Materials Letters 185 (2016) 593–597

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Materials Letters
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Featured Letter

Mechanical and biological behavior of biomedical PEEK matrix

composites: A focused review
Patricia R. Monich a, Bruno Henriques a,c, Antonio P. Novaes de Oliveira d,
Júlio C.M. Souza b,c, Márcio C. Fredel a,n
a
Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Florianópolis, 88040-900 Brazil
b
Centre Microelectromechanical Systems (CMEMS), University of Minho, Campus Azurém, Guimarães, 4800-058 Portugal
c
Center for Research on Dental Implants (CEPID), Post-graduate Program in Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis,
88040-900 Brazil
d
Laboratory of Glass-Ceramic Materials (VITROCER), Federal University of Santa Catarina (UFSC), Florianópolis, 88040-900 Brazil

art ic l e i nf o a b s t r a c t

Article history: The aim of this study was to conduct a focused review on the mechanical and biological behavior of PEEK
Received 8 April 2016 composites for biomedical applications. A Medline bibliographical search was carried out. The following
Received in revised form search items were analyzed: “PEEK and composites”. The selection criteria used for this article were:
30 August 2016
research papers written in English focused on the mechanical and biological behavior of PEEK compo-
Accepted 3 September 2016
Available online 4 September 2016
sites. Results indicated the incorporation of bioactive particles into PEEK to enhance the bioactivity al-
though some of those fillers can decrease the strength of the composite. On the other hand, the addition
Keywords: of 3-D braided carbon fiber increased significantly the mechanical strength of PEEK composites. In fact,
PEEK the chemical composition, microstructure and properties of the fillers can affect both biocompatibility
Composites
and mechanical strength of PEEK composites. This reveals a great challenge in this field leading to novel
Biomaterials
development to simultaneously improve the mechanical strength and bioactivity of PEEK composites. A
Bioactivity
Reinforced composite potential strategy is to produce ternary composites whereas one of the fillers provides bioactivity for the
composite while the other is responsible to enhance the mechanical strength. Another way could be to
perform a surface treatment in the particles in order to increase the adhesion between matrix and filler.
& 2016 Elsevier B.V. All rights reserved.

1. Introduction
Nowadays, polyetheretherketone (PEEK) is considered to be
one of the most important engineering polymers due to its
properties such as: high mechanical strength, thermal stability
(beyond 300 °C) and chemical resistance in corrosive environ-
ments. Also, PEEK possesses a high biocompatibility as a result
from its resistance to degradation. Such properties are extremely
interesting for a large field of applications for the biomedical,
aerospace and automotive industry [1,2]. Since 1987, PEEK has
been increasingly applied as a biomaterial for orthopedic implant
and prostheses [1]. In vitro biocompatibility assays have revealed
that PEEK does not induce any mutagenic or cytotoxic activity [3].
In fact, PEEK has been considered to be a bioinert material, since it
does not cause any adverse reaction nor release any ions or con-
stituents to the human tissues [4]. On the other hand, the hydro-
phobic nature on PEEK surface limits cell adhesion and protein
n
Corresponding author.
E-mail address: m.fredel@ufsc.br (M.C. Fredel).
absorption which can reduce the wound healing capacity on os-
seointegration [5,6]. One way found by previous studies to over-
come this issue is by modifying the PEEK surface to stimulate cell
attachment and proliferation [5]. Another way could be by in-
corporating bioactive particles into PEEK, such as hydroxyapatite
[4]. Concerning mechanical strength, PEEK composites have been
also developed to increase its mechanical strength for biomedical
applications, such as the case of carbon fibers reinforced PEEK. For
instance, PEEK has an elastic modulus (E) in the range of 3–4 GPa
that can be increased up to those of the cortical bone (E around
18 GPa) with the addition of carbon fibers [1]. This reveals a great
advantage of PEEK over conventional materials for implants such
as titanium, considering the E of titanium can be up to 10 times
higher than that of the cortical bone. Bone resorption and implant
loosening could occur due to that mismatch of properties. Fur-
thermore, such mismatch can lead to overloading resulting in
bone loss [6]. Therefore, PEEK composites could be possibly used
in applications concerning a material with an elastic modulus si-
milar to that of the bone. Regarding those issues, the main aim of
the present study was to conduct a focused review on the

http://dx.doi.org/10.1016/j.matlet.2016.09.005
0167-577X/& 2016 Elsevier B.V. All rights reserved.
594 P.R. Monich et al. / Materials Letters 185 (2016) 593–597

potential mechanical and biological behavior of PEEK composites

[12]
Ref.

[10]

[13]
[15]
[16]

[19]
[18]
[7]
[6]
[9]
for biomedical applications. A Medline bibliographical search

Summary of mechanical properties of PEEK composites reported in literature. The tensile strength, bending strength and E of the cortical bone ranged from 50 to 151 MPa, 135–193 MPa and 10–20 GPa, respectively [23].
(from 1989 up to 2016) was carried out using the following search

Bending Strength PEEK: 116.6 7 8.6 MPa (20 vol%: 123.5 7 7.3 MPa)
items: “PEEK and composites”. The selection criteria used in this

Tensile Strength PEEK: 82.5 7 10.5 MPa (40 wt%: 137.6 7 9.1 MPa)
Bending Strength PEEK:  150 MPa (36 vol%: 456.2 715.6 MPa)
Tensile Strength PEEK: 84.0 7 1.9 MPa (40 wt%: 75.0 7 2.7 MPa)
article were: research papers written in English; meta-analysis

Bending Strength PEEK:  125 MPa (25 vol%: 93.8 7 10.3 MPa)

Tensile Strength PEEK:  89 MPa (25 wt%/20 wt%:  135 MPa)

Tensile Strength PEEK: 86 7 1.5 MPa (40 wt%: 747 2.2 MPa)
and prospective cohort studies. It was only considered articles
related to the subject that focused on the mechanical and biolo-

Tensile Strength PEEK:  92.8 MPa (40 wt%: 86.6 MPa)

Tensile Strength PEEK:  35 MPa (30 vol%:  81 MPa)
gical properties of PEEK composites.

Tensile Strength PEEK:  80 MPa (30 vol%: 49 MPa)

2. PEEK matrix composites

Previous articles analyzed in this review studied the addition of

β-tricalcium phosphate (β-TCP), titanium (Ti), calcium silicate (CS),
hydroxyapatite (HA), strontium containing hydroxyapatite (Sr-
HA), nano-fluorohydroxyapatite (nano-FHA) and 3-D braided car-
bon fiber (C3-D) into PEEK, as well as the simultaneously in-
corporation of nano-hydroxyapatite and carbon fibers (nano-HA-
CF) into the polymer. Details of the resulting composites are
shown as follow, while the most relevant mechanical properties
are summarized in Table 1.
Petrovic et al. [7] developed PEEK composites filled with dif-
ferent content of β-TCP. The incorporation of 40 wt% β-TCP in-
creased E of the composite in approximately 76%, although the

Bending stiffness PEEK: 4.677 0.4 GPa (20 vol%: 6.43 7 0.6 GPa)
tensile strength decreased in approximately 7%. The biological
assay demonstrated that the composites did not induce cytotoxi-

Mechanical Properties of PEEK and composite (% filler)

city, although they inhibit the cell proliferation. In fact, β-TCP-
PEEK composites have not revealed any advantageous effect on the

E PEEK: 2.20 7 0.17 GPa (40 wt%: 4.60 7 0.12 GPa)

E PEEK: 3.5 7 0.3 GPa (25/20 wt%: 16.5 7 0.7 GPa)

proliferation of osteogenic cells.

E PEEK: 3.9 7 0.5 GPa (40 wt%: 12.17 0.4 GPa)

E PEEK: 2.3 7 0.2 GPa (40 wt%: 4.4 7 0.3 GPa)
Jung et al. [6] studied the effect of incorporating titanium

E PEEK:  4.51 GPa (25 vol%: 9.6 7 0.7 GPa)

particles into PEEK to improve its mechanical properties and
biocompatibility. Biological assays showed that the cells adhered

E PEEK:  2.2 GPa (30 vol%:  3 GPa)

and spread in preference onto the metal particles, which may

E PEEK:  4 GPa (36 vol%: 30 GPa)

E PEEK: 4.1 GPa (40 wt%: 7.2 GPa)

E PEEK:  3 GPa 30 vol%: 7 GPa

suggest that titanium could stimulate initial cell attachment, en-
hancing the in vivo osseointegration process. The mechanical as-
says showed that the incorporation of 30 vol% titanium into PEEK
increased E in approximately 36% while the tensile strength in-
creased in 131%.
Previous studies have reported that CaO, SiO2-based glasses
have induced the formation and development of apatite nuclei on
their surface [8]. The formation of an apatite layer on the surface of
glass and glass-ceramics is fundamental for bonding to the natural
bone [8]. Kim et al. [9] incorporated 30CaO
70SiO2 (CS) micro-
spheres into PEEK to obtain a bioactive bone-repairing material
Co-braiding and compression molding

with mechanical properties similar to those of the natural bone. It

was observed the formation of hydroxyapatite on the surfaces of
all CS-PEEK composites after immersion into simulated body fluid
(SBF), indicating a potentially bond to the natural bone. Ad-
Cold press and sintering

ditionally, the bending stiffness and strength increased in 38% and

Compression molding

Compression molding
Compression molding

in 6%, respectively, with the addition of 20 vol% CS particles. It was

Injection molding

Injection molding
Injection molding
Injection molding

Injection molding

not observed a significantly decrease in mechanical strength of the

composites after immersion in SBF. Furthermore, Ma et al. [10]
Processing

developed a PEEK composite filled with nano-CS that improved

the wettability of the material increasing the attachment, pro-
liferation and spreading of MC3T3-E1 cells. It was also observed
the formation of an apatite layer on the nano-CS-PEEK composite
Filler content

after immersion in SBF, that revealed a high bioactivity [11]. Ad-

15 60 vol%
10 50 vol%

15 30 vol%

18 54 vol%
20 60 wt%

20 60 wt%
5 40 vol%

ditionally, the incorporation of 40 wt% nano particles increased the

5 40 wt%

25/20 wt%

E in 91%, although it decreased the tensile strength of the com-

40 wt%

After surface treatment.

posite in 14%.
Bakar et al. [12] incorporated up to 40 vol% HA into PEEK in
order to develop a bioactive material with an E similar to that of
Nano-HA-CF

the natural bone for load-bearing orthopedic applications. Results

Nano-FHA
Nano-HA
Nano-CS

of tensile strength tests showed an increase of approximately 133%

Sr-HA
β-TCP
Table 1

Filler

C3 D

in E after incorporation of 30 vol% HA. On the other hand, the

HA
CS
Ti

tensile strength decreased in approximately 39% with the addition

 P.R. Monich et al. / Materials Letters 185 (2016) 593–597
of the same amount of HA. That could be a result of low interfacial
interaction between the polymer and ceramic. The biological be-
havior of the composite was assessed by in vivo assays and the
results indicated a high bioactivity of the composite. Ma et al. [13]
developed composites of nano-HA-PEEK and they also reported an
increased in E (109%) and a decrease in tensile strength (11%) with
the addition of 40 wt% nano-HA. Also, biological assays revealed a
high bioactivity for nano-HA-PEEK.
The addition of strontium into HA influences the dissolution
mechanism and mechanical properties of that ceramic. Further-
more, it can also result in positive effects on bone formation and
remodeling [14]. Wong et al. [15] reported an increase around
113% in E and a decrease of 25% in bending strength with the in-
corporation of 25 vol% Sr-HA into PEEK. The biological assays
showed that Sr-HA-PEEK composite have a higher bioactivity than
that recorded on HA-PEEK composites.
Nano-FHA is a bioactive ceramic that is chemical and crystal-
lographically similar to the natural apatite found in bones and
teeth [16]. The presence of F ions leads to an antimicrobial activity
that could prevent dental caries [17]. Wang et al. [16] incorporated
nano-FHA into PEEK in order to enhance antibacterial and os-
seointegration effects for dental applications. Mechanical tests
revealed that nano-FHA acts as reinforcement filler in PEEK con-
sidering that both E and tensile strength increased in 210% and
67%, respectively, with the incorporation of 40 wt% nano-FHA into
PEEK. Furthermore, microbiological assays revealed an anti-
bacterial activity on that composite. In vivo assays showed high
bioactivity, osseointegration and bone-implant contact area. Such
results revealed a potential application of nano-FHA-PEEK in oral
implantology.
Luo et al. [18] developed three-dimensional braided carbon fi-
ber-reinforced PEEK composites. The surface of carbon fibers was
treated by anodic oxidization in 5 wt% (NH4)2HPO4 to enhance the
adhesion between carbon fibers and PEEK. The composites
showed excellent mechanical properties: the E and tensile
strength increased in approximately 650% and 204%, respectively,
with the addition of 36 vol% C3-D. Furthermore, the surface treat-
ment of carbon fibers promoted an increase of approximately
Fig. 1. Schematic illustration of PEEK composites for biomedical applications: (A) PEEK reinforced with carbon fibers. (B) PEEK embedded with bioactive particles. (C) PEEK
embedded with fibers and bioactive particles.
595
232% in bending strength when compared to PEEK. In fact, the
surface treatment enhanced the adhesion between fiber and ma-
trix, which provided the transfer of stress from PEEK to the fibers.
In vitro biological assays showed that the composite allowed the
adhesion, spreading, and proliferation of osteogenic cells, in-
dicating a high cytocompatibility.
Ternary composites are also developed in order to improve the
mechanical properties and biocompatibility of materials [19]. For
instance, Deng et al. [19] developed a PEEK ternary composite to
improve simultaneously the biocompatibility and mechanical
properties of PEEK by adding nano-HA and CF into the polymer.
The incorporation of 25 wt% nano-HA and 20 wt% CF into PEEK
increased the E and tensile strength in approximately 371% and
52%, respectively. The biological assays showed a higher cell at-
tachment, proliferation and osteogenic differentiation than those
recorded for PEEK. Furthermore, in vivo evaluation demonstrated
that the ternary composite enhanced the bioactivity and osseoin-
tegration in canine tooth defect model. Another study showed that
the biocompatibility and osseointegration of that ternary compo-
site could be increased by altering the roughness of the material
[20].
Schematic illustrations of the microstructure related to differ-
ent devices produced of PEEK composites are shown in Fig. 1. The
microstructure of PEEK reinforced with short carbon fibers is il-
lustrated in Fig. 1A while PEEK embedded with bioactive particles
and PEEK embedded with fibers and bioactive particles are shown
in Fig. 1B and C, respectively. The size, length and orientation of
the carbon fibers influence significantly the mechanical strength
and the elastic modulus of such composites. For instance, con-
tinuous fibers can provide a higher strength when compared to
short carbon fibers [4]. During the processing via the injection
molding technique, short carbon fibers are usually oriented which
will result in anisotropic properties on the composite considering
the fiber directions [21]. On the other hand, three-dimensional
braided carbon fiber-reinforced PEEK composite is stiffer and
stronger than PEEK reinforced with short carbon fibers. In addi-
tion, that composite reveals an isotropic fiber arrangement which
results in high strength in the three orthogonal directions [22].
596 P.R. Monich et al. / Materials Letters 185 (2016) 593–597
PEEK has been also studied as a coating for biomedical struc-
tures [24–27]. In fact, coatings based on PEEK and its composites
can protect metallic substrates against wear and release of ions
and particles to the surrounding human tissues [24,26]. Previous
studies have reported the wear and/or corrosion behavior of
Ti6Al4V substrates coated with PEEK and its composites by tri-
bological tests [24,25]. For instance, simultaneous wear and elec-
trochemical tests revealed that PEEK veneer protected the Ti6Al4V
from corrosion and wear, once the tribologic counterbody could
not contact the substrate [24]. Also, PEEK provided a lower coef-
ficient of friction and specific wear rate when compared to tita-
nium-based structure [24]. The incorporation of 5% wt. zirconia
nanoparticles into PEEK has also been reported as a strategy to
enhance the tribological properties of the resultant composite,
that can be selected as a potential candidate for bearing material
for synthetic cervical discs [25]. Furthermore, another previous
study has reported the electrophoretic deposition of PEEK-nano
alumina on stainless steel. The increase in PEEK-alumina interface
strength was recorded by scratch tests when the amount below
30 wt% alumina was added into PEEK. Results of that previous
study revealed that the coating with PEEK-alumina composite
decreased the localized corrosion of the stainless steel substrate
[26]. Finally, PEEK-based coatings or membranes can embed
therapeutic substances like antibiofilm compounds that can per-
form the disruption of pathogenic biofilms [27]. Further studies
should be carried out considering specific applications (e.g. coat-
ings or membranes) related to the incorporation of bioactive, re-
inforcement and therapeutic fillers.
3. Conclusions
The present short review analyzed previous studies on the
mechanical and biological behavior of PEEK composites. It has
been noted that the compatibility between PEEK matrix and in-
organic fillers allows the development of several materials with
tailored properties for biomedical applications. The main out-
comes of the present focused review can be drawn as follow:
 PEEK embedding bioactive ceramic such as β-TCP composites
have revealed high biocompatibility although any advantageous
effects were not detected on the proliferation of osteogenic
cells. Additional studies on the distribution of bioactive ceramic
on the PEEK surfaces should be performed;
 Three-dimensional braided carbon fiber-reinforced PEEK com-
posites revealed higher mechanical strength (E at 30 GPa and
bending strength at 456.2 MPa) when compared to PEEK (E at
approximately 4 GPa and tensile strength at approximately
150 MPa);
 The addition of bioactive ceramic (e.g. hydroxyapatite) im-
proved the bioactivity of the ternary composites maintaining a
high mechanical strength of the composite;
 Previous studies have shown that the surface treatment of the
fillers can enhance the adhesion between PEEK and inorganic
content leading to an improvement of the mechanical strength
of the composite;
 Currently, studies are performed to select novel inorganic par-
ticles to enhance mechanical strength and bioactivity of PEEK
composites. The volume content, microstructure, chemical
composition and properties of the fillers as well as the bonding
between PEEK and fillers are issues to be overcome in order to
enhance simultaneously the mechanical strength and bioactiv-
ity of PEEK composites.
Acknowledgments
The authors acknowledge the financial support provided by
CAPES and the Project PVE/CAPES/CNPq 407035/2013-3 UFSC/
UMINHO (Portugal).
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