Case Report – “Innovative, Biocompatible and Radiolucent”
10 December 2013
ZT René Aumüller, Dr. med. dent. Ingrid Eiber-Fäth
PEEK is the chemical abbreviation for polyetheretherketone. This high-performance polymer is characterised by excellentmechanical and chemical properties. In humanmedicine thismaterial has long been used for the preparation of different kinds of implants. Artificial cranial plates, components of finger and knee joints or intervertebral bodies(cages) are just a few examples of the versatile use ofthematerial in the area oflong-termimplantation. Forseveral years, PEEK has also increasingly been applied in dentistry. Due to its combination of superior biocompatibility and ideal mechanical properties, the material is particularly attractive for dental medicine and prostheticdentistry (CAD/CAMaidedframework fabrication). Thepresentarticlewilldescribe the use of a highly biocompatible framework material.
I n comparison with traditional materials, PEEK offers a whole range of advantages: it is a highpurity material without fillers which has elasticity properties similar to those of human bone; it is absolutely non-corrosive,radiolucent andhasa low water absorption rate. Even after more than ten years of implant application and more than four million implantsworldwide, there have been no indications of allergic reactionsto the material. In the present case we used PEEK manufactured by the British company JUVORA Ltd. This off-white and unfilled PEEK— without fillers or additives—is ideally suited forthe fabrication of detachable and partially detachable prostheses. Due to its shock absorbing properties, this high-performance material is also well suited for use in implant technology for comprehensive restorations which can also be directly screwed in.
Thepatientconsultedthedentalpractice of Dr Eiber-Fäth and Dr Schramm in the town of Stein near Nuremberg, Germany. Existing dental bridges had to be removed. Some severely damaged teeth were extracted. Following this, planning for the restoration of the maxilla and mandible could begin. The patient had read informative literature about the high-performance material PEEK. After receiving sufficient information on alternative options with regards to dental techniques and materials, the patient chose PEEK. A telescopic denture for the maxilla and mandible was planned.
Restoration and try-in
The primary telescopes were made from zirconium oxide ceramic using CAD/CAM. Then, an insertion keywas produced in order to verify and ensure proper fit of the primary parts in the mouth. An impression was taken by means of an individual tray. After the master model was prepared, the finished primary telescopes for the maxillaandmandiblewerescannedand the secondary construction was designed using CAD software. The secondary construction may be designed without sublingual bars with regard to PEEK dental framework material. material. Despite the high number of telescopes we decided to insert a transpalatalbardue to the pre-existing periodontal damage and to ensure later expandability of the prosthesis. For the mandible we constructed a conventional sublingual bar. After milling, the fit was very good and the secondary structure was adjusted minimally and tested using the articulator. We positioned the teeth bymeans of pre-milled facets.Consequently,therewasnoneed to mill the teeth. This also allowed for a guaranteed colour stability of the facets. The try-in was very satisfactory. The patient was enthusiastic about the lightweightandthesimple,smoothand tilt-free insertion of the prosthesis.
Fig. 1: Plastic insertion key for checking the fit of the telescopes in the mouth. – Fig. 2: Mandible frame with sublingual bar. – Fig. 3: Basal viewofthe maxilla frame made of PEEK. – Fig. 4: Transparent matricesfor complete light-curing.
As we use light-curing composites, the matrix was made of transparent silicone. The basis was pre-treated using an approved and tested bonder. After applying the light-cured opaque the teeth were fixed with a light-cured composite. A transparent matrix material proved to be very helpful. It facilitated the fixing ofthe vestibularfacets. Subsequently, the remaining basis was finished using pink synthetic material. It proved easy to polish the material. When choosing the material to be used we adhered to the material specifications issued by JUVORA which were tested for compatibility, particularly with regards to the adhesion of the prosthesis.
Fig. 5: For permanent bonding the bonder approved by JUVORA is of great importance. – Fig. 6: A functional frame was very important to us. – Fig. 7: The finished frame ready to be inserted.
Using the new material proved to be a success for all parties involved. The patient benefited fromthe highwearing comfort due to the light-weight and elastic framework. This allows for smooth and easy insertion and removal and provides a tension-free fit.
A good and even friction could be realised thanks to the excellent mechanical properties of PEEK. The chosen material PEEK allows for new treatment approaches to be realised by tried and tested dental care and prosthetic dentistry production methods. PEEK does not react with existing dentures and istherefore ideally suited for patients with allergies. Moreover, the material is highly wear and abrasion resistant. Elaboration of the milling strategy in our in-house milling centre for our Röders machine was made with little effort due to existing know-how. The instruments included in our portfolio could be integrated into the process. So, it was not necessary to purchase new and costly special equipment. As the indicationsforthismaterial are constantly expanding, and due to extensive clinical testing of the material, we see a great future potential for PEEK.
Praxis Dr Eiber-Fäth/Dr Schramm
Phone: +49 911 675331
Reger Zahntechnik und Fräscenter Nürnberg
Südallee 7, 90475 Nuremberg, Germany
Phone: +49 911 860960