[Requirements for trauma rehabilitation centers : Post-acute rehabilitation (phase C) after severe trauma injury]. / Anforderungen an Traumarehabilitationszentren : Postakute Rehabilitation (Phase C) nach schwerer Unfallverletzung.

Severely injured patients need a qualified and seamless rehabilitation after the end of the acute treatment. This post-acute rehabilitation (phase C) places high demands on the rehabilitation facility in terms of personnel, material, organizational and spatial requirements.The working group on trauma rehabilitation of the German Society for Orthopedics and Traumatology e. V. (DGOU) and other experts have agreed on requirements for post-acute phase C rehabilitation for seriously injured people. These concern both the personnel and material requirements for a highly specialized orthopedic trauma surgery trauma rehabilitation as well as the demands on processes, organization and quality assurance.A seamless transition to the follow-up and further treatment of seriously injured people in the TraumaNetzwerk DGU® is ensured through a high level of qualification and the corresponding infrastructure of supraregional trauma rehabilitation centers. This also places new demands on the TraumaZentren DGU®. Only if these are met can the treatment and rehabilitation of seriously injured people be optimized.

[A phase model of trauma rehabilitation : How can we avoid the "rehab-hole"?] / Phasenmodell der Traumarehabilitation : Wie können wir das "Rehaloch" vermeiden?

Advances in the rescue chain and first aid of polytrauma patients, which have consequently increased their chance of survival, have led to an increase in demands for rehabilitation. However, there is still a large hole in the continuity of rehabilitation between acute patient care and in-patient rehabilitation, the so-called "rehab-hole". The consequences are untapped rehabilitation potential, loss of strength, endurance and motivation as well as impairment of function of the patient.Based on the phase model of neurological/neurosurgical rehabilitation, we propose a step model for the rehabilitation of polytrauma patients that ensures an uninterrupted chain of rehabilitation. After acute patient care (phase a) and a potentially required early patient rehabilitation (phase b), trauma rehabilitation should seamlessly continue on to phase c. The implementation of phase c after acute patient rehabilitation requires changes in the structure of "orthopaedic" rehabilitation clinics and financial support due the large consumption of resources by more complexly injured patients in this phase. The subsequent rehabilitation in phase d is well established and complies with current rehabilitation measures (AHB, BGSW). Further rehabilitation measures may be essential for social and occupational reintegration of the patient (phase e), depending on the complexity of their injuries after the accident. For patients with long-lasting results after an accident, it is crucial to implement continuous follow-ups (phase f) to ensure a better long-term outcome.In order to implement this phase model it is necessary to establish specialized facilities that meet the particular requirements needed for phase c. This tri-phased treatment model in trauma centres can therefore be used in trauma rehabilitation. In addition to the already established local and regional rehabilitation centres, nationwide trauma rehabilitation centres have adopted phase c rehabilitation.

Influence of sandblasting and bonding on the shear bond strength between differently pigmented polyetheretherketone (PEEK) and veneering composite after artificial aging.

OBJECTIVE: Achieving a strong bond between Polyetheretherketone (PEEK) and veneering composites is challenging due to PEEKs low surface energy. This study examined the effects of sandblasting and bonding on the shear bond strength (SBS) between veneering composite and pigmented PEEK, considering artificial aging. METHODS: Of three pigmented PEEK compounds (DC4420R, DC4450R, DC4470R; Evonic Operations GmbH, Marl, Germany), 40 specimens each were milled and polished up to 2500 grit. Prior to veneering, specimens were divided into 4 subgroups: Subgroup 1: Polishing; 2: Polishing + bonding; 3: Sandblasting; 4: Sandblasting + bonding. Sandblasting was performed using Al2O3. Adhesive was an agent containing MMA (Signum Universal Bond, Kulzer GmbH, Hanau, Germany). After veneering (Composite, Kulzer GmbH) the subgroups were divided into 2 subgroups. One subgroup was immersed in 37 °C warm distilled water for 24 h. The second subgroup was artificially aged by thermocycling (TCL) with 5000 cycles in distilled water (5 °C / 55 °C; 30 s). Surface roughness, water contact angles and failure modes were recorded. SBS was measured using a universal testing machine. RESULTS: Results demonstrated that the combination of sandblasting and bonding significantly improved the SBS compared to polishing alone. PEEK color did not significantly influence the SBS. Aging by TCL had a negative effect on the SBS. SIGNIFICANCE: Sandblasting and the use of an adhesive containing MMA were found to be effective in achieving satisfactory SBS between veneering composite and pigmented PEEK surfaces. These pretreatment methods demonstrate their potential for establishing durable and reliable bonding in clinical applications.

PEEK dental implants: a review of the literature.

The insertion of dental implants containing titanium can be associated with various complications (eg, hypersensitivity to titanium). The aim of this article is to evaluate whether there are existing studies reporting on PEEK (polyetheretherketone) as an alternative material for dental implants. A systematic literature search of PubMed until December 2010 yielded 3 articles reporting on dental implants made from PEEK. One article analyzed stress distribution in carbon fiber-reinforced PEEK (CFR-PEEK) dental implants by the 3-dimensional finite element method, demonstrating higher stress peaks due to a reduced stiffness compared to titanium. Two articles reported on investigations in mongrel dogs. The first article compared CFR-PEEK to titanium-coated CFR-PEEK implants, which were inserted into the femurs and evaluated after 4 and 8 weeks. The titanium-coated implants showed significantly higher bone-implant contact (BIC) rates. In a second study, implants of pure PEEK were inserted into the mandibles beside implants made from titanium and zirconia and evaluated after 4 months, where PEEK presented the lowest BIC. The existing articles reporting on PEEK dental implants indicate that PEEK could represent a viable alternative material for dental implants. However, further experimental studies on the chemical modulation of PEEK seem to be necessary, mainly to increase the BIC ratio and to minimize the stress distribution to the peri-implant bone.

Mechanical Properties of New Generations of Monolithic, Multi-Layered Zirconia.

New monolithic multi-layered zirconia restorations are gaining popularity due to their excellent aesthetic properties. However, current knowledge of these newest multi-layer ceramics in terms of mechanical properties is scarce. Three monolithic, multi-layered zirconia materials (Katana, Kuraray Noritake, Japan) were selected for comparison: High Translucent Multi-layered zirconia (HTML), Super Translucent Multi-layered zirconia (STML) and Ultra Translucent Multi-layered zirconia (UTML). Fifteen specimens per group were cut from pre-sintered blocs in each of the four layers (L1, L2, L3, L4) and in different thicknesses (0.4 mm, 0.8 mm and 1.2 mm). Critical fracture load (Fcf) was recorded in 3-point-bending. Flexural strength (σ) in MPa, Vickers hardness (HV) in N/mm2, fracture toughness (KIc) in MPa*m1/2, Weibull Modulus (m) and characteristic Weibull strength (σw) in MPa were assessed. Statistical analysis was performed using ANOVA analysis. FS and KIc were significantly higher (p < 0.05) for Katana™ HTML (652.85 ± 143.76−887.64 ± 118.95/4.25 ± 0.43−5.01 ± 0.81) in comparison to Katana™ STML (280.17 ± 83.41−435.95 ± 73.58/3.06 ± 0.27−3.84 ± 0.47) and UTML (258.25 ± 109.98−331.26 ± 56.86/2.35 ± 0.31−2.94 ± 0.33), with no significant differences between layers and layer thicknesses. The range of indications should be carefully considered when selecting the type of monolithic zirconia for fabrication of dental restorations, as materials widely differ in mechanical properties.

Ultrasonic welding of polyetheretherketone for dental applications.

OBJECTIVE: Due to its favorable properties, the high-performance polymer polyetheretherketone (PEEK) is used as a metal-free alternative for the fabrication of denture frameworks. For dental applications, PEEK is available in different colors, such as red or white, by compounding with different fillers. In order to permanently bond such different dental PEEK types together in a denture framework, ultrasonic welding could be a viable process. Therefore, the aim of this study was to determine the optimum processing welding parameters for welding different dental PEEK grades in terms of maximum weld strength. METHODS: Rectangular plates from three PEEK compounds were prepared according to the dimensions of a removable partial denture (RPD) of PEEK. These were combined in a way that four groups resulted, whereas the combination of pure PEEK served as control. In each group, 5 samples were ultrasonically welded at one of four welding energies using a microprocessor-controlled ultrasonic welder, where the welder was activated only once. Afterwards, the samples were subjected to tensile tests to evaluate the shear bond strength (SBS) of the joint. RESULTS: Increasing the welding energy resulted in an increase in the welding time. Accordingly, the increase in the welding energy increased the surface deformation for all tested samples. The shear bond strengths ranged from 4.8 ± 0.68 MPa for samples welded with 50 Ws to 16.37 ± 1.69 MPa for samples welded with 90 Ws. Excessive weld energy of 130 Ws led to a significant decrease of SBS due to a severe indentation and perforation induced by the sonotrode. SIGNIFICANCE: The SBS and topography of the welded samples were systematically studied and the optimal welding parameters were determined. This could serve as a reference and instruction for clinical applications.

The Video Microscopy-Linked Electrochemical Cell: An Innovative Method to Improve Electrochemical Investigations of Biodegradable Metals.

An innovative, miniature video-optical-electrochemical cell was developed and tested that allows for the conducting of electrochemical corrosion measurements and simultaneous microscopic observations over a small, well-defined surface area of corroding or degrading samples. The setup consisted of a miniature electrochemical cell that was clamped onto the metal sample and fixed under a video microscope before being filled with electrolyte. The miniature cell was comprised of afferent/efferent electrolyte ducts as well as a connection to the Mini Cell System (MCS) for electrochemical measurements. Consequently, all measured and induced currents and voltages referred to the same small area corroding completely within the field of view of the microscope, thus allowing for real-time observation and linking of surface phenomena such as hydrogen evolution and oxide deposition to electrochemical data. The experimental setup was tested on commercial purity (cp) and extra-high purity (XHP) magnesium (Mg) samples using open circuit potential and cyclic voltammetry methods under static and flowing conditions. The corrosion potential was shifted more anodically for cp Mg in comparison to XHP Mg under dynamic conditions. The corrosion current assessed from the cyclic voltametric curves were higher for the cp Mg in comparison to XHP Mg. However, there were no differences between static and flow conditions in the case of XHP Mg in contrast to cp Mg, where the current density was two times higher at dynamic conditions. The measurements and observations with this new method pave the way for a more detailed understanding of magnesium corrosion mechanisms, thus improving predictive power of electrochemical corrosion measurements on newly developed magnesium or other biodegradable alloys applied for medical devices. Different electrochemical tests can be run under various conditions, while being easy to set up and reproduce as well as being minimally destructive to the sample.

A New Setup for Simulating the Corrosion Behavior of Orthodontic Wires.

The aim of this study was to create a new reliable setup to evaluate commercially available orthodontic wires used during orthodontic treatment. The setup includes various techniques applied for testing metal alloy materials. The materials were tested under extreme conditions to simulate their behavior in the mouth. The alloy composition of each wire was tested. The electrochemical (EC) testing and characterization of the corrosion performance of the wires was calculated by the electrochemical curves at pH = 1 in two different applied potentials to test the reaction of the material. The liquid collected after the EC measurements was analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) to verify the reliability of the EC curves and for a more accurate evaluation of the corrosion behavior of the wires. Therefore, the EC measurements were compared to the actual values obtained from the released ions found in the solution. At the end, a surface analysis was performed to detect corrosion on the wires. In conclusion, this study developed a setup to test and better understand the corrosion behavior and ion release of the orthodontic wires, metal alloy dental materials, and other metals used in the oral cavity. This method can contribute to dental material selection in patients with underlying health conditions.

Performance of PEEK based telescopic crowns, a comparative study.

OBJECTIVE: Telescopic crowns are suitable components of partial dentures to efficiently anchor dental supra-structures to teeth or dental implants and achieve high chewing performance and wear comfort. Usually alloy- or metal-based structures are used for the primary and the secondary crowns. The advantage is the possibility to produce precise structures with a high perfection and sufficient friction force, but the disadvantage is the corrosion instability. The recent introduction of zirconia ceramics has enabled the fabrication of ceramic primary crowns, thus reducing corrodibility. The novel application of the high-performance polymer polyetheretherketone (PEEK) as another metal-free alternative material offers a new perspective for such applications. Therefore, the aim of this work was to assess the performance of telescopic crowns of PEEK by comparing telescopic crowns based on the combination of PEEK (prim. crown) + PEEK (sec. crown) with the pairings ZrO2 (prim. crown) + PEEK (sec. crown) and CoCr-alloy (prim. crown) + PEEK (sec. crown). METHODS: All specimens were CAD/CAM planned and manufactured based on a model of a tooth 26. One master dental technician performed the post-treatment. For each group of material pairing, n = 9 telescopic crown pairs were manufactured and tested. Herein not only the maximum retention force was measured but also the retention force vs. pull-off distance were analyzed. As there is no commonly accepted test protocol available, the influence of various pull off speeds were tested as well. All measurements were first made with three blocks of three crowns (3C), subsequently with three blocks of two crowns (2C) and finally with nine single crowns (1C). The long-term behavior was estimated by performing 10.000 cycles, which is related to a life-time of more than 10 years. RESULTS: The maximum retention force in case of PEEK + PEEK was higher in comparison to the other tested material pairings. In the range between 1 and 10 mm/ min pull off speed there was no significant influence by the pull off speed. More influence on the friction force would be expected by changes of the number of the crowns acting simultaneously. The friction force was decreasing with decreasing number of crowns but not linearly in any tested case. The long-term test has shown that the friction force remained constant. SIGNIFICANCE: The performance of PEEK + PEEK telescopes is comparable with the usually applied material pairings. Over long time no loss in retention force could be observed. The retention force - distance progression in the PEEK + PEEK pairing offers more security against a possible loss of retention during repair or relining. For further tests of the performance of telescopic crowns or to estimate of friction force limits, a setup with at least two, but preferably three, crowns tested in parallel is suggested.

Mechanical properties of fused filament fabricated PEEK for biomedical applications depending on additive manufacturing parameters.

DESIGN: of experiments was employed to investigate the combinations of 3D-printing parameters for Polyether ether ketone (PEEK) with a fused filament fabrication (FFF) process and to quantitatively evaluate the quality of 3D printed parts. This research was conducted using a newly developed FFF 3D printer and PEEK filament. Standard PEEK parts were 3D printed for bending and compression tests. Based on the Box-Behnken design, a three factors based experiment was designed using the Response Surface Methodology (RSM). Nozzle diameter, nozzle temperature and printing speed were involved. The density and dimensional accuracy of these printed parts were evaluated, and the bending and compression tests were conducted. The nozzle diameter was found to be the most significant parameter affecting the bending and compression performance of the printed PEEK samples, followed by printing speed and nozzle temperature. The highest accuracy in sample width was obtained with a 0.6 mm nozzle while the most accurate diameter was obtained with a 0.4 mm nozzle. A combination of a 0.4 mm nozzle diameter, 430 °C nozzle temperature and printing speed of 5 mm/s was beneficial to get the densest samples and therefore the highest bending strength; a reduction of internal defects was achieved with a 0.2 mm nozzle, a higher nozzle temperature of 440 °C and slower printing speed leading to better bending modulus. The best compression properties were achieved with a 0.6 mm nozzle, with relatively low influence of the other parameters. Different parameter combinations have been found to obtain optimal mechanical properties. Optimized parameters for better dimension accuracy of small additively manufactured PEEK parts were also achieved depending on the shape of the specimens.

The impact of different low-pressure plasma types on the physical, chemical and biological surface properties of PEEK.

OBJECTIVE: Plasma treatment can be used as surface treatment of PEEK (poly-ether-ether-ketone) to increase the bonding strength between veneering composite and dental prosthetic frameworks of PEEK or enhance biocompatibility of PEEK implants. These improvements are probably based on chemical changes of the PEEK surface. However, the aim of the study was to evaluate the impact of different low-pressure plasma treatments on surface properties of PEEK, such as roughness, hydrophilicity, micro-hardness, crystallinity and biological activity of PEEK. METHODS: Due to different plasma treatments, 143 disc-shaped specimens of pure implantable PEEK were divided into 4 groups: PEEK (no plasma treatment, n = 29), H-PEEK (hydrogen plasma treatment, n = 38), O-PEEK (oxygen plasma treatment, n = 38), H/O-PEEK (hydrogen/oxygen plasma treatment with a gas mix ratio of 2:1, n = 38). Subsequently, surface roughness, surface contact angle, surface crystallinity, surface micro-hardness and human osteoblast cell coverage area of each group were examined. RESULTS: The hydrophilicity, crystallinity and micro-hardness of the plasma-treated groups increased significantly compared to the untreated group, whereas significant differences in the results of the micro-hardness tests could be shown between all groups up to a test force of 0.02N. Cell density was significantly higher on treated vs. untreated PEEK surfaces. Oxygen and H/O plasma treatments revealed to be most effective, whereas H/O plasma worked ten times faster to achieve the same effects. SIGNIFICANCE: The hydrogen-oxygen, 2/1-mixed plasma treatment combines the effect of hydrogen and oxygen plasma which strongly improve the surface properties of PEEK implant material, such as hydrophilicity, crystallinity, surface micro-hardness and HOB cell adhesion.

Parameters Influencing the Outcome of Additive Manufacturing of Tiny Medical Devices Based on PEEK.

In this review, we discuss the parameters of fused deposition modeling (FDM) technology used in finished parts made from polyether ether ketone (PEEK) and also the possibility of printing small PEEK parts. The published articles reporting on 3D printed PEEK implants were obtained using PubMed and search engines such as Google Scholar including references cited therein. The results indicate that although many have been experiments conducted on PEEK 3D printing, the consensus on a suitable printing parameter combination has not been reached and optimized parameters for printing worth pursuing. The printing of reproducible tiny-sized PEEK parts with high accuracy has proved to be possible in our experiments. Understanding the relationships among material properties, design parameters, and the ultimate performance of finished objects will be the basis for further improvement of the quality of 3D printed medical devices based on PEEK and to expand the polymers applications.

High-translucent yttria-stabilized zirconia ceramics are wear-resistant and antagonist-friendly.

OBJECTIVES: To evaluate two-body wear of three zirconia ceramics stabilized with 3, 4 and 5mol% yttria and to compare their wear behavior with that of a lithium-disilicate glass-ceramic. METHODS: Sixteen rectangular-shaped specimens made from three grades of zirconia ceramics and a lithium-disilicate glass-ceramic were polished and dynamically loaded in a chewing simulator (2kg vertical load, 2.1Hz) under water at 90°C for 1.2×106 cycles (about 7 days) in the ball-on-plate mode against steatite antagonists. Surface roughness was measured before and after wear testing. Wear tracks were scanned with a non-contact 3D profilometer and super-impositions were used to determine wear loss of the antagonists. Wear surfaces were imaged by SEM. XRD and micro-Raman spectroscopy were used to characterize phase transformation and stress status in the worn and unworn areas of the zirconia ceramics. RESULTS: Independent of fracture toughness, strength and aging-susceptibility, the three zirconia ceramics showed a similar and limited amount of wear (∼10µm in depth) and were more wear-resistant than the lithium-disilicate glass-ceramic (∼880µm in depth). Abrasive wear without obvious cracks was observed for all investigated zirconias, whereas the glass-ceramic with a lower fatigue threshold and high susceptibility to surface dissolution exhibited significant abrasion, fatigue and corrosion wear. All three zirconia ceramics yielded a lower antagonist wear than the glass-ceramic and no significant differences were found between the zirconia ceramics. SIGNIFICANCE: In the context of this study, high-translucent zirconia ceramics stabilized with a higher yttria content, recently introduced in the dental field, were as wear-resistant and antagonist-friendly as conventional high-strength zirconia and suitable for monolithic restorations.

Bacterial leakage and bending moments of screw-retained, composite-veneered PEEK implant crowns.

Due to its elastic modulus close to bone, the high-performance material PEEK (polyetheretherketone) represents an interesting material for implant-supported dental prostheses. Besides a damping effect of masticatory forces, it might have a sealing effect against bacterial leakage of the implant-abutment interface (IAI). So far, PEEK has only been used for provisional implant crowns. Therefore, the aim of the study was the evaluation of the bacterial tightness of screw-retained PEEK crowns on titanium implants with conical IAI during masticatory simulation and subsequent bending moment testing. Ten screw-retained implant crowns in the shape of an upper central incisor consisting of a PEEK crown framework veneered with composite were connected to NobelActive RP titanium implants (4.3 × 11.5 mm, Nobel Biocare AB, Göteborg, Sweden) with a tightening torque of 15 Ncm. Prior to tightening, the interior of the implant was inoculated with a bacterial suspension of Enterococcus faecium. The specimens were overmolded with indicating agar (Kanamycin-Aesculin-Azid-Agar (KAAA), Oxoid Limited, Basingstoke United Kingdom), that turns black in contact with E. faecium. The specimens were subjected to a cyclic masticatory simulation whereby a force of 50 N cm was applied at an angle of 30° to the implant axis for 1.2 million cycles. Afterwards, the specimens were subjected to a static loading test according to ISO 14801:2007 to determine the bending moment. During masticatory simulation neither a loosening of the implant screws nor any damage to the veneer or the PEEK framework occurred. Furthermore, no bacterial leakage could be observed in any of the specimens. The average maximum bending moment was measured at 352.13 ±â€¯48.96 N cm. Regarding masticatory forces, PEEK implant crowns seem to be applicable as definitive implant-supported restorations. Furthermore, the bacterial tightness of the IAI of screw-retained one-piece PEEK implant crowns is advantageous compared to superstructures of conventional materials. Further studies are necessary to substantiate the clinical significance of these findings.

Continuous high-frequency stimulation in freely moving rats: development of an implantable microstimulation system.

High-frequency stimulation (HFS) of basal ganglia and thalamic nuclei is an established treatment for various movement disorders and has recently been extended to other neuro-psychiatric conditions. Numerous experimental studies in small laboratory animals provided important insights in the mode of action of HFS. However, the interpretation of the results is often limited by the use of short-term HFS, while patients receive continuous stimulation for many years. One reason is the lack of an established model for the application of long-term HFS in small animals. Therefore, we thought to develop an implantable microstimulation system for small laboratory animals and to establish a protocol for long-term HFS by defining non-damaging stimulus parameters with respect to brain integrity. For this purpose, we designed a miniaturized, microcontroller-based, and programmable microstimulator that allows the reliable application of continuous HFS for up to 5 weeks. Chronic HFS (total stimulation time: 3 weeks) of the subthalamic nucleus with up to 100 microA (5.2 nC/phase) through monopolar electrodes comprising activated iridium did not induce significant tissue damage as assessed by various histological techniques (Nissl's, hematoxylin and eosin, Klüver-Barrera, van Gieson's staining, NeuN and GFAP-immunoreactivity). In conclusion, chronic HFS with an implantable stimulator can be successfully applied in small animals.

Influence of different low-pressure plasma process parameters on shear bond strength between veneering composites and PEEK materials.

OBJECTIVE: The aim of this study was to evaluate the impact of oxygen and argon/oxygen low-pressure plasma on the shear bond strength (SBS) between dental PEEK compounds and veneering composites as a function of plasma process time. METHODS: Of an unfilled PEEK ("Juvora") and two pigment powder filled PEEK compounds ("DC4420", "DC4450"), 273 rectangular plates were prepared and polished up to 1200 grit. Afterwards the samples were sandblasted and randomly assigned to five different surface pre-treatment groups (1. No plasma (control); 2. O2 plasma for 3min; 3. O2 plasma for 35min; 4. Ar/O2 plasma for 3min; 5. Ar/O2 plasma for 35min). Surface roughness and water contact angles were recorded using three samples of each PEEK compound for each of the plasma treatment groups. An adhesive (visio.link, Bredent GmbH & Co KG, Senden, Germany) was applied onto the specimen surfaces and light cured. A mold was used to shape three different veneering composites (a) Vita VM LC, "Vita" (Vita Zahnfabrik, Bad Säckingen, Germany); (b) GC GRADIA, "Gradia" (GC Europe, Leuven, Belgium); (c) GC GRADIA DIRECT Flo, "Gradia Flo" (GC Europe, Leuven, Belgium)) into a cylindrical form on the sample surface before light curing. SBS was measured using a universal testing machine after 24h of incubation in distilled water at 37°C. RESULTS: The two pigment filled PEEK compounds treated with O2 plasma and veneered with Gradia Flo showed the highest SBS values (34.92±6.55MPa and 34.2±1.87MPa) followed by the combination of the unfilled PEEK material with Gradia Flo (29.57±3.71MPa). The SBS values of the samples veneered with Gradia were lower, but not significantly so. The SBS values of the specimens with Vita were for the most part associated with significantly lower results. SIGNIFICANCE: A low-pressure plasma process using oxygen plasma for a duration of 35min, preceded by sandblasting, seems to be the most effective in increasing shear bond strength between veneering composites and PEEK materials.

Maximum insertion torque of a novel implant-abutment-interface design for PEEK dental implants.

Frequent reports attest to the various advantages of tapered implant/abutment interfaces (IAIs) compared to other types of interfaces. For this reason, a conical IAI was designed as part of the development of a PEEK (polyetheretherketone)-based dental implant. This IAI is equipped with an apically displaced anti-rotation lock with minimal space requirements in the form of an internal spline. The objective of this study was the determination of the average insertion torque (IT) at failure of this design, so as to determine its suitability for immediate loading, which requires a minimum IT of 32Ncm. 10 implants each made of unfilled PEEK, carbon fiber reinforced ("CFR") PEEK (> 50vol% continuous axially parallel fibers) as well as of titanium were produced and tested in a torque test bench. The average IT values at failure of the unfilled PEEK implants were measured at 22.6 ± 0.5Ncm and were significantly higher than those of the CFR-Implants (20.2 ± 2.5Ncm). The average IT values at failure of the titanium specimens were significantly higher (92.6 ± 2.3Ncm) than those of the two PEEK variants. PEEK- and CFR-PEEK-implants in the present form cannot adequately withstand the insertion force needed to achieve primary stability for immediate loading. Nevertheless, the achievable torque resilience of the two PEEK-variants may be sufficient for a two-stage implantation procedure. To improve the torque resistance of the PEEK implant material the development of a new manufacturing procedure is necessary which reinforces the PEEK base with continuous multi-directional carbon fibers as opposed to the axially parallel fibers of the tested PEEK compound.

Hydrophilicity, Viscoelastic, and Physicochemical Properties Variations in Dental Bone Grafting Substitutes.

The indication-oriented Dental Bone Graft Substitutes (DBGS) selection, the correct bone defects classification, and appropriate treatment planning are very crucial for obtaining successful clinical results. However, hydrophilic, viscoelastic, and physicochemical properties' influence on the DBGS regenerative potential has poorly been studied. For that reason, we investigated the dimensional changes and molecular mobility by Dynamic Mechanical Analysis (DMA) of xenograft (cerabone®), synthetic (maxresorb®), and allograft (maxgraft®, Puros®) blocks in a wet and dry state. While no significant differences could be seen in dry state, cerabone® and maxresorb® blocks showed a slight height decrease in wet state, whereas both maxgraft® and Puros® had an almost identical height increase. In addition, cerabone® and maxresorb® blocks remained highly rigid and their damping behaviour was not influenced by the water. On the other hand, both maxgraft® and Puros® had a strong increase in their molecular mobility with different damping behaviour profiles during the wet state. A high-speed microscopical imaging system was used to analyze the hydrophilicity in several naturally derived (cerabone®, Bio-Oss®, NuOss®, SIC® nature graft) and synthetic DBGS granules (maxresorb®, BoneCeramic®, NanoBone®, Ceros®). The highest level of hydrophilicity was detected in cerabone® and maxresorb®, while Bio-Oss® and BoneCeramic® had the lowest level of hydrophilicity among both naturally derived and synthetic DBGS groups. Deviations among the DBGS were also addressed via physicochemical differences recorded by Micro Computed Tomography, Scanning Electron Microscopy, Fourier Transform Infrared Spectroscopy, X-ray powder Diffractometry, and Thermogravimetric Analysis. Such DBGS variations could influence the volume stability at the grafting site, handling as well as the speed of vascularization and bone regeneration. Therefore, this study initiates a new insight into the DBGS differences and their importance for successful clinical results.

In vitro degradation of a biodegradable polylactic acid/magnesium composite as potential bone augmentation material in the presence of titanium and PEEK dental implants.

OBJECTIVE: The aim of this study was to assess the degradation behavior by measuring the H2 release of a biodegradable composite consisting of a polylactic acid matrix reinforced with 30% wt. spherical magnesium microparticles (PLA/Mg) as potential bone augmentation material in combination with dental implants of either titanium or polyetheretherketone (PEEK) in order to evaluate the potential influence of the titanium dental implants on the corrosion behavior of the Mg particles within the PLA matrix. METHODS: Three PEEK dental implants and three titanium dental implants were put into a central perforation of six PLA/Mg-discs. These samples were incubated at 37°C for 30days in McCoy's 5A modified medium and the H2 release was evaluated. RESULTS: Between day 7 and day 16 the average H2 release per cm2 of the surface of the PLA/Mg-samples in combination with the titanium implants was significantly higher than that of the sample group combined with the implants of PEEK (3.1±0.4ml vs. 2.8±0.4ml). This significant difference disappeared afterwards, whereas the H2 release was highest at day 30 and amounted 3.5±0.7ml/cm2 for the group with the titanium implants and 3.2±0.8ml/cm2 for the group with the PEEK implants. SIGNIFICANCE: Regarding the similar values of the degradation depending H2 release of the two implant material groups, the co-implantation of a PLA/Mg composite is not only possible with new metal-free implant materials such as PEEK, but also with conventional implants of titanium.

The impact of argon/oxygen low-pressure plasma on shear bond strength between a veneering composite and different PEEK materials.

OBJECTIVE: The aim of the study was to evaluate the impact of low-pressure argon/oxygen plasma with and without previous sandblasting on the shear bond strength (SBS) between dental PEEK compounds and a veneering composite. METHODS: Of one type of unfilled PEEK and two pigment powder filled PEEK compounds, forty rectangular plates each were prepared and polished up to 4000 grit. The samples were randomly assigned to four surface pre-treatment groups, each consisting of ten specimens (1. Untreated; 2. Plasma treatment; 3. Sandblasting; 4. Sandblasting+plasma treatment). Plasma treatment was performed for 35min using a low-pressure plasma system with a 1:1 mixture of the process gases argon and oxygen. Surface roughness and water contact angles were recorded. An adhesive (Visio.link, Bredent GmbH & Co KG, Senden, Germany) was applied onto the specimen surfaces and light cured. A mold was used to shape the veneering composite (Vita VM LC, Vita Zahnfabrik, Bad Säckingen, Germany) into a cylindrical form on the sample surface before light curing. SBS was measured after 24h incubation at 37°C in distilled water using a universal testing machine. RESULTS: The samples pre-treated according to group 4 (sandblasting and plasma treatment) showed the highest SBS overall, whereas the unfilled PEEK showed the highest SBS (19.8±2.46MPa) compared to the other PEEK materials (15.86±4.39MPa and 9.06±3.1MPa). SIGNIFICANCE: Sandblasting and surface activation with low-pressure argon/oxygen plasma in combination with an adhesive causes a favorable increase in shear bond strength, especially on unfilled PEEK material.