{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T09:23:59Z","timestamp":1787045039772,"version":"build-2736575974"},"update-to":[{"DOI":"10.12688\/f1000research.150799.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000}}],"reference-count":23,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5:p>Background The \u201call-on-four\u201d concept represents a significant advancement in dental implantology. particularly beneficial in cases of extensive jaw bone loss where invasive bone regeneration procedures are typically required. However, the successful implementation of this technique necessitates meticulous planning concerning implant selection, materials, and prosthesis design. The recent introduction of PEEK (Polyetheretherketone) in dentistry, especially in all-on-four prosthetics, prompts questions regarding its clinical efficacy and comparative biomechanical and biological advantages over conventional materials such as titanium and zirconia. While some studies have compared PEEK with other materials, systematic reviews evaluating its efficacy are scarce. This systematic review protocol intends to assess the evidence regarding the viability of PEEK as a potential alternative within the all-on-four approach in dental implantology. Methods This systematic review protocol will adhere to the Cochrane Handbook for Systematic Review of Interventions and align with the Methodological Expectations of the Cochrane Intervention Reviews (MECIR) guidelines. Utilizing a comprehensive search strategy, multiple databases, including PubMed, EMBASE, Scopus, EBSCO, Web of Science, Cochrane Central, and registries of clinical trials, will be explored. The search aims to identify randomized controlled trials and non-randomized studies investigating the application of PEEK in the all-on-four approach for dental procedures. Emphasizing clinically relevant outcomes such as implant survival, prosthesis success, peri-implant complications, and patient satisfaction, this review aims to provide insights into the effectiveness and potential benefits of using PEEK in all-on-four prosthetics. Non-randomized studies will be assessed for bias using ROBINS-I, while randomized controlled trials will undergo evaluation with the Cochrane Risk of Bias assessment tool, ROB II. Discussion The outcomes derived from this systematic review hold great significance for dental practitioners exploring the all-on-four concept. Understanding PEEK\u2019s advantages and limitations compared to titanium and zirconia facilitates tailored treatment plans, enhancing success and satisfaction, ultimately improving dental care quality. Systematic review registration PROSPERO: CRD42024531175 (Registered on 13\/04\/2024).<\/ns5:p>","DOI":"10.12688\/f1000research.150799.2","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T11:05:07Z","timestamp":1738235107000},"page":"507","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes of Polyetheretherketone (PEEK) Hybrid Prosthesis in All-on-Four Rehabilitation: A Systematic Review Protocol"],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7574-1872","authenticated-orcid":false,"given":"Hanen","family":"Boukhris","sequence":"first","affiliation":[{"name":"faculty of dental medicine-department of prosthodontics-LR12SP10 Monastir Monastir 4000 University of Monastir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayet","family":"Hajjami","sequence":"additional","affiliation":[{"name":"faculty of dental medicine-department of prosthodontics-LR12SP10 Monastir Monastir 4000 University of Monastir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6568-9425","authenticated-orcid":false,"given":"Souha","family":"Ben youssef","sequence":"additional","affiliation":[{"name":"Faculty of dental medicine, department of oral surgery, LR12SP10 Monastir Monastir 4000 University of Monastir"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.33448\/rsd-v9i11.10632","article-title":"Indications, materials and properties of 3D printing in dentistry: a literature overview.","volume":"9","author":"L Arcila","year":"2020","journal-title":"ResSocDev."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"331-338","DOI":"10.1007\/s10266-019-00441-7","article-title":"An update on applications of 3D printing technologies used for processing polymers used in implant dentistry.","volume":"108","author":"M Revilla-Le\u00f3n","year":"2020","journal-title":"Odontology."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"30-40","DOI":"10.2341\/18-229-L","article-title":"3D printing in dentistry-state of the art.","volume":"45","author":"A Kessler","year":"2020","journal-title":"Oper. Dent."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"103957","DOI":"10.1016\/j.jmbbm.2020.103957","article-title":"Fatigue behavior and damage modes of high performance poly-ether-ketone-ketone PEKK bilayered crowns.","volume":"110","author":"O Alsadon","year":"2020","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"9264-9277","DOI":"10.1016\/j.biomaterials.2013.08.071","article-title":"Cytocompatibility, osseointegration, and bioactivity of three-dimensional porous and nanostructured network on polyetheretherketone.","volume":"34","author":"Y Zhao","year":"2013","journal-title":"Biomaterials."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"106-112","DOI":"10.1016\/j.jpor.2016.07.005","article-title":"Three-dimensional analysis of marginal and internal fit of copings fabricated with polyetherketoneketone (PEKK) and zirconia.","volume":"61","author":"S Bae","year":"2017","journal-title":"J. Prosthodont. Res."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"867-872","DOI":"10.1016\/j.prosdent.2017.09.008","article-title":"Polyetherketoneketone (PEKK), a framework material for complete fixed and removable dental prostheses: a clinical report.","volume":"119","author":"J Dawson","year":"2018","journal-title":"J. Prosthet. Dent."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"692-702","DOI":"10.1111\/cid.12662","article-title":"Short-term report of an ongoing prospective cohort study evaluating the outcome of full-arch implant-supported fixed hybrid polyetheretherketone-acrylic resin prostheses and the All-on-Four concept.","volume":"20","author":"P Mal\u00f3","year":"2018","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref9","first-page":"1033-1040","article-title":"Maxillary and mandibular all-on-four implant designs: a review.","volume":"22","author":"R Durkan","year":"2019","journal-title":"Niger. J. Clin. Pract."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"715-725","DOI":"10.1016\/j.msec.2016.07.059","article-title":"Comparison between all-on-four and all-on-six treatment concepts and framework material on stress distribution in atrophic maxilla: a prototyping guided 3D-FEA study.","volume":"69","author":"C Bhering","year":"2016","journal-title":"Mater. Sci. Eng. C."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"581-585","DOI":"10.11607\/ijp.5369","article-title":"Comparative evaluation of a four-implant-supported polyetherketoneketone framework prosthesis: a three-dimensional finite element analysis based on cone beam computed tomography and computer-aided design.","volume":"30","author":"K Lee","year":"2017","journal-title":"Int. J. Prosthodont."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1078-1086","DOI":"10.1111\/clr.13654","article-title":"Biofilm formation on metal alloys, zirconia and polyetherketoneketone as implant materials in vivo.","volume":"31","author":"B Zeller","year":"2020","journal-title":"Clin. Oral Implants Res."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"92-99","DOI":"10.1016\/j.msec.2013.10.022","article-title":"The role of superstructure material on the stress distribution in mandibular full-arch implant-supported fixed dentures. A CT-based 3D-FEA.","volume":"35","author":"M Ferreira","year":"2014","journal-title":"Mater. Sci. Eng. 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We appreciate your careful consideration of the manuscript and your insightful comments, which will help improve the clarity and precision of the report. Below, we address each of your reservations:  \n<b>Clarity of English Language:<\/b>  We recognize the importance of clear and concise language in scientific writing. We will thoroughly revise the manuscript to improve the flow and readability, ensuring that sentences are more straightforward and easier to follow. A native English speaker will assist with the final editing to enhance the language quality further.   \n<b>Introduction Section:<\/b>  \n<b>In vivo vs. In vitro studies:<\/b> We understand the need for clarification regarding the inclusion criteria for in vivo studies. We will revise the introduction to explicitly state that only in vivo studies will be included in the review, as outcomes cannot be effectively evaluated through in vitro studies. \n<b>Focus on Implant Dentistry:<\/b> We acknowledge that the introduction should primarily focus on implant dentistry rather than 3D printing manufacturing. The first sentences will be rephrased to center on available dental materials for CAD\/CAM manufacturing, as this aligns better with the focus of the review. \n<b>PEKK Mention:<\/b> We will remove the mention of PEKK from the introduction as it will not be part of the review, streamlining the discussion. \n<b>Material Composition and Properties:<\/b> We agree with your suggestion to include a brief mention of PEEK's composition and its relevant properties in the introduction. This information will be incorporated to provide a better context for readers.   \n<b>Comparison of PMMA with PEEK:<\/b>  We acknowledge that PMMA is primarily a provisional material, and comparing it with PEEK may not be entirely appropriate. In light of this, we will revise the text to focus more on titanium and Co-Cr alloys as the gold standard materials for all-on-four prosthetics. Additionally, we will highlight the clinical advantages that zirconia and PEEK bring to the outcomes of such treatments.   \n<b>Objectives (Primary Objectives):<\/b>  \n<b>Inclusion of Base Metals:<\/b> We will consider incorporating base metals into the review, as their inclusion may provide a more comprehensive comparison. This will be reflected in the revised primary objectives. \n<b>Outcome Measures and Aesthetic Success:<\/b> We will provide clearer details on how each outcome will be measured, including the evaluation of aesthetic success, which is crucial for patient satisfaction and clinical outcomes.   \n<b>Eligibility Criteria:<\/b>  \n<b>Clarification of &quot;Success&quot; vs. &quot;Survival&quot;:<\/b> We will ensure that the terms &quot;success&quot; and &quot;survival&quot; are clearly defined and not used interchangeably. The manuscript will specify how each outcome is measured, distinguishing between these two concepts.   \n<b>Measures of Effect:<\/b>  We will revise the manuscript to clearly define the methods used to assess each outcome, including the rationale behind the selection of these measures. The objectives of the study will be more explicitly stated to ensure clarity.   \n<b>Study Design Appropriateness:<\/b>  We will revisit the study design section and provide a more thorough explanation of why the chosen design is appropriate for addressing the research question, ensuring that all methodological details align with the objectives of the review.    We believe that these revisions will strengthen the manuscript and enhance its clarity and precision. Once again, we appreciate your constructive feedback, and we are confident that the revised version will meet your expectations. Sincerely,","URL":"https:\/\/f1000research.com\/articles\/13-507\/v2#referee-comment-13165","order":2,"name":"referee-comment-13165","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.177496.r423867, Omid Panahi, Centro Escolar University, Manila, Metro Manila, 18 Aug 2026, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-507\/v2#referee-response-423867","order":3,"name":"referee-response-423867","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}