Mechanical Properties of PEEK Post-Cores Compared to Other Post-Cores: A Systematic Review and Meta-Analysis

Abstract

Recently, polyetherpolyetherketone (PEEK) has gained popularity as a dental biomaterial. However, there is a lack of consensus on its potential use as an endodontic post-core material. The aim of this review was to systematically critique and synthesize the evidence on PEEK-based post-cores in comparison to other materials. An electronic search was conducted on PubMed, Medline, Embase, ISI Web of Science, Ovid, Cochrane, and ClinicalTrials.Gov using relevant keywords. Seven in vitro studies were included in this review. Meta-analysis of fracture resistance was carried out on results reported in three studies. Overall, in most of the studies, PEEK post-cores performed similar to glass-fiber post-cores. The meta-analysis revealed no significant difference between the fracture strengths of PEEK and glass-fiber post-cores. However, in most studies, several sources of bias were identified. Within the limitations of this review, it may be concluded that mechanical and physical properties of PEEK posts are similar to those of glass-fiber post-cores. Nonetheless, long-term clinical studies are required to translate these conclusions into clinical practice.

Keywords

polyetheretherketone - systematic review - endodontics - endodontic post - post-cores

Publikationsverlauf

Artikel online veröffentlicht:
07. Mai 2025

• References

• 1 Torabinejad M, White SN. Endodontic treatment options after unsuccessful initial root canal treatment: alternatives to single-tooth implants. J Am Dent Assoc 2016; 147 (03) 214-220
• 2 Mosharaf R, Abolhasani M, Fathi AH, Rajabi A. The effect of ferrule/crown ratio and post length on the applied stress and strain distribution to the endodontically treated maxillary central teeth: a finite element analysis. Front Dent 2023; 20: 16
• 3 Baran GR. The metallurgy of Ni-Cr alloys for fixed prosthodontics. J Prosthet Dent 1983; 50 (05) 639-650
• 4 Ince Yusufoglu S, Saricam E, Ozdogan MS. Finite element analysis of stress distribution in root canals when using a variety of post systems instrumented with different rotary systems. Ann Biomed Eng 2023; 51 (07) 1436-1448
• 5 Spear F, Holloway J. Which all-ceramic system is optimal for anterior esthetics?. J Am Dent Assoc 2008; 139 (suppl): 19S-24S
• 6 Ribeiro MTH, Oliveira G, Oliveira HLQ. et al. Survival of severely compromised endodontically treated teeth restored with or without a fiber glass post. J Appl Oral Sci 2023; 31: e20230241
• 7 Lin L, Zhuo Y, Cai P, Chen X, Zheng Z, Lin J. Use of an intraoral scanner and CAD-CAM for simultaneous restoration with a personalized titanium post-core and a zirconia crown. J Oral Sci 2024; 66 (01) 82-84
• 8 Lee KS, Shin JH, Kim JE. et al. Biomechanical evaluation of a tooth restored with high performance polymer PEKK post-core system: a 3D finite element analysis. BioMed Res Int 2017; 2017: 1373127
• 9 Dib Zakkour S, Dib Zakkour J, Guadilla Y, Montero J, Dib A. Comparative evaluation of the digital workflow and conventional method in manufacturing complete removal prostheses. Materials (Basel) 2023; 16 (21) 6955
• 10 Martins MD, Junqueira RB, de Carvalho RF, Lacerda MFLS, Faé DS, Lemos CAA. Is a fiber post better than a metal post for the restoration of endodontically treated teeth? A systematic review and meta-analysis. J Dent 2021; 112: 103750
• 11 Ozkurt Z, Işeri U, Kazazoğlu E. Zirconia ceramic post systems: a literature review and a case report. Dent Mater J 2010; 29 (03) 233-245
• 12 Alqurashi H, Khurshid Z, Syed AUY, Rashid Habib S, Rokaya D, Zafar MS. Polyetherketoneketone (PEKK): an emerging biomaterial for oral implants and dental prostheses. J Adv Res 2020; 28: 87-95
• 13 Srimaneepong V, Heboyan A, Zafar MS. et al. Fixed prosthetic restorations and periodontal health: a narrative review. J Funct Biomater 2022; 13 (01) 15
• 14 Najeeb S, Zafar MS, Khurshid Z, Siddiqui F. Applications of polyetheretherketone (PEEK) in oral implantology and prosthodontics. J Prosthodont Res 2016; 60 (01) 12-19
• 15 Huang L, Nemoto R, Okada D. et al. Investigation of stress distribution within an endodontically treated tooth restored with different restorations. J Dent Sci 2022; 17 (03) 1115-1124
• 16 Heboyan A, Lo Giudice R, Kalman L, Zafar MS, Tribst JPM. Stress distribution pattern in zygomatic implants supporting different superstructure materials. Materials (Basel) 2022; 15 (14) 4953
• 17 Saisho H, Marcolina G, Perucelli F, Goulart da Costa R, Machado de Souza E, Rached RN. Fracture strength, pull-out bond strength, and volume of luting agent of tooth-colored CAD-CAM post-and-cores. J Prosthet Dent 2023; 129 (04) 599-606
• 18 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151 (04) 264-269 , W64
• 19 Benli M, Eker Gümüş B, Kahraman Y, Huck O, Özcan M. Surface characterization and bonding properties of milled polyetheretherketone dental posts. Odontology 2020; 108 (04) 596-606
• 20 Teixeira KN, Duque TM, Maia HP, Gonçalves T. Fracture resistance and failure mode of custom-made post-and-cores of polyetheretherketone and nano-ceramic composite. Oper Dent 2020; 45 (05) 506-515
• 21 Özarslan M, Büyükkaplan UŞ, Özarslan MM. Comparison of the fracture strength of endodontically treated teeth restored with polyether ether ketone, zirconia and glass-fibre post-core systems. Int J Clin Pract 2021; 75 (09) e14440
• 22 Kole S, Ergun G. Bond strength of various post-core restorations with different lengths and diameters following cycle loading. J Mech Behav Biomed Mater 2023; 142: 105804
• 23 Pourkhalili H, Maleki D. Fracture resistance of polyetheretherketone, Ni-Cr, and fiberglass postcore systems: an in vitro study. Dent Res J (Isfahan) 2022; 19: 20
• 24 Rakotoaridina K, Delrieu J, Pages P, Vergé T, Nasr K, Canceill T. Evaluation of poly(etheretherketone) post's mechanical strength in comparison with three metal-free biomaterials: an in vitro study. Polymers (Basel) 2023; 15 (17) 3583
• 25 Schmidt L, Shokraneh F, Steinhausen K, Adams CE. Introducing RAPTOR: RevMan parsing tool for reviewers. Syst Rev 2019; 8 (01) 151
• 26 Sheth VH, Shah NP, Jain R, Bhanushali N, Bhatnagar V. Development and validation of a risk-of-bias tool for assessing in vitro studies conducted in dentistry: The QUIN. J Prosthet Dent 2024; 131 (06) 1038-1042
• 27 Sugano K, Komada W, Okada D, Miura H. Evaluation of composite resin core with prefabricated polyetheretherketone post on fracture resistance in the case of flared root canals. Dent Mater J 2020; 39 (06) 924-932
• 28 Attia MA, Shokry TE, Abdel-Aziz M. Effect of different surface treatments on the bond strength of milled polyetheretherketone posts. J Prosthet Dent 2022; 127 (06) 866-874
• 29 Lima MO, Ferretti MA, Caldas RA. et al. Application of polyetheretherketone (PEEK) posts: evaluation of fracture resistance and stress distribution in the root: in vitro and finite element analyses. Braz Oral Res 2023; 37: e047
• 30 Monteiro LC, Pecorari VGA, Gontijo IG, Marchi GM, Lima DANL, Aguiar FHB. PEEK and fiberglass intra-radicular posts: influence of resin cement and mechanical cycling on push-out bond strength. Clin Oral Investig 2022; 26 (12) 6907-6916
• 31 Ahmad SM, Dawood SN, Dalloo GAM, Al-Barazanchi TRH. Evaluation of mechanical properties of different polyetheretherketone endodontic post systems: an in vitro study. BMC Oral Health 2023; 23 (01) 537
• 32 Gontijo IG, Ferretti MA, Caldas RA. et al. Biomechanical behavior of weakened roots restored with custom-made post-and-cores of glass fiber and polyetheretherketone. J Prosthodont 2023; 32 (09) 807-814
• 33 Ona M, Wakabayashi N, Yamazaki T, Takaichi A, Igarashi Y. The influence of elastic modulus mismatch between tooth and post and core restorations on root fracture. Int Endod J 2013; 46 (01) 47-52
• 34 Eskitaşcioğlu G, Belli S, Kalkan M. Evaluation of two post core systems using two different methods (fracture strength test and a finite elemental stress analysis). J Endod 2002; 28 (09) 629-633
• 35 Lee JJ, Nettey-Marbell A, Cook Jr A, Pimenta LAF, Leonard R, Ritter AV. Using extracted teeth for research: the effect of storage medium and sterilization on dentin bond strengths. J Am Dent Assoc 2007; 138 (12) 1599-1603
• 36 Khurshid Z, Nedumgottil BM, Ali RMM, Bencharit S, Najeeb S. Insufficient evidence to ascertain the long-term survival of PEEK dental prostheses: a systematic review of clinical studies. Polymers (Basel) 2022; 14 (12) 2441