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today EAO Madrid October 05, 2017

“Research on PEEK implants is both challenging and motivating” An interview with EAO presenter Dr Pär Johansson, Sweden science & practice (cid:132) In 2010, Dr Pär Johansson received his dentistry degree at Malmö Uni- versity in Sweden, where he submit- ted a master thesis on implant surfaces. A few years later, he joined a research team at the same de- partment as they were launching an interesting project on a new implant- able material, PEEK (polyetherether- ketone). In an interview with today international Johansson spoke about the advantages and challenges of PEEK implants and what the new material could mean for the future of implantology. today international: What, in your opinion, has been the greatest devel- opment implantology throughout the decades? in dental Dr Pär Johansson: Since the discovery of osseointegration, the de- velopment of dental implantology has been extraordinary and ex- tremely fast. The advancement began by experimenting with different im- plant materials and inventive shapes and forms. Thereafter, the implant surface was modified using several subtractive and additive methods to shorten the healing time and in- crease the success rate. Today, re- searchers are attempting to improve osseointegration by loading the im- plant surface with pharmaceuticals or proteins. As a researcher, I would say that the most important develop- ments in dental implantology have been the surface improvements and, to some extent, our understanding of bone and implant interaction. As a cli- nician, the greatest developments have been improved treatment proto- cols and the implementation of digi- tal appliances. At the 2017 European Association for Osseointegration (EAO) congress, you will be giving a lecture about PEEK implants. What was your moti- vation behind specialising in this im- plant material? The project became my PhD pro- ject, which I am defending later this year. PEEK is a highly advanced pol- ymer with properties that could im- prove the treatment outcomes of sev- eral procedures. The challenge is that PEEK is not optimal as a loadbearing (cid:24)Dr Pär Johansson works in the PCR lab in Malmö University, Sweden. He’s doing PCR (polymerase chain reaction) to evaluate gen-expression on PEEK implants implanted in rabbit bone. In detail he is pipetting specific primers that he wish to analyse. never shown any signs of provoking hypersensitivity. The colour of PEEK is more natural, and this enables the manufacturing of aesthetic implants for thin biotypes and diverse dental components. Finally, PEEK is trans- parent to X-rays, which is a feature highly useful after spine surgery, al- procedures and ongoing research has introduced more applications. In den- tistry, the introduction of PEEK has been slow, but the material may well be functional in healing abutments, temporary cylinders and dental frameworks. Introduction of new bio- materials is a slow process which re- quire a comprehensive evaluation by the U.S. Food and Drug Administra- tion before it can be implemented for clinical trials. PEEK-OPTIMA (Invibio) is currently the only commercial PEEK polymer approved by the FDA as a medical device. What are the main advantages of PEEK in comparison with conven- tional implant materials like tita- nium? What are its limitations? The main advantage in spine and trauma surgery is its superior biome- lowing the postoperative radiograph to be viewed and analysed without any disturbing artefacts. The results of a study in rabbit bone you conducted in 2016 proved that the addition of a nanosized hy- droxyapatite-coating to PEEK sur- faces improved the bone-implant contact and demonstrated strong osteoconductive properties at the perforation. How important are these findings to advancing research on PEEK implants? This aforementioned study is the third by our research group on PEEK. There were two main areas of investi- gation regarding the material used in this study, the use of PEEK as a bio- material and the innovative coating technique by which a nanosized hy- droxyapatite coating is applied to the implant surface. Further, this study (cid:5) 10 PEEK is not optimal as a loadbearing implant. implant because of the bio-inert sur- face which does not osseointegrate without modification. Therefore, re- search on PEEK implants is both chal- lenging and motivating, particularly since the arena of applications, espe- cially in dentistry, is so unexplored. It has been argued that implantable PEEK polymers are a next-genera- tion biomaterial. Is that fact or fan- tasy? I would say that PEEK has come a long way to becoming the next-gen- eration biomaterial in the orthopae- dic field. Today, PEEK is the standard implant material in several spinal chanical properties compared with metals. PEEK has an elastic modulus similar to that of human bone, while that of titanium is almost eightfold higher. Differences in elastic modu- lus between the implant and the sur- rounding tissue may promote stress shielding and inhibit bone growth or lead to bone resorption. Furthermore, titanium and metal alloys have, in some documented cases, caused signs of hypersensitivity and allergy. These days, there is also an increas- ing demand for non-metallic restora- tions and biomaterials. PEEK is bio-in- ert, has a non-reactive surface and, according to current literature, has 8 26th EAO Annual Scientific Meeting (cid:24)Dr Johansson is examinating histological sections of the implant in rabbit bone before looking at this in the microscope. This is a histological image from a PEEK implant with a hydroxyapatite coating. This one is implanted into rabbit bone and retrieved after three weeks of healing. At the bottom of the implant you can see the osteoconductive properties of hydroxyapatite on PEEK as the bone bends and grow along the implant surface.

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