A Comparative Analysis of Mechanical Properties of Polyetheretherketone (PEEK) vs. Standard Materials Used in Orthodontic Fixed Appliances: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
- The inclusion criteria were defined according to PICOS framework:
- Sample (P) = PEEK materials;
- Intervention (I) = Applications in fixed orthodontic appliances;
- Comparison (C) = Mechanical properties of conventional orthodontic materials;
- Outcome (O) = Quantitative analysis of different kinds of mechanical investigation;
- Study design (S) = In vivo or in vitro experimental studies.
2.2. Information Sources
2.3. Search Strategy and Study Selection
2.4. Data Extraction
2.5. Assessment of Risk of Bias in Individual Studies
2.6. Summary of Measurements and Synthesis of Results
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Risk of Bias in Studies
3.4. Results of Individual Studies
4. Discussion
5. Conclusions
- PEEK archwires exhibit the optimum orthodontic force, particularly the “0.019 × 0.025 in2” PEEK archwire in a “0.022 × 0.028 in” slot-lid ligation bracket which could provide a higher load than a “0.016 in” Ni-Ti wire. PEEK wire dimensions do not affect static friction. PEEK wires can maintain 70% to 80% of the initial load under a stress relaxation test for 24 h which was favorable for orthodontic treatment. Further investigation into load deflection, friction properties over a longer period, and intra-oral simulation are still needed. Moreover, PEEK tubes offer esthetic appeal and orthodontic efficiency.
- PEEK brackets address ceramic bracket issues such as brittleness and bulkiness. They also demonstrate lower friction and adhesive wear characteristics, potentially replacing metal and ceramic materials in the future. As this study marks the initial exploration of PEEK brackets, more research is required to fully assess their potential in the clinical settings.
- Research on PEEK fixed lingual retainers revealed that incorporating a retention pad into the PEEK fixed retainer did not enhance retention; rather, it impeded physiological tooth movement. Additionally, larger dimensions increase rigidity, raising the risk of debonding. Hence, wire-form PEEK retainers are preferred and a hemi-elliptical, cross-sectional shape with a thickness of “0.039 in” (≈1.0 mm) and a width of “0.059 in” (≈1.5 mm) should be used in further experiments. Moreover, surface treatment of PEEK retainers is necessary and a comparison between two methods, 98% sulfuric acid for 60s and air abrasion, should be conducted.
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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No. | Author, Year | Application | Comparing Materials | Applied Tests | Conclusion |
---|---|---|---|---|---|
1. | Maekawa et al., 2015 [16] | Orthodontic wires | PEEK “0.039 × 0.039 in2” (≈1.0 × 1.0 mm2) Stainless steel (SS), Cobalt-chromium (Co-Cr), Titanium-molybdenum (Ti-Mo), Nickel-titanium (Ni-Ti) “0.016 × 0.022 in2” (≈0.40 × 0.55 mm2) | Three-point bending test | PEEK showed highest bending strength and delivered similar force to Ni-Ti wire which was smaller in dimension. |
2. | Tada et al., 2017 [17] | Orthodontic wires | PEEK (“0.016 in”, “0.016 × 0.022 in2”, “0.019 × 0.025 in2”) Ni-Ti (“0.016 in”) | Three-point bending test under three conditions (No ligation (NL), elastomeric ligation (EL), and slot lid ligation (SL)) Stress relaxation test Static friction test (EL only) | Use of “0.016 in” PEEK wire should be avoided. “0.019 × 0.025 in2” PEEK wire with the use of SL was suggested as an alternative to Ni-Ti wire. |
3. | Shirakawa et al., 2018 [18] | Orthodontic wire sleeves | SS, Co-Cr, and Ni-Ti with and without PEEK tube (“0.018 in” and “0.017 × 0.025 in2”) | Friction test and surface roughness of a bracket slot (SS, Co-Cr, and Ni-Ti with and without PEEK tube) | Significantly lower friction values were recorded for all wires covered by the PEEK tube, except for “0.016 in” Ni-Ti where there was no significant difference. Alterations on the brackets were undetected when covered by the PEEK tube. |
4. | Wu et al., 2024 [19] | Orthodontic bracket | PEEK, Ceramic | Surface roughness and morphology Coefficient of friction (COF) | PEEK can maintain a smooth surface similar to the ceramic brackets. PEEK also exhibited better mechanical properties and lower friction than ceramic. |
5. | Alabbadi el al., 2023 [20] | Orthodontic fixed lingual retainer | PEEK, flat braided wire–Bond A. Braid | Aging procedure, failure bonding force test, measurement of connector retainer displacement, and adhesive remnant index (ARI) | A braided rectangular wire may be preferred due to its adequate debonding force, lower ARI, and greater permission of tooth movement compared to PEEK retainer. |
6. | Roser et al., 2023 [21] | Orthodontic fixed lingual retainer | PEEK, stainless steel twistflex retainer | Aging followed by load capacity test | PEEK retainer exhibited the highest failure rate during aging and showed significantly lower strength compared to twistflex retainer. These findings indicate the limitations of long-term reliability. |
7. | Kadhum et al., 2021 [22] | Orthodontic fixed lingual retainer | PEEK wire “0.031 in” (≈0.8 mm) with three surface preparations (no surface treatment, air abrasion, air abrasion followed by conditioning with a thin layer of visio.link) “0.0195 in” dead-soft coaxial wire, “0.010 × 0.028 in2” three strands stainless steel braided retainer wire, “0.010 × 0.028 in2” solid flat titanium dead-soft wire | Debonding from acrylic blocks, Debonding from bovine teeth, Pull-out test | Pre-treatment of PEEK wire with air abrasion alone showed comparable outcomes to the metallic retainer. |
8. | Win et al., 2023 [23] | Orthodontic fixed lingual retainer | PEEK, stainless steel wire “0.036 in” (≈0.9 mm) | Three-point bending test via finite element analysis and laboratory test | Hemi-elliptical PEEK retainer with a thickness of “0.039 in” (≈1.0 mm) and width of “0.059 in” (≈1.5 mm) was mentioned as an optimal dimension to be used a fixed lingual retainer. |
9. | Roser et al., 2024 [24] | Orthodontic fixed lingual retainer | PEEK “0.047 × 0.138 in2” (≈1.2 × 3.5 mm2), stainless steel twistflex retainer “0.022 in” (≈0.55 mm) | Horizontal and vertical tooth mobility test | PEEK retainer notably limits tooth mobility compared to multistranded retainers. Further experiments on modification of the PEEK retainer designs are needed. Selection of appropriate retainer types is required, particularly for patients with previous or high-risk periodontal damage. |
No. | Study | Signaling Questions | Summary | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
I | II | III | IV | V | VI | VII | VIII | IX | X | XI | XII | |||
1 | Maekawa et al., 2015 [16] | 1 | 0 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 0 | 1 | 2 | 58.33% (M) |
2 | Tada et al., 2017 [17] | 2 | 0 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 66.67% (M) |
3 | Shirakawa et al., 2018 [18] | 2 | 0 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 66.67% (M) |
4 | Wu et al., 2024 [19] | 2 | 0 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 66.67% (M) |
5 | Alabbadi et al., 2023 [20] | 2 | 2 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 75.00% (L) |
6 | Roser et al., 2023 [21] | 2 | 0 | 1 | 2 | 2 | 1 | 2 | 2 | 1 | 0 | 2 | 2 | 70.83% (L) |
7 | Kadhum et al., 2021 [22] | 2 | 0 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 66.67% (M) |
8 | Win et al., 2023 [23] | 2 | 0 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 66.67% (M) |
9 | Roser et al., 2024 [24] | 2 | 0 | 2 | 2 | 2 | 0 | 2 | 2 | 0 | 0 | 2 | 2 | 66.67% (M) |
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Win, P.P.; Moe, O.G.; Chen, D.D.-S.; Peng, T.-Y.; Cheng, J.H.-C. A Comparative Analysis of Mechanical Properties of Polyetheretherketone (PEEK) vs. Standard Materials Used in Orthodontic Fixed Appliances: A Systematic Review. Polymers 2024, 16, 1271. https://doi.org/10.3390/polym16091271
Win PP, Moe OG, Chen DD-S, Peng T-Y, Cheng JH-C. A Comparative Analysis of Mechanical Properties of Polyetheretherketone (PEEK) vs. Standard Materials Used in Orthodontic Fixed Appliances: A Systematic Review. Polymers. 2024; 16(9):1271. https://doi.org/10.3390/polym16091271
Chicago/Turabian StyleWin, Pyi Phyo, Oak Gar Moe, Daniel De-Shing Chen, Tzu-Yu Peng, and Johnson Hsin-Chung Cheng. 2024. "A Comparative Analysis of Mechanical Properties of Polyetheretherketone (PEEK) vs. Standard Materials Used in Orthodontic Fixed Appliances: A Systematic Review" Polymers 16, no. 9: 1271. https://doi.org/10.3390/polym16091271