{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T02:55:21Z","timestamp":1785466521178,"version":"3.56.0"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CMTR"],"abstract":"<jats:p>Maxillofacial skeletal reconstruction presents significant challenges due to anatomical complexity, functional requirements, and aesthetic demands. Traditional materials such as titanium and autogenous bone grafts have limitations, prompting interest in Polyetheretherketone (PEEK), a versatile thermoplastic polymer with advantages like biocompatibility, radiolucency, and elasticity similar to human bone. This multi-year case series evaluates the clinical outcomes of PEEK implants used in 56 cases on 53 patients for maxillofacial reconstruction, primarily for trauma (44 patients) and deformity (9 patients). PEEK implants were applied to various facial regions including the orbit, zygoma, mandible, and maxilla. The majority of surgeries utilised virtual surgical planning. Patient-specific implants were fabricated using 3D imaging technologies, allowing customisation for optimal fit and functionality. The mean patient age was 37 years with a split of 37 to 16 females. Some complications were noted such as infection and paraesthesia. However, the majority of patients experienced positive outcomes. The findings support PEEK implants as a safe, effective, and adaptable material for maxillofacial surgery, with potential for further advancements in material properties and surgical technologies to improve long-term outcomes.<\/jats:p>","DOI":"10.3390\/cmtr19010008","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:59:54Z","timestamp":1769003994000},"page":"8","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Over a Decade of Maxillofacial PEEK Patient-Specific Innovation: A Retrospective Review of the Evolution from In-House Craft to Virtual Design and Remote Manufacturing"],"prefix":"10.3390","volume":"19","author":[{"given":"Nicholas J.","family":"Lee","sequence":"first","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Broomhall, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth","family":"Honeybone","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Broomhall, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2295-7853","authenticated-orcid":false,"given":"Mohammed","family":"Anabtawi","sequence":"additional","affiliation":[{"name":"Leeds Hospitals NHS Trust, Great George St, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew","family":"Thomas","sequence":"additional","affiliation":[{"name":"University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3NE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5682-4987","authenticated-orcid":false,"given":"Sachin M.","family":"Salvi","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Broomhall, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1016\/j.jcms.2015.06.043","article-title":"Primary and secondary reconstruction of complex craniofacial defects using polyetheretherketone custom-made implants","volume":"43","author":"Gerbino","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.ijom.2016.01.019","article-title":"Interlocking polyetheretherketone implant","volume":"45","author":"Thomas","year":"2016","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"20","DOI":"10.3109\/01676830.2015.1099691","article-title":"Digital import of orbital implants to enhance navigation in reconstruction of the deep orbit","volume":"35","author":"Varley","year":"2015","journal-title":"Orbit"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1145.e1","DOI":"10.1016\/j.joms.2020.12.009","article-title":"The use of interlocking polyetheretherketone (PEEK) patient-specific facial implants in the treatment of facial deformities. A retrospective review of Ten patients","volume":"79","author":"Anabtawi","year":"2021","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_5","first-page":"e349","article-title":"Properties of polyetheretheretherketone (PEEK) implant abutments: A systematic review","volume":"14","year":"2022","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.4103\/0976-237X.96824","article-title":"Reliability of natural head position in orthodontic diagnosis: A cephalometric study","volume":"3","author":"Bansal","year":"2012","journal-title":"Contemp. Clin. Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1016\/j.joms.2015.06.026","article-title":"Patient specific implants: Reconstruction of orbital defects with custom peek implants","volume":"73","author":"Weaver","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S39","DOI":"10.1016\/j.bjoms.2012.04.249","article-title":"Uses of Peek in maxillofacial reconstruction: A 6 year review of cases","volume":"50","author":"Abdullakutty","year":"2012","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1016\/j.jcms.2015.04.028","article-title":"Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature","volume":"43","author":"Nieto","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jcms.2010.10.003","article-title":"A treatment algorithm for patients with large skull bone defects and first results","volume":"39","author":"Lethaus","year":"2011","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1002\/ppap.201100034","article-title":"Cell adhesion to peek treated by plasma immersion ion implantation and deposition for active medical implants","volume":"9","author":"Awaja","year":"2012","journal-title":"Plasma Process. Polym."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.wneu.2014.06.003","article-title":"Comparison of polyetheretherketone and titanium cranioplasty after decompressive craniectomy","volume":"83","author":"Thien","year":"2015","journal-title":"World Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/01.scs.0000249359.56417.7e","article-title":"Complex orbito-fronto-temporal reconstruction using computer-designed Peek Implant","volume":"18","author":"Scolozzi","year":"2007","journal-title":"J. Craniofacial Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.bjoms.2013.09.011","article-title":"Cone beam computed tomography for imaging orbital trauma\u2014Image quality and radiation dose compared with conventional multislice computed tomography","volume":"52","author":"Brisco","year":"2014","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ijom.2017.02.739","article-title":"Correction of facial deformity with bespoke patient-specific polyetheretherketone implant: In-house manufacturing to Virtual Planning and navigational technology","volume":"46","author":"Thomas","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.bjoms.2025.07.002","article-title":"PEEK-on-PEEK orbital implantation: A secondary augmentation approach for delayed Enophthalmos","volume":"63","author":"Amoura","year":"2025","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.bjoms.2011.04.077","article-title":"Use of two-piece polyetheretherketone (PEEK) implants in orbitozygomatic reconstruction","volume":"50","author":"Goodson","year":"2012","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.jcms.2016.07.005","article-title":"Outcome in patient-specific peek cranioplasty: A two-center cohort study of 40 implants","volume":"44","author":"Jonkergouw","year":"2016","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1227\/NEU.0000000000000477","article-title":"Polyetheretherketone implants for the repair of large cranial defects","volume":"75","author":"Rosenthal","year":"2014","journal-title":"Neurosurgery"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kwarcinski, J., Boughton, P., Ruys, A., Doolan, A., and Van Gelder, J. (2017). Cranioplasty and Craniofacial Reconstruction: A review of implant material, manufacturing method and Infection Risk. Appl. Sci., 7.","DOI":"10.3390\/app7030276"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1002\/cre2.205","article-title":"Biofilm formation on polyetheretherketone and titanium surfaces","volume":"5","author":"Barkarmo","year":"2019","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"37","DOI":"10.22203\/eCM.v008a05","article-title":"Concise review of mechanisms of bacterial adhesion to biomaterials and of techniques used in estimating bacteria-material interactions","volume":"8","author":"Katsikogianni","year":"2004","journal-title":"Eur. Cell Mater."},{"key":"ref_23","first-page":"301","article-title":"Influence of topography and hydrophilicity on initial oral biofilm formation on microstructured titanium surfaces in vitro","volume":"23","author":"Wieland","year":"2011","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.fsc.2007.09.001","article-title":"Custom-designed facial implants","volume":"16","author":"Binder","year":"2008","journal-title":"Facial Plast. Surg. Clin. N. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/j.jcms.2019.03.018","article-title":"The use of patient specific polyetheretherketone implants for reconstruction of maxillofacial deformities","volume":"47","author":"Suojanen","year":"2019","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1001\/archfaci.11.1.53","article-title":"Use of customized polyetheretherketone (PEEK) implants in the reconstruction of complex maxillofacial defects","volume":"11","author":"Kim","year":"2009","journal-title":"Arch. Facial Plast. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1016\/j.bjoms.2018.10.067","article-title":"Long term follow-up of patients with peek onlay implants in the maxillofacial region\u2014The east grinstead experience and a review of literature","volume":"56","author":"Garg","year":"2018","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e85","DOI":"10.1016\/j.bjoms.2017.08.358","article-title":"Custom-made facial onlay implants: Our experience of 50 consecutive cases","volume":"55","author":"Collier","year":"2017","journal-title":"Br. J. Oral Maxillofac. 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