An In Vitro Evaluation of the Effect of Various Adhesives

and Surface Treatments on Bond Strength of Resin Cement

to Polyetheretherketone
Ipek Caglar, DDS, PhD, Sabit Melih Ates, DDS, PhD, & Zeynep Yesil Duymus, DDS, PhD
Department of Prosthodontics, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey

Keywords
Adhesives; PEEK; resin cement; shear bond
strength; surface roughness.
Correspondence
Ipek Caglar, Department of Prosthodontics,
Faculty of Dentistry, Recep Tayyip Erdogan
University, Menderes St, No: 64, 53100, Rize,
Turkey. E-mail: ipeksatiroglu@hotmail.com
The authors deny any conflicts of interest.
This study was orally presented at BASS
Congress in Greece on 5–7 May 2017.
This study was supported by the Research
Projects Fund of Recep Tayyip Erdogan
University (Grant No: 2015.53001.111.08.04).
Accepted February 4, 2018
doi: 10.1111/jopr.12791
Abstract
Purpose: To investigate the effect of various surface pretreatments and adhesive
systems on bond strength of resin cement to polyetheretherketone (PEEK).
Materials and Methods: 360 PEEK specimens were divided into 4 groups to receive
the following pretreatments (n = 90): no pretreatment, sandblasting, silica coating
and Er:YAG laser. Surface roughness (SR) and scanning electron microscopy (SEM)
evaluations were conducted after mechanical pretreatments for topographical surface
evaluations. After the pretreatments, each group was divided into 3 subgroups (n = 30)
according to the adhesive system used: no adhesive system, Visio.link, and Signum
PEEK Bond. Resin cement was applied, and specimens underwent 5000 thermocycles
(5-55°C) before shear bond strength (SBS) test. One-way ANOVA and Tukey test
were used to analyze the SR data; 2-way ANOVA and Fisher’s LSD test were used to
analyze the SBS data at the confidence interval of 95% (α = 0.05).
Results: The sandblasting group demonstrated the highest SR values (p < 0.05).
No significant differences in SR values were identified among silica coating, laser,
and control groups (p ˃ 0.05). Conditioning with Visio.link after sandblasting group
exhibited the highest SBS values (p < 0.05). No significant differences in SBS values
were found between laser and control group (p ˃ 0.05). Conditioned groups presented
higher SBS values than unconditioned groups (p < 0.05). Between the two adhe-
sive systems, Visio.link demonstrated statistically significant higher SBS values than
Signum PEEK Bond (p < 0.05).
Conclusion: Silica coating and sandblasting were shown to provide superior pretreat-
ment of PEEK surface. Laser pretreatments showed no effectiveness on bond strength
of resin cement to PEEK. Adhesive systems improved the resin bonding to PEEK.

Polyetheretherketone (PEEK) is a high-performance thermo-
plastic polymer that has superior chemical, thermal, and me-
chanical properties and excellent biocompatibility.1 A modified
PEEK with 20% inorganic fillers has been used in dentistry for
implants, temporary abutments for implant-supported prosthe-
ses, healing abutments, implant-supported bars, clamp material,
or frameworks for removable and fixed partial prostheses.1-5
Among other thermoplastic polymers, PEEK absorbs less wa-
ter than polymethyl methacrylate (PMMA) and does not shrink
during the polymerization process like composite resin and
PMMA. This material has low elastic modulus, which makes
it as elastic as bone and allows it to act as a stress breaker and
reduce forces transferred to the restorations.2,3
Zoidis4 evaluated these properties in vivo and recommended
PEEK implant frameworks in combination with prefabricated
high-impact PMMA veneers for an alternative treatment
for All-on-4 implant restorations. PEEK crown framework
was suggested for patients who exhibited nocturnal bruxism
and clenching but refused to use an occlusal appliance.5
Additional advantages of this polymer are elimination of
allergic reactions and metallic taste, high polishing qualities,
low plaque affinity, and good wear resistance.3-6 An in vivo
study reported that PEEK should probably be considered as an
alternative removable partial denture framework material for
patients with taste sensitivity or allergies to conventional Cr-Co
frameworks.7 Although PEEK has significant advantages for
dental applications, difficulties in establishing a strong and
durable adhesion to dental material are the major clinical
disadvantage.1,2,9 Current studies focus on enhancing PEEK
surface for reacting with resins to allow bonding, because the
clinical performance of fixed dental prostheses mainly relies
on the luting procedure.2,3,8,9 Generally, two methods to obtain
a strong bonding performance between the resin cement and
PEEK have been the focus of recent studies: the alteration of

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Bond Strength of Resin Cement to PEEK Caglar et al

Table 1 Materials and equipment used

Material Product name Manufacturer Composition Lot. no.

PEEK breCAM.BioHPP Bredent GmbH & Co KG PEEK, 20% weight titanium oxide 420212
Aluminum oxide Cobra Renfert GmbH Aluminum oxide sand (50 μm mean 15941205
particle size)
Tribochemical The CoJet system 3M ESPE Silicatized sand (30 μm mean particle 625642
silica coating size)
Adhesive Visio.link Bredent GmbH & Co KG MMA, pentaerythritol triacrylate, photo 142655
system initiators
Adhesive Signum PEEK Bond Heraeus Kulzer GmbH Bond I: Bifunctional molecules based Bond
system on phosphoric acid esters and thiol I: 10133
compounds; Bond
Bond II: MMA, PMMA, photoinitators II:
010500

Resin cement Panavia SA Cement Plus Kuraray Noritake Paste A: MDP, Bis-GMA, TEGDMA, B40206
Dental Inc. hydrophobic aromatic dimethacrylate,
HEMA;
Paste B: Hydrophobic aromatic
dimethacrylate, hydrophobic aliphatic
dimethacrylate

Dental laser Lightwalker AT Fotona Er:YAG laser (2940 nm wavelength)

Dental Basic Classic Renfert GmbH Blasting with special mixing chamber
sandblaster technology by using abrasive from
25–70 μm
Polymerizing Solidilite Shofu Dental Halogen light (400–550 nm wavelength)
unit

PEEK: Polyetheretherketone, MMA: Methylmethacrylate, PMMA: Polymethylmethacrylate, Bis-GMA: Bisphenol A diglycidylmethacrylate, MDP: Methacryloy-
loxydecyl dihydrogen phosphate, TEGDMA: Triethyleneglycol dimethacrylate, HEMA: Hydroxymethacrylate.

the PEEK surface and conditioning with an adhesive system to
enable the chemical interactions.9,10
Several studies have examined the bond strength between
resin and PEEK material by various pretreatments such as sand-
blasting, silica coating,11,12 treating the surface with piranha
etching,2,13 sulfuric acid,14,15 or different types of plasma.16
Studies have found that sandblasting improves the bond
strength between resin and PEEK material and propose this
as one of the best initial pretreatment alternatives for PEEK
surfaces.11,14,17 Rosentritt et al18 reported that tribochemical
treatment might be an alternative pretreatment on PEEK sur-
faces to achieve successful bonding; however, to our knowl-
edge, there are relatively few reports on material processing
and no reports on PEEK surface treatment with lasers. Er:YAG
laser is a commonly used laser system for surface treatment
of dental materials.19-21 However, there is no consensus in the
literature about the laser parameters for optimal bond strength
of resin-based materials.
Surface pretreatments arrange the PEEK surface for mi-
cromechanical bonding to resin; however, additional adhesives
are essential in establishing a strong bond between PEEK and
resin. Most studies reported that adhesive systems that contain
methylmethacrylate (MMA) were able to constitute a sufficient
bond to PEEK.8-10,12 Studies showed that the combination with
pretreatments enhances the bond strength because mechanical
treatments provide more functional groups to which the com-
ponents of adhesive systems can bond.16,22
All PEEK studies have reported that bonding to PEEK must
be improved to achieve adequate, long-term adhesion clini-
cally; however, information concerning the potential and lim-
itations of PEEK in bonding to dental material is still insuffi-
cient. Therefore, the aim of this study was to evaluate the effect
of mechanical pretreatments and adhesive systems on the bond
strength of resin cement to PEEK. The null hypotheses were
that PEEK surface pretreatments or conditioning with adhe-
sives would have no effect on the bond strength values between
PEEK and resin cement.
Materials and methods
Specimen preparation
The compositions and details of the materials used in this study
are shown in Table 1. Three hundred and sixty disk-shaped
PEEK specimens were milled from a prefabricated blank
(breCAM.BioHPP; Bredent GmbH, Senden, Germany). These
specimens were embedded in an autopolymerizing acrylic resin
(Meliodent; Heraeus Kulzer GmbH, Hanau, Germany), and the
bonding surfaces of each specimen were polished with 600-
and 800-grit silicon carbide paper under running water. Then,
the specimens were cleaned in an ultrasonic cleaner (Eurosonic

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Caglar et al Bond Strength of Resin Cement to PEEK

E4D; Euronda, Vicenza, Italy) for 10 minutes with distilled Table 2 Classification of specimens in test groups with respect to pre-
water and air dried before surface treatment. treatments and adhesive systems used

PEEK Control (n = 90) No adhesive (n = 30)

Surface pretreatments
Visio.link (n = 30)
All specimens were randomly divided into four pretreatment Signum PEEK Bond (n = 30)
groups (n = 90 per group): group (C): no surface pretreatment PEEK Sandblasting (n = 90) No adhesive (n = 30)
was applied; group (B): PEEK surfaces were sandblasted with Visio.link (n = 30)
50 μm Al2 O3 particles (Cobra; Renfert GmbH, Hilzingen, Ger- Signum PEEK Bond (n = 30)
many) for 15 seconds at a pressure of 2.7 atm and a distance of PEEK Silica coating (n = 90) No adhesive (n = 30)
10 mm perpendicular to the bonding surface by using a dental Visio.link (n = 30)
sandblaster (Basic Classic; Renfert GmbH); group (S): silica Signum PEEK Bond (n = 30)
was coated with CoJet System (CoJet Sand; 3M ESPE, Seefeld,
PEEK Laser (n = 90) No adhesive (n = 30)
Germany) for 15 seconds at a pressure of 2.7 atm and a dis- Visio.link (n = 30)
tance of 10 mm perpendicular to the bonding surface; group Signum PEEK Bond (n = 30)
(L): specimen surfaces were irradiated by using Er:YAG laser
(Lightwalker AT; Fotona, Ljubljana, Slovenia) with a wave-
length of 2.940 nm, a power setting of 150 mJ, and a 10 Hz
repetition rate at an average power output of 1.5 W in QSP
mode (5 × 50 μs pulse duration).21 Laser energy was applied
to the surface with a noncontact handpiece (H02-N, 0.9 mm
spot size), and the laser beam was aligned perpendicular to
the specimen surface at a distance of 10 mm. The entire sur-
face of the specimen was scanned manually with the laser beam
while being cooled with water and air.21 After pretreatments, all
specimens were cleaned with the distilled water in an ultrasonic
cleaner for 60 seconds and dried with oil-free air.

Surface roughness measurements and SEM

evaluations
For topographical surface evaluation of each test group, an ad-
ditional specimen was prepared, sputter coated with gold, and
analyzed by SEM (JSM-6010LA; JEOL Ltd, Tokyo, Japan) at
2000× magnification. A profilometer (Perthometer M2; Mahr
GmbH, Göttingen, Germany) was used to measure the Ra (av-
erage roughness height) in micrometers (μm) after each surface
treatment, and the data were calculated by three single individ-
ual measurements.
Adhesive system application
After pretreatment, each group was subdivided into three
groups according to adhesive system (n = 30 per subgroup): no
adhesive system, Visio.link (Bredent GmbH & Co KG, Senden,
Germany) and Signum PEEK bond-experimental bond (Her-
aeus Kulzer GmbH, Hanau, Germany) (Table 2). All adhesives
were used according to manufacturer’s instructions. Visio.link
was applied to the PEEK surface and light polymerized at
220 mW/cm2 for 90 seconds (Bre.Lux Power Unit; Bredent
GmbH & Co KG). Signum PEEK Bond I was applied and
vaporized for 10 seconds, and then Signum PEEK Bond II
was applied and the light was polymerized at 225 mW/cm2 for
90 seconds (HiLite Power; Heraeus Kulzer GmbH).
Resin cement application
Resin cement (Panavia SA Cement Plus; Kuraray, Osaka,
Japan) was placed in a specially design mold (4 mm diame-
ter x 5 mm height) located in the center of the PEEK surface
and polymerized according to manufacturer’s instructions.
Figure 1 SBS test mechanism.
Aging process and SBS test
All specimens were stored in distilled water at 37°C for
24 hours. Then, they underwent 5000 thermocycles (between 5
and 55°C) with a 20-second dwell time in each water bath by us-
ing an automated thermocycling machine (Gökceler Machines,
Sivas, Turkey) before the SBS test.
SBS test was performed with a universal test machine (Model
3340; Instron Corp., Norwood, MA) at a 1 mm/min crosshead
speed. The specimens were positioned parallel to the loading
direction in the jig of the testing machine with the PEEK surface
(Fig 1). The maximum shear load was recorded immediately
before debonding. The following formula was used to calculate
SBS data: fracture load/bonding surface area = N/mm2 = MPa.
Statistical analysis
Statistical analysis was performed using statistical software
(SPSS v.17; IBM, Armonk, NY). The Shapiro-Wilk Test was
used to confirm that SBS and SR data were normally distributed.
One-way ANOVA and Tukey test were used to analyze the SR
data, and 2-way ANOVA and Fisher’s LSD test were used to
analyze the SBS data at a confidence interval of 95% (α = 0.05).

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Bond Strength of Resin Cement to PEEK
Figure 2 Surface topography of untreated PEEK surface (2000×).
Figure 3 Surface topography of laser-irradiated PEEK surface (2000×).
Figure 4 Surface topography of silica-coated PEEK surface (2000×).
Results
Surface roughness and SEM evaluations
Mean surface roughness values and standard deviations of spec-
imens with different surface pretreatments are presented in
Table 3. According to the variance analysis used for the com-
parison of the data, statistically significant differences were
found regarding the SR values (F = 408.383, p < 0.05). The
4 Journal of Prosthodontics 0 (2018) 1–8 
Caglar et al
Figure 5 Surface topography of sandblasted PEEK surface (2000×).
Table 3 Mean and standard deviation of surface roughness values of
test groups (μm)
Group Mean ± SD
C 1.11 ± 0.09a
B 2.64 ± 0.28b
S 1.20 ± 0.17a
L 1.19 ± 0.20a
Different superscript lowercase letters indicate statistically significant differ-
ences between groups (p < 0.05). C: control group, no treatment; B: sandblast-
ing; S: silica coating; L: Er:YAG laser irradiation at 150 mJ 10 Hz.
sandblasting group showed significantly higher SR values than
other groups (p < 0.05). The silica coating group and laser
group exhibited slightly higher SR values than control groups;
however, no statistically significant differences were found be-
tween them.
SEM evaluations showed that the control group (Fig 2) pro-
duced slight regular surface scratches, and the laser group
(Fig 3) displayed an image similar to the control group; how-
ever, the sandblasting group (Fig 4) demonstrated an irregular,
fissured surface, which was rougher than control group. For the
silica coating group, SiO2 particles were clearly seen as white
spots. Similar to SR values, the sandblasting group displayed
a more rugged, rough surface compared to other pretreatments
(Fig 5).
Shear bond strength
Mean SBS and standard deviation of specimens with differ-
ent surface treatments and adhesive systems are shown in
Table 4. According to the variance analysis used for the compar-
ison of the data, statistically significant differences were found
regarding SBS values (p < 0.05). All SBS values were found
to be higher than 5 MPa, so all tested specimens met the stan-
dard of ISO 10477.23 The unconditioned control group showed
the lowest mean SBS value. Specimens conditioned with Vi-
sio.link after sandblasting showed the highest mean SBS value
(F = 25.646, p < 0.05).
Among the pretreatments, the silica coating and sandblast-
ing groups presented significantly higher SBS values than the
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Caglar et al Bond Strength of Resin Cement to PEEK

Table 4 Mean and standard deviation for shear bond strength values of test groups (MPa)

Group Adhesive system Mean ± SD

C No adhesive 5.58 ± 0.38bA

Visio.link 12.54 ± 2.19aA
Signum PEEK Bond 12.31 ± 1.74aA
B No adhesive 11.65 ± 2.09aB
Visio.link 19.86 ± 2.52bB
Signum PEEK Bond 11.86 ± 0.93aA
S No adhesive 9.59 ± 1.58aB
Visio.link 18.76 ± 1.97bB
Signum PEEK Bond 10.55 ± 2.23aA
L No adhesive 5.71 ± 1.24aA
Visio.link 9.69 ± 1.69bC
Signum PEEK Bond 6.30 ± 0.77aB
a,b,c
Significant differences between adhesive systems within 1 pretreatment (p < 0.05). A, B, C: Significant differences between pretreatments within 1 adhesive
system (p < 0.05). C: control group, no treatment; B: sandblasting; S: silica coating; L: Er:YAG laser irradiation at 150 mJ 10 Hz.

Table 5 Modes of failure in each group of specimens

Failure mode

Group Adhesive system Adhesive Cohesive Mix Total

C No adhesive 30 0 0 30
Visio.link 18 0 12 30
Signum PEEK Bond 19 0 11 30
B No adhesive 22 0 8 30
Visio.link 11 0 19 30
Signum PEEK Bond 21 0 9 30
S No adhesive 27 0 3 30
Visio.link 14 0 16 30
Signum PEEK Bond 23 0 7 30
L No adhesive 30 0 0 30
Visio.link 30 0 0 30
Signum PEEK Bond 30 0 0 30

control and laser group (F = 89.550, p < 0.05); however, no Discussion

significant differences were found between the silica coating
and sandblasting groups (p > 0.05). The laser group exhibited
similar SBS values to the control group (p > 0.05).
According to the adhesive systems used, conditioned groups
presented higher SBS values than unconditioned groups, re-
gardless of the pretreatment groups. Between two adhesive
systems, Visio.link demonstrated statistically significant higher
SBS values (F = 230.583, p < 0.05) than Signum PEEK
Bond for all pretreatments. The exception was the control
group; here, both adhesive systems significantly increased
the SBS values (p < 0.05), but no significant difference
was found between Visio.link and Signum PEEK Bond (p >
0.05).
The predominant type of failure was adhesive, but sand-
blasting, silica coating, and control groups with or with-
out adhesive systems also showed mixed failures (Table 5).
The conditioned and unconditioned laser group only showed
adhesive failures. No cohesive failure was observed in the tested
specimens.
This in vitro study evaluated the effects of surface pretreat-
ments and adhesive systems on bond strength of resin cement
to PEEK. The results showed that sandblasting and silica coat-
ing increased the SBS significantly; however, 1.5 W (150 mJ)
Er:YAG laser irradiation had no effect on resin bonding to
PEEK. Both adhesive systems had a significant effect on resin
bonding to PEEK. Pretreatments increased the effect of Vi-
sio.link, but did not affect the bonding effectiveness of Signum
PEEK Bond. The SBS values of conditioned and unconditioned
laser pretreatments were significantly lower than other pretreat-
ments. Therefore, the null hypothesis that pretreatments or con-
ditioning with adhesives had no effect on bond strength values
between PEEK and resin cement was rejected.
Surface roughness is an important parameter for adhe-
sive procedures. Therefore, various surface pretreatments were
used to increase microroughness and bonding area of the
material.18 Sandblasting is a simple method of surface treat-
ment. It increases the surface roughness, creates a fresh and

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Bond Strength of Resin Cement to PEEK
active surface layer by removing organic contaminant from
the material surface, and advances micromechanical interlock-
ing of polymer-based dental materials.9,11,24 Previous stud-
ies reported a significant increase in SBS values after sand-
blasting compared to nonpretreated PEEK due to variation of
surface morphology.9,14,15,17,18 In agreement with previous
studies, in this study, the specimens sandblasted with 50 μm
Al2 O3 showed significantly higher SR (2.64 ± 0.28 μm) and
SBS (11.65 ± 2.09 MPa) values than the control group. High
SBS values of the sandblasting group are related to the topog-
raphy of treated surfaces by sandblasting, because irregularities
in the bonding area increase the contact area for the material
to bond with. SEM images verified this view that an irregu-
lar fissure pattern with larger grooves is more suitable for the
flow of both adhesive and resin cement, as observed with sand-
blasted PEEK specimens (Fig 5). Additionally, alumina powder
inserted in the PEEK surface may interfere with the application
of bonding.
Silica coating is another surface pretreatment option for dif-
ferent dental material surfaces such as composite or ceramic.
The CoJet system consists of 30 μm Al2 O3 particles sand coated
with SiO2 incorporated into the PEEK surface to improve the
bonding of resin during this process. Schmidlin et al11 evalu-
ated the bonding potential of pretreated PEEK surfaces to resin
and reported that silica coating (11.5 ± 3.2 MPa) significantly
increased the SBS values. Although there were no significant
differences in SR values between silica coating and the con-
trol group, silica-coated (9.59 ± 1.58 MPa) PEEK specimens
exhibited higher SBS values than the control group (5.58 ±
0.38 MPa) in the current study. Rosentritt et al18 reported that
roughening of the surface alone with pretreatments was not suf-
ficient to guarantee a stable bonding between resin cement and
PEEK surface. In addition, they posited that surface topography
and conditioning of the surface were more crucial for bonding
procedure than SR. In this study, SEM evaluation clearly dis-
played irregularities and silica particles on the PEEK surface.
Most probably the silica particles and modified surface mor-
phology enhance the initial bonding with self-adhesive resin
cement.
To the knowledge of the authors, this is the first evaluation
of the effect of laser application on bonding performance of
resin cement to PEEK. For this reason, the results of this study
cannot be compared to other available studies. There were no
significant differences found in SR and SBS values between
the laser and control groups. In addition, the SEM image of
laser-treated PEEK surfaces displayed a complicated structure
with deeper and narrow pits, which make the flow of resin
materials difficult (Fig 3).
Generally, dental adhesives are used to improve bonding
of inert PEEK surface to resin. The bonding success between
PEEK and resin is related to the content and solvents of the ad-
hesive system. Previous studies found that adhesive systems
that contain MMA monomers caused higher bond strength
values between PEEK and resin.15,16,18,25 For this reason, Vi-
sio.link and Signum PEEK bond were chosen for adhesive
systems in this study. With regard to the adhesive systems,
Visio.link and Signum PEEK Bond led to an increase in SBS
values for all pretreatment groups; however, the Visio.link adhe-
sive system demonstrated statistically significant higher shear
6 Journal of Prosthodontics 0 (2018) 1–8 
Caglar et al
bond strength values than Signum PEEK Bond (p < 0.05).
The differences between the two systems may be related to the
chemical composition of adhesives or pretreatments applied be-
fore conditioning. Signum PEEK Bond comprises MMA and
bifunctional monomers based on phosphoric acid esters; how-
ever, the main constituents of Visio.link are MMA and PETIA
(pentaerythritol triacrylate). Because of PETIA’s high capacity
to modify the PEEK surface, Visio.link provided higher bond
strength values to PEEK restorations. Despite this study, previ-
ous studies stated that both Visio.link and Signum PEEK Bond
increased the bond strength values significantly, and there were
no differences between them.2,9 The differences of these stud-
ies may contribute to the pretreatments used before condition-
ing. These studies used strong acids for modifying the PEEK
surface; however, only mechanical pretreatments were used in
this study. Also, Uhrenbacher et al9 evaluated the veneering
composite resin bonding to PEEK, whereas we evaluated self-
adhesive resin cement.
In the current study, the highest SBS values were shown
in specimens conditioned with Visio.link in the sandblasting
group (19.86 ± 2.52 MPa). Kern and Lehmann26 also reported
only multifunctional methacrylate containing adhesive systems
on sandblasted PEEK surfaces promising durable bonding to
PEEK. Another study also corroborated these finding and noted
that conditioning the PEEK surface with MMA-containing
adhesive systems after silica coating or sandblasting increased
the SBS values.15 Stawarczyk et al12 noted that Visio.link
acted as the positive control group, because all previous
studies showed very high bonding properties after the use
of Visio.link as conditioner on different pretreated PEEK
surfaces, and recommended sandblasting as one of the best
initial pretreatment options for PEEK surfaces.12,16,18,21 Thus,
the current findings are not surprising.
The conditioned laser group exhibited higher SBS values
than the unconditioned laser group in this study. Although a
statistically significant increase was found in conditioning with
Visio.link, Signum PEEK Bond had no statistically significant
effect on SBS for laser (p > 0.05). The results showed that
adhesive effectiveness on laser was lower than other pretreat-
ments. The surface morphology after laser treatments may be
the reason for low SBS values. Laser-treated PEEK surfaces
represent a complicated structure, and resin cement may not
flow onto the material (Fig 3). Furthermore, the physical prop-
erties of the bonding area are important for the bonding process.
If the laser creates a moisture surface after application, adhesive
penetration would be troubled because methacrylate in the ad-
hesive system is hydrophobic, and sufficient bonding would not
be achieved on the moisture surface. Hence, additional studies
are required to investigate the physical properties after laser
pretreatment and should focus on laser parameters.
The acceptable SBS value at the interface of resin-based ma-
terial and framework is 5 MPa according to the requirements
of ISO 10477.23 However, the minimum clinical SBS value of
resin-based material under oral conditions has been reported to
be 10 to 12 MPa.27,28 In this study all tested specimens were
found to be within the range of ISO 10477,23 but clinical re-
quirements for SBS values cannot be reached in the control and
laser treatment group. Thus, the results of this study demon-
strated that PEEK crown should be sandblasted with 50 μm
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Caglar et al
Al2 O3 particle or silica coated before cementation for improved
bonding. Nontreated PEEK surface should be conditioned by
MMA containing adhesives before cementation.
SBS tests are more suitable for evaluating the adhesive ca-
pabilities of resin-based materials. Any changes in the surface
features of the tested material may affect the SBS values, which
are related to chemical and mechanical adhesion.24,29 However,
a high amount of adhesive failures occurred in this study be-
cause the bond strength of resin cement to PEEK was not suffi-
ciently high.24 The mixed failure is mainly due to the irregular
distribution of the shear forces at the resin/PEEK interface.
The aging consisted of thermocycling for 5000 thermal cy-
cles (5°C/55°C; dwell time, 20 seconds), which corresponds
to approximately 4 to 5 years clinical service.16 The effect of
thermocycling on the SBS of resin cement to pretreated PEEK
specimens plays an important role in long-term predictability,
because studies have shown that intraoral thermal changes are
easily simulated by using the thermoycling method.9,16,30 In
this way, all tested specimens received a standardized and re-
producible thermal stress, but there is no systematic standard
procedure for subjecting materials to thermocycling regimens
at present.
This study has some limitations. Only one type of laser pa-
rameter was used. Different lasers and laser parameters for
resin bonding to PEEK must be further investigated. Although
conventional and resin cements are used for the cementation of
PEEK based restorations, in this study only resin cement was
evaluated. Additional comparative studies with different lut-
ing cements are recommended. All specimens were produced
and evaluated under in vitro conditions, so this study cannot
reflect the conditions of clinical applications exactly. Further
structured in vivo studies are necessary for clinical assessment.
Conclusions
Within the limitations of this in vitro study:
1. Silica coating and sandblasting demonstrated the highest
SBS values among the pretreatments applied to PEEK.
2. 1.5 W (150 mJ) Er:YAG laser pretreatment of PEEK
surface did not influence the bonding effectiveness of
resin cement.
3. Adhesives improved the bond strength of PEEK restora-
tions with or without surface pretreatments.
4. The SEM evaluations showed that surface topography
affects the adhesion more than surface roughness.
References
1. Silthamitag P, Chaijareenont P, Tattakorn K, et al: Effect of
surface pretreatments on resin composite bonding to PEEK. Dent
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2. Stawarczyk B, Jordan P, Schmidlin PR, et al: PEEK surface
treatment effects on tensile bond strength to veneering resins. J
Prosthet Dent 2014;112:1278-1288
3. Kurtz SM, Devine JN: PEEK biomaterials in trauma, orthopedic,
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