The Use of a Modified Poly-Ether-Ether-Ketone (PEEK)

as an Alternative Framework Material for Removable Dental

Prostheses. A Clinical Report
Panagiotis Zoidis, DDS, MS, Dr Dent, Ioannis Papathanasiou, DDS, & Gregory Polyzois, DDS, MScD,
Dr Dent
Department of Prosthodontics, Dental School, National and Kapodistrian University of Athens, Greece

Keywords Abstract
BioHPP; distal extension; high-performance
polymer; PEEK; removable dental prosthesis.
This clinical report presents a modified poly-ether-ether-ketone (PEEK) as an alter-
native material for the fabrication of distal extension removable dental prosthesis
Correspondence
(RDP) frameworks. This material can be used for patients allergic to metals, or who
Panagiotis Zoidis, Department of dislike the metallic taste, the weight, and the unpleasant metal display of the denture
Prosthodontics, Dental School, National and framework and retentive clasps. This modified PEEK material, known as BioHPP, is
Kapodistrian University of Athens, 2 Thivon a biocompatible, nonallergic, rigid material, with flexibility comparable to bone, high
Street, 11527, Athens, Greece. polishing and low absorption properties, low plaque affinity, and good wear resistance.
E-mail: pzoidis@dent.uoa.gr It has been used for years in orthopedics and medical technology. BioHPP frameworks
can be constructed either via CAD/CAM manufacturing or via the conventional lost
This paper was completed as part of the wax technique. The clinical use of a BioHPP RDP framework is presented as an
postgraduate program co-financed by the alternative for the treatment of a distal extension case.
“Scholarships Programme of the State
Scholarships Foundation (IKY Scholarships)
with an individualized assessment process of
the Academic Year 2012 to 2013” Act from
the resources of the operational program,
“Education and Lifelong Learning,” of the
European Social Fund (ESF), NSRF 2007 to
2013.

The authors declare no conflicts of interest

with respect to the authorship and publication
of this article.

Accepted March 13, 2015

doi: 10.1111/jopr.12325

Traditional removable dental prostheses (RDP) with chrome-
cobalt frameworks and clasps have been an inexpensive and
predictable treatment option for the rehabilitation of partially
edentulous patients.1 The esthetically unacceptable display of
metal clasps, the increased weight of the prosthesis, the po-
tential for metallic taste, and allergic reactions to metals led
to the introduction of a number of thermoplastic materials in
clinical practice such as nylon and acetal resins. Nylons pro-
vide improved esthetics and reduction of rotational forces on
the abutment teeth due to their low elastic modulus. The major
disadvantage of a nylon RDP is the inability for a reline proce-
dure and the lack of occlusal rests as well as rigid frameworks,
that could lead to occlusal instability and sinking, especially
in Kennedy class I and II cases. On the other hand, acetal
resins present adequate mechanical strength to form a frame-
work more rigid than nylon with retentive clasps, connectors,
and supportive elements; however, the acetal resin material
lacks natural translucency and vitality.2-5
An alternative restoration material (poly-ether-ether-ketone
[PEEK]) has been successfully used over the last years in the
medical field, and orthopedics, specifically. A modified PEEK
material containing 20% ceramic fillers is a high performance
polymer (BioHPP; Bredent GmbH, Senden, Germany), which
presents high biocompatibility, good mechanical properties,
high temperature resistance, and chemical stability.6-8 Due to
a 4 GPa modulus of elasticity, it is as elastic as bone and can
reduce stresses transferred to the abutment teeth. Furthermore,
the white color of BioHPP frameworks provides a different

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High Performance Polymer as Alternative RDP Framework Material Zoidis et al

Figure 1 Existing RDP with conventional Roach clasps, buccal view. Figure 2 Existing RDP lingual bar, occlusal rest seats, and clasps.

esthetic approach than the conventional metal framework dis-

play does. Additional advantages of this polymer material are
elimination of allergic reactions and metallic taste, high polish-
ing qualities, low plaque affinity, and good wear resistance.9-12
Although PEEK in general has been successfully used for years
in orthopedics and medical technology,13 it has only recently
been used in dentistry. Thus, studies evaluating the properties
of this material are limited.14-22 The existing reports on this ma-
terial are generally in vitro, emphasizing the need for further
clinical tests.
The purpose of this clinical report was to present an alter-
native treatment approach using a BioHPP framework in com-
bination with the traditional denture base acrylic resins for the Figure 3 BioHPP framework, lingual plate.
fabrication of a mandibular RDP.

Clinical report
Pretreatment
A 70-year-old female patient presented with a conventional
Cr-Co mandibular distal extension RDP. The major connector
was a lingual bar; traditional roach clasps engaged the lower
left second premolar and the lower right first premolar, which
served as abutment teeth. Minor connectors emerged from the
lingual bar engaging rest seats lingual to mandibular left ca-
nine, mesial to mandibular right first premolar as well as distal
and mesial to the left first and second mandibular premolar,
respectively (Figs 1 and 2).
The patient complained of the metallic taste, the weight, and
the unpleasant display of the metal clasps of her existing Cr-Co Figure 4 BioHPP framework, C clasps.
RDP and demanded an alternative material for the construction
of a new RDP. She presented no history of allergy to metal or Treatment
acrylics. The initial impression was performed with irreversible hydro-
colloid impression material (Blueprint Cremix; Dentsply De-
Treatment plan Trey GmbH, Konstanz, Germany), and the diagnostic cast was
constructed with stone (Moldadur; Heraeus Kultzer GmbH &
The treatment plan consisted of a modified PEEK material Co KG, Hanau, Germany). A custom tray was constructed on
(BioHPP) distal extension RDP framework with regular acrylic this diagnostic cast using a light-cured resin material (Fastray
denture teeth and conventional heat-cure acrylic resin bases, LC; Harry J. Bosworth Company, Skokie, IL). Border molding
employing the existing design. with green stick compound (Kerr Corporation, Orange, CA)

2 Journal of Prosthodontics 0 (2015) 1–5 

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Zoidis et al
Figure 5 Heavy, conventional Cr-Co distal extension RDP.
Figure 6 BioHPP distal extension RDP, 27.5% lighter.
was performed for the edentulous areas, and polysulfide im-
pression material (Permlastic; Kerr Corporation) was used for
the final impression. Type IV dental stone (Prima-rock; Whip
Mix Corporation, Louisville, KY) was used for the fabrication
of the definitive cast.
The BioHPP framework was constructed with the con-
ventional lost wax technique using a vacuum press
device (2 press; Bredent GmbH) especially designed for this
material. The wax model was invested in a mold using a special
Journal of Prosthodontics 0 (2015) 1–5 
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High Performance Polymer as Alternative RDP Framework Material
investment (Brevest; Bredent GmbH). The mold was heated
between 630°C and 850°C to melt the wax, and then cooled at
400°C. In that temperature, BioHPP melted and was vacuum
pressed into the mold under 5.5 to 6 bar pressure. The usual
devesting procedure was followed as soon as the mold had
cooled down (35 minutes), and the framework was fitted to the
definitive cast. The major connector design was a lingual plate
instead of the conventional lingual bar to better withstand the
torsional forces from the distal extension RDP (Fig 3). Conven-
tional C clasps were constructed, engaging a 0.5 mm undercut
on the abutment teeth (Fig 4).
Centric relation records were performed using bite reg-
istration wax (Aluwax; Aluwax Dental Products Company,
Allendale, MI), and the final try-in confirmed treatment po-
sition validity and tooth setup. Conventional acrylic denture
teeth (Bioblend Trubyte; Dentsply International, York, PA)
were used, and the heat-cured acrylic resin (Trevalon; De Trey
Division, AD International Ltd, Weybridge, Surrey, UK) was
processed according to the manufacturer’s instructions. A clin-
ical remount followed by occlusal adjustments was performed
to accommodate processing discrepancies. The distal extension
RDP was delivered, and sore spots were relieved at the 48-hour
recall appointment.
The patient was very pleased with the “negative weight” of
her new RDP and the white “healthy shade” of the framework
and the retentive parts (Figs 5 and 6). Clasp retention was
evaluated as equal and more “gentle” compared with the old
Cr-Co RDP.
Discussion
The choice of the material for the construction of RDPs should
be based on clinical examination, patient’s demands, and sci-
entific evidence. Behr et al,1 in a retrospective study evaluating
the clinical performance of Co-Cr RDPs, estimated a 10-year
survival rate of 90%; however, traditional RDPs do not always
comply with the patient’s esthetic demands for a metal-free
restoration.
A modified PEEK high performance polymer (BioHPP)
combined with regular acrylic denture teeth and conventional
heat-cured denture base acrylic resin was used as an alterna-
tive RDP framework material. Due to its white color and high
strength, BioHPP permits the fabrication of metal-free clasps
and occlusal rests, providing occlusal stability and metal-free
esthetics.
Due to the viscoelasticity of the edentulous ridges, distal
extension RDPs exhibit a greater rotation around the supporting
rests under occlusal loading. This could lead to creation of
distal torque on the abutment teeth. In our case, the use of
BioHPP for the construction of the framework of a Kennedy
class I RDP was thought to be beneficial for the periodontal
health of the abutment teeth. The elasticity of this material
might reduce the distal torque and the stress on the abutment
teeth. Therefore, it could be hypothesized that BioHPP would
be a viable alternative for abutments with reduced periodontal
support when restoring distal extension cases.
The retentive force of BioHPP clasps could be a matter
of concern. According to Tannous et al,21 PEEK clasps of-
fer a lower retentive force than metal clasps; however, properly
3
High Performance Polymer as Alternative RDP Framework Material
designed PEEK clasps with an undercut of 0.5 mm could pro-
vide adequate retention for clinical use.
BioHPP clasps are gentler to the enamel and the porcelain
restorative materials than conventional Cr-Co clasps are. The
phenomenon of porcelain scoring caused by Cr-Co clasps dur-
ing RDP insertion is absent when using BioHPP clasps, due to
the material’s elastic properties. Also, clasps made of BioHPP
result in healthy periodontium, especially in cases of tissue
proximity, due to the material’s low plaque affinity properties.22
Due to its insolubility in water and low reactivity with
other materials, BioHPP could be suitable for patients aller-
gic to Cr-Co, or sensitive to the metallic taste of conventional
Cr-Co frameworks. Another important advantage of this type of
restoration is that it could be easily relined if resorption occurs
since conventional heat-cured acrylic resin is used as a denture
base material.
The weight of a removable prosthesis may affect patient sat-
isfaction. BioHPP has a low specific weight that permits the
fabrication of lighter prostheses providing high patient satis-
faction and comfort during function. In our case, the BioHPP
RDP weighed 27.5% less than its Cr-Co predecessor, although
it used a lingual plate instead of a lingual bar.
According to Zlataric et al,23 proper design of an RDP is
important for the maintenance of periodontal health. Compared
to nylon RDPs that cover a great part of soft tissues, BioHPP
RDPs provide a hygienic design that simplifies oral hygiene.
As already mentioned, BioHPP is a material recently in-
troduced in dentistry. Unfortunately, there is lack of studies
evaluating the clinical behavior of this material. Stain resis-
tance and color stability have been described in the literature,22
but through laboratory tests. In vitro tests by the University
of Jena22 show that BioHPP can be polished to a roughness
of 0.018 µm Ra following a strict polishing protocol. Clinical
long-term tests are required to prove good stain resistance and
color stability.
Another matter of concern is the fatigue resistance of
BioHPP. Although in vitro studies regarding a three-unit fixed
partial denture provide breaking values greater that 1200 N un-
der fatigue stress10 (1.2 million cycles), there is no scientific
evidence of how this material behaves under fatigue stress when
it is used as an RDP framework. This, combined with the lack
of long-term clinical follow-up, suggest careful use of BioHPP,
as an alternative material for RDP frameworks in case of metal
allergies, complying with the literature for other thermoplastic
resins,4,24 until there is enough clinical evidence to support its
use as a substitute material.
The above distal extension RDP presents a short-term, 1-year
clinical follow-up, presenting no framework breakage and good
clasp retention. There has been no sign of change in the BioHPP
framework, apart from the high-gloss surface appearing to have
lost some of its shine, in accordance with the literature.12 Short-
term recall appointments are required to record clinical status.
Conclusion
Due to the lack of solid clinical evidence, BioHPP should
not be considered as a substitute framework material for
a well-designed Cr-Co RDP. Under the present conditions,
BioHPP should probably be considered as an alternative RDP
4 Journal of Prosthodontics 0 (2015) 1–5 
Zoidis et al
framework material for patients with taste sensitivity or al-
lergies to conventional Cr-Co frameworks. Further long-
term clinical evidence is needed to consolidate the scientific
data.
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