REVIEWS

Polyetheretherketone in Implant
Prosthodontics: A Scoping Review
Andrea Paratelli, DDS
Giammarco Perrone, DDS
Department of Prosthodontics and Restorative Dentistry, School of Dentistry, Complutense University of
Madrid, Madrid, Spain.

Rocío Ortega, DDS, PhD

Department of Prosthetic Dentistry, School of Dentistry, European University of Madrid, Madrid, Spain.

Miguel Gómez-Polo, DDS, PhD

Department of Prosthodontics and Restorative Dentistry, School of Dentistry, Complutense University of
Madrid, Madrid, Spain.

Purpose: To undertake a scoping review of the available research on the application of polyetheretherketone
(PEEK) in implant prosthodontics, map the available literature in order to highlight possible gaps in
knowledge and, if possible, extract clinical guidelines. Materials and Methods: The literature on PEEK in
implant prosthodontics published through August 2018 was identified with an online search of MEDLINE
(via PubMed), Science Direct, Embase (via Ovid), and Google Scholar databases. Qualitative and quantitative
syntheses were carried out for original research studies. Results: The amount of published original research
studies was found to be limited. PEEK was found to be applied as a material in the fabrication of implant-
supported fixed dental prosthesis (IFDP) frameworks (43%), prosthetic implant abutments (35%), implant
abutment screws (15%), and retention clips on implant bars (7%). Only 38% of the studies were clinical
studies, while 15% were observational and 47% were in vitro. The studies identified did not permit the
estimation of long-term survival nor success rates for any of the prosthetic components. The results only
allowed a preliminary short-term assessment of PEEK IFDP frameworks, which presented satisfactory survival
but alarming success rates over the first year of service. Conclusion: In light of the paucity of evidence on
the viability of PEEK as an implant-prosthodontic material, its use cannot yet be endorsed. Clinicians should
heed the suggested protocols to improve mechanical performance and lower the incidence of prosthetic
complications. Further high-quality research is needed for an enhanced understanding of the material’s
viability. Int J Prosthodont 2020;33:671–679. doi: 10.11607/ijp.6649

P
lastic materials have a broad range of applications today, and there are many dif-
ferent categories of polymers available. High-performance polymers are plastics
that meet stringent requirements for temperature stability, chemical resistance,
and mechanical properties. Since their formulations can be altered as required, these
materials can be designed favoring any one of these characteristics over the others to
meet specific objectives. High-performance polymers find many applications in many
different fields, such as engineering, industry, and medicine (ie, medical devices).1,2
Polyetheretherketone (PEEK) is a polycyclic aromatic semi-crystalline thermoplastic
polymer with mechanical properties that are favorable for biomedical applications. By
incorporating hydroxyapatite particulates into a PEEK matrix, some authors have ob-
tained a composite polymer that showed a tensile strength ranging from 49.0 to 83.3
Correspondence to:
MPa, which matches the lower limits of cortical bone (50 to 150 MPa).3 Thanks to its Dr Andrea Paratelli
elastic behavior, which is similar to human bone, PEEK is widely used in spinal surgery, Complutense University of Madrid
Pza. Ramón y Cajal s/n, 28040
orthopedic surgery, and maxillofacial surgery as a bone and cartilage substitute.4,5
Madrid, Spain
PEEK was first introduced in three forms of unfilled versions: PEEK-LT1, PEEK-LT2, Email: andrea.paratelli@gmail.com
and PEEK-LT3. Subsequently, fillers such as ceramics, hydroxyapatite, beta-calcium
Submitted July 26, 2019;
phosphate, and carbon fibers were added to the PEEK formula to increase its bio-
accepted June 9, 2020.
activity and improve its mechanical properties, leading to materials such as BioHPP ©2020 by Quintessence
(Bredent).6,7 Many filled PEEK versions are now being used to manufacture biomedical Publishing Co Inc.

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 Reviews

Articles identified through online search (n = 1,910)

Articles identified from reference lists

and systematic reviews (n = 25)

Abstracts screened after excluding duplicates (n = 1,522)

Records excluded after title and

abstract screening (n = 1,376)

Articles selected for full-text analysis (n = 146)

Records excluded after full-text

analysis (n = 133)

Articles included in qualitative and quantitative syntheses (n = 13)

Fig 1   Flowchart of literature search protocol.

implants.7 Due to its favorable mechanical properties,
PEEK has also reached the field of dentistry, where it
has been implemented in several areas. Combining its
properties with the ongoing diffusion of CAD/CAM
technology, PEEK components can now be digitally de-
signed and then 3D printed, achieving high precision to
meet clinical requirements.
A variety of reviews have discussed the applications
of PEEK in oral implantology and tooth-supported
prosthodontics, which include components for tooth-
supported fixed dental prostheses (FDPs), tooth-sup-
ported removable dental prostheses (RDPs), bioactive
nanocomposites, and dental implants.8–15
PEEK was initially introduced to the implant prosth-
odontics field as a material for the fabrication of interim
restoration components such as implant abutments,
thanks to its fabrication feasibility with CAD/CAM, its
affordable price, and its better mechanical performance
compared to common resin materials.16 However, no
review articles focusing exclusively on PEEK’s role in im-
plant prosthodontics have been identified. It has been
reported by several authors that the evidence regarding
PEEK in dentistry is still limited in quantity2,13; thus, a
scoping review seems to be the most appropriate type of
review article to conduct on this topic in order to assess
whether conducting a further systematic review on the
application of this polymer in implant prosthodontics
would be indicated. Therefore, the present scoping re-
view was conducted in order to systematically map the
research done in this area, as well as to identify any exist-
ing gaps in knowledge regarding PEEK material behavior
when applied as an implant-prosthodontic component.
The following research question was formulated: What
is known from the literature about the application of
PEEK in implant prosthodontics?
MATERIALS AND METHODS
A search of the literature was carried out in the follow-
ing databases: MEDLINE via PubMed, Science Direct,
Embase via Ovid, and Google Scholar. The following
keyword search strategy was applied: PEEK OR poly-
etheretherketone OR poly-ether-ether-ketone OR high-
performance polymer* OR high performance polymer*
OR BioHPP AND (dentistry OR implant-prosthodontics).
As a search filter, only articles published through August
31, 2018, were considered. Additionally, reference lists
and previous review articles were also screened for rel-
evant articles. Regarding the Google Scholar database,
only the first 300 results were considered, as suggested
by Haddaway et al.17 No review protocol has been reg-
istered for this work.

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 Paratelli et al

Table 1   Studies Included in Qualitative and Quantitative Syntheses

Study, y Subjects Component type/material
Agustín-Panadero et al,26 2015 In vitro Resin prosthetic implant abutment

Al-Rabab’ah et al,21 2017 Humans IFCDP framework/titanium-reinforced resin prosthetic implant abutment

Bayer et al,30 2012 Humans Retention clips on implant bars

Bechir et al,22 2016 Humans IFCDP framework

Malo et al,23 2018 Humans IFCDP framework

Maté-Sanchez de Val et al,29 2016 Animals Titanium-reinforced resin prosthetic implant abutment

Nazari et al,24 2016 In vitro Three-unit IFDP framework

Neumann et al,6 2014 In vitro Implant-abutment screws

Ostman et al,28 2008 Humans Titanium-reinforced resin prosthetic implant abutment

Preis et al,25 2017 In vitro Single-unit IFDP framework

Santing et al,27 2012 In vitro Titanium-reinforced resin prosthetic implant abutment

Schwitalla et al,7 2016 In vitro Implant-abutment screws

Zoidis,20 2018 Humans IFCDP framework

The PRISMA Extension for Scoping Reviews (PRISMA-
ScR) checklist was followed as a guideline for the correct
reporting of the items required for this type of review.18
An initial assessment of article eligibility was performed
by screening titles and abstracts, followed by a full-text
analysis. The titles and abstracts of the search results were
initially screened by two reviewers (A.P. and G.P.) for pos-
sible inclusion. To avoid excluding potentially relevant ar-
ticles, abstracts providing an unclear result were included
in the full-text analysis. The full texts of all possibly relevant
studies were obtained for independent assessment by
the two reviewers against the stated inclusion criteria.
Disagreements were brought to an independent reviewer
(M.G.) and resolved through discussion.
To be included in the preliminary evaluation, the fol-
lowing criteria had to be met by the article: abstract
present; related to PEEK in its unfilled and filled presen-
tations; and related to dentistry.
To be included in the qualitative and quantitative
syntheses, the following criteria had to be met: articles
discussing PEEK’s applications in implant prosthodontics
that registered variables linked to the relevant prosthetic
component.
No discriminations were made regarding the manufac-
turing process of the material, its composition, its surface
modification, or its veneering procedures. Only original
research papers and case reports were considered for
the qualitative and quantitative analyses. Historical and
systematic reviews, book chapters, and letters to the
editor were excluded from the analyses; however, if
considered pertinent, they were used for contextualizing
the material’s background.
One independent author (A.P.) carried out the data
charting, with the objective of extracting information
regarding sample size, follow-up period, survival rate,
success rate, fracture strength of the restoration, fracture
strength of the prosthetic component, and complica-
tions. Descriptive statistical analysis was performed for
the data that were deemed suitable. For human and
animal studies that reported the necessary information,
weighted arithmetic means for survival and success rates
were calculated. Survival was considered as the presence
of the prosthetic component inside the mouth at the
time of observation. Success was considered as absence
of complications at the time of observation.19 In case sur-
vival and success rates regarding the same application of
the material were available from multiple studies, human
and animal data were pooled separately. Interexaminer
agreement was calculated using κ statistics.
RESULTS
A total of 1,910 articles were identified from the three
databases searched (MEDLINE, Science Direct, Embase
via Ovid, and Google Scholar; Fig 1). After checking
for duplicates, the titles and abstracts of 1,522 articles
were screened. Of these articles, 146 were selected for
a full-text assessment; of those, 13 were included in
the qualitative and quantitative summaries after a full-
text review (Table 1).6,7,20–30 During screening of the
abstracts, a κ value of 0.91 for interexaminer agreement
was calculated, and during full-text analysis, a κ value
of 0.83 was observed. Disagreements were resolved
through discussion between the reviewers. Different

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 Reviews

Table 2   PEEK as IFDP Framework Material

Treatment Study Sample size, Follow-up, Fracture Survival

phase Application Study design n mo strength, N rate, %

Al-Rabab’ah et al21 In vivo 2 24 NA 100

IFCDP Bechir et al22 In vivo 35 12 NA 100

framework
Malo et al23 In vivo 49 12 NA 98
Definitive
Zoidis20 In vivo 1 24 NA 100
Three-unit IFDP
Nazari et al24 In vitro 10 NA 1,430 N NA
framework
Single-unit IFDP (1) 921;
Preis et al25 In vitro 32 NA NA
framework (2) 1,921
NA = not applicable.

Table 3   PEEK as Prosthetic Implant Abutment Material

Treatment Study Sample
phase Type of abutment Implant system Study design size, n
Titanium-reinforced SKY elegance
Definitive Al-Rabab’ah et al21 In vivo 1
resin abutment (Bredent)
Resin abutment NR Agustín-Panadero et al26 In vitro 8
QuickBridge
Ostman et al28 In vivo 74a
(Zimmer Biomet)
Interim Titanium-reinforced
resin abutment Maté-Sanchez de Val
SKY elegance Experimental 24
et al29
RN synOcta (Straumann) Santing et al27 In vitro 32
NA = not applicable; NR = not reported. aMinimum sample size

study designs were identified. In vivo clinical studies
consisted of 38% (5 studies) of the total, but only 2
had a controlled design, and only 1 was randomized. In
vivo observational studies consisted of 15% (2 studies)
of the total, while in vitro research consisted of 47% (6
studies) of the total.
The applications for PEEK as a material for the manu-
facture of components involved in implant-prosthodontic
rehabilitation procedures were: IFDP frameworks (43%);
prosthetic implant abutments (35%); implant-abutment
screws (15%); and retention clips for attaching dental
prostheses to implant bars (7%). Studies on the applica-
tion of PEEK as a material for the manufacture of implant
healing abutments were not included in this paper, since
they were considered more closely related to the surgi-
cal rather than the prosthetic aspect of the treatment.
Table 2 lists the studies involving PEEK as a frame-
work material for IFDPs. No in vivo studies providing
a control group were found; only two case series.20,21
Two uncontrolled clinical studies22,23 and two in vitro
studies were identified.24,25 The prosthetic design units
identified were implant-supported fixed complete dental
prostheses (IFCDP); three-unit IFDPs; and single-unit
IFDPs. Single-unit and three-unit IFDPs located posteri-
orly accounted for information regarding only fracture
strength, while no information about fracture strength
was recorded for elements located anteriorly, nor for
IFCDPs. In partial IFDPs, the failure pattern was found
to be from adhesive fracture between the framework
and veneering materials in all the samples tested for
fracture resistance.
From the four in vivo studies reporting information on
IFCDPs, 87 prostheses were identified.20–23 The weighted
arithmetic means showed that, over the first 12 months
following prosthetic rehabilitation, IFCDPs had a mean
survival rate of 98.87% and a mean success rate of
85.05%. An incidence rate of 16% was identified for the
appearance of complications over the first 12 months.
Of those complications, 64.28% were found to be of a
mechanical nature, while 35.72% were biologic. Among
the mechanical complications, 77.8% involved adhesive
fracture between the framework and the veneering
materials, 11.1% involved fracture of the framework
material, and 11.1% were reports of discoloration of the

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 Paratelli et al

Mean overall Mean overall

survival Success success Failure
rate, % rate, % rate, % Complications pattern Veneering material

98.87 50 85.05 1 discoloration NA Milled composite resin

3 soft tissue lesions;

88.57 NA Composite resin paste
2 unpleasant taste
1 framework
83.67 7 adhesive fractures Milled composite resin
fracture
100 0 NA Milled composite resin

NAp NA NA NA Adhesive fracture Composite resin paste

(1) Composite resin paste;

NA NA NA NA Adhesive fracture
(2) Milled composite resin

Follow-up, Fracture Type of

mo strength, N Survival rate, % Success rate, % Complications restoration

24 NA 100 100 0 Lithium-disilicate crown

NA 329.4 NA NA NA NA
1 restoration fracture;
6 NA 100 NR Chairside resin restoration
2 screw loosening

2 NA 100 100 0 NA

NA > 2,000 NA NA NA NA

prosthesis. Among the biologic complications were the
appearance of soft tissue lesions and unpleasant taste.
Table 3 lists the studies that discuss PEEK applications
as a prosthetic implant abutment material. One case
report was identified for the application of PEEK as a
definitive prosthetic implant abutment,21 while two in
vitro studies and two clinical studies were identified for
PEEK interim prosthetic implant abutments.26–29 The
use of PEEK in a definitive titanium-reinforced resin
prosthetic implant abutment had only one case report,
which showed 100% survival and success rates over 24
months.21 One in vivo controlled animal study, which
included 24 subjects, reported a 100% survival rate over
a 2-month period where PEEK was used in an interim
titanium-reinforced resin prosthetic implant abutment.29
Studies involving PEEK as a material for the fabrication
of implant-abutment screws and round clips for denture
retention over implant bars are listed in Table 4. Only two
in vitro studies concerning PEEK as an implant-abutment
screw material were found.6,7 Using PEEK for retention
clips to attach the prosthesis to round implant bars was
discussed in only one randomized clinical trial, which
showed 100% success and survival rates over the first
6 months.30
DISCUSSION
The limitations of this review include the search strat-
egy selected for the analyzed databases, which was
intentionally designed to be more general, as one of
the objectives was to identify all possible applications
of the material in the field of interest. For the same rea-
son, another limitation relating to reproducibility of the
online search may be the inclusion of Google Scholar
among the analyzed databases. Its search algorithms
often lead to wide amounts of results; however, this
made it possible to map the literature not indexed in
the other databases searched in this review.
According to the evidence obtained, PEEK applications
in implant prosthodontics may be summarized as follows.
IFDP Material
The role of PEEK as an IFDP component was the one re-
ported most often. All of the studies that discussed PEEK

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 Reviews
Table 4   Other PEEK Applications in Implant Prosthodontics
Study
Application Study Material design
(1) Unfilled PEEK; In
Neumann et al6
(2) 30% CFR-PEEK vitro
Implant
abutment
screw (1) 15% short CFR-PEEK;
(2) 40% short CFR-PEEK; In
Schwitalla et al7
(3) 50% continuous vitro
CFR-PEEK
Prosthetic
In
retention Bayer et al30 Unfilled PEEK
vivo
systems
NA = not applicable; NR = not reported; CFR = carbon fiber–reinforced.
as a definitive IFDP material applied the polymer to the
manufacture of frameworks, which were subsequently
veneered with resin materials.20–25
The resistance to fracture of PEEK IFDPs has been
described as inferior to nickel-chromium and zirconia,
but clinically acceptable. However, it should be men-
tioned that the information reported by the in vitro
studies included in this review refers to static fatigue
loads, and no information has been provided about
their performance under cyclic fatigue stress, which is
a more relevant indicator for the behavior of oral re-
habilitations. The fabrication design and type of resin
veneer also impacted the resistance to fracture, favoring
cemented restorations over screw-retained ones and
veneering with milled composite resin over composite
paste.25,31 Therefore, in situations where the choice of
screw-retained or a cemented design is equally indicated,
cemented restorations are believed to account for bet-
ter mechanical performance, and regarding the choice
of veneering procedure and material, milled composite
resin should be preferred. Different fabrication proce-
dures have also been shown to influence the mechanical
properties of the prosthesis. Restorations manufactured
using CAD/CAM–milled PEEK appear to be more resis-
tant to fracture than elements made using other fabrica-
tion methods.32
IFCDPs have been shown to provide highly successful
treatment for patients with edentulism.33 PEEK IFCDPs
may offer a reasonable meeting point between the
affordability and ease of repair of metal-acrylic IFDPs
and the better mechanical performance of zirconia and
metal-porcelain IFCDPs.34–36
Despite the limited number of cases reported, based
on the results discussed in this review, PEEK IFCDPs
seem to have satisfactory survival rates (98.87%) at 12
months. Besides the fact that this statement is based
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Sample Follow- Fracture Survival Success
size, n up, mo strength, N rate, % rate, %
(1) 10; (1) 149.5;
NA NA NA
(2) 10 (2) 145.2
(1) 152.7;
NR NA (2) 157.3; NA NA
(3) 191.7
30 6 NA 100 100
on only four studies, it should also be noted that all of
the included studies present short follow-up periods;
however, the results are comparable to those achieved by
metal-acrylic, metal-porcelain, and zirconia IFCDPs.33–35
On the other hand, the success rates for PEEK IFCDPs
showed more alarming data, as a 16% incidence rate
for the appearance of complications was observed at
12 months. Resin-veneered polymethyl methacrylate
(PMMA) and ceramic-veneered zirconia IFCDPs were
reported as showing annual complication rates of 6.6%
with a 90.6% survival rate, free of complications, at 12
months.37 These figures suggest that PEEK IFCDPs incur
greater risk. The incidence of complications reported
here, however, should be interpreted considering certain
limitations—namely, only 87 PEEK IFCDPs were identi-
fied, with a follow-up at 12 months for 84 prostheses
and at 24 months for 3 prostheses. Besides the limited
number of cases, the 12-month follow-up period pro-
vides limited clinical significance in the case of definitive
prostheses.
Biologic complications, which were unpleasant taste
and soft tissue lesions, made up 35.72% of the total
cases observed. However, it should be noted that the
authors of the study reporting taste alterations stated
that some of the patients were also suffering from sys-
temic conditions at the time of evaluation,22 thus adding
another level of bias to the incidence rate for complica-
tions. PEEK has been previously appointed as a bioinert
material38; however, Trindade et al recently observed
that this material triggers higher immune activation with
respect to titanium during the process of osseointegra-
tion.39 The authors suggested that the knowledge of
the material’s chemical inertia was most likely based
on in vitro studies, since information regarding the role
of the immune system in the downregulation of the
inflammatory process during the PEEK-host interaction

was not available.40 It is not yet clear whether the soft
tissue lesions observed in this review may be related to
PEEK’s interaction with the host tissues or to confound-
ing factors from the designs of the included studies;
however, in light of the results mentioned above, this
might be worthy of further investigation.
Regarding mechanical failures, 77.8% consisted of
adhesive fracture between the framework and veneering
materials. Failure patterns in single- and multi-unit IFDPs
also mostly consisted of adhesive fractures between the
framework and veneering material,24,25,31 which cor-
roborates the findings observed for IFCDPs. This should
indicate satisfactory resistance for the framework, even
though, to date, no durable and predictable bonding
strategy between a PEEK framework and composite
veneer has been found. Future investigations should
focus on finding the right balance between supplement-
ing the PEEK formula with fillers and choosing the right
surface-conditioning protocol and veneering procedure
to obtain optimal mechanical performance.
Implant Abutment Material
Several in vitro and in vivo studies reported using pros-
thetic implant abutments composed entirely or partially
of PEEK.21,27–29,41–48 However, only five studies discussed
abutment-related variables that were of interest for this
paper.21,26–29
In terms of mechanical performance, PEEK resin im-
plant abutments have been described as significantly
less resistant to fracture than titanium abutments.26
Their higher shock absorption capability does not nega-
tively affect stress distribution in the implant or the pe-
ripheral bone when compared to other restoration and
abutment materials.44 Nevertheless, these abutments
showed higher stress concentration in the restoration
crowns, which is especially relevant in the case of central
incisors where the restoration is thinner, thus suggesting
that PEEK resin implant abutments may require specific
precautions when it comes to the design of a crown
restoration.27,44
PEEK titanium-reinforced resin implant abutments
have been used in cases of immediate loading by sev-
eral authors.21,28 These systems are composed of a ti-
tanium core and an overlying PEEK sleeve, which may
be removable or not, depending on the design of the
element. More recently, an abutment composed of a
titanium core with a ceramic-reinforced PEEK sleeve has
been introduced to the market.21 Even if supported by
only one animal study, the evidence seems to indicate
that this abutment is superior to titanium in terms of
soft tissue adaptation. This abutment is also suitable
for the “one abutment—one time” concept, meaning
that titanium-reinforced PEEK abutments could also be
used as both provisional and definitive abutments.29
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Paratelli et al
An in vitro study conducted by Santing et al reported
that composite resin crowns supported by titanium-
reinforced PEEK abutments are capable of bearing static
loads up to 2,000 N.27
Among the limitations of this paper was the impos-
sibility to estimate success and survival rates for PEEK
prosthetic implant abutments due to the paucity of in
vivo information and the heterogeneity of the systems
identified. However, it can be deduced from the results
that PEEK titanium-reinforced implant abutments could
provide superior results in terms of mechanical resistance
when applied as either an interim or a definitive abut-
ment. Therefore, use of a titanium core is preferred to
the resin-only version of the component. The thickness
and manufacturing process of the interim restoration
could be more significant to the outcome of treatment
with PEEK abutments than they would be for titanium
abutments. Future research should focus on the me-
chanical resistance of titanium-reinforced PEEK abut-
ments, as well as long-term in vivo outcomes.
Implant Abutment Screws
The proportional advantages given by PEEK abutment
screws are related to their shock absorption properties,
as well as their easier removal in case of fracture due to
their lower friction coefficients. When tested for frac-
ture strength compared to titanium, PEEK screws were
shown to be 5 times less resistant, and no differences
were found between the unfilled and carbon fiber–filled
versions of the material. However, no description of the
carbon fiber design was provided by the authors.6 In a
more recent study, Schwitalla et al7 reported that PEEK
screws filled with short carbon fibers (with a composition
of up to 40%) showed similar mechanical behavior to
what was reported by Neumann et al6 and also observed
a 20% increase in tensile strength when the PEEK was
filled with a continuous carbon fiber composition of at
least 50%.
It has been demonstrated that the addition of PMMA
cement improves the mechanical resistance of carbon
fiber–reinforced PEEK screws.49
The design of the connection between the implant
and the restoration is another factor that could affect the
mechanical performance of the abutment screw. Since
PEEK abutment screws have a higher tendency to incur
plastic deformation than titanium, the relations between
different implant connections and screw designs should
also be investigated further.
The upcoming challenge for PEEK abutment screws
will consist of finding the right balance in the filler com-
position in terms of quantity and structure, the abut-
ment material, and the implant connection design. To
date, scientific evidence lacks the consistency required
to recommend them for clinical use.
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 Reviews
Prosthetic Retention Systems
Plastic retention clips have been studied in several sce-
narios to investigate their retention of tooth-supported
RDPs. They have been described as less retentive than
commonly used materials such as cobalt-chromium, but
still retentive enough to serve their clinical purpose. PEEK
resin clips have been shown to be potentially reliable as
a retention clasp for anchoring tooth-supported RDPs
with a 10-year service life; however, it seems that it is
necessary to increase their diameter to twice that of
the metal clasps in order to obtain sufficient long-term
retention.50
In cases of implant-supported prostheses, there is
limited evidence about using PEEK for retention clips.
Bayer et al reported in a human randomized clinical trial
that PEEK clips applied as retention devices over round
implant bars had sufficient retentive force, with a clini-
cally acceptable 20% retention loss after 6 months.30
A more recent high-performance polymer named
polyetherketoneketone (PEKK) has been claimed to pro-
vide promising mechanical performances when com-
pared to other members of the polyaryletherketones
(PAEKs) family.51 Its favorable mechanical properties
are given by a higher compression strength, an elastic
modulus similar to human bone, and a higher polishing
capability.52 In terms of bacterial adhesion, PEKK has
also been demostrated to provide comparable results
to conventional PEEK.53 PEKK is currently indicated for
producing retention devices for implant-supported over-
dentures.54 Further investigations are needed to gain a
better understanding of this material’s biocompatibility
and feasibility for implant prosthetic treatments.
Further research is also needed to clarify diameter- and
shape-related specifications for different designs of im-
plant bars, as well as their long-term retention capability
since, to date, these parameters are still unknown.
CONCLUSIONS
Despite PEEK being used for the fabrication of several
components involved in implant prosthodontic reha-
bilitation, the scientific evidence available is limited in
quantity and quality. The lack of evidence means that
undertaking a systematic review is not appropriate or
necessary, but advocates further, better designed clini-
cal research. The use of PEEK in implant prosthodontics
should not yet be endorsed; however, if used, clini-
cians should heed the suggested protocols regarding
this choice of prosthetic component, as well as its fab-
rication procedure and veneering material or overlying
restoration, bearing in mind that long-term outcomes
are still uncertain.
678 The International Journal of Prosthodontics
© 2020 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
ACKNOWLEDGMENTS
The authors did not receive any funding from third-party sources for
the realization of this scoping review. Regarding the studies included
in this review (n = 13), 3 (23%) were industry sponsored, 1 (7%) was
nonsponsored, 7 (54%) did not report funding sources, and 2 (15%)
were public-sponsored. The authors report no conflicts of interest.
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Literature Abstract

Oral Saliva and COVID-19

Outbreak pneumonia announced in Wuhan, China, in December 2019, had its causative factor classified as a new coronavirus (SARS-
CoV-2). Since saliva can host several viruses, including SARS-CoV-2, the transmission chance for viruses through saliva, particularly those
causing respiratory infections, is unavoidable. COVID-19 can be detected through salivary diagnostic testing, which has many advantages
for medical care professionals and patients. It should be noted that not only does saliva offer an ecologic niche for the colonization and
development of oral microorganisms, but it also prevents the overgrowth of particular pathogens, such as viral factors. The aim of this
study is to gather all the information about saliva and its association with COVID-19 for health care professionals across the world.
Baghizadeh Fini M. Oral Oncol 2020;108:104821. References: 23. Reprints: Maryam Baghizadeh Fini, m.baglizadeh92@gmail.com —Steven Sadowsky, USA

Volume 33, Number 6, 2020 679

© 2020 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.