Title PEEK RPD Frameworks Produce Equally Good Support and Stability When Compared to Cast Metal Frameworks
Clinical Question In patients who need a removable partial denture, does the use of PEEK frameworks compared to traditional metal frameworks provide comparable stability and support?
Clinical Bottom Line For patients requiring removable partial dentures (RPDs), using PEEK frameworks may provide comparable support and stability to cast metal frameworks, with potential advantages in biocompatibility and durability. This conclusion is supported by limited evidence primarily from mechanical testing, but long-term clinical trials, including patient satisfaction data, are needed to establish its full effectiveness. PEEK frameworks are within the capability of general dental practices but may require additional training and resources to implement widely.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
33581866Pordeus, 202225 patients included in 15 studies Systematic Review and Meta Analysis
Key resultsPEEK frameworks were preferred for their aesthetics by patients, however such clasps facilitate plaque accumulation. Co-Cr required more adjustments. There was no significant difference between additive manufacturing techniques and indirect methods (P = .455). Overall, CAD-CAM frameworks performed comparably to conventional methods. The study reported no clinical complications related to the resin component after a 2-year follow-up. Therefore, it is suggested that the lower modulus of elasticity of PEEK and acrylic resin, compared to metal and resin, may help mitigate interface issues. There are clinical challenges of using PEEK, such as polishability and retention. Additionally, a standardized framework design has not yet been established for planning with this material. Further clinical studies are needed to enable precise planning and rehabilitation using RPDs.
39191558Bertotti, 202418 in vitro studies, with 13 studies on commercially pure titanium (CP Ti) and/or Titanium alloy and 5 studies on PEEK. Systematic Review
Key resultsPolyetheretherketone (PEEK) had significantly lower retention forces; however, it was sufficient for use, even after 10 years. PEEK frameworks had no significant difference in fatigue resistance compared to Cobalt-Chrome (CoCr) frameworks or mechanical stability. However, PEEK exerted higher stress on mucosa, potentially affecting comfort and denture stability. PEEK showed enhanced structural integrity and easier fabrication processes. Biocompatibility tests revealed high compatibility for both Ti and PEEK, with minimal plaque accumulation and low ion release. Further research is needed to evaluate their long-term performance despite their clinical suitability.
Evidence Search (PEEK RPD) AND (Metal RPD) OR [Polyetheretherketone and Metal RPD]
Comments on
The Evidence		 The meta-analysis performed by Pordeus/2022 systematically reviewed the literature through 2019 using explicit review criteria, with four databases searched (PubMed, Cochrane, Web of Science, and SciELO). The study included clinical data from 25 patients and in vitro data on additive manufacturing. The article adheres to most of the PRISMA checklist criteria, providing a clear rationale and following a systematic, transparent, and reproducible search process. It offers detailed descriptions of the data collection methods and synthesizes the results appropriately. However, the article lacks a comprehensive analysis of the quality of the included studies, and variations in the methodologies across the papers were noted, which led the reviewers to assess the studies in a categorical manner. Despite these limitations, the study follows good reporting practices for a systematic review and meta-analysis. The systematic review performed by Bertotti/2024 reviewed the literature up to March 2024 following explicit review criteria based on the PRISMA guidelines. Three databases (PubMed/MEDLINE, Embase, and Web of Science) were searched. The included studies focused on the mechanical and biological properties of Ti and PEEK compared to CoCr in removable partial dentures. All studies were in vitro, and no clinical trials were included. The follow-up period for material testing varied across studies, simulating years of use for the dentures. The studies comprised comparative analyses with CoCr and evaluated outcomes like retention strength and biocompatibility. Most included studies were assessed as moderate to low risk of bias using the MINORS tool. However, the review's reliance on in vitro studies limits its direct clinical applicability. No control groups or long-term clinical trials were included.
Applicability This study performed by Pordeus/2022 involved adults requiring RPDs due to partial edentulism. The predominant materials used were cobalt-chromium (Co-Cr) and polyetheretherketone (PEEK). The analysis concluded that Co-Cr frameworks often required more adjustments compared to PEEK, which was preferred for its superior aesthetics. Patients favored PEEK frameworks not only for their appearance but also for their better fit. Additionally, the use of CAD-CAM technology in fabricating PEEK frameworks reduced operator error, shortened production times, and improved the fit, enhancing its clinical relevance. Unlike Co-Cr frameworks produced using costly SLM techniques, which often require adjustments, PEEK frameworks fabricated through milling required fewer adjustments, making them more cost-effective. This further supports their potential for clinical adoption. The study performed by Bertotti, 2024 included patients with partial tooth loss requiring removable partial dentures (RPDs), exploring Titanium (Ti) and Polyetheretherketone (PEEK) as alternatives to Cobalt-Chrome (CoCr) frameworks. Since Ti and PEEK provide improved biocompatibility and reduce risks of toxicity or allergic reactions compared to CoCr, one potential benefit is offering patients safer options, especially those with metal sensitivities. This flexibility may enhance patient satisfaction and compliance. Potential drawbacks include Ti's lower rigidity, which may affect long-term durability, and PEEK's higher mucosal stress, potentially causing discomfort. The higher costs of these materials may also limit accessibility for some patients.
Specialty (Prosthodontics)
Keywords PEEK, RPD, Metal RPD, Polyetheretherketone, Cobalt-Chrome, CoCr, Framework, RPD Framework, CAD-CAM
ID# 3562
Date of submission 10/17/2024
E-mail fletcherp1@uthscsa.edu
Author Patricia Fletcher
Co-author(s) Cori Ballard
Co-author(s) e-mail ballardc@uthscsa.edu
Faculty mentor Kyumin Whang
Faculty mentor e-mail WHANG@UTHSCSA.EDU
   
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)
None available