Research progress on enhancing osseointegration properties of polyetheretherketone implants through various modification methods_Journal of Biomedical Engineering

Authors：

LIU Shilai ^1,2 , FENG Xiaoke ^1,2 ,  CHEN Chunxia ^1,2

1. Department of Prosthodontics, Tianjin Stomatological Hospital, School of Medicine, Nankai University, Tianjin 300041, P. R. China;
2. Tianjin Key Laboratory of Oral and maxillofacial Function Reconstruction, Tianjin 300041, P. R. China;

Corresponding author：

Keywords：

Polyetheretherketone; Implants; Osseointegration

DOI：

10.7507/1001-5515.202408033

Video：

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[Abstract] This review article summarizes the current modification methods employed to enhance the osseointegration properties of polyetheretherketone (PEEK), a novel biomaterial. Our analysis highlights that strategies such as surface treatment, surface modification, and the incorporation of bioactive composites can markedly improve the bioactivity of PEEK surfaces, thus facilitating their effective integration with bone tissue. However, to ensure widespread application of PEEK in the medical field, particularly in oral implantology, additional experiments and long-term clinical evaluations are required. Looking ahead, future research should concentrate on developing innovative modification techniques and assessment methodologies to further optimize the performance of PEEK implant materials. The ultimate goal is to provide the clinical setting with even more reliable solutions.

1.	Yu D, Lei X, Zhu H. Modification of polyetheretherketone (PEEK) physical features to improve osteointegration. Journal of Zhejiang University-Science B, 2022, 23(3): 189-203.
2.	Batak B, Çakmak G, Johnston W M, et al. Surface roughness of high-performance polymers used for fixed implant-supported prostheses. Journal of Prosthetic Dentistry, 2021, 126(2): 254.
3.	Zhang X, Hu Y, Chen K, et al. Bio-tribological behavior of articular cartilage based on biological morphology. Journal of Materials Science Materials in Medicine, 2021, 32(11): 132.
4.	Sulaya K, Guttal S S. Clinical evaluation of performance of single unit polyetheretherketone crown restoration-a pilot study. The Journal of Indian Prosthodontic Society, 2020, 20(1): 38-44.
5.	Tasopoulos T, Chatziemmanouil D, Kouveliotis G, et al. PEEK maxillary obturator prosthesis fabrication using intraoral scanning, 3D printing, and CAD/CAM. The International Journal of Prosthodontics, 2020, 33(3): 333-340.
6.	Liu Y, Fang M, Zhao R, et al. Clinical applications of polyetheretherketone in removable dental prostheses: accuracy, characteristics, and performance. Polymers, 2022, 14(21): 4615.
7.	满毅, 于海洋, 王佐林, 等. 种植修复临床评价标准. 华西口腔医学杂志, 2019, 37(1): 1-6.
8.	Arabbeiki M, Niroomand M R, Rouhi G. Improving dental implant stability by optimizing thread design: Simultaneous application of finite element method and data mining approach. The Journal of Prosthetic Dentistry, 2023, 130(4): 602.
9.	Qin L, Yao S, Zhao J, et al. Review on development and dental applications of polyetheretherketone-based biomaterials and restorations. Materials, 2021, 14(2): 408.
10.	Rahmitasari F, Ishida Y, Kurahashi K, et al. PEEK with reinforced materials and modifications for dental implant applications. Dentistry Journal, 2017, 5(4): 35.
11.	Oladapo B I, Zahedi S A, Ismail S O, et al. 3D printing of PEEK–cHAp scaffold for medical bone implant. Bio-Design and Manufacturing, 2021, 4(1): 44-59.
12.	Peng T Y, Shih Y H, Hsia S M, et al. In vitro assessment of the cell metabolic activity, cytotoxicity, cell attachment, and inflammatory reaction of human oral fibroblasts on polyetheretherketone (PEEK) implant-abutment. Polymers, 2021, 13(17): 2995.
13.	Kurtz S M, Devine J N. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials, 2007, 28(32): 4845-4869.
14.	Hunt H B, Donnelly E. Bone quality assessment techniques: geometric, compositional, and mechanical characterization from macroscale to nanoscale. Clinical Reviews in Bone and Mineral Metabolism, 2016, 14(3): 133-149.
15.	Hernandez J L, Park J, Yao S, et al. Effect of tissue microenvironment on fibrous capsule formation to biomaterial-coated implants. Biomaterials, 2021, 273: 120806.
16.	Torstrick F B, Lin A S P, Potter D, et al. Porous PEEK improves the bone-implant interface compared to plasma-sprayed titanium coating on PEEK. Biomaterials, 2018, 185: 106-116.
17.	Khoury J, Selezneva I, Pestov S, et al. Surface bioactivation of PEEK by neutral atom beam technology. Bioactive Materials, 2019, 4: 132-141.
18.	Converse G L, Conrad T L, Roeder R K. Mechanical properties of hydroxyapatite whisker reinforced polyetherketoneketone composite scaffolds. Journal of the Mechanical Behavior of Biomedical Materials, 2009, 2(6): 627-635.
19.	Kligman S, Ren Z, Chung C H, et al. The impact of dental implant surface modifications on osseointegration and biofilm formation. Journal of Clinical Medicine, 2021, 10(8): 1641.
20.	Li Y, Wang J, He D, et al. Surface sulfonation and nitrification enhance the biological activity and osteogenesis of polyetheretherketone by forming an irregular nano-porous monolayer. J Mater Sci Mater Med, 2020, 31(1): 11.
21.	Wan T, Jiao Z, Guo M, et al. Gaseous sulfur trioxide induced controllable sulfonation promoting biomineralization and osseointegration of polyetheretherketone implants. Bioactive Materials, 2020, 5(4): 1004-1017.
22.	Mahjoubi H, Buck E, Manimunda P, et al. Surface phosphonation enhances hydroxyapatite coating adhesion on polyetheretherketone and its osseointegration potential. Acta Biomater, 2017, 47: 149-158.
23.	Durham J W, Montelongo S A, Ong J L, et al. Hydroxyapatite coating on PEEK implants: biomechanical and histological study in a rabbit model. Materials Science and Engineering: C, 2016, 68: 723-731.
24.	Baştan F E, Atiq Ur Rehman M, Avcu Y Y, et al. Electrophoretic co-deposition of PEEK-hydroxyapatite composite coatings for biomedical applications. Colloids and Surfaces B: Biointerfaces, 2018, 169: 176-182.
25.	Makino T, Kaito T, Sakai Y, et al. Computed tomography color mapping for evaluation of bone ongrowth on the surface of a titanium-coated polyetheretherketone cage in vivo: A pilot study. Medicine, 2018, 97(37): e12379.
26.	Xian P, Chen Y, Gao S, et al. Polydopamine (PDA) mediated nanogranular-structured titanium dioxide (TiO2) coating on polyetheretherketone (PEEK) for oral and maxillofacial implants application. Surface and Coatings Technology, 2020, 401: 126282.
27.	Zhang Y, Wu H, Yuan B, et al. Enhanced osteogenic activity and antibacterial performance in vitro of polyetheretherketone by plasma-induced graft polymerization of acrylic acid and incorporation of zinc ions. Journal of Materials Chemistry B, 2021, 9(36): 7506-7515.
28.	Zheng X, Luo H, Li J, et al. Zinc-doped bioactive glass-functionalized polyetheretherketone to enhance the biological response in bone regeneration. Journal of Biomedical Materials Research Part A, 2024, 112(9): 1565-1577.
29.	Chai H, Wang W, Yuan X, et al. Bio-activated PEEK: promising platforms for improving osteogenesis through modulating macrophage polarization. Bioengineering, 2022, 9(12): 747.
30.	Ren Y, Sikder P, Lin B, et al. Microwave assisted coating of bioactive amorphous magnesium phosphate (AMP) on polyetheretherketone (PEEK). Materials Science and Engineering: C, 2018, 85: 107-113.
31.	Yu X, Ibrahim M, Liu Z, et al. Biofunctional Mg coating on PEEK for improving bioactivity. Bioactive Materials, 2018, 3(2): 139-143.
32.	Ji Y, Yu X, Zhu H. Fabrication of Mg coating on PEEK and antibacterial evaluation for bone application. Coatings, 2021, 11(8): 1010.
33.	Wei X, Zhou W, Tang Z, et al. Magnesium surface-activated 3D printed porous PEEK scaffolds for in vivo osseointegration by promoting angiogenesis and osteogenesis. Bioactive Materials, 2022, 20: 16-28.
34.	Major L, Lackner J M, Kot M, et al. Correlative microscopic characterization of biomechanical and biomimetic advanced CVD coatings on a PEEK substrate. Progress in Organic Coatings, 2019, 134: 244-254.
35.	Wang C H, Guo Z S, Pang F, et al. Effects of graphene modification on the bioactivation of polyethylene-terephthalate-based artificial ligaments. ACS Applied Materials Interfaces, 2015, 7(28): 15263-15276.
36.	Ouyang L, Deng Y, Yang L, et al. Graphene-oxide-decorated microporous polyetheretherketone with superior antibacterial capability and in vitro osteogenesis for orthopedic implant. Macromolecular Bioscience, 2018, 18(6): e1800036.
37.	Wang H, Lin C, Zhang X, et al. Mussel-inspired polydopamine coating: a general strategy to enhance osteogenic differentiation and osseointegration for diverse implants. ACS Applied Materials & Interfaces, 2019, 11(7): 7615-7625.
38.	Zhu Y, Cao Z, Peng Y, et al. Facile surface modification method for synergistically enhancing the biocompatibility and bioactivity of poly(ether ether ketone) that induced osteodifferentiation. ACS Applied Materials & Interfaces, 2019, 11(31): 27503-27511.
39.	Yang X, Xiong S, Zhou J, et al. Coating of manganese functional polyetheretherketone implants for osseous interface integration. Frontiers in Bioengineering and Biotechnology, 2023, 11: 1182187.
40.	Wang X, Nakamoto T, Dulińska-Molak I, et al. Regulating the stemness of mesenchymal stem cells by tuning micropattern features. Journal of Materials Chemistry B, 2016, 4(1): 37-45.
41.	Senatov F, Maksimkin A, Chubrik A, et al. Osseointegration evaluation of UHMWPE and PEEK-based scaffolds with BMP-2 using model of critical-size cranial defect in mice and push-out test. Journal of the Mechanical Behavior of Biomedical Materials, 2021, 119: 104477.
42.	Zhang Y, Hao L, Savalani M M, et al. In vitro biocompatibility of hydroxyapatite-reinforced polymeric composites manufactured by selective laser sintering. Journal of Biomedical Materials Research Part A, 2009, 91(4): 1018-1027.
43.	Ma R, Weng L, Bao X, et al. In vivo biocompatibility and bioactivity of in situ synthesized hydroxyapatite/polyetheretherketone composite materials. Journal of Applied Polymer Science, 2013, 127(4): 2581-2587.
44.	Wang L, Huang F J, Wu Z Z, et al. Cytocompatibility of nano-hydroxyapatite/polyetheretherketone composite materials with Sprague Dawley rat osteoblasts. Materials Technology, 2016, 31(sup1): 28-32.
45.	Swaminathan P D, Uddin M N, Wooley P, et al. Fabrication and biological analysis of highly porous PEEK bionanocomposites incorporated with carbon and hydroxyapatite nanoparticles for biological applications. Molecules, 2020, 25(16): 3572.

1. Yu D, Lei X, Zhu H. Modification of polyetheretherketone (PEEK) physical features to improve osteointegration. Journal of Zhejiang University-Science B, 2022, 23(3): 189-203.
2. Batak B, Çakmak G, Johnston W M, et al. Surface roughness of high-performance polymers used for fixed implant-supported prostheses. Journal of Prosthetic Dentistry, 2021, 126(2): 254.
3. Zhang X, Hu Y, Chen K, et al. Bio-tribological behavior of articular cartilage based on biological morphology. Journal of Materials Science Materials in Medicine, 2021, 32(11): 132.
4. Sulaya K, Guttal S S. Clinical evaluation of performance of single unit polyetheretherketone crown restoration-a pilot study. The Journal of Indian Prosthodontic Society, 2020, 20(1): 38-44.
5. Tasopoulos T, Chatziemmanouil D, Kouveliotis G, et al. PEEK maxillary obturator prosthesis fabrication using intraoral scanning, 3D printing, and CAD/CAM. The International Journal of Prosthodontics, 2020, 33(3): 333-340.
6. Liu Y, Fang M, Zhao R, et al. Clinical applications of polyetheretherketone in removable dental prostheses: accuracy, characteristics, and performance. Polymers, 2022, 14(21): 4615.
7. 满毅, 于海洋, 王佐林, 等. 种植修复临床评价标准. 华西口腔医学杂志, 2019, 37(1): 1-6.
8. Arabbeiki M, Niroomand M R, Rouhi G. Improving dental implant stability by optimizing thread design: Simultaneous application of finite element method and data mining approach. The Journal of Prosthetic Dentistry, 2023, 130(4): 602.
9. Qin L, Yao S, Zhao J, et al. Review on development and dental applications of polyetheretherketone-based biomaterials and restorations. Materials, 2021, 14(2): 408.
10. Rahmitasari F, Ishida Y, Kurahashi K, et al. PEEK with reinforced materials and modifications for dental implant applications. Dentistry Journal, 2017, 5(4): 35.
11. Oladapo B I, Zahedi S A, Ismail S O, et al. 3D printing of PEEK–cHAp scaffold for medical bone implant. Bio-Design and Manufacturing, 2021, 4(1): 44-59.
12. Peng T Y, Shih Y H, Hsia S M, et al. In vitro assessment of the cell metabolic activity, cytotoxicity, cell attachment, and inflammatory reaction of human oral fibroblasts on polyetheretherketone (PEEK) implant-abutment. Polymers, 2021, 13(17): 2995.
13. Kurtz S M, Devine J N. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials, 2007, 28(32): 4845-4869.
14. Hunt H B, Donnelly E. Bone quality assessment techniques: geometric, compositional, and mechanical characterization from macroscale to nanoscale. Clinical Reviews in Bone and Mineral Metabolism, 2016, 14(3): 133-149.
15. Hernandez J L, Park J, Yao S, et al. Effect of tissue microenvironment on fibrous capsule formation to biomaterial-coated implants. Biomaterials, 2021, 273: 120806.
16. Torstrick F B, Lin A S P, Potter D, et al. Porous PEEK improves the bone-implant interface compared to plasma-sprayed titanium coating on PEEK. Biomaterials, 2018, 185: 106-116.
17. Khoury J, Selezneva I, Pestov S, et al. Surface bioactivation of PEEK by neutral atom beam technology. Bioactive Materials, 2019, 4: 132-141.
18. Converse G L, Conrad T L, Roeder R K. Mechanical properties of hydroxyapatite whisker reinforced polyetherketoneketone composite scaffolds. Journal of the Mechanical Behavior of Biomedical Materials, 2009, 2(6): 627-635.
19. Kligman S, Ren Z, Chung C H, et al. The impact of dental implant surface modifications on osseointegration and biofilm formation. Journal of Clinical Medicine, 2021, 10(8): 1641.
20. Li Y, Wang J, He D, et al. Surface sulfonation and nitrification enhance the biological activity and osteogenesis of polyetheretherketone by forming an irregular nano-porous monolayer. J Mater Sci Mater Med, 2020, 31(1): 11.
21. Wan T, Jiao Z, Guo M, et al. Gaseous sulfur trioxide induced controllable sulfonation promoting biomineralization and osseointegration of polyetheretherketone implants. Bioactive Materials, 2020, 5(4): 1004-1017.
22. Mahjoubi H, Buck E, Manimunda P, et al. Surface phosphonation enhances hydroxyapatite coating adhesion on polyetheretherketone and its osseointegration potential. Acta Biomater, 2017, 47: 149-158.
23. Durham J W, Montelongo S A, Ong J L, et al. Hydroxyapatite coating on PEEK implants: biomechanical and histological study in a rabbit model. Materials Science and Engineering: C, 2016, 68: 723-731.
24. Baştan F E, Atiq Ur Rehman M, Avcu Y Y, et al. Electrophoretic co-deposition of PEEK-hydroxyapatite composite coatings for biomedical applications. Colloids and Surfaces B: Biointerfaces, 2018, 169: 176-182.
25. Makino T, Kaito T, Sakai Y, et al. Computed tomography color mapping for evaluation of bone ongrowth on the surface of a titanium-coated polyetheretherketone cage in vivo: A pilot study. Medicine, 2018, 97(37): e12379.
26. Xian P, Chen Y, Gao S, et al. Polydopamine (PDA) mediated nanogranular-structured titanium dioxide (TiO2) coating on polyetheretherketone (PEEK) for oral and maxillofacial implants application. Surface and Coatings Technology, 2020, 401: 126282.
27. Zhang Y, Wu H, Yuan B, et al. Enhanced osteogenic activity and antibacterial performance in vitro of polyetheretherketone by plasma-induced graft polymerization of acrylic acid and incorporation of zinc ions. Journal of Materials Chemistry B, 2021, 9(36): 7506-7515.
28. Zheng X, Luo H, Li J, et al. Zinc-doped bioactive glass-functionalized polyetheretherketone to enhance the biological response in bone regeneration. Journal of Biomedical Materials Research Part A, 2024, 112(9): 1565-1577.
29. Chai H, Wang W, Yuan X, et al. Bio-activated PEEK: promising platforms for improving osteogenesis through modulating macrophage polarization. Bioengineering, 2022, 9(12): 747.
30. Ren Y, Sikder P, Lin B, et al. Microwave assisted coating of bioactive amorphous magnesium phosphate (AMP) on polyetheretherketone (PEEK). Materials Science and Engineering: C, 2018, 85: 107-113.
31. Yu X, Ibrahim M, Liu Z, et al. Biofunctional Mg coating on PEEK for improving bioactivity. Bioactive Materials, 2018, 3(2): 139-143.
32. Ji Y, Yu X, Zhu H. Fabrication of Mg coating on PEEK and antibacterial evaluation for bone application. Coatings, 2021, 11(8): 1010.
33. Wei X, Zhou W, Tang Z, et al. Magnesium surface-activated 3D printed porous PEEK scaffolds for in vivo osseointegration by promoting angiogenesis and osteogenesis. Bioactive Materials, 2022, 20: 16-28.
34. Major L, Lackner J M, Kot M, et al. Correlative microscopic characterization of biomechanical and biomimetic advanced CVD coatings on a PEEK substrate. Progress in Organic Coatings, 2019, 134: 244-254.
35. Wang C H, Guo Z S, Pang F, et al. Effects of graphene modification on the bioactivation of polyethylene-terephthalate-based artificial ligaments. ACS Applied Materials Interfaces, 2015, 7(28): 15263-15276.
36. Ouyang L, Deng Y, Yang L, et al. Graphene-oxide-decorated microporous polyetheretherketone with superior antibacterial capability and in vitro osteogenesis for orthopedic implant. Macromolecular Bioscience, 2018, 18(6): e1800036.
37. Wang H, Lin C, Zhang X, et al. Mussel-inspired polydopamine coating: a general strategy to enhance osteogenic differentiation and osseointegration for diverse implants. ACS Applied Materials & Interfaces, 2019, 11(7): 7615-7625.
38. Zhu Y, Cao Z, Peng Y, et al. Facile surface modification method for synergistically enhancing the biocompatibility and bioactivity of poly(ether ether ketone) that induced osteodifferentiation. ACS Applied Materials & Interfaces, 2019, 11(31): 27503-27511.
39. Yang X, Xiong S, Zhou J, et al. Coating of manganese functional polyetheretherketone implants for osseous interface integration. Frontiers in Bioengineering and Biotechnology, 2023, 11: 1182187.
40. Wang X, Nakamoto T, Dulińska-Molak I, et al. Regulating the stemness of mesenchymal stem cells by tuning micropattern features. Journal of Materials Chemistry B, 2016, 4(1): 37-45.
41. Senatov F, Maksimkin A, Chubrik A, et al. Osseointegration evaluation of UHMWPE and PEEK-based scaffolds with BMP-2 using model of critical-size cranial defect in mice and push-out test. Journal of the Mechanical Behavior of Biomedical Materials, 2021, 119: 104477.
42. Zhang Y, Hao L, Savalani M M, et al. In vitro biocompatibility of hydroxyapatite-reinforced polymeric composites manufactured by selective laser sintering. Journal of Biomedical Materials Research Part A, 2009, 91(4): 1018-1027.
43. Ma R, Weng L, Bao X, et al. In vivo biocompatibility and bioactivity of in situ synthesized hydroxyapatite/polyetheretherketone composite materials. Journal of Applied Polymer Science, 2013, 127(4): 2581-2587.
44. Wang L, Huang F J, Wu Z Z, et al. Cytocompatibility of nano-hydroxyapatite/polyetheretherketone composite materials with Sprague Dawley rat osteoblasts. Materials Technology, 2016, 31(sup1): 28-32.
45. Swaminathan P D, Uddin M N, Wooley P, et al. Fabrication and biological analysis of highly porous PEEK bionanocomposites incorporated with carbon and hydroxyapatite nanoparticles for biological applications. Molecules, 2020, 25(16): 3572.

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Latest ArticlesResearch progress on enhancing osseointegration properties of polyetheretherketone implants through various modification methods

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