Biological, Biomechanical, and Histopathological Evaluation of Polyetherketoneketone Bioactive Composite as Implant Material

Abstract

While polyetherketoneketone is a high-performance thermoplastic polymer, its hydrophobicity and inertness limit bone adhesion. This study aimed to evaluate a novel PEKK/CaSiO₃/TeO₂ nanocomposite, comparing it to PEKK/15 wt.% CaSiO₃ and PEKK groups. The in vitro study, involving 90 discs (n = 30), assessed the cytotoxicity of all groups after 24, 72, and 168 h. The in vivo animal study, using cylinder-type implants (n = 30), evaluated osseointegration through biomechanical push-out tests, descriptive histopathological examinations of decalcified sections stained with hematoxylin and eosin, and histomorphometric analysis of new bone formation area after 2- and 6-week healing intervals. The cytocompatibility of PEKK/15 wt.% CaSiO₃/1 wt.% TeO₂ composite confirmed its acceptance as a biomedical material. Additionally, in vivo study results showed that the PEKK/15 wt.% CaSiO₃/1 wt.% TeO₂ had the highest shear strength value and the highest new bone formation area compared to other experimental groups. The multimodal concept of adding CaSiO₃ micro fillers and TeO₂ nanofillers to PEKK produces a cytocompatible composite that enhances osseointegration and new bone formation in a rabbit's femur after 2- and 6-week healing intervals.