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Clinical Performance of Additively Manufactured and Milled PEEK Inlays vs Indirect Composite Resin Inlays
TAKE-HOME MESSAGE
- This randomized clinical trial compared the clinical performance of 3D-printed and milled polyetheretherketone (PEEK) inlays with that of milled composite resin inlays over a 1-year follow-up period. Although all groups demonstrated acceptable clinical performance, PEEK restorations (both 3D-printed and milled) showed a statistically significant difference in color match compared with composite restorations, with the PEEK groups receiving lower scores. However, no significant differences were observed in other parameters or across different time points. The 1-year follow-up period is relatively short for assessing the long-term clinical efficacy, and further research with longer follow-up periods is needed to fully understand the durability and performance of the material.
- PEEK materials show promise as an alternative to the indirect composite resin for posterior intracoronal restorations, offering good clinical performance over a 1-year period; however, clinicians should be aware of potential esthetic limitations.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersSTATEMENT OF PROBLEM
Data on polymer materials, particularly polyetheretherketone (PEEK) used in restorative dentistry, are scarce, as is knowledge concerning the clinical efficacy of PEEK restorations produced through additive manufacturing when compared with existing indirect materials and techniques.
PURPOSE
The purpose of this randomized clinical trial was to evaluate the clinical performance of additively manufactured and milled PEEK inlays compared with composite resin inlays according to modified United State Public Health Service (USPHS) criteria over a 1-year follow- up.
MATERIAL AND METHODS
Participants were allocated into 3 distinct categories based on the materials and techniques used: R1 denoting teeth restored with 3 dimensionally (3D) printed PEEK inlays (N=16), R2 representing teeth restored with milled PEEK inlays (N=16), and R3 indicating the comparator group comprising teeth restored with milled composite resin inlays (N=16). After the placement of inlay restorations, evaluations were conducted at 3 time points (T): baseline (T0), 6 months (T1), and 12 months (T2) by using the modified USPHS criteria for assessing anatomic form, color match, marginal discoloration, marginal adaptation, surface texture, secondary caries, retention, and postoperative sensitivity. Ordinal data were analyzed using the Kruskal-Wallis test, followed by the Dunn post hoc test for between group comparisons, as well as the Friedman test, followed by the Nemenyi post hoc test for within group comparisons (α=.05).
RESULTS
Across all parameters and intervals, most of the restorations within each group exhibited an alfa score, with no statistically significant differences noted (P>.05). However, concerning color match, all restorations within the PEEK groups received a bravo score, indicating a statistically significant difference in intergroup comparison between the milled composite resin groups and the PEEK group (P<.001). However, no significant variances were noted in the scores evaluated across different follow-up periods (P>.05).
CONCLUSIONS
Subtractive and additive manufacturing techniques, as well as PEEK and composite resin materials together, offer clinically acceptable functioning restorations over 1 year. PEEK material can be used as a suitable alternative to commonly used indirect composite resin intracoronal restorations in posterior areas. Improvements in terms of surface texture and esthetics are required.
Additional Info
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Evaluation of clinical performance of additively manufactured and milled polyetheretherketone (PEEK) inlays compared with indirect composite resin inlays over a one-year follow-up: A randomized clinical trial
J Prosthet Dent 2024 Aug 06;[EPub Ahead of Print], DM El-Shafey, D Yehia, D Ezz, A Tawfik, P Bills, MA El-BazFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study compared the clinical performance of composite inlays manufactured from two different materials, with two different manufacturing processes used for one of the materials. A relatively new material, polyetheretherketone (PEEK), was investigated in two different modes: one being an additive or printing mode and the other being a CAD-CAM milling mode. The comparison material was a CAD-CAM milled composite resin (BRILLIANT Crios by Coltène). Thus, three groups were compared (3D-printed PEEK inlays, milled PEEK inlays, and milled resin composite inlays). Clinical evaluations were conducted at 0, 6, and 12 months using the United States Public Health Service criteria for anatomic form, color match, marginal discoloration, surface texture, secondary caries, retention, and postoperative sensitivity. Mostly, Alfa scores were obtained in all three groups — except for color match, where both the PEEK groups exhibited Bravo scores for all restorations, thus differing significantly from the composite resin group. An Alfa score indicates an ideal result, whereas a Bravo score indicates a noticeable difference but not enough to cause failure of the restoration. It appears that the new material PEEK performs adequately in either printing or CAD-CAM mode over 1 year. The main limitation of this study is the relatively short observation period. In order to recommend a new technique or material, at least 5 years of clinical observation would be desirable. Another issue not discussed in the paper is the comparison of inlays with direct restorations. Inlays have the advantage of better contour control, including the proximal contact, which can be difficult to obtain with direct composite restorations. Also, a stronger material can be used, as it is pre-polymerized under ideal conditions. Since it is polymerized before being shaped, polymerization shrinkage and subsequent stress are thus eliminated. The downside of the inlay technique is a larger preparation owing to the taper needed for proper insertion. Also, the additional time required for scanning and manufacturing the inlay makes the procedure significantly more expensive than a directly placed composite.