Polyetheretherketone computer‐aided design and computer‐aided manufacturing framework for All‐on‐Four mandibular full‐arch prosthesis: 3 Years' retrospective study of peri‐implant soft tissue changes and ridge base relationship

Abstract

Purpose This study was conducted to evaluate the clinical peri‐implant soft tissue changes during the first year after occlusal loading and the ridge base relation after 3 years for mandibular computer‐aided design and computer‐aided manufacturing (CAD‐CAM) screw‐retained implant‐supported hybrid prosthesis of polyetheretherketone (PEEK) framework utilized with All‐on‐Four treatment concept. Materials and methods Sixteen completely edentulous patients were rehabilitated by four implants following the All‐on‐Four protocol. After 3 months, the definitive prosthesis was constructed to be a screw‐retained CAD‐CAM milled framework from the modified PEEK (BioHPP), bonded to polymethylmethacrylate teeth and a pink shaded indirect light‐polymerized nanofilled composite resin imitating the soft tissues. Peri‐implant soft tissue changes regarding plaque, bleeding, gingival scores, and probing depth were evaluated at prosthesis insertion (T0), 6 months (T1), and 12 months (T2) after insertion. Also, monitoring of the ridge base relation was performed using cone beam computed tomography at time of insertion (T0), and 1 year (T1), 2 years (T2), and 3 years (T3) after mandibular fixed detachable All‐on‐Four framework insertion. Using Shapiro‐Wilk tests using SPSS® software version 22 (SPSS Inc., Chicago, IL), all clinical data were nonparametric, while the ridge base relation data were parametric. Results There were statistically significant differences regarding a plaque, gingival, and bleeding scores for all implants with the advancement of time. However, there was a statistically insignificant difference regarding probing depth in the posterior implants (p = 0.581). Regarding ridge base relation, there was a significant difference between observation times only in the anterior ridge area in between the two anterior implants (p = 0.011). Conclusions Within the limitations of the study, the full‐arch PEEK framework of fixed‐detachable, hybrid prosthesis used with the All‐on‐Four concept for rehabilitation of mandibular edentulous arches is an acceptable treatment approach. Based on the stable ridge base relation posteriorly found in this study, less stress is distributed to the underlining bone due to the shock‐absorbing ability of PEEK. Special considerations for frequent soft tissue follow‐up and regular maintenance of oral hygiene measures are recommended.

Patient satisfaction and soft tissue changes around BioHPP® bar compared to cobalt chromium bar retaining mandibular implant-over dentures: A randomized clinical trial

“…Despite that some studies mentioned that implant number has no influence on the soft tissue in implant supported overdenture cases, the All-on-Four treatment concept was established to intensify the use of existing remnant bone in atrophic jaws, which permits instant function and evades regenerative procedures (15) (16) . Adding to that an efficient prosthetic basis can be established from the well-spread implants (17) .…”

The All-on-4 Concept Using Polyetheretherketone (PEEK)—Acrylic Resin Prostheses: Follow-Up Results of the Development Group at 5 Years and the Routine Group at One Year

“…All four patients with biological complications presented history of periodontitis or smoking habits, representing risk indicators for the incidence of biological complications [44,45]. The good results registered for these outcome measures (implant survival, marginal bone loss and biological complications) can be potentially attributable to PEEK's properties, specifically its shock absorption characteristics [9,10,[46][47][48]. Recent finite element analysis studies reported conflicting results when evaluating PEEK infrastructures used in full-arch implant-supported rehabilitations and the ad modum All-on-4 concept: Tribst et al [24], Ersöz et al [26], Yu et al [27] and Dayan et al [28] reported that PEEK frameworks transferred more stress to the bone in both compression and tensile stress compared to other metallic frameworks (including titanium) in what could be perceived as placing the rehabilitations at an increased risk of biological complications.…”

“…The use of alternative materials for implant-supported rehabilitations is the object of constant development. One such alternative is polyetheretherketone (PEEK), a highperformance thermoplastic polymer whose application was extended from the aerospace and automotive industry [1] to medicine [2][3][4] and dentistry [5][6][7][8][9][10][11][12], either alone or reinforced with polymer composite materials [13,14]. Given its original development (Victrex plc, Lancashire, UK), the properties that make PEEK an exciting alternative include creep and wear resistance, biostability, biocompatibility, superior mechanical behavior, and compatibility with medical diagnostic imaging [15].…”

“…Its use in implant dentistry has received a significant amount of attention, from the scientific community over the last decade from implants [16] to abutments [17] to infrastructures in full-arch implant-supported rehabilitations [6][7][8][9][10][11][18][19][20][21][22][23]. Regarding the latter, the use of PEEK has been involved in some disagreement over its potential favorable or detrimental effects on bone and dental implants, with opposing conclusions from finite element analysis studies [24][25][26][27][28][29].…”

Comparative Analysis of the Mechanical Properties and Biocompatibility between CAD/CAM and Conventional Polymers Applied in Prosthetic Dentistry

“…Another possible application of PEEK is for the production of post-and-core restorations and occlusal splints [75]. Glass fiber-reinforced PEEK provides excellent mechanical properties, shear bond strength, and biocompatibility when used for post-and-core restorations according to Zhao et al [76].…”