Hybrid Polyetheretherketone (PEEK)–Acrylic Resin Prostheses and the All-on-4 Concept: A Full-Arch Implant-Supported Fixed Solution with 3 Years of Follow-Up

Abstract

Background: The aim of this three-year prospective study was to examine the outcome of a solution for full-arch rehabilitation through a fixed implant-supported hybrid prosthesis (polyetheretherketone (PEEK)-acrylic resin) used in conjunction with the All-on-4 concept. Methods: Thirty-seven patients (29 females, 8 males), with an age range of 38 to 78 years (average: 59.8 years) were rehabilitated with 49 full-arch implant-supported prostheses (12 maxillary rehabilitations, 13 mandibular rehabilitations and 12 bimaxillary rehabilitations). The primary outcome measure was prosthetic survival. Secondary outcome measures were marginal bone loss, plaque and bleeding scores, veneer adhesion issues, biological complications, mechanical complications, and the patients’ subjective evaluation. Results: There were two patients (maxillary rehabilitations) lost to follow-up, while one patient withdrew (maxillary rehabilitation). One patient with bimaxillary rehabilitation fractured the mandibular PEEK framework, rendering a 98% prosthetic survival rate. Implant survival was 100%. Average (standard deviation) marginal bone loss at 3-years was 0.40 mm (0.73 mm). Veneer adhesion was the only technical complication (n = 8 patients), resolved for all patients. Nine patients (n = 11 prostheses) experienced mechanical complications (all resolved): fracture of acrylic resin crowns (n = 3 patients), prosthetic and abutment screw loosening (n = 4 patients and 3 patients, respectively), abutment wearing (n = 1 patient). One patient experienced a biological complication (peri-implant pathology), resolved through non-surgical therapy. A 90% satisfaction rate was registered for the patients’ subjective evaluation. Conclusions: Based on the results, the three-year outcome suggests the proposed rehabilitation solution as a legitimate treatment option, providing a potential shock-absorbing alternative that could benefit the implant biological outcome.

Prosthetic complications and patient satisfaction with maxillary polyether ether ketone hybrid prosthesis veneered with acrylic or composite resin for patients rehabilitated by “All on four” concept

“…This is an advantage compared to rigid metallic frames. In line with our finding, Nobre et al 15 noted that prosthetic survival was influenced by the state of the opposing jaw and prosthetic failure occluded in patients rehabilitated by All on four concept in the upper and lower jaw with bruxism that caused a framework fracture, which suggest occlusal overload.…”

“…In this study we reported no acrylic resin fracture from the PEEK frame. The difference in the results may be due to in the study of Nobre et al 15 , the majority of the Prostheses contained more than one cantilevered teeth rendering technical complications (veneer adhesion issues) more common due to flexing of the PEEK framework distal cantilever. However, in this study no cantilevers or maximum one tooth cantilever was used.…”

“…Furthermore, in this study we provided a rough finish, and vertical and horizontal thread in the remaining PEEK infrastructure that increased mechanical retention of the acrylic resin in the PEEK infrastructure. Also, no fixed restoration was present in the opposing arch in this study, while in the study of Nobre et al 15 patients with All on four fixed restoration in opposing jaw and patients with bruxism were included.…”

“…In contrast, Wachtel et al 27 reported that single screw-retained PEEK implant crowns veneered with composite have no damage to the veneer or the PEEK framework during masticatory simulation and concluded that PEEK implant crowns considered definitive restorations 27 . Also, Nobre et al 15 reported more veneer adhesion problems (acrylic resin avulsion from PEEK infrastructure) for patients rehabilitated with full-arch fixed hybrid PEEK-acrylic resin prosthesis used in conjunction with the All on four concept. In this study we reported no acrylic resin fracture from the PEEK frame.…”

“…Computer-aided design/computer-aided manufacturing (CAD/CAM), the biocompatibility and shock absorption has increased use of PEEK 15 . Reviewing the literature, the use of fullarch hybrid PEEK veneered with PMMA acrylic resin 9,15,16 or composite resin 7 prosthesis and supported by 4 implants through the all-on-four concept was reported successfully. However, comparison of clinical performance of both types of veneer materials on PEEK framework was not evaluated.…”