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Implant Tribune Asia Pacific Edition

18 IMPLANT NEWS Implant Tribune Asia Pacific Edition | 11/2017 “Research on PEEK implants is both challenging and motivating” An interview with Dr Pär Johansson, Sweden materials and inventive shapes and forms. Thereafter, the im­ plant surface was modiied using several subtractive and additive methods to shorten the healing time and increase the success rate. Today, researchers are attempting to improve osseointegration by loading the implant surface with pharmaceuticals or proteins. As a researcher, I would say that the most important developments in dental implantology have been the surface improvements and, to some extent, our understand­ ing of bone and implant interac­ tion. As a clinician, the greatest developments have been im­ proved treatment protocols and the implementation of digital ap­ pliances. At the 2017 European Association for Osseointegration (EAO) con- gress, you gave a lecture about PEEK implants. What was your motivation behind specialising in this implant material? Dr Pär Johansson is the founder and CEO of three dental clinics in Malmö. “The colour of PEEK is more natural, and this enables the manufacturing of aesthetic implants for thin biotypes [...].” By Monique Mehler, DTI In 2010, Dr Pär Johansson received his dentistry degree at Malmö Uni- versity in Sweden, where he sub- mitted a master thesis on implant surfaces. A few years later, he joined a research team at the same department as they were launch- ing an interesting project on a new implantable material, PEEK (poly- ether ether ketone). In an interview with Dental Tribune, Johansson spoke about the advantages and challenges of PEEK implants and what the new material could mean for the future of implantology. What, in your opinion, has been the greatest development in dental implantology throughout the dec- ades? Since the discovery of osseo­ integration, the development of dental implantology has been ex­ traordinary and extremely fast. The advancement began by exper­ imenting with different implant The project became my PhD project, which I am defending later this year. PEEK is a highly ad­ vanced polymer with properties that could improve the treatment outcomes of several procedures. The challenge is that PEEK is not optimal as a load­bearing implant because of the bioinert surface which does not osseointegrate without modiication. Therefore, research on PEEK implants is both challenging and motivating, par­ ticularly since the arena of appli­ cations, especially in dentistry, is so unexplored. It has been argued that implanta- ble PEEK polymers are a next-gen- eration biomaterial. Is that fact or fantasy? I would say that PEEK has come a long way to becoming the next­generation biomaterial in the orthopaedic ield. Today, PEEK is the standard implant material in several spinal procedures and ongoing research has introduced more applications. In dentistry, 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 biomaterials is a slow process which require a comprehensive evaluation by the U.S. Food and Drug Administration before it can be implemented for clinical trials. PEEK­OPTIMA (Invibio) is cur­ rently 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 biomechanical properties com­ pared with metals. PEEK has an elastic modulus similar to that of human bone, while that of tita­ nium is almost eightfold higher. Differences in elastic modulus be­ tween 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 hypersensi­ tivity and allergy. These days, there is also an in­ creasing demand for non­metallic restorations and biomaterials. PEEK is bioinert, has a non­reac­ tive surface and, according to cur­ rent literature, has never shown any signs of provoking hypersen­ sitivity. The colour of PEEK is more natural, and this enables the man­ ufacturing of aesthetic implants for thin biotypes and diverse den­ tal components. Finally, PEEK is transparent to X­rays, which is a feature highly useful after spine surgery, allowing the postopera­ tive 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 indings to advancing re- search on PEEK implants? This aforementioned study is the third by our research group on PEEK. There were two main areas of investigation regarding the ma­ terial used in this study, the use of PEEK as a biomaterial and the in­ novative coating technique by which a nanosized hydroxyapa­ tite coating is applied to the im­ plant surface. Further, this study evaluated a PEEK implant with a unique design: the implant is manufactured with an apical per­ foration to enable evaluation of the bone fusion. The design is mainly aimed to be correlated to spinal applica­ tions where PEEK implants are currently used as cages between the vertebrae to facilitate bone fusion. The results of this study show the signiicant effect of sur­ face modiication using nano­hy­ droxyapatite. These outcomes are important in inspiring and facili­ tating future research on PEEK and nano­hydroxyapatite. This coating technique can further be applied to PEEK implants with other design and surface proper­ ties of the core material. 1 2 Fig. 1: Dr Pär Johansson at his lab at Malmö University, Sweden, conducting PCR (polymerase chain reaction) to evaluate gen-expression on PEEK implants implanted in rabbit bone.—Fig. 2: A histological image of a PEEK implant with a hydroxyapatite coating.

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