Multifunctional surface of the nano-morphic PEEK implant with enhanced angiogenic, osteogenic and antibacterial properties.

Polyetheretherketone (PEEK) is a high-performance polymer suitable for use in biomedical coatings. The implants based on PEEK have been extensively studied in dental and orthopedic fields. However, their inherent inert surfaces and poor osteogenic properties limit their broader clinical applications. Thus, there is a pressing need to produce a multifunctional PEEK implant to address this issue. In response, we developed sulfonated PEEK (sPEEK)-Cobalt-parathyroid hormone (PTH) materials featuring multifunctional nanostructures. This involved loading cobalt (Co) ions and PTH (1-34) protein onto the PEEK implant to tackle this challenge. The findings revealed that the controlled release of Co2+ notably enhanced the vascular formation and the expression of angiogenic-related genes, and offered antimicrobial capabilities for sPEEK-Co-PTH materials. Additionally, the sPEEK-Co-PTH group exhibited improved cell compatibility and bone regeneration capacity in terms of cell activity, alkaline phosphatase (ALP) staining, matrix mineralization and osteogenic gene expression. It surpassed solely sulfonated and other functionalized sPEEK groups, demonstrating comparable efficacy even when compared to the titanium (Ti) group. Crucially, animal experiments also corroborated the significant enhancement of osteogenesis due to the dual loading of cobalt ions and PTH (1-34). This study demonstrated the potential of bioactive Co2+ and PTH (1-34) for bone replacement, optimizing the bone integration of PEEK implants in clinical applications.

Enhancing bioactivity and biocompatibility of polyetheretherketone (PEEK) for dental and maxillofacial implants: A novel sequential soaking process.

Polyetheretherketone (PEEK) exhibits excellent biocompatibility, fatigue resistance, and an elastic modulus similar to bone, presenting broad application prospects in the field of dental and maxillofacial implants. However, the bioinertness of PEEK limits its applications. In this study, we developed a method to generate biocompatible and bioactive PEEK through a simple sequential soaking process, aimed at inducing bone differentiation and enhancing antibacterial properties. Initially, a three-dimensional (3D) porous network was introduced on the PEEK surface by soaking in concentrated sulfuric acid and water. Subsequently, the sulfonated PEEK surface was treated with oxygen plasma, followed by immersion in a dopamine solution to coat a polydopamine (PDA) layer. Finally, polydopamine phosphate ester-modified 3D porous PEEK was obtained through the reaction of phosphoryl chloride with surface phenolic hydroxyl groups. Systematic studies were conducted using scanning electron microscopy, X-ray photoelectron spectroscopy, water contact angle analysis, cell proliferation and adhesion, osteogenic gene expression detection, alkaline phosphatase staining, alizarin red staining, and bacterial culture. Overall, compared to unmodified PEEK, the modified PEEK significantly enhanced in vitro cell proliferation and adhesion, osteogenic differentiation, and antibacterial properties. The simple surface modification measures combined in this study may represent a promising technology and could facilitate the application of PEEK in dental and maxillofacial implants.

Effects of combined modification of sulfonation, oxygen plasma and silane on the bond strength of PEEK to resin.

OBJECTIVE: This study aimed to evaluate the combined effects of sulfonation, non-thermal oxygen plasma and silane on the shear bond strength (SBS) of PEEK to resin materials. MATERIALS AND METHODS: Two hundred and eighty specimens were randomly divided into four groups: (A) untreated; (B) sulfonation for 60 s; (C) oxygen plasma for 20 min; (D) sulfonation for 60 s and oxygen plasma for 20 min. According to the instructions, 120 samples (N = 30) were coated with silane, adhesive, and resin composites. Each group of bonding specimens was divided into two subgroups (n = 15) to measure immediate and post-aging SBS. The surface morphology and the interface between the samples and adhesive were analyzed through SEM. Physicochemical characteristics of the surface and mechanical properties were determined through XPS, FTIR, light interferometry, contact angle measurement, and three-point bending tests. RESULTS: Sulfonation produced a porous layer of approximately 20 µm thickness on the surface, and the oxygen plasma increased the O/C ratio and oxygen-containing groups of the sample surface. After coating with silane, the SBS values of sulfonated PEEK and plasma-treated PEEK increased (9.96 and 10.72 MPa, respectively), and dual-modified PEEK exhibited the highest SBS value (20.99 MPa), which was significantly higher than that of blank group (p > 0.01). After 10,000 thermal cycles, the dual-modified PEEK still displayed a favorable SBS (18.68 MPa). SIGNIFICANCE: Sulfonation strengthened the mechanical interlocking between PEEK and the resin while oxygen plasma established a chemical bonding between silane and PEEK. This dual modification of the surface microstructure and chemical state synergistically improved the bond strength of PEEK to resin and resulted in considerable long-term effects.

A structural equation modeling approach to determine the correlation between the vertical and sagittal skeletal patterns and posterior basal bones mismatching in patients with skeletal Class III malocclusion.

INTRODUCTION: Matching the maxillomandibular basal bone width is essential to the stability of orthodontic treatment. We aimed to determine the relationship between basal bone width mismatching and the vertical and sagittal skeletal pattern in patients with skeletal Class III malocclusion through shape analysis and structural equation modeling (SEM). METHODS: Cone-beam computed tomography images were collected from 45 men and 51 women. Width mismatching of the basal bone was determined using generalized Procrustes analysis. Twenty-two parameters from the synthesized cephalogram were measured, followed by factor analysis and SEM. RESULTS: Mismatch occurred at the second molar (men, -4.29 ± 4.32 mm; women, -5.55 ± 4.43 mm) and retromolar regions (men, -8.49 ± 5.11 mm; women: -8.93 ± 5.25 mm). The sum of angles had the largest loading for vertical-1 (extracted from 18 vertical cephalometric measurements) (men, 0.9477; women, 0.9489), followed by MP-SN angle (0.9408) in men and N-Me/S-Go (0.9342) in women. Wits appraisal and anteroposterior dysplasia indicator were largest for Sagittal-1. SEM showed a positive effect of male vertical-1 and 2 on width difference in the retromolar region (P <0.001; B >0). Female vertical-1 had a significant positive effect on DW7 (P <0.001; B = 5.535) and DWR (P = 0.016; B = 3.427) as vertical-2. Sagittal-1 showed a negative correlation with DW7 in both genders (P <0.05; B <0) and with DWR in men. CONCLUSIONS: Basal bone width mismatching occurred at the second molar and retromolar regions, especially in low-angle and patients with severe skeletal Class III malocclusion.

The relationship between the size of temporomandibular joint condyle and the sagittal disc-condyle position in adults.

OBJECTIVE: To explore the relationship between the size of temporomandibular joint (TMJ) condyle and the sagittal disc-condyle position and the relationship between the condylar size and craniofacial structure. METHODS: Seventy-four subjects (23.82 ± 3.77 years) underwent cone beam computed tomography (CBCT) and lateral cephalograms for orthodontics and volunteered to undergo magnetic resonance imaging (MRI). Mimics was used to calculate the volume and surface area of the condyle. MRI was used to evaluate the sagittal disc-condyle position. The lateral cephalograms were analyzed by Jarabak analysis. RESULTS: The condylar volume and surface area were negatively correlated with the sagittal disc-condyle position. The condylar volume and surface area were positively correlated with Ar-Go, S-Go, and S-Go/N-Me*100% (p < 0.05) and negatively correlated with ∠Ar-Go-Me and ∠N-Go-Me (p < 0.05). CONCLUSION: Condylar size was negatively correlated with the sagittal disc-condyle position. The condylar size was correlated with the vertical skeletal pattern.

Skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) in young adults.

OBJECTIVES: To observe skeletal width changes after mini-implant-assisted rapid maxillary expansion (MARME) and determine the possible factors that may affect the postexpansion changes using cone-beam computed tomography (CBCT) in young adults. MATERIALS AND METHODS: Thirty-one patients (mean age 22.14 ± 4.76 years) who were treated with MARME over 1 year were enrolled. Four mini-implants were inserted in the midpalatal region, and the number of activations ranged from 40 to 60 turns (0.13 per turn). CBCT was performed before MARME (T0), after activation (T1), and after 1 year of retention (T2). The mean period between T1 and T0 was 6 ± 1.9 months and between T2 and T1 was 13 ± 2.18 months. A paired t-test was performed to compare T0, T1, and T2. The correlations between the postexpansion changes and possible contributing factors were analyzed by Pearson correlation analysis. RESULTS: The widths increased significantly after T1. After T2, the palatal suture width decreased from 2.50 mm to 0.75 mm. From T1 to T2, decreases recorded among skeletal variables varied from 0.13 mm to 0.41 mm. This decrease accounted for 5.75% of the total expansion (2.26 mm) in nasal width (N-N) and 19.75% at the lateral pterygoid plate. A significant correlation was found between postexpansion change and palatal cortical bone thickness and inclination of the palatal plane (ANS-PNS/SN; P < .05). CONCLUSIONS: Expanded skeletal width was generally stable after MARME. However, some amount of relapse occurred over time. Patients with thicker cortical bone of the palate and/or flatter palatal planes seemed to demonstrate better stability.

Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion.

OBJECTIVES: To evaluate changes in dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion (MARME) and observe correlations between changes of upper airway and vertical skeletal pattern in young adults. MATERIALS AND METHODS: In this retrospective study, 22 patients (mean age, 22.6 ± 4.5 years; 4 male 18 female) with transverse discrepancy underwent MARME. Cone beam computed tomography was taken before and 3 months after expansion. Vertical and horizontal dimensions and volume of the nasal cavity, nasopharyngeal, retropalatal, retroglossal and hypopharyngeal airway were compared before and after MARME. Correlations between changed volume and dimensions were explored, as well as the vertical skeletal pattern. RESULTS: Nasal osseous width, maxillary width, volume of the nasal cavity and nasopharynx increased significantly (P < .05). Enlarged nasopharyngeal volume correlated with increased nasal width at the PNS plane (P < .05). There were no correlations between expanded volume and maxillary width. No measurements except nasal cavity volume had a correlation with Sum angle. Increased maxillary width correlated negatively with hard palate thickness (P < .05). CONCLUSIONS: (1) MARME caused an increase in volume of the nasal cavity and nasopharynx, with expansion of nasal osseous width and maxillary width. (2) Enlarged nasal width at the PNS plane contributed to the increase in nasopharynx volume. Enlarged maxillary width showed no direct relation with increased volume. (3) In this study, it was unclear about the association between changes of the upper airway and vertical skeletal pattern because of complex structures. (4) Palate thickness affected skeletal expansion of the maxilla in MARME.