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Peek implant
Important points of seminar
Introduction of Dental implant
What is ossteointegration
Requirement of dental implant
Steps to select proper case of Dental implant
Implant design , diameter in details , bone
factor ,biocompatibility.
Materials for dental implant and surface cotting
Important points of seminar
History of the PEEK
What is the PEEK
Types of peek
Uses of the PEEK in Dentistry
What is the PEEK Implant made of
Are implant Peek is safe
Properties of the Peek
Advantages ,Disadvantages of the PEEK Implation
Researches
summary
Introduction of Dental Implant
A dental implant is a metal post that replaces
the root portion of a missing tooth. An artificial
tooth (crown) is placed on an extension of the
post (abutment) on the dental implant, giving
you the look of a real tooth
A dental implant (also known as an
endosseous implant or fixture) is
interfacing with the bone of the jaw
or skull to support a dental prosthesis
such as a crown, a bridge or a
denture.
The basis for modern dental implants is a
biologic process called osteointegration.
Materials such as titanium or zirconia form an
intimate bond to bone.
The implant fixture is first placed, so that it is likely
to ossteointegrate, then a dental prosthetic is
added.
Osseointegration
Definition of
The direct structural and functional connection
between the living bone and surface of a load-
bearing implant (Branemark, 1983).
The ability of an implant to bond with the
surrounding host bone is another fundamental
requirement for permanent orthopedic implants
The requirements for dental
implant treatment- 10 key factors
A healthy mouth without tooth decay and gum
disease ( good oral hygiene )
Adequate bone height- ideally greater than
8mm . This can be assessed on a CBCT scan.
 The requirements for dental implant
treatment- 10 key factors
Enough space for prosthesis, teeth or bridge. This
should be assessed on articulated study models,
digital photographs or intra oral scans.
Sound levels of keratinized tissue- attached
gingiva-surrounding .
A stable bite ,Lack of parafunctional habits-
bruxism- tooth grinding at night can cause even
the best treatment to fail
The requirements for dental implant
key factors
10
-
treatment
Great oral hygiene- dental implants
require more than just brushing. Special
care is needed to clean them properly to
avoid perimplantitis.
Adequate bone width- ideal greater than
5mm. This can be assessed on a cbcT
scan.
The requirements for dental implant
key factors
10
-
treatment
Regular visits to the dental hygienist
and regular check ups.
A great implant dentist!
Steps to select proper case for
Dental implant
 1- Medical health of the patient for example not preferred the diabetic patient,
smoker patient, because they lead to failure of oseointegration by formation of
fibrous capsule between implant and bone lead to failure and loose of implant
and and progress of bone resorption , malignant disease of bone ( Affect of
healing of bone and osteointegration )
 2- Situation of mouth good or bad oral hygiene like gingivitis , gingival abscess.
 3- Denisty of bone determined by CBCT con beam computerized tomography
like D1, D2, D3, D4, D5.
 4- proper select of length and diameter of implant
 5- proper selection of implant material and the design suitable of which type of
bone
 6- Proper cooling during drilling by irrigation to avoid heat generation lead to
Blood supply destruction = necrosis of bone .
What are the different types of
implant?
Types of Dental Implants
 Endosteal Implants. Endosteal implants are the most
common type of dental implant. ...
 Subperiosteally Implants. Another type of dental implant
is Subperiosteally Implants. ...
 Zygomatic Implants. ...
 Bone Augmentation. ...
 Sinus Lift. ...
 Ridge Expansion.
Biocompatibility and implant
design
Implants made of commercially pure titanium
have established in Osseo integration, against
which few other materials compare.
Biocompatibility and implant
Osseointegration
design( Material
and coating)
 Related materials such as niobium are able
to produce a high degree of Osseo
integration
 More recently resorbable coatings improve
the initial rate of bone healing against the
implant surface and then resorbed within a
short time frame to allow establishment of a
bone to metal contact.
 Surface roughness varies
greatly between different
systems. Surfaces which are
machined, grit-blasted,
etched, plasma sprayed
and coated are available.
Biocompatibility and implant design
(Roughness)
By increasing surface roughness there is the
potential to increase the surface contact
with bone but this may be at the expense
of more ionic exchange and surface
corrosion.
Bacterial contamination of the implant
surface will also be affected by the surface
roughness if it becomes exposed in patient
mouth.
Implant length
The implant design has a great influence on
initial stability and subsequent function.
The main design parameters are:
Implant length — implants are generally
available in lengths from about 6 mm to 20 mm.
The most common lengths employed are
between 8 and 15 mm which correspond quite
closely to normal root lengths.
What significant of face thread and
angle
Pitch = distance between 2 threads
Thread depth greater than width, so lead to
bone enter to depth more thane the width
Implant shape
 Hollow-cylinders, solid-cylinders, hollow screws or
solid screws are commonly employed shapes which
are designed to maximize the potential area for
Osseointegration and provide good initial stability.
 Even minor alterations in the size and pitch of
threads can implant property.
 Screw shaped implants also offer good load
distribution characteristics in function.
Which implant are preferred in soft
bone
Primary stability by healing
Secondary stability by ossteointegration
Taper better than conical in any type of bone
especially dense bone because it give
compression on bone lead to strengthen it.
Which implant are preferred in soft
bone
Dense bone= parallel wall of implant to avoid
over compression on bone that lead to micro
fracture of bone.
Outer diameter determine pitch diameter =
ideal 2mm on both side of inner diameter
Face angle dissipate force and analyze it .
Soft bone (D3,D4) especially in posterior maxilla
= lead to high number of thread
Which implant are preferred in soft
bone
Thread
1. square =in soft bone ( force =compression)
2. v shape = force = high face angle = high lateral
stress.
In soft bone (D3,d4) conical or taper implant – lead
to high thread number , low pitch ,high thread depth
Zero face angle = square shaped thread prefer
because it prevent lateral force and form only
compressive force only that strength bone lead to
intimate stability , and avoid heat generation ,so
preserve blood supply from necrosis.
Implant diameter
 Most implants are approximately 4 mm in diameter. At
least 3.25 mm in diameter is required to ensure
adequate implant strength.
 Implant diameter may be more important than implant
length in the distribution of loads to the surrounding
bone.
 Implant diameters up to 6 mm are available, which are
considerable stronger, but they are not so widely used
High diameter lead to high surface area.
Bone factors
The stability of the implant at the time of
placement is very important and is dependent
upon bone quantity and quality as well as implant
design.
The edentulous ridge can be classified in terms of
shape and bone quality.
Following loss of a tooth the alveolar bone resorbs
in width and height.
In extreme cases bone resorption
proceeds to a level which is
beyond the normal extent of the
alveolar process.
 Radiographic determination of
bone quantity and quality is
considered and procedures
which can be used to augment
bone .
Bone which is predominantly
cortical may offer good initial
stability at implant placement but
is more easily damaged by
overheating during the drilling
process, especially with sites more
than 10 mm in depth
 At the other extreme, bone with a thin or absent
cortical layer and sparse trabeculation offers very
poor initial implant stability and fewer cells with a
good osteogenic potential to promote Osseo
integration.
 Success is highly dependent upon a surgical
technique which avoids heating the bone. Slow
drilling speeds, the use of successive incrementally
larger sharp drills and copious saline irrigation aim
to keep the temperature below that at which bone
tissue damage occurs (around 47°C for 1 minute.
 Further refinements include cooling the irrigate and
using internally irrigated drills. Methods by which
these factors are controlled are considered in more
detail (Basic Implant Surgery).
 Factors which compromise bone quality are
infection, irradiation and heavy smoking.
 The effects of the latter two area result of a
diminution of the vascular supply to the bone which
compromises the healing response, a feature which
has been well described in the healing of fractures
Loading conditions
Following installation of an implant it is
important that it is not loaded during the
early healing phase.
 Movement of the implant within the bone at
this stage results in fibrous tissue
encapsulation rather than Osseo integration.
This has been compared to the healing of a
fracture where stabilization of the bone
fragments is very important to prevent non-
union.
PEEK materials
Polyetheretherketone (PEEK) is a semi-crystalline
linear polycyclic thermoplastic that has been
proposed as a substitute for metals in
biomaterials.
 PEEK can also be applied to dental implant
materials as a superstructure, implant abutment,
or implant body.
History of PEEK Implant
 PEEK had emerged as an alternative for
metal implants by the late 1990s,
widely advertised as a biomaterial for
implants in April 1998.
The initial use of these implants was for
orthopedic purposes especially spinal
surgery.
Polyether ether ketone (PEEK) is
an organic compound material
now being used in 3D printing for
manufacturing of complex design
geometry and patient-specific
implants for Orthopedics.
What is a peek implant?
 Polyetheretherketone (PEEK) is a synthetic material
that was used initially in spine and hip surgery.
 It has the properties of being biocompatible,
resistant to thermal and ionizing radiation,
 and resembles cortical bone biomechanically.

Types of PEEK
Carbone fiber reinforce PEEK
Glass fiber reinforced PEEK
Peek combined with (nano particle
of titanium dioxide)
Are PEEK implants safe?
Medical grade PEEK is more than just inert in the
human body. It is entirely biocompatible, and
proven to be safe with cellular and genetic
material.
Patients and their surgical teams can be
confident that PEEK is a viable, long-term option
for their implants.
PEEK surface treatment
Sulfuric acid etching can improve
bond strength of resin cement to PEEK
surface
The use of hydrophobic adhesive
containing Methyl metacrylates was
able to bond to PEEK and composite
resin
BIC – Bone Implant Contact -
Types of PEEK
It has been reported that
PEEK compared with
titanium , presented the
lowest Bic
Incorporation nanohydroxyl
fluoroapatite (n-FHA), Could
inhibit bacterial adhesion and
accelerate bacterial death, in
order to reduce the risk of peri-
implantitis
Biofilm formation
Biofilm formation on the
surface of PEEK was equal tro,
or lower than on surface of
zirconia or titanium
Biocompatibility of PEEk
1- One of these showed no evidence of cell
damge caused PEEK
2- A case report in contrast described the clinical
evidence of allergy to PEEK, in which the removal of
the implant alleviated the patient allergic
symptoms.
 3- A 3 case report described of how a PEEK implant
lead to poor osseointegration and subsequent
infections and implant loss.
Abutment material
PEEK is currently used as a provisional
abutment because this material has
been demonstrated to reduce stress
shielding around the implant
PEEK is not used as a definitive
abutment material because its
fracture resistance is lower than that
of titanium
CAD-CAM of PEEK
PEEK is a good material for producing
fixed and removable prostheses with
CAD- CAM , because it is easier to mill
It is mechanical properties are not
adversely affected by the milling process ,
and it is fracture resistance is higher than
that of other materials
Why is PEEK used in implants?
PEEK is widely used for spinal implants as the
durability and resistance of PEEK implants
resemble the characteristics of bone.
 PEEK implants lessen the weight and stress
shielding.
It has more esthetic property than titanium
Types OF manufacturing PEEK
implant
3D PREP rapid crystallization and so lead to high
residual stress
SPLA peek longer period lower residual stress
must be a great due to high temperature rate =
release of residual stress.
How is PEEK made?
PEEK can been synthesized by using nucleophilic
substitution of 4,4' - difluorobenzophenone with
hydroquinone in the presence of anhydrous
potassium carbonate under microwave
irradiation to produce a good yield
Why is PEEK chemically resistant?
The only solvents which will
attack PEEK are concentrated
nitric acid and sulphoric acids.
Does PEEK degrade in the body?
Studies have shown that thermal degradation
occurs in PEEK at temperatures between the
glass transition and melt transition, but that
temperatures exceeding the processing
temperature of PEEK are needed to produce
volatile degradation products
Why is PEEK used in implants?
PEEK is widely used for spinal implants as the
durability and resistance of PEEK implants
resemble the characteristics of bone.
PEEK implants decrease the risk of osteolytic,
lessen the weight and stress shielding.
 The authors present a
case report showing
their experience with
the use of Poly Ether
Ether Ketone (PEEK)
implants as an
innovative solution for
the skeleton and soft
tissues’ reshaping in
facial aesthetic plastic
surgery.
PEEK Application in Healthcare and
Medical Area
As spinal arthroplasty devices, specifically for
spinal artificial discs, they are good
replacement for cobalt chromium molybdenum
or metal.
 They help the movement of the spine and they
withstand the load of body without breaking.
 It is also used in other orthopedic surgeries such
as hip replacements because of their high
strength.
Why PEEK implant is a good substitute for
other traditional implants?
Before PEEK become popular in medical
community, titanium was a biomaterial specially
as an interbody fusion device. PEEK is a better
option than titanium for most of surgeons due to
the following advantages:
Flexibility : PEEK as a flexible biomaterial is still an
excellent weight-bearing material PEEK’s ability
to bend resembles the behavior of bone.
Aesthetic feature
In the area of dental implants, Ti is the main material.
PEEK implants are a good replacement for having a more aesthetic
appearance than Ti.
Thermal resistance
PEEK material shows high-temperature stability compared to other metal
implants which created a more comfortable situation for the Patients.
It is extensively reported by patients with titanium plates that they
experience an intensive pain when their body’s temperatures fluctuate.
Radiolucency
Titanium is not transparent to X-rays, MRI, CT scans.
PEEK is clear and does not interfere with medical imaging.
Therefore, the created image is readable ( radiopaque) which is
an important feature for postoperative monitoring.
Significant Properties of PEEK
Heat resistant: PEEK shows
high resistance to heat.
 It has high melting point at 343 °C
and it is suitable for high temperature
electrical and biomedical
applications.
Significant Properties of PEEK
 Light-weighted: lighter than other implants more
comfortable.
 High tensile strength: These implants, with the
tensile strength of about 90-100 MPa, can
tolerate the weight of load without breaking.
 Flexible: They have the capacity to be bent
easily compared to other traditional implants.
This feature makes the PEEK implants an
appropriate option for cardiac valves.
More properties of PEEK include:
 Long life
 Insoluble
 low density (1.32 g/cm3),
 low elastic modulus
 low moisture absorption
 You can subscribe to Mandible Health Newsletter and get
updated articles on PEEK innovations. If you are a surgeon
and carried out orthopedic implants or if you are a patient
undergone implant replacement, please share your
experiences with us.
For PEEK Implant Suitable
case
these implants are suitable for specific
situations
 low functional and high esthetic
demands or as completely viable
alternatives to titanium in all situations
What are the advantages of
PEEK?
a mechanical properties of PEEK compared with
human bone tissue; lack of electrochemical
activity in vivo;
 excellent corrosion resistance and
biocompatibility; considerable fatigue strength;
 wear resistance; tensile strength, compressive
strength, and ductility.
Advantages of PEEK
1.rigid from ketone group and ether group
flexible
2. excellent resistance to chemical and solvent
even in elevated temperature
3.ultimate part quick dissolve but peek part is
rigid
4. absorb if no moisture
5. Extremely strong and chemically inert
( corrosion resistance), PEEK features enhanced
thermal and mechanical properties.
Advantages of PEEK
 5. Biocompatible
 6. conformable
 7. strong enough to protect the brain.
 8. can be printed by 3D due to high crystallization and high glass
transition temperature.
 9.PEEK is a good replacement due to their compound structure,
elastic module, osteogenic, enough fatigue limits and other
functional properties
 10. light in weight and at the same time stiff and strong.
 11. easy sterilization.
Disadvantages of PEEK
1. Extremely expensive and high
cost
2. Exhausted process in
condition
Researches
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 definite element method,
demonstrating higher stress peaks due to a
reduced stiffness compared to titanium.

Researches
Two articles reported on
investigations in mongrel dogs. The
first article compared CFR-PEEK to
titanium-coated CFR-PEEK implants,
which were inserted into the femurs
and evaluated after 4 and 8 weeks.
Researches
 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.
References
 Andreas Schwitalla , Wolf-Dieter Müller,PEEK dental implants: a review of the
literature , 2011 Sep 9, J Oral Implantol. 2013 Dec;39(6):743-9.
DECEMBER 01 2016
 Sana Zohaib BDS, MSc; Muhammad Sohail Zafar BDS, MSc, PhD . Bioactivity
and Osseointegration of PEEK Are Inferior to Those of Titanium: A Systematic
Review ,Shariq Najeeb, BDS, MSc; Zohaib Khurshid BDS, MRes; J Oral
Implantol (2016) 42 (6): 512–516. DECEMBER 01 2016.
 Fitria Rahmitasari.Universitas Hangtuah.Yuichi Ishida.The University of
Tokushima.Kosuke Kurahashi,PEEK with Reinforced Materials and
Modifications for Dental Implant Applications. December 2017Dentistry
Journal 5(4):35.
References
 HatimAlqurashiab ,Zohaib Khurshidc ,Azeem Ul Yaqin
,SyedcSyed ,Rashid HabibdDinesh, RokayaeMuhammad ,
SohailZafarfg, Polyetherketoneketone (PEKK): An emerging
biomaterial for oral implants and dental prostheses. Volume
28, February 2021, Pages 87-95.
 Lakshmana Bathala, Vaishnavi Majeti, Narendra Rachuri, Nibha
Singh and Sirisha Gedela, Author information Article notes Copyright
and License information Disclaimer. J Med Life. 2019 Jan-Mar; 12(1):
5–9.
 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.
summary
 Q1: In Which case we prefer PEEK implant?
1. In non stress bearing tooth ( Light in weight)
2. In esthetic area to avoid metal appearance of titanium in case of gingival
recession.
3. 3. lowest bone implant contact.
 Q2: Which are the best bone implant contact
titanium, zircone, PEEK Implant ?
 Titanium is the best BIC then zircon implant.
 PEEK is lowest bone implant contact.
summary
 Q3:mention type of implant have higher stress
peaks?
1. Carbone fiber PEEK
2. pure Peek due to reduce stiffness of it
than
3. titanium implant
conclusion
Peek implant is necessary to decrease the
stress distribution around the bone and
increase the fracture resistance because
it has elastic modulus similar to the
cortical bone 3-4 Gpa, biocompatibility,
and color appearance.
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Peek implant persentation - Copy (1).pdf

  • 2. Important points of seminar Introduction of Dental implant What is ossteointegration Requirement of dental implant Steps to select proper case of Dental implant Implant design , diameter in details , bone factor ,biocompatibility. Materials for dental implant and surface cotting
  • 3. Important points of seminar History of the PEEK What is the PEEK Types of peek Uses of the PEEK in Dentistry What is the PEEK Implant made of Are implant Peek is safe Properties of the Peek Advantages ,Disadvantages of the PEEK Implation Researches summary
  • 4. Introduction of Dental Implant A dental implant is a metal post that replaces the root portion of a missing tooth. An artificial tooth (crown) is placed on an extension of the post (abutment) on the dental implant, giving you the look of a real tooth
  • 5. A dental implant (also known as an endosseous implant or fixture) is interfacing with the bone of the jaw or skull to support a dental prosthesis such as a crown, a bridge or a denture.
  • 6. The basis for modern dental implants is a biologic process called osteointegration. Materials such as titanium or zirconia form an intimate bond to bone. The implant fixture is first placed, so that it is likely to ossteointegrate, then a dental prosthetic is added.
  • 7.
  • 8.
  • 9. Osseointegration Definition of The direct structural and functional connection between the living bone and surface of a load- bearing implant (Branemark, 1983). The ability of an implant to bond with the surrounding host bone is another fundamental requirement for permanent orthopedic implants
  • 10.
  • 11.
  • 12. The requirements for dental implant treatment- 10 key factors A healthy mouth without tooth decay and gum disease ( good oral hygiene ) Adequate bone height- ideally greater than 8mm . This can be assessed on a CBCT scan.
  • 13.  The requirements for dental implant treatment- 10 key factors Enough space for prosthesis, teeth or bridge. This should be assessed on articulated study models, digital photographs or intra oral scans. Sound levels of keratinized tissue- attached gingiva-surrounding . A stable bite ,Lack of parafunctional habits- bruxism- tooth grinding at night can cause even the best treatment to fail
  • 14. The requirements for dental implant key factors 10 - treatment Great oral hygiene- dental implants require more than just brushing. Special care is needed to clean them properly to avoid perimplantitis. Adequate bone width- ideal greater than 5mm. This can be assessed on a cbcT scan.
  • 15. The requirements for dental implant key factors 10 - treatment Regular visits to the dental hygienist and regular check ups. A great implant dentist!
  • 16. Steps to select proper case for Dental implant  1- Medical health of the patient for example not preferred the diabetic patient, smoker patient, because they lead to failure of oseointegration by formation of fibrous capsule between implant and bone lead to failure and loose of implant and and progress of bone resorption , malignant disease of bone ( Affect of healing of bone and osteointegration )  2- Situation of mouth good or bad oral hygiene like gingivitis , gingival abscess.  3- Denisty of bone determined by CBCT con beam computerized tomography like D1, D2, D3, D4, D5.  4- proper select of length and diameter of implant  5- proper selection of implant material and the design suitable of which type of bone  6- Proper cooling during drilling by irrigation to avoid heat generation lead to Blood supply destruction = necrosis of bone .
  • 17.
  • 18.
  • 19.
  • 20.
  • 21. What are the different types of implant? Types of Dental Implants  Endosteal Implants. Endosteal implants are the most common type of dental implant. ...  Subperiosteally Implants. Another type of dental implant is Subperiosteally Implants. ...  Zygomatic Implants. ...  Bone Augmentation. ...  Sinus Lift. ...  Ridge Expansion.
  • 22. Biocompatibility and implant design Implants made of commercially pure titanium have established in Osseo integration, against which few other materials compare.
  • 23. Biocompatibility and implant Osseointegration design( Material and coating)  Related materials such as niobium are able to produce a high degree of Osseo integration  More recently resorbable coatings improve the initial rate of bone healing against the implant surface and then resorbed within a short time frame to allow establishment of a bone to metal contact.
  • 24.  Surface roughness varies greatly between different systems. Surfaces which are machined, grit-blasted, etched, plasma sprayed and coated are available.
  • 25. Biocompatibility and implant design (Roughness) By increasing surface roughness there is the potential to increase the surface contact with bone but this may be at the expense of more ionic exchange and surface corrosion. Bacterial contamination of the implant surface will also be affected by the surface roughness if it becomes exposed in patient mouth.
  • 26.
  • 27. Implant length The implant design has a great influence on initial stability and subsequent function. The main design parameters are: Implant length — implants are generally available in lengths from about 6 mm to 20 mm. The most common lengths employed are between 8 and 15 mm which correspond quite closely to normal root lengths.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33. What significant of face thread and angle Pitch = distance between 2 threads Thread depth greater than width, so lead to bone enter to depth more thane the width
  • 34. Implant shape  Hollow-cylinders, solid-cylinders, hollow screws or solid screws are commonly employed shapes which are designed to maximize the potential area for Osseointegration and provide good initial stability.  Even minor alterations in the size and pitch of threads can implant property.  Screw shaped implants also offer good load distribution characteristics in function.
  • 35.
  • 36. Which implant are preferred in soft bone Primary stability by healing Secondary stability by ossteointegration Taper better than conical in any type of bone especially dense bone because it give compression on bone lead to strengthen it.
  • 37. Which implant are preferred in soft bone Dense bone= parallel wall of implant to avoid over compression on bone that lead to micro fracture of bone. Outer diameter determine pitch diameter = ideal 2mm on both side of inner diameter Face angle dissipate force and analyze it . Soft bone (D3,D4) especially in posterior maxilla = lead to high number of thread
  • 38. Which implant are preferred in soft bone Thread 1. square =in soft bone ( force =compression) 2. v shape = force = high face angle = high lateral stress. In soft bone (D3,d4) conical or taper implant – lead to high thread number , low pitch ,high thread depth Zero face angle = square shaped thread prefer because it prevent lateral force and form only compressive force only that strength bone lead to intimate stability , and avoid heat generation ,so preserve blood supply from necrosis.
  • 39. Implant diameter  Most implants are approximately 4 mm in diameter. At least 3.25 mm in diameter is required to ensure adequate implant strength.  Implant diameter may be more important than implant length in the distribution of loads to the surrounding bone.  Implant diameters up to 6 mm are available, which are considerable stronger, but they are not so widely used High diameter lead to high surface area.
  • 40.
  • 41. Bone factors The stability of the implant at the time of placement is very important and is dependent upon bone quantity and quality as well as implant design. The edentulous ridge can be classified in terms of shape and bone quality. Following loss of a tooth the alveolar bone resorbs in width and height.
  • 42.
  • 43. In extreme cases bone resorption proceeds to a level which is beyond the normal extent of the alveolar process.  Radiographic determination of bone quantity and quality is considered and procedures which can be used to augment bone .
  • 44. Bone which is predominantly cortical may offer good initial stability at implant placement but is more easily damaged by overheating during the drilling process, especially with sites more than 10 mm in depth
  • 45.  At the other extreme, bone with a thin or absent cortical layer and sparse trabeculation offers very poor initial implant stability and fewer cells with a good osteogenic potential to promote Osseo integration.  Success is highly dependent upon a surgical technique which avoids heating the bone. Slow drilling speeds, the use of successive incrementally larger sharp drills and copious saline irrigation aim to keep the temperature below that at which bone tissue damage occurs (around 47°C for 1 minute.
  • 46.  Further refinements include cooling the irrigate and using internally irrigated drills. Methods by which these factors are controlled are considered in more detail (Basic Implant Surgery).  Factors which compromise bone quality are infection, irradiation and heavy smoking.  The effects of the latter two area result of a diminution of the vascular supply to the bone which compromises the healing response, a feature which has been well described in the healing of fractures
  • 47. Loading conditions Following installation of an implant it is important that it is not loaded during the early healing phase.  Movement of the implant within the bone at this stage results in fibrous tissue encapsulation rather than Osseo integration. This has been compared to the healing of a fracture where stabilization of the bone fragments is very important to prevent non- union.
  • 48.
  • 49.
  • 50.
  • 51.
  • 52.
  • 53. PEEK materials Polyetheretherketone (PEEK) is a semi-crystalline linear polycyclic thermoplastic that has been proposed as a substitute for metals in biomaterials.  PEEK can also be applied to dental implant materials as a superstructure, implant abutment, or implant body.
  • 54.
  • 55. History of PEEK Implant  PEEK had emerged as an alternative for metal implants by the late 1990s, widely advertised as a biomaterial for implants in April 1998. The initial use of these implants was for orthopedic purposes especially spinal surgery.
  • 56. Polyether ether ketone (PEEK) is an organic compound material now being used in 3D printing for manufacturing of complex design geometry and patient-specific implants for Orthopedics.
  • 57. What is a peek implant?  Polyetheretherketone (PEEK) is a synthetic material that was used initially in spine and hip surgery.  It has the properties of being biocompatible, resistant to thermal and ionizing radiation,  and resembles cortical bone biomechanically. 
  • 58. Types of PEEK Carbone fiber reinforce PEEK Glass fiber reinforced PEEK Peek combined with (nano particle of titanium dioxide)
  • 59. Are PEEK implants safe? Medical grade PEEK is more than just inert in the human body. It is entirely biocompatible, and proven to be safe with cellular and genetic material. Patients and their surgical teams can be confident that PEEK is a viable, long-term option for their implants.
  • 60. PEEK surface treatment Sulfuric acid etching can improve bond strength of resin cement to PEEK surface The use of hydrophobic adhesive containing Methyl metacrylates was able to bond to PEEK and composite resin
  • 61. BIC – Bone Implant Contact - Types of PEEK It has been reported that PEEK compared with titanium , presented the lowest Bic
  • 62. Incorporation nanohydroxyl fluoroapatite (n-FHA), Could inhibit bacterial adhesion and accelerate bacterial death, in order to reduce the risk of peri- implantitis
  • 63. Biofilm formation Biofilm formation on the surface of PEEK was equal tro, or lower than on surface of zirconia or titanium
  • 64. Biocompatibility of PEEk 1- One of these showed no evidence of cell damge caused PEEK 2- A case report in contrast described the clinical evidence of allergy to PEEK, in which the removal of the implant alleviated the patient allergic symptoms.  3- A 3 case report described of how a PEEK implant lead to poor osseointegration and subsequent infections and implant loss.
  • 65. Abutment material PEEK is currently used as a provisional abutment because this material has been demonstrated to reduce stress shielding around the implant PEEK is not used as a definitive abutment material because its fracture resistance is lower than that of titanium
  • 66. CAD-CAM of PEEK PEEK is a good material for producing fixed and removable prostheses with CAD- CAM , because it is easier to mill It is mechanical properties are not adversely affected by the milling process , and it is fracture resistance is higher than that of other materials
  • 67. Why is PEEK used in implants? PEEK is widely used for spinal implants as the durability and resistance of PEEK implants resemble the characteristics of bone.  PEEK implants lessen the weight and stress shielding. It has more esthetic property than titanium
  • 68. Types OF manufacturing PEEK implant 3D PREP rapid crystallization and so lead to high residual stress SPLA peek longer period lower residual stress must be a great due to high temperature rate = release of residual stress.
  • 69. How is PEEK made? PEEK can been synthesized by using nucleophilic substitution of 4,4' - difluorobenzophenone with hydroquinone in the presence of anhydrous potassium carbonate under microwave irradiation to produce a good yield
  • 70. Why is PEEK chemically resistant? The only solvents which will attack PEEK are concentrated nitric acid and sulphoric acids.
  • 71. Does PEEK degrade in the body? Studies have shown that thermal degradation occurs in PEEK at temperatures between the glass transition and melt transition, but that temperatures exceeding the processing temperature of PEEK are needed to produce volatile degradation products
  • 72. Why is PEEK used in implants? PEEK is widely used for spinal implants as the durability and resistance of PEEK implants resemble the characteristics of bone. PEEK implants decrease the risk of osteolytic, lessen the weight and stress shielding.
  • 73.  The authors present a case report showing their experience with the use of Poly Ether Ether Ketone (PEEK) implants as an innovative solution for the skeleton and soft tissues’ reshaping in facial aesthetic plastic surgery.
  • 74. PEEK Application in Healthcare and Medical Area As spinal arthroplasty devices, specifically for spinal artificial discs, they are good replacement for cobalt chromium molybdenum or metal.  They help the movement of the spine and they withstand the load of body without breaking.  It is also used in other orthopedic surgeries such as hip replacements because of their high strength.
  • 75. Why PEEK implant is a good substitute for other traditional implants? Before PEEK become popular in medical community, titanium was a biomaterial specially as an interbody fusion device. PEEK is a better option than titanium for most of surgeons due to the following advantages: Flexibility : PEEK as a flexible biomaterial is still an excellent weight-bearing material PEEK’s ability to bend resembles the behavior of bone.
  • 76. Aesthetic feature In the area of dental implants, Ti is the main material. PEEK implants are a good replacement for having a more aesthetic appearance than Ti. Thermal resistance PEEK material shows high-temperature stability compared to other metal implants which created a more comfortable situation for the Patients. It is extensively reported by patients with titanium plates that they experience an intensive pain when their body’s temperatures fluctuate. Radiolucency Titanium is not transparent to X-rays, MRI, CT scans. PEEK is clear and does not interfere with medical imaging. Therefore, the created image is readable ( radiopaque) which is an important feature for postoperative monitoring.
  • 77. Significant Properties of PEEK Heat resistant: PEEK shows high resistance to heat.  It has high melting point at 343 °C and it is suitable for high temperature electrical and biomedical applications.
  • 78. Significant Properties of PEEK  Light-weighted: lighter than other implants more comfortable.  High tensile strength: These implants, with the tensile strength of about 90-100 MPa, can tolerate the weight of load without breaking.  Flexible: They have the capacity to be bent easily compared to other traditional implants. This feature makes the PEEK implants an appropriate option for cardiac valves.
  • 79. More properties of PEEK include:  Long life  Insoluble  low density (1.32 g/cm3),  low elastic modulus  low moisture absorption  You can subscribe to Mandible Health Newsletter and get updated articles on PEEK innovations. If you are a surgeon and carried out orthopedic implants or if you are a patient undergone implant replacement, please share your experiences with us.
  • 80. For PEEK Implant Suitable case these implants are suitable for specific situations  low functional and high esthetic demands or as completely viable alternatives to titanium in all situations
  • 81. What are the advantages of PEEK? a mechanical properties of PEEK compared with human bone tissue; lack of electrochemical activity in vivo;  excellent corrosion resistance and biocompatibility; considerable fatigue strength;  wear resistance; tensile strength, compressive strength, and ductility.
  • 82. Advantages of PEEK 1.rigid from ketone group and ether group flexible 2. excellent resistance to chemical and solvent even in elevated temperature 3.ultimate part quick dissolve but peek part is rigid 4. absorb if no moisture 5. Extremely strong and chemically inert ( corrosion resistance), PEEK features enhanced thermal and mechanical properties.
  • 83. Advantages of PEEK  5. Biocompatible  6. conformable  7. strong enough to protect the brain.  8. can be printed by 3D due to high crystallization and high glass transition temperature.  9.PEEK is a good replacement due to their compound structure, elastic module, osteogenic, enough fatigue limits and other functional properties  10. light in weight and at the same time stiff and strong.  11. easy sterilization.
  • 84. Disadvantages of PEEK 1. Extremely expensive and high cost 2. Exhausted process in condition
  • 85. Researches 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 definite element method, demonstrating higher stress peaks due to a reduced stiffness compared to titanium.
  • 86.  Researches Two articles reported on investigations in mongrel dogs. The first article compared CFR-PEEK to titanium-coated CFR-PEEK implants, which were inserted into the femurs and evaluated after 4 and 8 weeks.
  • 87. Researches  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.
  • 88. References  Andreas Schwitalla , Wolf-Dieter Müller,PEEK dental implants: a review of the literature , 2011 Sep 9, J Oral Implantol. 2013 Dec;39(6):743-9. DECEMBER 01 2016  Sana Zohaib BDS, MSc; Muhammad Sohail Zafar BDS, MSc, PhD . Bioactivity and Osseointegration of PEEK Are Inferior to Those of Titanium: A Systematic Review ,Shariq Najeeb, BDS, MSc; Zohaib Khurshid BDS, MRes; J Oral Implantol (2016) 42 (6): 512–516. DECEMBER 01 2016.  Fitria Rahmitasari.Universitas Hangtuah.Yuichi Ishida.The University of Tokushima.Kosuke Kurahashi,PEEK with Reinforced Materials and Modifications for Dental Implant Applications. December 2017Dentistry Journal 5(4):35.
  • 89. References  HatimAlqurashiab ,Zohaib Khurshidc ,Azeem Ul Yaqin ,SyedcSyed ,Rashid HabibdDinesh, RokayaeMuhammad , SohailZafarfg, Polyetherketoneketone (PEKK): An emerging biomaterial for oral implants and dental prostheses. Volume 28, February 2021, Pages 87-95.  Lakshmana Bathala, Vaishnavi Majeti, Narendra Rachuri, Nibha Singh and Sirisha Gedela, Author information Article notes Copyright and License information Disclaimer. J Med Life. 2019 Jan-Mar; 12(1): 5–9.
  • 90.  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.
  • 91. summary  Q1: In Which case we prefer PEEK implant? 1. In non stress bearing tooth ( Light in weight) 2. In esthetic area to avoid metal appearance of titanium in case of gingival recession. 3. 3. lowest bone implant contact.  Q2: Which are the best bone implant contact titanium, zircone, PEEK Implant ?  Titanium is the best BIC then zircon implant.  PEEK is lowest bone implant contact.
  • 92. summary  Q3:mention type of implant have higher stress peaks? 1. Carbone fiber PEEK 2. pure Peek due to reduce stiffness of it than 3. titanium implant
  • 93. conclusion Peek implant is necessary to decrease the stress distribution around the bone and increase the fracture resistance because it has elastic modulus similar to the cortical bone 3-4 Gpa, biocompatibility, and color appearance.