BioHPP in prosthetic dentistry: a narrative review of mechanical, biological, and clinical properties
DOI:
https://doi.org/10.2340/biid.v13.45303Keywords:
BioHPP, polyetheretherketone, high-performance polymer, prosthetic dentistry, dental implants, adhesion, CAD/CAM, biocompatibility, mechanical properties, prosthodonticsAbstract
Biocompatible high-performance polymer (BioHPP), a high-performance polymer derived from polyetheretherketone (PEEK) and reinforced with ceramic fillers, has emerged as a promising alternative to conventional metal and ceramic framework materials in prosthetic dentistry. With an elastic modulus (~4 GPa) comparable to that of cortical bone, BioHPP promotes physiological stress distribution and reduces stress shielding, thereby supporting peri-implant bone preservation. Its excellent chemical inertness and low bacterial affinity minimize mucosal inflammation and reduce the risk of peri-implant disease. However, the material’s low surface energy and hydrophobicity pose challenges to long-term adhesive stability, necessitating specific surface modification techniques and specialized adhesive systems. Clinically, BioHPP has been successfully applied in single crowns, fixed partial dentures, full-arch hybrid prostheses (e.g. All-on-Four), bar-retained overdentures, maxillofacial frameworks, customized abutments, and provisional restorations. Despite its favorable biomechanical and biological profile, limitations such as inherent opacity, restricted fracture toughness, and the scarcity of long-term clinical data highlight the need for further interdisciplinary research and material innovation. This narrative review comprehensively evaluates the mechanical, biological, and adhesive characteristics of BioHPP, compares its performance with traditional framework materials, and discusses its clinical applications and future perspectives in prosthetic rehabilitation.
Downloads
References
Reda R, Zanza A, Galli M, De Biase A, Testarelli L, Di Nardo D. Applications and clinical behavior of BioHPP in prosthetic dentistry: a short review. J Compos Sci. 2022;6(3):90. https://doi.org/10.3390/jcs6030090 DOI: https://doi.org/10.3390/jcs6030090
Moussa SG, El Afandy HM. Patient satisfaction and soft tissue changes around BioHPP bar compared to cobalt-chromium bar retaining mandibular implant-overdentures: a randomized clinical trial. Al-Azhar J Dent Sci. 2023;26(3):381–90. https://doi.org/10.21608/ajdsm.2023.213530.1434 DOI: https://doi.org/10.21608/ajdsm.2023.213530.1434
Bathala L, Majeti V, Rachuri N, Singh N, Gedela S. The role of polyether-ether-ketone (PEEK) in dentistry – a review. J Med Life. 2019;12(1):5. https://doi.org/10.25122/jml-2019-0003 DOI: https://doi.org/10.25122/jml-2019-0003
Georgiev J, Vlahova A, Kissov H, Aleksandrov S, Kazakova R. Possible application of BioHPP in prosthetic dentistry: a literature review. J IMAB. 2018;24(1):1896–8. https://doi.org/10.5272/jimab.2018241.1896 DOI: https://doi.org/10.5272/jimab.2018241.1896
Zoidis P, Papathanasiou I, Polyzois G. The use of a modified poly-ether-ether-ketone (PEEK) as an alternative framework material for removable dental prostheses: a clinical report. J Prosthodont. 2016;25(7):580–4. https://doi.org/10.1111/jopr.12325 DOI: https://doi.org/10.1111/jopr.12325
Wei X, Wang M, Pan Y, Lin H, Jiang L, Wang Y, et al. Influence of fabrication method on the biological properties of modified PEEK. Dent Mater J. 2023;42(1):72–8. https://doi.org/10.4012/dmj.2022-115 DOI: https://doi.org/10.4012/dmj.2022-115
Gama LT, Bezerra AP, Schimmel M, Garcia RCMR, de Luca Canto G, Gonçalves TMSV. Clinical performance of polymer frameworks in dental prostheses: a systematic review. J Prosthet Dent. 2024;131(4):579–90. https://doi.org/10.1016/j.prosdent.2022.03.002 DOI: https://doi.org/10.1016/j.prosdent.2022.03.002
Guo L, Smeets R, Kluwe L, Hartjen P, Barbeck M, Cacaci C, et al. Cytocompatibility of titanium, zirconia and modified PEEK after surface treatment using UV light or non-thermal plasma. Int J Mol Sci. 2019;20(22):5596. https://doi.org/10.3390/ijms20225596 DOI: https://doi.org/10.3390/ijms20225596
Arslan E, Caglar I. Enhancing PEEK bond strength: the impact of chemical and mechanical surface modifications on surface characteristics and phase transformation. BMC Oral Health. 2025;25(1):511. https://doi.org/10.1186/s12903-025-05933-3 DOI: https://doi.org/10.1186/s12903-025-05933-3
Wiesli MG, Özcan M. High-performance polymers and their potential application as medical and oral implant materials: a review. Implant Dent. 2015;24(4):448–57. https://doi.org/10.1097/ID.0000000000000285 DOI: https://doi.org/10.1097/ID.0000000000000285
Liu Y, Fang M, Zhao R, Liu H, Li K, Tian M, et al. Clinical applications of polyether-ether-ketone in removable dental prostheses: accuracy, characteristics, and performance. Polymers (Basel). 2022;14(21):4615. https://doi.org/10.3390/polym14214615 DOI: https://doi.org/10.3390/polym14214615
Erdaş G, Özdemir H. The use of PEEK and PEKK in prosthodontics. Curr Res Dent Sci. 2023; (early online).
Amjadi M, Safari MR, Dini Torkamani R, Kheiri Manjili M, Jamshidi D, Sobhan F, et al. Comparative assessment of post-fatigue resistance of mandibular first molars restored with polyether-ether-ketone and lithium disilicate endocrowns. Sci World J. 2024;2024:8648372. https://doi.org/10.1155/tswj/8648372 DOI: https://doi.org/10.1155/tswj/8648372
Kandeel ZM, Abdelhamed AM, Neena AF. Strain developed around dental implants loaded with two CAD-CAM reinforced polymeric superstructure materials: an in vitro comparative study. Alex Dent J. 2023;48(2):124–31. https://doi.org/10.21608/adjalexu.2022.127546.1262 DOI: https://doi.org/10.21608/adjalexu.2022.127546.1262
Elshamy AH, Abdel Kader SH, Nassif MS. The effect of superstructure material on stress distribution in bone around implants supporting fixed partial denture: an in vitro study. Alex Dent J. 2022;47(3):116–24. https://doi.org/10.21608/adjalexu.2021.71459.1182 DOI: https://doi.org/10.21608/adjalexu.2021.71459.1182
Andrikopoulou E, Zoidis P, Artopoulou II, Doukoudakis A. Modified PEEK resin-bonded fixed dental prosthesis for a young cleft lip and palate patient. J Esthet Restor Dent. 2016;28(4):201–7. https://doi.org/10.1111/jerd.12221 DOI: https://doi.org/10.1111/jerd.12221
Ahmed GA, El-Etreby A, El-Fattah GA. Comparison of shear bond strength and color reproduction of two different high-performance polymers veneered with two different thicknesses of resin composite: an in vitro study. Braz Dent Sci. 2023;26(4) :e3959. https://doi.org/10.4322/bds.2023.e3959. DOI: https://doi.org/10.4322/bds.2023.e3959
Younes AA, Korsel AM, El Tokhey HM, Ali KM, Kamel MS. The effect of different implant abutment materials on the stress distribution to the bone–implant contact. Egypt Dent J. 2020;66(2):1289–94. https://doi.org/10.21608/edj.2020.25438.1062 DOI: https://doi.org/10.21608/edj.2020.25438.1062
Beleidy M, Ziada A. Marginal accuracy and fracture resistance of posterior crowns fabricated from CAD/CAM PEEK cores veneered with HIPC or nanohybrid conventional composite. Egypt Dent J. 2020;66(4):2541–52. DOI: https://doi.org/10.21608/edj.2020.40096.1217
Elsebai DII, Eid HI, Osama AM, Mohamed HT. Effect of CAD/CAM-constructed BioHPP versus zirconia frameworks reinforced maxillary complete denture on fracture resistance: an in vitro study. Open Access Maced J Med Sci. 2023;11(D):55–60. https://doi.org/10.3889/oamjms.2023.11546 DOI: https://doi.org/10.3889/oamjms.2023.11546
Al-Asad HM, El Afandy MH, Mohamed HT, Mohamed MH. Hybrid prosthesis versus overdenture: effect of BioHPP prosthetic design rehabilitating edentulous mandible. Int J Dent. 2023;2023:4108679. https://doi.org/10.1155/2023/4108679 DOI: https://doi.org/10.1155/2023/4108679
Hanno K. Full-mouth implant rehabilitation using fixed-detachable BioHPP frameworks in the presence of one-piece implants: a clinical report. J Dent Health Oral Res. 2022;3(2):1–10. DOI: https://doi.org/10.46889/JDHOR.2022.3209
Mohamed MN, Mohamed GF, Hassan NO. Comparative evaluation of physical properties of conventionally constructed versus CAD/CAM-milled frameworks for Kennedy Class I partial dentures. Egypt Dent J. 2019;65(4):3663–70. https://doi.org/10.21608/edj.2019.75998 DOI: https://doi.org/10.21608/edj.2019.75998
Lo Giudice R, Puleio F, Matarese M, Nicita F, Pantè GG, Previti C, et al. BioHPP and soft tissue: confocal laser scanning evaluation of junctional connective tissue. Clin Oral Implants Res. 2019;30(Suppl 18):283–4. https://doi.org/10.1111/clr.239_13509 DOI: https://doi.org/10.1111/clr.239_13509
Discepoli N, Mirra R, De Rubertis I, Ricciardi R, La Francesca N, Bellan C. Histopathologic assessment of soft-tissue healing around polyether-ether-ketone and titanium abutments: a randomized controlled human study. J Osseointegr. 2025;17(1):40–7. https://doi.org/10.1155/ijod/7500003 DOI: https://doi.org/10.1155/ijod/7500003
Montaser A. Evaluation of marginal fit and fracture resistance of zirconia implant abutment supporting two types of metal-free CAD/CAM restorations. Al-Azhar J Dent. 2022;9(2):14. DOI: https://doi.org/10.21608/adjg.2022.109371.1460
Almuhayya S, Alshahrani R, Alsania R, Albassam A, Alnemari H, Babaier R. Biofilm formation on three high-performance polymeric CAD/CAM composites: an in vitro study. Polymers (Basel). 2025;17(5):676. https://doi.org/10.3390/polym17050676 DOI: https://doi.org/10.3390/polym17050676
Lee E-H, Lee S-W, Seo Y, Deng Y-H, Lim Y-J, Kwon H-B, et al. Manganese-oxide nanozyme-doped diatom for safe and efficient treatment of peri-implantitis. ACS Appl Mater Interfaces. 2022;14(24):27634–50. DOI: https://doi.org/10.1021/acsami.2c05166
Luo C, Liu Y, Peng B, Chen M, Liu Z, Li Z, et al. PEEK for oral applications: recent advances in mechanical and adhesive properties. Polymers (Basel). 2023;15(2):386. https://doi.org/10.3390/polym15020386 DOI: https://doi.org/10.3390/polym15020386
Sarfaraz H, Rasheed MN, Shetty SK, Prabhu UM, Fernandes K, Mohandas S. Comparison of the bond strength of composite resin to zirconia and to polyether-ether-ketone: an in vitro study. J Pharm Bioallied Sci. 2020;12(Suppl 1):S504–9. https://doi.org/10.4103/jpbs.JPBS_147_20 DOI: https://doi.org/10.4103/jpbs.JPBS_147_20
Erjavec AK, Črešnar KP, Švab I, Vuherer T, Žigon M, Brunčko M. Determination of shear bond strength between PEEK composites and veneering composites for the production of dental restorations. Materials (Basel). 2023;16(9):3286. DOI: https://doi.org/10.3390/ma16093286
Adeeb Gabra EN, Sadek HMA, Hamdy AM, Wahsh MM. Effect of surface treatment and resin cement type on the bond strength of polyether-ether-ketone to lithium-disilicate ceramic. BMC Oral Health. 2024;24(1):513. https://doi.org/10.1186/s12903-024-04269-8 DOI: https://doi.org/10.1186/s12903-024-04269-8
El-Wassefy NA. Shear bond strength of two veneering composite resins to a modified polyether-ether-ketone material: influence of surface pretreatments and thermocycling. Egypt Dent J. 2019;65(3):2821–30. https://doi.org/10.21608/edj.2019.72677 DOI: https://doi.org/10.21608/edj.2019.72677
Gonçalves TMSV, Reginaldo I, Baroudi K, Wanghon ZML, Santos Diamantino P, Gimenez MG, et al. Effect of adhesive system on bond strength of PEEK and PEKK. J Compos Sci. 2025;9(4):165. DOI: https://doi.org/10.3390/jcs9040165
Yousry MA, Hussein SA, Al Abbassy FH. Evaluation of shear bond strength of high-performance polymers to its resin veneering and to dentin: an in vitro study. Alex Dent J. 2018;43(2):62–8. https://doi.org/10.21608/adjalexu.2018.57626 DOI: https://doi.org/10.21608/adjalexu.2018.57626
Alnafaiy SM, Labban N, Albaijan R, AlKahtani RN, Al-Aali KA, Abozaed HW, et al. Evaluation of shear bond strength and failure modes of lithium-disilicate ceramic veneering material to different high-performance polymers. Polymers (Basel). 2025;17(5):554. https://doi.org/10.3390/polym17050554 DOI: https://doi.org/10.3390/polym17050554
Kowalski R, Frąckiewicz W, Kwiatkowska M, Światłowska-Bajzert M, Sobolewska E. Comparison of performance parameters of BioHPP and Biocetal used in the production of prosthetic restorations in dentistry: part I, mechanical tests. Materials (Basel). 2025;18(3):561. https://doi.org/10.3390/ma18030561 DOI: https://doi.org/10.3390/ma18030561
Aboelnagga MM. Comparative stress analysis of BioHPP and PEKK CAD/CAM frameworks in mandibular All-on-Four fixed-detachable prosthesis on its supporting implants. Ain Shams Dent J. 2023;32(4):6–18. DOI: https://doi.org/10.21608/asdj.2022.146267.1127
Shash YH, El-Wakad MT, Eldosoky MA, Dohiem MM. Evaluation of stress and strain on mandible caused using ‘All-on-Four’ system from PEEK in hybrid prosthesis: finite-element analysis. Odontology. 2023;111(3):618–29. https://doi.org/10.1007/s10266-022-00771-z DOI: https://doi.org/10.1007/s10266-022-00771-z
Jin H-Y, Teng M-H, Wang Z-J, Li X, Liang J-Y, Wang W-X, et al. Comparative evaluation of BioHPP and titanium as frameworks veneered with composite resin for implant-supported fixed dental prostheses. J Prosthet Dent. 2019;122(4):383–8. https://doi.org/10.1016/j.prosdent.2019.03.003 DOI: https://doi.org/10.1016/j.prosdent.2019.03.003
Nabhan MS. Effect of different fixed-detachable implant-supported prosthesis materials on stresses induced on supporting structures. Egypt Dent J. 2019;65(1):445–52. https://doi.org/10.21608/edj.2019.72720 DOI: https://doi.org/10.21608/edj.2019.72720
Güneş F, Kocacıklı M, Korkmaz T. Dental implantolojide polieter-eter-keton (PEEK): geleneksel derleme. Selcuk Dent J. 2023;10(3):611–7. https://doi.org/10.15311/selcukdentj.1238899 DOI: https://doi.org/10.15311/selcukdentj.1238899
Sen S, Mondal S, Mukhopadhyay S, Maji S, Das S. Esthetic clasp material: a review. J Orofac Rehabil. 2022;2(2):28–36.
Saeedi E, Sayed TMA, Thabet YG, Mohamed SL, Sabet ME. Evaluation of the accuracy and adaptation of BioHPP removable partial denture frameworks constructed by milling vs the pressing technique. Int J Prosthodont. 2022;35(5):647–52. https://doi.org/10.11607/ijp.7822 DOI: https://doi.org/10.11607/ijp.7822
Hanna EG, Amine S, Prasad B, Younes K. Exploring polyether-ether-ketone in dental implants and abutments: a focus on biomechanics and finite-element methods. Rev Adv Mater Sci. 2024;63(1):20240031. https://doi.org/10.1515/rams-2024-0031 DOI: https://doi.org/10.1515/rams-2024-0031
Pascalis FD. Soft-tissue integration with a hybrid abutment using the ‘one abutment–one time’ therapeutic protocol: case series. Quintessence Int. 2022;53(7):703–8.
Patil AA, Kalsekar B, Kasat SJ, Patil SS. Fabrication of maxillary obturator using a combination of PEEK, acrylic resin, and silicone: a case report. Int J Prosthodont Restor Dent. 2022;12(1):46–50. https://doi.org/10.5005/jp-journals-10019-1357 DOI: https://doi.org/10.5005/jp-journals-10019-1357
El-Hussein IG. Impact of milled PEEK versus conventional chrome-cobalt framework on retention of definitive obturators for unilateral total maxillectomy patients. Al-Azhar J Dent. 2024;10(4):22. https://doi.org/10.58675/2974-4164.1607 DOI: https://doi.org/10.58675/2974-4164.1607
Gouda A, Sherif A, Wahba M, Morsi T. Effect of veneering material type and thickness ratio on flexural strength of bi-layered PEEK restorations before and after thermal cycling. Clin Oral Investig. 2023;27(6):2629–39. https://doi.org/10.1007/s00784-022-04829-8 DOI: https://doi.org/10.1007/s00784-022-04829-8
Porojan L, Toma FR, Bîrdeanu MI, Vasiliu RD, Uțu I-D, Matichescu A. Surface characteristics and color stability of dental PEEK related to water saturation and thermal cycling. Polymers (Basel). 2022;14(11):2144. https://doi.org/10.3390/polym14112144 DOI: https://doi.org/10.3390/polym14112144
El-Shimy KRAE, Zaki A. One-year clinical evaluation of pressed BioHPP PEEK-based versus zirconia-based single crowns: randomized controlled clinical trial. NeuroQuantology. 2022;20(17):901–14.
Rajamani VK, Reyal SS, Gowda EM, Shashidhar MP. Comparative prospective clinical evaluation of CAD/CAM-milled BioHPP PEEK inlays and zirconia inlays. J Indian Prosthodont Soc. 2021;21(3):240–8. https://doi.org/10.4103/jips.jips_57_21 DOI: https://doi.org/10.4103/jips.jips_57_21
Fareed AM, Elsheehy OM, Nabil O. Efficacy of two surface treatment methods of PEEK on shear bond strength to veneering composite: an in vitro study. Adv Dent J. 2023;5(4):734–41. https://doi.org/10.21608/adjc.2023.228885.1381 DOI: https://doi.org/10.21608/adjc.2023.228885.1381
Gama LT, Duque TM, Özcan M, Philippi AG, Mezzomo LAM, Gonçalves TMSV. Adhesion to high-performance polymers applied in dentistry: a systematic review. Dent Mater. 2020;36(4):e93–108. https://doi.org/10.1016/j.dental.2020.01.002 DOI: https://doi.org/10.1016/j.dental.2020.01.002
Robaian A, Alshehri AM, Alqhtani NR, Almudahi A, Alanazi KK, Abuelqomsan MA, et al. Effect of surface treatments and thermal aging on bond strength between veneering resin and CAD/CAM provisional materials. Polymers (Basel). 2025;17(5):563. https://doi.org/10.3390/polym17050563 DOI: https://doi.org/10.3390/polym17050563
Speroni S, Antonelli L, Coccoluto L, Giuffrè M, Sarnelli F, Tura T, et al. The effectiveness and predictability of BioHPP superstructures in Toronto–Brånemark implant-prosthetic rehabilitations: a case report. Prosthesis. 2025;7(1):10. https://doi.org/10.3390/prosthesis7010010 DOI: https://doi.org/10.3390/prosthesis7010010
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aslı Bengisu Karayel, Ragibe Şenay Canay
This work is licensed under a Creative Commons Attribution 4.0 International License.
Biomaterial Investigations in Dentistry is a Diamond Open Access peer-reviewed journal, publishing research in oral biomaterials science. The publishing of articles is free for authors, thanks to the support of Acta Odontologica Scandinavica Society (AOSS), a not-for-profit society. 
