The effect of surface treatments on the bond strength of polyetheretherketone posts: a systematic review protocol

Hanen Boukhris; Aymen Ben Hadj Khalifa; Hayet Hajjami; Souha Boudegga Ben Youssef

doi:10.12688/f1000research.154750.1

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Study Protocol

The effect of surface treatments on the bond strength of polyetheretherketone posts: a systematic review protocol

[version 1; peer review: 1 approved with reservations]

Hanen Boukhris ¹, Aymen Ben Hadj Khalifa², Hayet Hajjami¹, Souha Boudegga Ben Youssef³

PUBLISHED 22 Aug 2024

Author details Author details

¹ Department of prosthodontics, LR12SP10, University of Monastir, Faculty of Dental Medicine, Monastir, Monastir, Tunisia
² Department of Dental Anatomy, University of Monastir, Faculty of Dental Medicine, Monastir, Monastir, Tunisia
³ department of oral surgery, LR12SP10, University of Monastir, Faculty of Dental Medicine, Monastir, Monastir, Tunisia

Hanen Boukhris
Roles: Conceptualization, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing

Aymen Ben Hadj Khalifa
Roles: Conceptualization, Formal Analysis, Methodology, Software

Hayet Hajjami
Roles: Conceptualization, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing

Souha Boudegga Ben Youssef
Roles: Supervision, Validation, Visualization

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Abstract*

Background

Polyetheretherketone (PEEK) is widely used in the biomedical field due to its outstanding biological and mechanical properties. Originally employed as a temporary abutment in implantology, recent research has expanded its indications for more definitive applications, such as frameworks and dental post and core. This shift requires a thorough assessment of PEEK’s adhesion and mechanical characteristics. However, PEEK’s inert properties and intricate chemistry create difficulties in surface treatment, resulting in reduced surface energy and inadequate adhesion. Inducing specific physical and chemical changes aims to overcome these challenges and enhance adhesion for PEEK. Despite its numerous clinical trials, standardized protocols remain lacking. This systematic review aims to assess the impact of surface treatments on the bonding performance of PEEK posts.

Methods

A detailed search of the literature will be conducted across several databases including PubMed, Scopus and clinical trial registries. Additional databases such as Cochrane Central, EMBASE, Web of Science and EBSCO will also be included. The search strategy will target controlled randomized studies and non-randomized clinical trials evaluating the impact of surface treatments on PEEK post adhesion strength. The Newcastle-Ottawa Scale (NOS) will be used to assess bias in non-randomized studies, while the Cochrane Risk of Bias (ROB II) tool will be employed for evaluating randomized controlled trials. Data extraction will focus on study design, treatment methods, outcomes and results.

This systematic review protocol will adhere to the guidelines for systematic reviews outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Discussion

The discussion will explore the implications of findings on clinical practice, highlighting the importance of enhancing PEEK’s bioactivity and surface energy to improve bonding efficacy in dental procedures. Moreover, it will suggest areas for future research to advance dental materials science, aiming to optimize the utilization of PEEK in dental applications

Systematic review registration

PROSPERO: CRD42024529783 (Registered on 08/04/2024).

Keywords

Polyetheretherketone (PEEK), Posts, Surface treatments, Bond strength, Systematic review

Corresponding author: Hanen Boukhris

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Boukhris H et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Boukhris H, Ben Hadj Khalifa A, Hajjami H and Boudegga Ben Youssef S. The effect of surface treatments on the bond strength of polyetheretherketone posts: a systematic review protocol [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:951 (https://doi.org/10.12688/f1000research.154750.1) First published: 22 Aug 2024, 13:951 (https://doi.org/10.12688/f1000research.154750.1) Latest published: 03 Apr 2025, 13:951 (https://doi.org/10.12688/f1000research.154750.3)

Introduction

Endodontically treated teeth (ETT) with over 50% loss of coronal structure are prone to shear forces during chewing and often necessitate post-and-core placement. Posts are employed to secure the core material, enhancing the stability and retention of the final restoration.¹^,²

The growing demand for aesthetic improvements in dental treatments has led to the widespread use of prefabricated fiber posts. These posts offer advantages like uniform stress distribution, biocompatibility, and ease of handling, making them preferable over metal posts for restoring endodontically treated teeth. However, they can cause mechanical stress at the restoration margin and fail to strengthen the tooth structure.

Despite their lower elasticity modulus compared to metal posts, fiber posts still exhibit significantly greater stiffness than dentin. Fiber post and core buildup materials can fail due to several mechanisms, such as cracking of the resin matrix, fracture of the fibers, and detachment at the interface.

A novel material with both low Young’s modulus and satisfactory aesthetics has emerged. Thermoplastic polymer Polyetheretherketone (PEEK) has excellent properties. It has a Young’s modulus (3-4 GPa) lower than that of dentin which helps reduce stress on both restorations and teeth. These qualities make PEEK suitable for various dental applications including post and core systems.³^–⁶

However, the achievement of adhesion between PEEK and resin materials is challenging due to its low surface energy and resistant surface modification. Various treatments including chemical and micromechanical methods are recommended to improve the bonding of composite resin to PEEK posts.⁷^–¹⁴

The goal of this systematic review is to assess how effectively PEEK posts perform with various surface treatments. This is crucial for dental professionals as it provides valuable information for developing dependable bonding protocols for PEEK posts and cores.

Protocol

Methods

This protocol outlines the process for conducting a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.¹⁵^,¹⁶ The methodology from the F1000 journal will be followed to ensure accuracy and consistency at every step. The review protocol is registered in PROSPERO (CRD42024531175) since April 8, 2024.

Objectives

Primary objective: To evaluate the effectiveness of various surface treatments in the improvement of bonding strength for Polyetheretherketone (PEEK) posts.

Secondary objectives:

- To provide evidence-based recommendations for clinicians in the choice of surface treatments for PEEK posts during bonding procedures.
- To identify gaps in the literature and to propose possible suggestions for further research.

Inclusion criteria

The inclusion criteria are structured according to the PICOS model. This model is designed to specify the key components of the research question.

The research question for this systematic review is: What is the effect of various surface treatments on retention and bond strength of polyetheretherketone (PEEK) posts used in dental restoration compared to untreated PEEK posts?

• Types of participants: This systematic review will focus on patients requiring dental restoration with polyetheretherketone (PEEK) posts. Eligible participants must be free from medical conditions affecting bone healing, avoid parafunctional habits such as bruxism and have no occlusal problems.
• Intervention types: This systematic review will explore PEEK (Polyetheretherketone) use in dental posts. Patients will receive interventions involving surface treatments like etching with 98% sulfuric acid and sandblasting with 50 μm alumina oxide (Al2O3).
• Types of outcomes: This systematic review will focus on evaluating PEEK posts in dental restorations with different surface treatments before bonding. Key outcomes include retention rate, fracture resistance compared to traditional posts, and marginal adaptation quality. It will also assess bond strength between PEEK posts and dental materials, post-operative sensitivity, restoration longevity and clinical success rate overall.
• Measures of effect: This systematic review will measure effects using quantitative and qualitative assessments. Quantitative measures include statistical analysis of retention rates, fracture resistance, bond strength and restoration longevity.
Qualitative measures involve evaluating marginal adaptation quality, post-operative sensitivity and clinical success rates through observational data and patient-reported outcomes. Meta-analytical techniques may be used to synthesize findings across studies for comparison.
• Study types: Included articles will mainly include randomized controlled trials and prospective or retrospective cohort studies. These studies specifically investigate the use of polyetheretherketone (PEEK) posts in dental restorations, focusing on surface treatments. They are chosen for their substantial data and rigorous methodology to meet the research objectives effectively.
Excluded articles will cover case reports, case series, abstracts, discussions, interviews, editorials, and opinion pieces, along with research that does not center on PEEK posts or surface treatments. Additionally, studies lacking adequate data or methodology will be omitted to ensure the review’s reliability and relevance.

Search strategy

A combination of keywords and precise subject headings relevant to the topic will be employed in the refined search strategy, ensuring a comprehensive exploration of pertinent literature. In addition to MEDLINE, databases such as Web of Science, EBSCO, Scopus, Cochrane Central and EMBASE will be meticulously searched to reduce the likelihood of missing relevant studies.

To achieve comprehensiveness, attempts will be made to locate grey literature and active clinical trials through sources such as dissertations, conference proceedings and clinical trial registries. The expert panel will offer guidance in identifying grey literature sources and evaluating their pertinence to the review.¹⁷

Furthermore, reference lists of included studies will be systematically examined as part of the search strategy to identify supplementary articles not retrieved solely through electronic databases.

This approach aims to reduce publication bias and ensure a thorough review of the available evidence.

Study selection

For this systematic review, the study selection process will involve a comprehensive search across all identified databases. Two independent reviewers will screen titles and abstracts to exclude irrelevant studies. Full-text articles of potentially eligible studies will be assessed using predefined inclusion criteria. These criteria will focus on studies that evaluate surface treatments of PEEK in dental post applications.

Reviewers will check article reference lists for additional relevant studies. Articles meeting inclusion criteria will proceed to data extraction.

During screening, any discrepancies among reviewers will be resolved through discussion. If needed, an additional reviewer (HH) will be consulted to ensure accuracy and consensus.

Evaluation of methodological quality and risk of bias

To guarantee the reliability of the findings, the methodological quality and risk of bias of the included studies will be evaluated using standardized tools.¹⁸

For randomized controlled trials, the Cochrane Risk of Bias (ROB II) tool will be utilized to assess methodological rigor across key domains: randomization procedures, adherence to intended interventions, completeness of outcome data, outcome measurement and accuracy in reporting results. Each domain will be categorized as having low, high or unclear risk of bias.¹⁹

The quality assessment of non-randomized studies will be conducted using the Newcastle-Ottawa Scale (NOS) which evaluates them based on three main criteria: the selection of study participants, group comparability and outcome ascertainment. Each study will be scored on these criteria with higher scores indicating better methodological quality.²⁰

Two independent reviewers will conduct the assessments to minimize bias and enhance reliability. Any discrepancies in the assessments will be resolved through discussion or by consulting an additional reviewer (HH) to reach a consensus.

Methodological rigor and assessment of bias will ensure that the review’s conclusions are based on high-quality evidence.

Extraction of data

Data items: The following details will be extracted from the selected studies: participant demographics, specifics of the interventions, outcome measures, study characteristics (publication year, author, study design …) and results pertaining to bond strength and surface characteristics.

Extraction method: A standardized data extraction form will be created in a Microsoft Excel sheet to systematically capture relevant data from each included study.

Data extraction will be conducted by two reviewers working autonomously to ensure consistent and precise handling of the information.

Discussion will be initiated to resolve any discrepancies, and if needed, input will be sought from a third reviewer (HH).

This structured approach will guarantee thorough and dependable data extraction for subsequent analysis.

Analysis and synthesis of data

The extracted data will be rigorously analyzed and synthesized to assess the effectiveness of surface treatments for PEEK in dental post materials. Initial descriptive analysis will summarize study details, participant characteristics, intervention particulars and outcome measures such as bond strength and surface characteristics. Quantitative synthesis, including meta-analysis where feasible, will calculate effect sizes with 95% confidence intervals and assess heterogeneity across studies using statistical tests such as Tau-squared, Cochran’s Q test and I-squared, systematically categorized to understand the range of variability.

Subgroup analyses will explore variations in treatment methods and material types. Sensitivity analyses will test result robustness, and qualitative synthesis will offer a narrative summary where quantitative synthesis is not possible. Findings will be interpreted in the context of clinical relevance, discussing methodological strengths and limitations while proposing directions for future research in optimizing PEEK’s performance in dental applications. Forest plot will be used to depict the results, providing a concise visualization of aggregated study effects.²¹

Discussion

The outcomes of this systematic review will be highly relevant for practitioners focused on aesthetic and digital dentistry, especially in the management of damaged teeth. By evaluating the efficacy of surface treatments for polyetheretherketone (PEEK) in dental post materials, this review aims to provide evidence-based guidance on enhancing bond strength and surface characteristics critical for durable dental restorations. The findings are anticipated to inform clinical decision-making, facilitating the selection of optimal surface treatment strategies to improve the longevity and aesthetic outcomes of PEEK-based restorations. Moreover, this review will identify areas where current research is lacking and propose avenues for future investigation, aiming to advance the field of dental materials science and enhance patient care in aesthetic and functional dental rehabilitation.

Ethics and dissemination

No ethical approval is needed for this systematic survey. The authors intend to present the findings at target conferences and publish the research findings in a peer-reviewed journal adopting open science practices.

Study status

This systematic review is currently in the data analysis process. The protocol of this systematic review was submitted to PROSPERO registry on 8th April, 2024 (CRD42024529783).

Data availability

No data are associated with this article.

Reporting guidelines

Figshare: PRISMA-P checklist for The Effect of Surface Treatments on the Bond Strength of Polyetheretherketone Posts: A Systematic Review protocol, https://doi.org/10.6084/m9.figshare.25771182.v1.²²

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

References

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7. Lee KS, Shin MS, Lee JY, et al.: Shear bond strength of composite resin to high performance polymer PEKK according to surface treatments and bonding materials. J. Adv. Prosthodont. 2017; 9(05): 350–357. PubMed Abstract | Publisher Full Text | Free Full Text
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9. Monteiro LC, Pecorari VGA, Gontijo IG, et al.: PEEK and Fiberglass Intra-Radicular Posts: Influence of Resin Cement and Mechanical Cycling on Push-out Bond Strength. Clin. Oral Investig. 2022; 26: 6907–6916. PubMed Abstract | Publisher Full Text
10. Song CH, Choi JW, Jeon YC, et al.: Comparison of the microtensile bond strength of a polyetherketoneketone (PEKK) tooth post cemented with various surface treatments and various resin cements. Materials (Basel). 2018; 11: 916. PubMed Abstract | Publisher Full Text | Free Full Text
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14. Mathew S, Raju IR, Sreedev CP, et al.: Evaluation of push out bond strength of fiber post after treating the intra radicular post space with different post space treatment techniques: a randomized controlled in vitro trial. J. Pharm. Bioallied Sci. 2017; 9: S197–S200. PubMed Abstract | Publisher Full Text
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Comments on this article Comments (0)

Version 3

VERSION 3 PUBLISHED 22 Aug 2024

Author details Author details

Hanen Boukhris
Roles: Conceptualization, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing

Aymen Ben Hadj Khalifa
Roles: Conceptualization, Formal Analysis, Methodology, Software

Hayet Hajjami
Roles: Conceptualization, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing

Souha Boudegga Ben Youssef
Roles: Supervision, Validation, Visualization

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (3)

version 3

Revised

Published: 03 Apr 2025, 13:951

https://doi.org/10.12688/f1000research.154750.3

version 2

Revised

Published: 06 Feb 2025, 13:951

https://doi.org/10.12688/f1000research.154750.2

version 1

Published: 22 Aug 2024, 13:951

https://doi.org/10.12688/f1000research.154750.1

© 2024 Boukhris H et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Boukhris H, Ben Hadj Khalifa A, Hajjami H and Boudegga Ben Youssef S. The effect of surface treatments on the bond strength of polyetheretherketone posts: a systematic review protocol [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:951 (https://doi.org/10.12688/f1000research.154750.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

Version 1

VERSION 1

PUBLISHED 22 Aug 2024

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Reviewer Report 18 Sep 2024

Marwa Emam, Ain Shams University,, , Cairo, Egypt

Approved with Reservations

https://doi.org/10.5256/f1000research.169814.r316835

Review report for the submitted manuscript “The effect of surface treatments on the bond strength of polyetheretherketone posts: a systematic review protocol”

I would like to thank the authors for submitting their protocol for review. The use of PEEK posts in dental applications is a developing subject, so a systematic assessment of surface treatment procedures is extremely important. PEEK's biocompatibility and mechanical strength make it excellent for dental posts, but the inert surface makes bonding challenging. This review could fill a crucial gap in clinical practice.
Overall, the language is clear, but minor editing of English language might be required in the final submitted review. Author might want to explore options for refining their text to improve its flow and readability. This can make their article more engaging and clear.
1. Title: - Approved as is.
2. Abstract: Kindly give a hint on the different surface treatment techniques of PEEK for the reader.
3. Introduction: -I think the introduction is a bit shallow. I would prefer the introduction to begin with PEEK material (history, chemical composition and properties) as it is the main objective of the study. Then going through the different applications quickly and concentrating on the endodontically treated teeth and post indications and PEEK post (ready & custom made) as one of the options available for clinicians. Finally, stating PEEK adhesion properties as a weakness that different surface treatments aim to improve.
-Kindly connect short paragraphs into paragraphs of 6-7 lines paragraphs.
-Kindly add references to the second & third paragraph.
- The authors could elaborate on the therapeutic relevance of PEEK's bond strength as compared to conventional materials like metal, zirconia or fiber posts.
4. Methods: -The protocol is well-structured and follows known principles for systematic reviews (PRISMA). The use of numerous databases (e.g., PubMed, Scopus, Cochrane Central) will ensure a thorough literature review. The intended use of risk-of-bias tools (ROB II and NOS) and data extraction procedures demonstrates a commitment to evidence of excellent quality synthesis.
Intervention types:
There is no mention of the surface treatments of PEEK aimed for exploration. Only 2 examples were mentioned so kindly give more details regarding treatments to be studied.
Outcomes:
More precise definitions would be useful in the outcomes section. While bond strength and retention are indicated, it is unclear how they would be tested. Providing additional details on the anticipated outcomes and their clinical significance could enhance the protocol.
Evaluation of methodological quality and risk of bias:
-The protocol’s description of bias assessment tools (ROB II and NOS) is good, but how will studies with unclear risks of bias be handled in the analysis? Also kindly give more details regarding the “standardized tools” you have mentioned as means of evaluation.
Meta analysis:
While the authors highlight the possibility of meta-analysis, it would be interesting to describe how they intend to deal with possible heterogeneity among studies (e.g., differences in surface treatments, study designs).
5. Conclusions: Although this protocol presents a well-designed systematic review that is expected to yield useful information about the surface treatments of PEEK posts in dental applications, it would be strengthened by adding the details addressed in the comments above for further enhancement.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Fixed prosthodontics, implant, occlusion, ceramics, dental materials, esthetics, digital dentistry.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Report a concern

Author Response 06 Feb 2025

Hanen Boukhris, Department of prosthodontics, LR12SP10, University of Monastir, Faculty of Dental Medicine, Monastir, Tunisia

06 Feb 2025

Author Response
We appreciate the reviewers’ valuable feedback, which has helped improve the clarity, depth, and rigor of our manuscript. Below, we provide detailed responses to each comment and indicate the revisions ... Continue reading
We appreciate the reviewers’ valuable feedback, which has helped improve the clarity, depth, and rigor of our manuscript. Below, we provide detailed responses to each comment and indicate the revisions made accordingly.

1.Introduction

Comment: "The introduction should start with PEEK’s material properties, history, and applications before discussing its role in post-and-core restorations."
Response: We have reorganized the introduction to first present PEEK’s chemical composition, mechanical properties, and biomedical applications before focusing on its role in post-and-core restorations. The revised introduction now follows a logical progression, improving the contextual framework of the study.

Comment: "Please provide more details on the different surface treatment techniques of PEEK."
Response: We have expanded the discussion on surface treatments, including plasma treatment, acid etching (98% sulfuric acid), sandblasting (50 μm alumina oxide), laser surface modification, silanization, and air abrasion. These modifications and their rationale are now clearly described.

Comment: "There is limited discussion on the comparative performance of PEEK posts against conventional materials like metal, zirconia, and fiber posts."
Response: The revised manuscript now includes a comparative analysis highlighting the strengths and limitations of PEEK versus conventional post materials, emphasizing its clinical relevance.

Comment: "How will studies with unclear risk of bias be handled in the analysis?"
Response: We have specified that studies with an unclear risk of bias will undergo sensitivity analysis, and their influence on the final conclusions will be carefully considered.

Comment: "Clarify how heterogeneity among studies will be addressed in the meta-analysis."
Response: A heterogeneity assessment will be conducted using I² statistics, and subgroup analysis or meta-regression will be applied if significant heterogeneity is detected.

Comment: "Provide more precise definitions of key outcomes."
Response: We have revised the outcomes section to specify assessment methods for bond strength (e.g., push-out tests), fracture resistance, and marginal adaptation quality.

These responses, along with the corresponding revisions, have strengthened our manuscript and improved its clarity. Thank you for your constructive feedback.
We appreciate the reviewers’ valuable feedback, which has helped improve the clarity, depth, and rigor of our manuscript. Below, we provide detailed responses to each comment and indicate the revisions made accordingly.

1.Introduction

Comment: "The introduction should start with PEEK’s material properties, history, and applications before discussing its role in post-and-core restorations."
Response: We have reorganized the introduction to first present PEEK’s chemical composition, mechanical properties, and biomedical applications before focusing on its role in post-and-core restorations. The revised introduction now follows a logical progression, improving the contextual framework of the study.

Comment: "Please provide more details on the different surface treatment techniques of PEEK."
Response: We have expanded the discussion on surface treatments, including plasma treatment, acid etching (98% sulfuric acid), sandblasting (50 μm alumina oxide), laser surface modification, silanization, and air abrasion. These modifications and their rationale are now clearly described.

Comment: "There is limited discussion on the comparative performance of PEEK posts against conventional materials like metal, zirconia, and fiber posts."
Response: The revised manuscript now includes a comparative analysis highlighting the strengths and limitations of PEEK versus conventional post materials, emphasizing its clinical relevance.

Comment: "How will studies with unclear risk of bias be handled in the analysis?"
Response: We have specified that studies with an unclear risk of bias will undergo sensitivity analysis, and their influence on the final conclusions will be carefully considered.

Comment: "Clarify how heterogeneity among studies will be addressed in the meta-analysis."
Response: A heterogeneity assessment will be conducted using I² statistics, and subgroup analysis or meta-regression will be applied if significant heterogeneity is detected.

Comment: "Provide more precise definitions of key outcomes."
Response: We have revised the outcomes section to specify assessment methods for bond strength (e.g., push-out tests), fracture resistance, and marginal adaptation quality.

These responses, along with the corresponding revisions, have strengthened our manuscript and improved its clarity. Thank you for your constructive feedback.
Competing Interests: none Close
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COMMENTS ON THIS REPORT

Author Response 06 Feb 2025

Hanen Boukhris, Department of prosthodontics, LR12SP10, University of Monastir, Faculty of Dental Medicine, Monastir, Tunisia

06 Feb 2025

Author Response
We appreciate the reviewers’ valuable feedback, which has helped improve the clarity, depth, and rigor of our manuscript. Below, we provide detailed responses to each comment and indicate the revisions ... Continue reading
We appreciate the reviewers’ valuable feedback, which has helped improve the clarity, depth, and rigor of our manuscript. Below, we provide detailed responses to each comment and indicate the revisions made accordingly.

1.Introduction

Comment: "The introduction should start with PEEK’s material properties, history, and applications before discussing its role in post-and-core restorations."
Response: We have reorganized the introduction to first present PEEK’s chemical composition, mechanical properties, and biomedical applications before focusing on its role in post-and-core restorations. The revised introduction now follows a logical progression, improving the contextual framework of the study.

Comment: "Please provide more details on the different surface treatment techniques of PEEK."
Response: We have expanded the discussion on surface treatments, including plasma treatment, acid etching (98% sulfuric acid), sandblasting (50 μm alumina oxide), laser surface modification, silanization, and air abrasion. These modifications and their rationale are now clearly described.

Comment: "There is limited discussion on the comparative performance of PEEK posts against conventional materials like metal, zirconia, and fiber posts."
Response: The revised manuscript now includes a comparative analysis highlighting the strengths and limitations of PEEK versus conventional post materials, emphasizing its clinical relevance.

Comment: "How will studies with unclear risk of bias be handled in the analysis?"
Response: We have specified that studies with an unclear risk of bias will undergo sensitivity analysis, and their influence on the final conclusions will be carefully considered.

Comment: "Clarify how heterogeneity among studies will be addressed in the meta-analysis."
Response: A heterogeneity assessment will be conducted using I² statistics, and subgroup analysis or meta-regression will be applied if significant heterogeneity is detected.

Comment: "Provide more precise definitions of key outcomes."
Response: We have revised the outcomes section to specify assessment methods for bond strength (e.g., push-out tests), fracture resistance, and marginal adaptation quality.

These responses, along with the corresponding revisions, have strengthened our manuscript and improved its clarity. Thank you for your constructive feedback.
We appreciate the reviewers’ valuable feedback, which has helped improve the clarity, depth, and rigor of our manuscript. Below, we provide detailed responses to each comment and indicate the revisions made accordingly.

1.Introduction

Comment: "The introduction should start with PEEK’s material properties, history, and applications before discussing its role in post-and-core restorations."
Response: We have reorganized the introduction to first present PEEK’s chemical composition, mechanical properties, and biomedical applications before focusing on its role in post-and-core restorations. The revised introduction now follows a logical progression, improving the contextual framework of the study.

Comment: "Please provide more details on the different surface treatment techniques of PEEK."
Response: We have expanded the discussion on surface treatments, including plasma treatment, acid etching (98% sulfuric acid), sandblasting (50 μm alumina oxide), laser surface modification, silanization, and air abrasion. These modifications and their rationale are now clearly described.

Comment: "There is limited discussion on the comparative performance of PEEK posts against conventional materials like metal, zirconia, and fiber posts."
Response: The revised manuscript now includes a comparative analysis highlighting the strengths and limitations of PEEK versus conventional post materials, emphasizing its clinical relevance.

Comment: "How will studies with unclear risk of bias be handled in the analysis?"
Response: We have specified that studies with an unclear risk of bias will undergo sensitivity analysis, and their influence on the final conclusions will be carefully considered.

Comment: "Clarify how heterogeneity among studies will be addressed in the meta-analysis."
Response: A heterogeneity assessment will be conducted using I² statistics, and subgroup analysis or meta-regression will be applied if significant heterogeneity is detected.

Comment: "Provide more precise definitions of key outcomes."
Response: We have revised the outcomes section to specify assessment methods for bond strength (e.g., push-out tests), fracture resistance, and marginal adaptation quality.

These responses, along with the corresponding revisions, have strengthened our manuscript and improved its clarity. Thank you for your constructive feedback.
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Version 3

VERSION 3 PUBLISHED 22 Aug 2024

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	1	2	3	4
Version 3 (revision) 03 Apr 25			read	read
Version 2 (revision) 06 Feb 25		read	read
Version 1 22 Aug 24	read

Marwa Emam, Ain Shams University,, , Cairo, Egypt
Noha Taymour, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Retno Ardhani, Universitas Gadjah Mada, Jalan, Indonesia
Marwa M Wahsh, Faculty of dentistry at Ainshams University, Cairo, Egypt; Galala University (Ringgold ID: 577705), Suez, Egypt

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Reviewer Report

4 Views

25 Apr 2025 | for Version 3

Marwa M Wahsh, Fixed Prosthodontics, Faculty of dentistry at Ainshams University, Cairo, Egypt; Prosthodontics, Galala University (Ringgold ID: 577705), Suez, Suez Governorate, Egypt

4 Views Cite this report Responses(0)

Approved

First, I would thank the Editorial Team, F1000Research, for the invitation to peer review this protocol. Next, I would like to express my appreciation for the authors’ efforts in presenting this systematic review plan.
Overall view:
This systematic review protocol aims to evaluate the effectiveness of different surface treatments to improve the bond strength of polyetheretherketone (PEEK) posts, which are increasingly used in dental restorations due to their high biocompatibility and mechanical properties. The authors focus on PEEK's inherent challenges—low surface energy and hydrophobicity—and propose a comprehensive analysis of surface treatment techniques, including acid etching, sandblasting, plasma treatment, and newer nanotechnology-based coatings. The protocol adheres to PRISMA guidelines and is registered in PROSPERO (CRD42024529783), ensuring methodological transparency.

Objectives:

Clear objectives.

Methodology:

The protocol includes comprehensive search through multiple databases (PubMed, Scopus, Cochrane, EMBASE, etc.) in addition to clinical trials.
The inclusion criteria are clear, the PICOS framework is appropriately applied. However, the exclusion criteria need to be specific.
The protocol clarifies how inconsistencies between in vitro and clinical data will be reconciled, which will make data interpretation more valid.
The clinical feasibility for using sulfuric acid as a surface treatment is debated due to toxicity risks.

Clinical significance:
The review can be a reference for clinicians to select appropriate surface treatments for different settings, e.g. sulfuric acid etching may be limited for non-clinical settings due to safety concerns, while other alternatives can be used more safely.
Final Recommendation:
This systematic review protocol addresses an applicable and clinically relevant question in restorative dentistry. Clinicians should expect the finalized review to provide evidence-based decisions, in addition researchers can use its findings to design new studies on under investigated treatments.
Future research should prioritize clinical trials comparing long-term performance of surface treatments and safer alternatives to corrosive agents like sulfuric acid.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Fixed prosthodontics- adhesion- ceramics- esthetics- color science

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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3 Views

18 Apr 2025 | for Version 3

Retno Ardhani, Universitas Gadjah Mada, Jalan, Indonesia

3 Views Cite this report Responses(0)

Approved

I acknowledge the author's effort to revise, thus increasing the clarity of the work. Vital points were well addressed and explained.

Competing Interests

No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

5 Views

22 Mar 2025 | for Version 2

Retno Ardhani, Universitas Gadjah Mada, Jalan, Indonesia

5 Views Cite this report Responses(0)

Not Approved

The study protocol is confirmed to be registered in the PROSPERO database. The aims of the study are clearly stated and supported by a proper study design. However, the lack of clarity to ensure study replicability is found. Please consider including (and confirm):
1. The applied keywords combination and what the Boolean operator used.
2. Does the combination apply to all databases?
3. Are there any exclusion criteria applied?
4. Graphical description to resume overall steps and selection criteria applied.
5. Do you also consider the variability of the resin-based cement material composition used in the research since it also influences adhesion between a post and adhesive cement? How do you manage this variation in your study?
6. Units that are bound to each parameter/outcome to ensure comparability. For example, how is the post-operative sensitivity evaluated? Is there any specific scale employed?
7. In this study, various surface modifications will be compared. However, modification on each surface treatment has the potential to result in different surfaces; for example, plasma treatment can be performed using various chemicals, or there are time and particle size modifications for sandblasting. How do you manage this variation?
Thank you.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Biomedical, Regenerative Therapy, Polymer, Surface Treatment

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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11 Views

24 Feb 2025 | for Version 2

Noha Taymour, Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

11 Views Cite this report Responses(1)

Approved With Reservations

I would like to thank the authors for their meticulous effort in developing this comprehensive protocol. This systematic review is particularly important as it aims to establish evidence on surface treatment techniques, offering insights that could lead to standardized protocols and improved clinical outcomes. The findings have the potential to bridge gaps in current knowledge and guide clinicians in selecting effective bonding strategies for PEEK posts, ultimately enhancing patient care and restoration longevity. Some points need to be addressed to ensure clarity and reliability of results
1-   The PROSPERO registration number in the abstract (CRD42024529783) conflicts with the protocol section (CRD42024531175).
2-   The introduction overlaps with the abstract’s background section. Streamline to avoid duplication.
3-   Please provide more comprehensive introduction with focus on the latest surface treatment for posts bonding.
4-   Each statement should be supported by evidence based reference. Please try to merge multiple sentences into one comprehensive paragraph.
5-   The inclusion criteria mention "patients requiring dental restoration," yet bond strength is often tested in vitro. Revise the PICOS framework to state whether in vitro, in vivo, and clinical studies are all eligible. If so, justify how heterogeneity between study types will be managed.
6-   Please Provide a rationale for excluding patients with certain conditions. For example, explain how these factors might confound bonding outcomes.
7-   The protocol lacks specific keywords/MeSH terms used. Please include a sample search string in the protocol to demonstrate how terms like "PEEK," "surface treatment," and "bond strength" will be combined.
8-   There is no mention of whether non-English studies will be included or excluded.
9-   Address how outcomes like "post-operative sensitivity" will be handled if absent in in vitro studies. Specify whether such outcomes are secondary or exploratory.
10-   While PROSPERO registration is noted, ethical considerations regarding patient data from included studies are not addressed. The authors could include a statement about ensuring ethical compliance in included studies.
11-   No discussion is provided on how this review differs from or builds upon existing systematic reviews on PEEK bonding.
12-   I would suggest including newer surface treatments like nanotechnology-based coatings or bioactive materials to ensure relevance to advancing dental practices.
13-   Standardize Outcome Reporting: for example (MPa for bond strength) to improve comparability across studies.
14-   Acknowledge in the study design the potential challenges in data findings from in vitro vs. in vivo studies and propose strategies to mitigate them.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Prosthodontics, Dental Implants, Polymers, Ceramics, Esthetic Dentistry, Digital Dentistry

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Author Response

03 Apr 2025

Hanen Boukhris, Department of prosthodontics, LR12SP10, University of Monastir, Faculty of Dental Medicine, Monastir, Tunisia

We sincerely appreciate the reviewers' thorough and insightful evaluation of our work. Their constructive feedback has been invaluable in refining the study and strengthening its overall quality.

In response, we have carefully addressed each concern, ensuring consistency in PROSPERO registration, refining the introduction to enhance clarity and conciseness, and reinforcing the methodology to improve robustness. We have also provided additional clarifications on inclusion criteria, search strategies, and ethical considerations, thereby enhancing transparency and reliability. Furthermore, we have incorporated the latest advancements in surface treatment techniques, ensuring that the study remains relevant to current scientific and clinical practices. Standardizing outcome metrics, particularly in bond strength measurement, further improves the study's comparability and applicability.

We believe these enhancements significantly contribute to the rigor and impact of our work. We remain open to any further recommendations and greatly value the reviewers' expertise and insights in advancing the quality of this research.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

12 Views

18 Sep 2024 | for Version 1

Marwa Emam, Ain Shams University,, , Cairo, Egypt

12 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Fixed prosthodontics, implant, occlusion, ceramics, dental materials, esthetics, digital dentistry.

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Responses (1)

Author Response

06 Feb 2025

Hanen Boukhris, Department of prosthodontics, LR12SP10, University of Monastir, Faculty of Dental Medicine, Monastir, Tunisia

We appreciate the reviewers’ valuable feedback, which has helped improve the clarity, depth, and rigor of our manuscript. Below, we provide detailed responses to each comment and indicate the revisions made accordingly.

1.Introduction

Comment: "The introduction should start with PEEK’s material properties, history, and applications before discussing its role in post-and-core restorations."
Response: We have reorganized the introduction to first present PEEK’s chemical composition, mechanical properties, and biomedical applications before focusing on its role in post-and-core restorations. The revised introduction now follows a logical progression, improving the contextual framework of the study.
Comment: "Please provide more details on the different surface treatment techniques of PEEK."
Response: We have expanded the discussion on surface treatments, including plasma treatment, acid etching (98% sulfuric acid), sandblasting (50 μm alumina oxide), laser surface modification, silanization, and air abrasion. These modifications and their rationale are now clearly described.
Comment: "There is limited discussion on the comparative performance of PEEK posts against conventional materials like metal, zirconia, and fiber posts."
Response: The revised manuscript now includes a comparative analysis highlighting the strengths and limitations of PEEK versus conventional post materials, emphasizing its clinical relevance.

Comment: "How will studies with unclear risk of bias be handled in the analysis?"
Response: We have specified that studies with an unclear risk of bias will undergo sensitivity analysis, and their influence on the final conclusions will be carefully considered.
Comment: "Clarify how heterogeneity among studies will be addressed in the meta-analysis."
Response: A heterogeneity assessment will be conducted using I² statistics, and subgroup analysis or meta-regression will be applied if significant heterogeneity is detected.
Comment: "Provide more precise definitions of key outcomes."
Response: We have revised the outcomes section to specify assessment methods for bond strength (e.g., push-out tests), fracture resistance, and marginal adaptation quality.

These responses, along with the corresponding revisions, have strengthened our manuscript and improved its clarity. Thank you for your constructive feedback.

View more View less

Competing Interests

none

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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The effect of surface treatments on the bond strength of polyetheretherketone posts: a systematic review protocol

Abstract

Abstract*

Background

Methods

Discussion

Systematic review registration

Keywords

Introduction

Protocol

Methods

Objectives

Inclusion criteria

Search strategy

Study selection

Evaluation of methodological quality and risk of bias

Extraction of data

Analysis and synthesis of data

Discussion

Ethics and dissemination

Study status

Data availability

Reporting guidelines

References

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