crystallinity of PTFE after irradiation, while the structure of PEEK remained stable. Microhardness testing indicated a notable increase in hardness for both polymers, particularly for PTFE, suggesting cross-linking of molecular chains. Surface roughness measurements demonstrated a decrease in roughness for both irradiated polymers. Tribology tests revealed that electron irradiation increased the coefficient of friction for PTFE and PEEK under various loads, which can be attributed to the alterations in their surface properties. Contact angle measurements indicated improved wettability of the irradiated surfaces, especially for PEEK, due to the formation of new functional groups. The total surface energy increased for both polymers post-irradiation, as determined using the Owens-Wendt-Rabel-Kaeble method. Electron irradiation leads to significant modifications in the surface and bulk properties of PEEK and PTFE, enhancing their tribomechanical and adhesive properties. These changes open new opportunities for the application of these materials in various engineering fields where specific performance characteristics are required.

Black Phosphorus and E7-Functionalized Sulfonated Polyetheretherketone with Effective Osteogenicity and Antibacterial Activity

Given its excellent biological properties and the matching of its elastic modulus with that of human bone tissue, medical polyetheretherketone (PEEK) is considered a desirable candidate for bone-implant materials. However, its poor osseointegrative and antibacterial properties greatly limit its clinical application. To address these concerns, a functional PEEK implant is needed. Herein, a novel photo-responsive multifunctional PEEK-based implant material (sPEEK/BP/E7) with both effective osteogenesis and good disinfection properties was constructed via the self-assembly of black phosphorus (BP) nanosheets, mussel-inspired polydopamine (PDA), and bioactive short peptide E7 on sulfonated PEEK (sPEEK). The versatile micro-/nano-structured PEEK surface provides superior hydrophilicity, a favorable osteogenic microenvironment, and excellent photothermal effects under near-infrared (NIR) irradiation. The in vitro results showed that sPEEK/BP/E7 displays enhanced cytocompatibility and osteogenicity in terms of cell adhesion, proliferation, alkaline phosphatase (ALP) activity, matrix mineralization, and osteogenesis-related gene expression, superior to those of the sPEEK and sPEEK/BP samples. In addition to osteogenesis, the multifunctional coating exhibited strong antibacterial activity against both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). Furthermore, it was confirmed in a rat femoral infection model that sPEEK/BP/E7 effectively resisted infection caused by S. aureus under NIR light irradiation and promoted osseointegration in vivo. Thus, this work presents a facile strategy to realize improvement of the “functional integration” of new polymer bone-implant materials and provide new ideas for their clinical application.

Obtaining excellent mechanical properties with additively manufactured short fiber reinforced polyether-ether-ketone thermoplastics through simultaneous vacuum and infrared heating

Additive manufacturing of short fiber reinforced thermoplastic composite with high-performance engineering thermoplastics is important in various industrial sectors because of their ability to manufacture complex and lightweight products. Although extensive studies in the literature are aimed at enhancing the mechanical performance of additively manufactured short fiber reinforced thermoplastics through methods like refining printing parameters, enhancing fiber fractions, and optimizing printing parameters, their mechanical performance remains limited. In this study, the individual effects of vacuum-assisted printing and infrared pre-heater-assisted printing and their combined effects were investigated to substantially increase the mechanical properties, interlaminar performance, and crystallinity ratios. The polyether ether ketone (PEEK) samples were printed with vacuum-assisted, infrared-assisted, and a combination of vacuum and infrared-assisted environments were subjected to three-point bending tests to evaluate their mechanical properties. Synergistic vacuum and infrared-assisted printing significantly enhanced the mechanical properties as the flexural strength increased by 54.58 % compared to printing under vacuum alone. Moreover, the flexural strength and elasticity modulus of samples printed with vacuum-infrared-assisted manufacturing increased by 324.48 % and 239.77 %, respectively, when compared to printing under atmospheric pressure without additional heating. Thermal and structural characterizations of the printed parts revealed that this significant improvement was attributed to reduced porosity ratios and increased crystallinity.

Effect of Different Screw Materials on ACL Reconstruction With the Tape Locking Screw Technique: A Retrospective Study From the FAST Cohort.

Screws for graft fixation are available in 3 different materials for anterior cruciate ligament reconstruction (ACLR) with the Tape Locking Screw (TLS) technique: titanium, poly-l-lactic acid bioabsorbable, and polyetheretherketone (PEEK). To compare the effect of the 3 different fixation materials on graft and implant survival after ACLR with the TLS technique. Cohort study; Level of evidence, 3. Included were 521 patients from the French Prospective ACL Study (FAST) cohort who underwent primary surgical ACLR with the TLS technique. Patients were divided into 3 groups depending on the type of screw material used: titanium (TLS-T group), poly-l-lactic acid bioabsorbable (TLS-B group), or PEEK (TLS-P group). The primary endpoint was a retear within 2 years after ACLR. The secondary endpoints were complication rate, return to sports rate, and functional scores. Objective and subjective functional scores-including the International Knee Documentation Committee, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm score-were evaluated preoperatively and at the 2-year follow-up. Pain was assessed with the KOOS-Pain subscore recorded pre- and postoperatively every 6 months up to 2 years. Patient satisfaction was recorded at the 2-year follow-up. No significant differences between the study groups were found in retear rates (4.4%, 4.5%, and 4.3% in the TLS-T, TLS-P, and TLS-B groups 2 years after surgery) or subjective and objective outcomes. The TLS-T group had the lowest rate of intraoperative implant-related complications (0.9%) compared with the TLS-P (4.3%) and TLS-B (7.7%) groups. Young age was a significant risk factor for retear in the TLS-T (P = .03) and TLS-B (P = .0001) groups, while a high level of sports was found to be a significant risk factor in the TLS-P (P = .04) group. All functional scores improved significantly at the 2-year follow-up (P < .0001), with no significant group difference. The KOOS-Pain subscore improved continuously with no significant group difference. The rate of return to preinjury sports was between 43.4% and 58.6%. The rate of highly satisfied patients at the final follow-up was between 86.2% and 91.8%. There was no difference in retear rate or objective and subjective functional scores between implant materials for TLS ACLR in this study.

The Effects of using PEEK Coping and Different Restorative Materials on the Stress Distribution in Tooth and Implant- supported Prostheses under Static Loading: 3D FEA.

This study was designed to evaluate the influence of utilizing Polyetheretherketone (PEEK) coping and three different dental restorative materials in the success of tooth and implant-supported fixed partial dentures (TISFPD) in the maxillary posterior region, under static loading by 3-Dimensional Finite Element Analysis (3D FEA). Six 3D FEA models were designed assuming the extraction of maxillary first and second molars. Bone, implant, abutment, PEEK coping, second premolar, periodontal ligament (PDL) and six 3-unit TISFPD with different restorative materials [Porcelain-Fused-to-Metal (PFM), PEEK-Composite (PC), Monolithic Zirconia (MZ)] were modeled. Then, PEEK copings were modeled to be cemented onto the implants as a double-crown system for the first three groups (PFMPEEK, PCPEEK and MZPEEK) whereas, the next three groups (PFM, PC, MZ) excluded a PEEK coping in their designs. The prostheses were loaded twice, vertically and obliquely. From the determined points, 250 N for vertical loading (0o to the long axis) and 200 N for the oblique loading (30o to the long axis) were applied. Von Mises tension, maximum and minimum principal tension value criterias were analyzed. Regardless of the material used for suprastructure, the maximum average stress was reduced by using PEEK coping. Considering the maximum stress distribution, PC appeared to have the highest stresses on the cortical bone, implant and screw. Additionally, the von Mises stresses formed in the PDL for each model were lower when PEEK coping was included in the design of the TISFPD, reducing the risk of intrusion. The stress distribution was positively affected by the PEEK coping in TISFPD design, reducing bone resorption and failure. This elastic material used generated lower stresses in the bone and implant, while no significant effect was found on stresses around natural teeth.