EXPERIMENTAL STUDY OF THE WEAR PROCESSES OF PATIENT-SPECIFIC TMJ ENDOPROSTHESIS COMPONENTS MADE OF TITANIUM (TI) AND POLYETHERETHERKETONE (PEEK)
DOI:
https://doi.org/10.11603/2311-9624.2024.4.15194Keywords:
temporomandibular joint (TMJ), TMJ replacement, endoprosthesis, patient-specific implant, ultra-high molecular weight polyethylene (UHMWPE), polyetheretherketone (PEEK).Abstract
The replacement of the temporomandibular joint (TMJ) with a two-component endoprosthesis has become a widely recognized standard procedure, supported by numerous high-quality evidence-based studies. These prostheses are traditionally fabricated using biocompatible or biologically inert materials. Objective. This study aimed to investigate the tribological properties and wear resistance of two-component endoprostheses made from titanium-polyetheretherketone (Ti-PEEK) and titanium-ultrahigh-molecular-weight polyethylene (Ti-UHMWPE) through an in vitro experiment replicating long-term cyclic loads. Materials and Methods. In vitro experimental studies were conducted to examine the frictional behavior, tribological properties, and wear debris of TMJ endoprosthesis components under prolonged cyclic loading. A system replicating functional clinical loading parameters was used to simulate long-term performance, with a total of 1 million loading cycles applied. Results. The study found no device failures throughout the entire experiment. Wear particles from PEEK and UHMWPE displayed similar morphological characteristics across a range of sizes, from < 0.1 μm to 100 μm. Conclusions. Patient-specific two-component TMJ endoprostheses with a titanium-PEEK friction pair exhibit excellent wear resistance. The wear particles generated during friction between titanium-PEEK and titanium-UHMWPE components were predominantly smaller than 10 μm. These smaller particles are biologically active and easily phagocytosed, suggesting minimal adverse biological impact.
References
Mercuri L.G. Alloplastic temporomandibular joint reconstruction. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 1998. Vol. 85, no. 6. P. 631–637.
Historical development of alloplastic temporomandibular joint replacement after 1945 and state of the art / O. Driemel et al. International Journal of Oral and Maxillofacial Surgery. 2009. Vol. 38, no. 9. P. 909–920.
Histological findings in soft tissues around temporomandibular joint prostheses after up to eight years of function / A. Westermark et al. International Journal of Oral and Maxillofacial Surgery. 2011. Vol. 40, no. 1. P. 18–25.
Twenty-Year Follow-up Study on a Patient-Fitted Temporomandibular Joint Prosthesis: The Techmedica/TMJ Concepts Device / L.M. Wolford et al. Journal of Oral and Maxillofacial Surgery. 2015. Vol. 73, no. 5. P. 952–960.
De Meurechy N., Braem A., Mommaerts M.Y. Biomaterials in temporomandibular joint replacement: current status and future perspectives – a narrative review. International Journal of Oral and Maxillofacial Surgery. 2018. Vol. 47, no. 4. P. 518–533.
Mercuri L.G. Silicone elastomer implants in surgery of the temporomandibular joint. British Journal of Oral and Maxillofacial Surgery. 2013. Vol. 51, no. 7. P. 584–586.
Wolford L.M. Factors to Consider in Joint Prosthesis Systems. Baylor University Medical Center Proceedings. 2006. Vol. 19, no. 3. P. 232–238.
Temporomandibular Joint Total Joint Replacement – TMJ TJR / ed. by L.G. Mercuri. Cham: Springer International Publishing, 2016.
Hussain O.T., Sah S., Sidebottom A.J. Prospective comparison study of one-year outcomes for all titanium total temporomandibular joint replacements in patients allergic to metal and cobalt – chromium replacement joints in patients not allergic to metal. British Journal of Oral and Maxillofacial Surgery. 2014. Vol. 52, no. 1. P. 34–37.
Ti based biomaterials, the ultimate choice for orthopaedic implants – A review / M. Geetha et al. Progress in Materials Science. 2009. Vol. 54, no. 3. P. 397–425.
Goodman S.B. Wear particles, periprosthetic osteolysis and the immune system. Biomaterials. 2007. Vol. 28, no. 34. P. 5044–5048.
Lymphocyte responses in patients with total hip arthroplasty / N.J. Hallab et al. Journal of Orthopaedic Research. 2005. Vol. 23, no. 2. P. 384–391.
The Biology of Aseptic Osteolysis / G. Holt et al. Clinical Orthopaedics and Related Research. 2007. Vol. 460. P. 240–252.
Ma, T., & Goodman, S.B. (2011). Biological effects of wear debris from joint arthroplasties. In Comprehensive Biomaterials (pp. 79–87).
Cellular events in the mechanisms of prosthesis loosening / A. Pizzoferrato et al. Clinical Materials. 1991. Vol. 7, no. 1. P. 51–81.
Rivard C.-H., Rhalmi S., Coillard C. In vivo biocompatibility testing of peek polymer for a spinal implant system: A study in rabbits. Journal of Biomedical Materials Research. 2002. Vol. 62, no. 4. P. 488–498.
Ingham E., Fisher J. Biological reactions to wear debris in total joint replacement. Proceedings of the Institution of Mechanical Engineers, Part H. Journal of Engineering in Medicine. 2000. Vol. 214, no. 1. P. 21–37.
The biological response to nanometre-sized polymer particles / A. Liu et al. Acta Biomaterialia. 2015. Vol. 23. P. 38–51.
Glant T.T., Jacobs J.J. Response of three murine macrophage populations to particulate debris: Bone resorption in organ cultures. Journal of Orthopaedic Research. 1994. Vol. 12, no. 5. P. 720–731.
Green T. Polyethylene particles of a ‘critical size’ are necessary for the induction of cytokines by macrophages in vitro. Biomaterials. 1998. Vol. 19, no. 24. P. 2297–2302.
Effect of size and dose on bone resorption activity of macrophages byin vitro clinically relevant ultra high molecular weight polyethylene particles / T.R. Green et al. Journal of Biomedical Materials Research. 2000. Vol. 53, no. 5. P. 490–497.
Evaluation of the response of primary human peripheral blood mononuclear phagocytes to challenge within vitro generated clinically relevant UHMWPE particles of known size and dose / J.B. Matthews et al. Journal of Biomedical Materials Research. 2000. Vol. 52, no. 2. P. 296–307.
Comparison of the response of primary human peripheral blood mononuclear phagocytes from different donors to challenge with model polyethylene particles of known size and dose / J.B. Matthews et al. Biomaterials. 2000. Vol. 21, no. 20. P. 2033–2044.
Human monocyte response to particulate biomaterials generated in vivo and in vitro / A.S. Shanbhag et al. Journal of Orthopaedic Research. 1995. Vol. 13, no. 5. P. 792–801.
Kurtz S.M., Devine J.N. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials. 2007. Vol. 28, no. 32. P. 4845–4869.
Suitability and limitations of carbon fiber reinforced PEEK composites as bearing surfaces for total joint replacements / A. Wang et al. Wear. 1999. Vol. 225–229. P. 724–727.
Primary and secondary reconstruction of complex craniofacial defects using polyetheretherketone custom-made implants / G. Gerbino et al. Journal of Cranio-Maxillofacial Surgery. 2015. Vol. 43, no. 8. P. 1356–1363.
Patel N., Kim B., Zaid W. Use of Virtual Surgical Planning for Simultaneous Maxillofacial Osteotomies and Custom Polyetheretherketone Implant in Secondary Orbito-Frontal Reconstruction. Journal of Craniofacial Surgery. 2017. Vol. 28, no. 2. P. 387–390.
Review of emerging temporomandibular joint total joint replacement systems / R. Elledge et al. British Journal of Oral and Maxillofacial Surgery. 2019. Vol. 57, no. 8. P. 722–728.
Genovesi W. A New Concept and Design for an Alloplastic TOTAL TMJ Prosthesis Using PEEK LT1 20% BA. Journal of Oral and Maxillofacial Surgery. 2018. Vol. 76, no. 10. P. e75–e76.
Biomechanical comparative analysis of temporomandibular joint, glenoid fossa and head of the condyle of conventional models prothesis with new PEEK design W. Genovesi et al. Journal of Oral Biology and Craniofacial Research. 2022.
Macrophage reactivity to different polymers demonstrates particle size- and material-specific reactivity: PEEK-OPTIMA® particles versus UHMWPE particles in the submicron, micron, and 10 micron size ranges / N.J. Hallab et al. Part B: Applied Biomaterials. Journal of Biomedical Materials Research. 2011. Vol. 100B, no. 2. P. 480–492.
The in vitro response of human osteoblasts to polyetheretherketone (PEEK) substrates compared to commercially pure titanium / K.B. Sagomonyants et al. Biomaterials. 2008. Vol. 29, no. 11. P. 1563–1572.
Hallab N.J., Bao Q.-B., Brown T. Assessment of epidural versus intradiscal biocompatibility of PEEK implant debris: an in vivo rabbit model. European Spine Journal. 2013. Vol. 22, no. 12. P. 2740–2751.
Du Z., Zhu Z., Wang Y. The degree of peri-implant osteolysis induced by PEEK, CoCrMo, and HXLPE wear particles: a study based on a porous Ti6Al4V implant in a rabbit model. Journal of Orthopaedic Surgery and Research. 2018. Vol. 13, no. 1.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 CLINICAL DENTISTRY

This work is licensed under a Creative Commons Attribution 4.0 International License.