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Received: 5 March 2019    Revised: 20 May 2019    Accepted: 20 May 2019

DOI: 10.1111/clr.13487

ORIGINAL RESEARCH

Soft tissue response to dental implant closure caps made of

either polyetheretherketone (PEEK) or titanium

Jordi Caballé‐Serrano1,2,3  | Vivianne Chappuis1  | Alberto Monje1  |

1 1,2
Daniel Buser  | Dieter D. Bosshardt

1
Department of Oral Surgery and
Stomatology, School of Dental Abstract
Medicine, University of Bern, Bern, Objective: Polyetheretherketone (PEEK) is a popular synthetic thermoplastic pol‐
Switzerland
2 ymer for medical applications, but its clinical use suffers from several limitations.
Robert K. Schenk Laboratory of
Oral Histology, School of Dental Therefore, the aim was to compare the soft tissue response to dental implant closure
Medicine, University of Bern, Bern,
caps made of PEEK or titanium as evaluated by the occurrence of multinucleated
Switzerland
3
Department of Oral and Maxillofacial
giant cells (MNGCs).
Surgery, School of Dental Material and methods: Forty‐two implants were placed in the maxilla of seven minia‐
Medicine, Universitat Internacional de
Catalunya, Barcelona, Spain
ture pigs. While commercially pure titanium (Ti) implants had a Ti closure cap, ceramic
implants made of either zirconia (Zr) or alumina‐toughened zirconia (Zr + Al) received
Correspondence
Dieter D. Bosshardt, Department of
a PEEK closure cap. Histomorphometry was performed to evaluate the number of
Oral Surgery and Stomatology, School small and large MNGCs being in contact with the PEEK or the Ti in different compart‐
of Dental Medicine, University of Bern,
Freiburgstrasse 7, 3010 Bern, Switzerland.
ments of the implant systems.
Email: dieter.bosshardt@zmk.unibe.ch Results: No histological signs of inflammation were noticed, and MNGCs were ob‐

Funding information
served on both PEEK and Ti closure caps and on all three implant types. Significantly
Dentalpoint AG in Switzerland, Grant/Award higher numbers of MNGCs were found on closure caps made of PEEK than on closure
Number: DP 2013-002
caps made of Ti on the external closure cap surface facing both soft (p = 0.0008 for
PEEK on Zr and p = 0.0016 for PEEK on Zr + Al) and hard tissues (p = 0.016 for PEEK
on Zr and p = 0.003 for PEEK on Zr + Al) as well as in the internal closure cap surface
(p = 0.014 for PEEK on Zr and p = 0.0088 for PEEK on Zr + Al). No statistically signifi‐
cant differences in the number of MNGCs were observed on the three implant types.
Conclusions: Significantly more MNGCs were in contact with PEEK than with Ti clo‐
sure caps.

KEYWORDS
abutment, dental implant, macrophage, multinucleated cell, PEEK, polyetheretherketone

1 |  I NTRO D U C TI O N
Polyetheretherketone (PEEK) is a semi‐crystalline colourless or‐
ganic thermoplastic polymer developed in 1978 (Eschbach, 2000)
with mechanical properties similar to human cortical bone (Wang
et al., 2010). PEEK was first applied in the 1980s for industrial pur‐
poses (Feldman, 1986) and later used in the medical field (Cook &
Rust‐Dawicki, 1995; Kurtz & Devine, 2007). PEEK can be used to
fabricate medical implants with good chemical and physical prop‐
erties such as stability at high temperatures, resistance to corrosion
and stability to sterilization processes (Ma & Tang, 2014). Besides
the aforementioned favourable physical and chemical properties,
PEEK is biocompatible as shown in vitro (Wenz, Merritt, Brown,
Moet, & Steffee, 1990) and in vivo in the orthopaedic arena (Rivard,

Clin Oral Impl Res. 2019;00:1–9. wileyonlinelibrary.com/journal/clr   © 2019 John Wiley & Sons A/S. |  1
Published by John Wiley & Sons Ltd
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2       CABALLÉ‐SERRANO et al.
Rhalmi, & Coillard, 2002), not being mutagenic (Katzer, Marquardt,
Westendorf, Wening, & von Foerster, 2002), which makes PEEK a
biocompatible implant material for bone prostheses with demand‐
ing mechanical and biological properties. However, PEEK may also
have some disadvantages in relation to mechanical strength, the ab‐
sorption of liquids, leakage of undesirable by‐products and problems
during sterilization.
 PEEK is also used to produce dental materials (Cook & Rust‐
Dawicki, 1995; Kurtz & Devine, 2007) such as bone substitutes
(Wu et al., 2012). Since the 1990s (Cook & Rust‐Dawicki, 1995), a
series of studies investigating PEEK for producing dental implants
have been published (Schwitalla & Muller, 2013). However, these
reports focused on the osseointegration process (Poulsson et al.,
2014) and not on the integration of PEEK with the soft tissues at
the histological level. In implant dentistry, PEEK is also used to
fabricate soft‐tissue‐level prosthetic hardware such as implant
prosthetic screws (Neumann, Villar, & Franca, 2014), transitional
abutments for immediate aesthetics (Tetelman & Babbush, 2008)
and healing abutments (Koutouzis, Richardson, & Lundgren, 2011).
A recent study analysing soft and hard tissue reactions to healing
abutments showed no differences between Ti and PEEK (Rea et
al., 2017). However, only histomorphometric data were reported,
not focusing on the PEEK–soft tissue interface. PEEK has also
been used to fabricate frameworks or abutments of fixed dental
prosthesis with good chemical adhesion properties (Caglar, Ates, &
Yesil Duymus, 2018; Stawarczyk et al., 2013, 2014). Some proper‐
ties using PEEK prosthetic abutments include high rigidity and low
plaque affinity due to a high polishing capability and low porosity.
These properties also made PEEK a suitable material for fabricating
partial removable denture frameworks (Zoidis, Papathanasiou, &
Polyzois, 2015).
Despite favourable biomechanical properties, PEEK is biologi‐
cally inert (Briem et al., 2005; Wang et al., 2010), causing, for ex‐
ample, a low bone‐to‐implant contact (Koch et al., 2010; Kurtz &
Devine, 2007). Adverse tissue reactions to PEEK have also been
described (Maldonado‐Naranjo, Healy, & Kalfas, 2015). In some
cases, occasional and slight infiltration of inflammatory cells not
characterized as a foreign body reaction were found throughout
a period of 3 years, when PEEK was implanted subcutaneously in
sheep (Nieminen et al., 2008). Other studies using lumbar bone spi‐
nal fusion devices found macrophages with occasional foreign body
giant cells showing a mild chronic inflammatory response 6 months
after implantation (Toth et al., 2006). Development of multinucle‐
ated giant cells (MNGCs) is influenced by the surface chemistry
and topography (Boehler, Graham, & Shea, 2011). Macrophages
and related cells can develop in bone and soft tissue compartments
(Chazaud, 2014; Ginhoux & Jung, 2014; Miron & Bosshardt, 2016)
being a possible indicator of an inflammatory response or a foreign
body reaction to the implanted biomaterial (Butterfield, Best, &
Merrick, 2006; Fujiwara & Kobayashi, 2005).
Closure caps on Ti dental implants are made of Ti with no obvi‐
ous complications reported in the literature. With the introduction
of ceramic implants, it was not possible to use Ti closure caps and
therefore PEEK closure caps were introduced. Nonetheless, there
are almost no data regarding the tissue response to PEEK dental
hardware. Therefore, the aim of the present study was to compare
the soft tissue response to dental implant closure caps made of ei‐
ther PEEK or Ti as evaluated by the presence of MNGCs.
2 | M ATE R I A L A N D M E TH O DS
2.1 | Animals and implants
Seven mature Goettinger miniature pigs with an average age of
25 months (range: 22–33 months) and an average weight of 50 kg
(range 45–60 kg) were used. Forty‐two implants were placed in
total, having even numbers in each group (i.e., N = 6 per group).
The protocol was approved by the Committee for Animal Research,
State of Bern, Switzerland, according to the ARRIVE guidelines
(Approval no. 53/12), using a study design that has been success‐
fully utilized in previous studies (Buser et al., 2004; Chappuis et
al., 2018; Saulacic, Bosshardt, Bornstein, Berner, & Buser, 2012;
Saulacic, Erdosi, Bosshardt, Gruber, & Buser, 2014). A detailed
protocol of the study design, surgical procedure and animal eu‐
thanasia is described in a previous publication that used the same
samples for the evaluation of osseointegration of dental implants
(Chappuis et al., 2016). Animals were premedicated using keta‐
mine (intramuscular [i.m.] 20 mg/kg), xylazine (i.m. 2 mg/kg), at‐
ropine (intravenous [i.v.] 0.05 mg/kg) and midazolam (i.v. 0.5 mg/
kg) to allow intubation. Inhalation anaesthesia was performed
with isoflurane (1.0%–1.5%). Fentanyl patches (5–10 mg/kg) and
additional local anaesthesia were applied (Ultracaine, Articaine
4% with epinephrine 1:200000, Sanofi‐Aventis AG) to ensure
intra‐ and postoperative analgesia. The animals received antibi‐
otic prophylaxis for 3  days (Duplocillin LA, 12000 U.I./kg; MSD
Animal Health GmbH, Luzern, Switzerland). The present study was
performed in three surgical phases. First, extracting the six maxil‐
lary incisors and allowing the sites to heal for 3 months; second,
implants were placed on one side of the maxilla, and third, after
4 weeks of healing the remaining implants were placed in the con‐
tralateral side of the maxilla following a split‐mouth design. One
implant of each type (three different types of implants) was placed
on one side of the anterior maxilla at the third surgical phase using
a systematic random protocol (Buser et al., 2004).
Three different dental implants were used: Ti implants made
of commercially pure Ti (cpTi grade 4, TST, Thommen Medical
AG—group Ti), Yttria‐stabilized zirconia with 5% yttria (Zerafil‐TZP,
Dentalpoint AG—group Zr) and Alumina‐toughened zirconia with
4% yttria and 20% alumina (Zerafil‐ATZ, Dentalpoint AG—group
Zr  +  Al). Implant sites were prepared according to the recommen‐
dations of the manufacturers. Ti implants had a Ti closure cap and
both types of zirconia implants had a polyetheretherketone (PEEK;
PEEK‐classix™ white, Invibio Ltd) closure cap. Ti closure caps were
screwed, while ceramic implants were provided with press‐fit PEEK
closure caps. PEEK was pure without surface treatment. Ti and PEEK
closure caps were inserted after implant placement.  Primary wound
CABALLÉ‐SERRANO et al. |
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closure was achieved to allow submerged healing. The animals were
euthanized yielding healing periods of 4 and 8 weeks.
2.2 | Histologic processing and analysis
The specimens were rinsed in water, dehydrated in ascending eth‐
anol fractions, infiltrated and embedded in methylmethacrylate.
The embedded blocks were serially cut into 500‐μm‐thick ground
sections using a slow‐speed diamond saw with a coolant (Varicut®
VC‐50; Leco). After mounting onto acrylic glass slides, the sections
were ground to a final thickness of 80 μm (Knuth‐Rotor‐3; Struers)
and superficially stained with toluidine blue/McNeal combined with
basic fuchsin (Schenk, Olah, & Hermann, 1984). While checking for
the MNGCs on the biomaterial surfaces, we noticed that there were
large and much smaller MNGCs present on the different biomateri‐
als. Therefore, we decided to categorize them into small (2–5 nuclei)
and large (>5 nuclei) multinucleated cells. Number of cells was nor‐
malized to the length of the surfaces analysed.
2.3 | Regions of interest
Two major regions were delineated: (a) an external compartment
displaying the outer closure cap surface exposed to the surround‐
ing soft and hard tissues. As the external compartment was partially
covered by bone after the process of osseointegration, two main
subregions were analysed, namely bone and soft tissue regions, and
(b) an internal compartment represented by the area within the void
between the PEEK or Ti closure cap and the opposing dental implant
surface, which was formed as a consequence of misfit. Regarding
the internal compartment, two subregions were analysed, one being
confined to the implant surface (either ceramic or Ti) and the other
one belonging to the surface of the PEEK or Ti closure caps. The dif‐
ferent regions of interest are presented in Figure 1.
2.4 | Statistical analysis
A sample size calculation using the data from a preliminary observa‐
tion was performed. The pilot study revealed that there were up to
10 times more multinucleated cells on PEEK closure caps than on
titanium closure caps. Using these values and establishing alpha risk
at 0.05 and a target power of 0.8, a sample size of 6 was obtained.
The arcsin approximation was used due to the presence of differ‐
ent proportions of multinucleated cells on PEEK and on titanium.
Density of small cells and large cells was assumed to depend on sev‐
eral categorical factors: “closure cap type” (Ti vs. PEEK on Zr implant
vs. PEEK on Zr + Al implant), “cell size” (small vs. large) and “healing
period” (4 weeks vs. 8 weeks). Due to the number of missing values,
the full model could only be considered for the analysis of the exter‐
nal part of the cap. For the internal part of the cap, a reduced model
was used instead. In this reduced model, the factor healing period
was not considered. To quantify the effects of these factors on the
outcome, repeated‐measures ANOVA was performed according to
Brunner and Langer (Brunner & Puri, 2001). Thus, nonparametric
methods were chosen due to the small sample size. The applications
used for the statistical analysis were nparLD (Noguchi, Gel, Brunner,
& Konietschke, 2012) and exactRankTests (CRAN R‐project).
For each model, a post hoc analysis was performed using Wilcoxon
signed‐rank tests for the paired case and Mann–Whitney–Wilcoxon

(a)

F I G U R E 1   Schematic drawing of Ti
and Zr implants illustrating the different
compartments for the analysis of closure
(b)
caps made of (a) polyetheretherketone
and (b) Ti. The internal part represents
the gap between the implant connection
and the closure cap. In this gap, there
are two different surfaces, one belongs
to the implant fixture and the other to
the implant cover screw. The soft tissue
compartment represents the part of
the closure cap that is in direct contact
with the soft tissue, whereas the bone
compartment represents the part of the
closure cap, which is in direct contact with
bone
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4       CABALLÉ‐SERRANO et al.
F I G U R E 2   Histological details of the different regions analysed on the polyetheretherketone (PEEK) closure caps. (a) Internal part of
the PEEK closure cap. (b) External compartment with bone facing the PEEK surface. (c) External compartment with tissue facing the PEEK
surface. Asterisks mark multinucleated giant cells
tests for the non‐paired case. Corrections for multiple testing were
only applied in the case of significant effects. If there were no sig‐
nificant effects, the post hoc tests are of an explorative nature, and
thus, no corrections were performed. p‐Values < 0.05 were consid‐
ered as statistically significant.
3 |   R E S U LT S
Healing was uneventful and without complications in all animals.
Histologically, no signs of inflammation were noticed (Figure 2).
Multinucleated giant cells were observed on all implant types and
on both PEEK and Ti closure caps (Figure 2). Their number varied
depending on location and biomaterial.
3.1 | External compartment
3.1.1 | Bone region
In this region of interest, the factors “closure cap type” (p = 0.007),
“cell size” (p = 0.0001) and the interaction amongst them (p = 0.0174)
showed statistical significances. Ti closure caps presented on aver‐
age up to 1 MNGC per surface unit, while Zr or Zr + Al closure caps
contained up to 6 MNGCs per surface unit. As neither the factor
“healing period” nor its interactions reached statistical significance,
the data were pooled for the post hoc tests. For the comparison be‐
tween “closure cap type” with “cell size,” Mann–Whitney–Wilcoxon
tests were performed and for the comparison between “cell size” for
the same “closure cap type” Wilcoxon signed‐rank tests were per‐
formed due to dependence. These tests showed a significantly lower
number of small MNGCs on Ti caps than on PEEK caps placed on Zr
implants (p  =  0.016) and on PEEK caps placed on Zr  +  Al implants
(p = 0.003), respectively (Figure 3). In PEEK closure caps, a fibrous
layer was always observed between the biomaterial and the bone.
In contrast, the bone was in direct contact with the Ti closure cap.
3.1.2 | Soft tissue region
The factors “closure cap type” (p = 0.0048) and “cell size” (p = 0.0001)
reached statistical significance. Since neither the factor “healing pe‐
riod” nor its interactions were significant, the factor “healing period”
could be pooled for the post hoc tests. Moreover, since the inter‐
action “closure cap type: cell size” was not statistically significant,
the mean values of small and large cells were considered in order
to do group comparisons. Because the samples were not paired,
Mann–Whitney–Wilcoxon tests were performed. The post hoc tests
showed a significantly lower number of MNGCs on Ti caps than on
PEEK caps placed on Zr implants (p = 0.0008) and on PEEK caps
placed on Zr + Al implants, respectively (p = 0.0016; Figure 4).
3.2 | Internal compartment
3.2.1 | Closure cap surface
The factor “closure cap type” exhibited a high statistical signifi‐
cance (p  <  0.0001). As neither “cell size” nor its interaction with
the “implant type” was significant, the mean (large and small cells)
values were again considered for the group comparisons. Because
the samples were not paired, Mann–Whitney–Wilcoxon tests were
performed to analyse the data. These tests showed a significantly
lower number of MNGCs on Ti caps (on average up to two MNGCs
per surface unit) than on PEEK caps placed on Zr implants (on aver‐
age 9–12 MNGCs per surface unit) (p = 0.014) and on PEEK caps
placed on Zr  +  Al implants (on average 9–12 MNGCs per surface
unit; p = 0.0088), respectively (Figure 5).
3.2.2 | Internal implant surface
No significant effect was noted regarding “implant type,” “cell size”
or the interaction amongst them. Although none of the effects were
significant, post hoc tests were performed for explorative reasons.
CABALLÉ‐SERRANO et al. |
      5

F I G U R E 3   Boxplots displaying the

normalized numbers of multinucleated
giant cells in contact with the closure caps
made of Ti and polyetheretherketone
placed on either Zr or Zr+Al in the bone
region of the external compartment

F I G U R E 4   Boxplot presenting the

normalized numbers of multinucleated
giant cells at the soft tissue region in the
external compartment for the closure
caps made of Ti and polyetheretherketone
placed on either Zr or Zr+Al

F I G U R E 5   Boxplots displaying the

normalized numbers of multinucleated
giant cells on the closure caps in the
internal compartment for the closure caps
made of Ti and polyetheretherketone
placed on either Zr or Zr+Al

Because the comparison of the “implant type” was insignificant, the
mean values of small and large cells were considered. Because the
samples were not paired, Mann–Whitney–Wilcoxon tests were per‐
formed. None of the p‐values for group comparisons reached signifi‐
cance at the 5% level (Figure 6).
4 | D I S CU S S I O N
An increasing number of reports are published on the mechanical
and adhesive properties of PEEK (Uhrenbacher et al., 2014; Zoidis,
Bakiri, & Polyzois, 2016; Zoidis & Papathanasiou, 2016). However,
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6       CABALLÉ‐SERRANO et al.
F I G U R E 6   Boxplots displaying the normalized numbers of multinucleated giant cells in contact with the three implant fixtures in the
internal compartment
not much studies addressed the tissue integration or tissue response
to this biomaterial, especially in the dental field. To the best of our
knowledge, up to date there is no study reporting the interaction of
soft tissues with PEEK utilizing quantitative and qualitative meth‐
ods. The present preclinical study demonstrates that MNGCs were
present on all investigated surfaces, but in different numbers. The
results demonstrate that significantly lower numbers of MNGCs
were found on closure caps made of Ti than on closure caps made
of PEEK, and this was true in the external compartment facing both
soft and hard tissues as well as in the internal compartment. These
data demonstrate that the closure cap material has an influence on
the number of MNGCs.
The chemical and physical characteristics of an implanted bio‐
material have been shown to influence the tissue response, thereby
triggering inflammation, immune response, healing, fibrous encap‐
sulation and, ultimately, osseointegration (Kasemo, 2002; Sridharan,
Cameron, Kelly, Kearney, & O'Brien, 2015). In a recent publication, it
was shown that the surface characteristics of PEEK can modulate the
bioactivity of PEEK (Ma & Tang, 2014). In vivo studies have identified
that surface topography of PEEK implants influences osseointegra‐
tion (Poulsson et al., 2014) and that a rough PEEK surface—as is the
case with Ti surfaces—favours cell attachment compared to a smooth
PEEK surface (Wu et al., 2012). It has been speculated that the per‐
sistence of MNGCs surrounding biomaterials at healed sites could
be triggered by the chemical composition of the material or by its
surface characteristics (Kasemo, 2002; Petillo et al., 1994; Sridharan
et al., 2015). Along these lines, it must be known that MNGCs can be
indicators of an inflammatory or a foreign body response to the im‐
planted biomaterial (Butterfield et al., 2006; Fujiwara & Kobayashi,
2005). Indeed, another study found inflammatory cells in soft tis‐
sues around PEEK implants (Nieminen et al., 2008; Toth et al., 2006).
In contrast, no inflammatory cells were found in the present study.
In the present study, we have also analysed the size of the MNGCs
having significant differences between groups. Under special condi‐
tions that require a greater action by macrophages, these cells can
fuse between them adopting a bigger size with greater number of
nuclei. Bigger cells exhibit, for example, a greater capacity of phago‐
cytosis possibly meaning a stronger foreign body reaction (McNally
& Anderson, 2011). Whether the higher number or size of MNGCs
in contact with the PEEK closure caps has a negative effect on the
surrounding tissues needs to be determined. Other preclinical (Rea
et al., 2017) and clinical (Koutouzis et al., 2011) data, however, docu‐
mented no adverse effects.
Polyetheretherketone is increasingly used as an implant prosthetic
hardware (Koutouzis et al., 2011; Neumann et al., 2014; Stawarczyk et
al., 2013, 2014; Tetelman & Babbush, 2008). In this context, another
interesting finding in the present study was the misfit of the PEEK clo‐
sure caps. However, this unfortunate event was rarely observed for
the Ti closure caps. It must be taken into consideration that closure
caps made of PEEK were press‐fit and not screwed, possibly playing
a role in the poor adaptation and sealing. Dental implant abutments
made of PEEK reinforced with Ti have shown good in vivo results with
adequate maintenance of crestal bone height (Mate Sanchez de Val et
al., 2016). Future studies should specifically compare misfit between
PEEK and Ti abutments, as misfit and leakage of prosthetic abutments
can negatively affect soft and hard tissues around implants (Assenza
et al., 2012; Canullo et al., 2015; Jansen, Conrads, & Richter, 1997). A
suboptimal fitting of PEEK abutments might then lead to an accumu‐
lation of MNGCs inside the implant structure, as shown in the pres‐
ent study, and possibly lead to the release of inflammatory molecules
around the implant, which eventually may lead to bone resorption.
Clinically, radiographic analysis of the fitting of prosthetic components
is important to ensure a correct adaptation. The fact that PEEK is ra‐
diolucent (Kurtz & Devine, 2007) might represent a disadvantage in
implant dentistry, since it does not allow to be radiographically anal‐
ysed. In this sense, prosthetic abutments made of a composite of PEEK
with a radiopaque material could eliminate this matter.
A large number of PEEK dental products have recently been
released without adequate biocompatibility testing. Furthermore,
PEEK has also gained popularity as a material for the fabrication of
CABALLÉ‐SERRANO et al.
prosthetic hardware such as CAD/CAM components, implant abut‐
ments and removable dentures. To date, the influence of this ma‐
terial on soft and hard tissues has not been fully addressed in the
literature. Our study presents novel data on the soft tissue integra‐
tion around PEEK components. The finding that higher numbers of
MNGCs are found on PEEK than on Ti closure caps might be the
primer for future research and development of new biomaterials in
dentistry with improved tissue integration. So far, an extrapolation
of these short‐term preclinical data to the human situation cannot
be made. MNGCs on dental biomaterials may be part of the nor‐
mal wound healing process and therefore a transient phenomenon
(Miron & Bosshardt, 2018). In contrast to this view, MNGCs are impli‐
cated in playing a role in the development of biological complications
that could lead to loss of osseointegration (Trindade, Albrektsson,
Tengvall, & Wennerberg, 2016).
The present study faces some limitations. First, preclinical re‐
search might not reflect precisely the clinical reality in humans.
Second, despite having statistical significant differences, the number
of implants used is low and a greater sample could help answer open
questions. This study was not specifically designed to analyse soft
tissue response to the closure caps. Nevertheless, when we saw the
high number of MNGCs on the PEEK biomaterial, we felt responsible
to report on this in a separate manuscript. Our final evaluation shows
indeed that there is a big difference in the cell response to different
biomaterial. Thus, we feel that is justified to have generated this ad‐
ditional data from this experiment. Having designed an experiment
specifically for the evaluation of the soft tissue response to closure
caps would likely not have changed the experimental design. It is ra‐
tional to conclude that in the present clinical setting, PEEK closure
caps triggered a significantly greater number of MNGCs on their sur‐
face compared to Ti closure caps. Moreover, the number of nuclei of
the cells was also significantly greater on PEEK closure caps. Further,
in vivo studies are warranted to shed light on possible implications of
PEEK components on the long‐term success of dental implants.
AC K N OW L E D G E M E N T S
The study was supported by a research grant from Dentalpoint AG
in Switzerland (DP 2013‐002). The authors wish to thank the staff at
the Surgical Research Unit ESI and at the Clinic for Large Animals for
excellent handling of the animals, Ms. Claudia Moser and Ms Denise
Schär for their professional help during surgical procedures, Mr.
David Reist for the histologic preparation of the specimens, Ms. Silvia
Owusu for performing the histomorphometric analysis, and authors
also would like to thank Dr. Richard J Miron for the critical reading
and corrections of the manuscript and Lukas Martig (University of
Bern, Institute of Mathematical Statistics and Actuarial Science) for
statistical advice.
C O N FL I C T O F I N T E R E S T
The authors declare no potential conflicts of interest with respect to
the authorship and/or publication of this article.
|
      7
AU T H O R C O N T R I B U T I O N S
JCS and DDB conceived the idea; VC performed the surgeries; VC,
DB and DDB conceived and prepared the protocol of the study.
JCS collected the data and together with AM analysed it. JCS and
DDB wrote the manuscript. All authors revised and approved the
manuscript.
ORCID
Jordi Caballé‐Serrano  https://orcid.org/0000-0003-4684-4770
Vivianne Chappuis  https://orcid.org/0000-0003-1227-7587
Alberto Monje  https://orcid.org/0000-0001-8292-1927
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How to cite this article: Caballé‐Serrano J, Chappuis V,
Monje A, Buser D, Bosshardt DD. Soft tissue response to
dental implant closure caps made of either
polyetheretherketone (PEEK) or titanium. Clin Oral Impl Res.
2019;00:1–9. https​://doi.org/10.1111/clr.13487​