Key Takeaways & Executive Findings
- •• PEEK has become a preferred material for skull defect repair, with global clinical applications exceeding 200,000 cases and an infection rate of 3.7%, significantly lower than PMMA (9.2%). • The field has evolved through three stages: traditional materials (2009-2014), clinical research (2015-2019), and 3D printing/finite element analysis (2020-2024), with the latest stage accounting for 42% of publications. • China, the United States, and Germany are the leading contributors, together accounting for over 75% of the literature, but China's research is predominantly clinical (68%) with limited basic innovation (15%). • The research focus has shifted from passive repair to active bioactivity promotion, with 3D printing, surface modification, and intelligent integration as core directions, and conductive PEEK is predicted to accelerate translation by 2026-2027.
Abstract
BACKGROUND: Polyetheretherketone (PEEK) synthetic material has become one of the preferred materials for repairing skull defects due to its low density, high strength, good toughness, excellent processing performance, and good biocompatibility, but there are few bibliometric analyses of PEEK for skull repair. OBJECTIVE: To explore the overall research trends, development context, research focuses, and hotspots of PEEK materials in the field of international skull defect repair using bibliometric methods. METHODS: The Web of Science Core Collection database was systematically searched for literature on PEEK materials for skull defect repair published from 1995 to 2024. On this basis, bibliometric methods were used to conduct quantitative statistics and visual analysis from the aspects of temporal dynamics of publication volume, country/region contribution, core research institution cooperation network, highly cited papers, high-yield journals, and keyword co-occurrence. RESULTS AND CONCLUSION: This study analyzed 105 studies on PEEK for skull defect repair published from 2009 to 2024. The development process was roughly divided into three stages: 2009-2014 traditional materials, 2015-2019 clinical research on PEEK, and 2020-2024 3D printing and finite element analysis, with the 2020-2024 stage accounting for 42%. Meanwhile, "3D printing, finite element analysis" and "PEEK, titanium alloy" were high-frequency technology combinations. China (21 articles), the United States (17 articles), and Germany (12 articles) were the main research countries. PEEK has been used in more than 200,000 clinical applications worldwide, with an infection rate of 3.7%, lower than that of polymethyl methacrylate (9.2%). PEEK research has shifted from "passive repair" to "active bioactivity promotion". Europe and the United States lead in clinical translation of 3D printing (equipment rate 82%, while China's domestic rate is 39%), but there is a lag of about 2 years between literature and clinical application for 3D-printed PEEK. It is predicted that conductive PEEK will accelerate translation in 2026-2027. The results indicate that PEEK has achieved a transformation from "passive repair" to "active bioactivity promotion", with 3D printing, surface modification, and intelligent integration as core directions. Global PEEK development is uneven; underdeveloped regions have high demand but less research (12%). China focuses on clinical research (68%) but lacks basic innovation (15%). It is necessary to promote low-cost 3D printing technology, establish translation hubs, support interdisciplinary research teams, and build a 10-year multicenter follow-up system.
1. Introduction
Skull defect repair technology has undergone a paradigm shift from autologous bone grafting to synthetic materials. Polyetheretherketone (PEEK), with its elastic modulus close to cortical bone (3.0-4.0 GPa) [1], radiolucency, and potential for personalized shaping [2], has gradually become an innovative alternative to titanium alloys. In the field of artificial materials, besides traditional titanium alloys and polymethyl methacrylate (PMMA), PEEK has gained attention in recent years as a new material with biomechanical properties closer to autologous bone [3]. Chen Zhiqian et al. [4] pointed out in a review that PEEK has good compatibility and a low risk of rejection. Clinical evidence shows that the infection rate of PEEK implants (approximately 3.7%) is significantly lower than that of PMMA (9.2%) [5-8]. However, PEEK still has limitations in long-term osseointegration and dynamic stress response, which urgently need to be overcome.
This field exhibits dual characteristics of technological fragmentation (biological modification, manufacturing processes, and clinical evaluation advancing independently) and regional imbalance (China, the United States, and Germany contributing more than 75% of the literature), necessitating systematic bibliometric analysis to integrate the knowledge map.
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ZHANG Zhanyue, ZHAO Lijun, ZHANG Chunyang, ZHANG Zhongqi, FU Kang, ZHANG Zhihong (2026). Application and development of polyetheretherketone material in skull defect repair. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21604
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Frequently Asked Questions
What is the infection rate of PEEK implants compared to PMMA?
The infection rate of PEEK implants is approximately 3.7%, which is significantly lower than that of PMMA at 9.2%.
Which countries are the main contributors to PEEK skull repair research?
China (21 articles), the United States (17 articles), and Germany (12 articles) are the main research countries, together accounting for over 75% of the literature.
What are the key technological combinations in PEEK skull repair research?
High-frequency technology combinations include '3D printing, finite element analysis' and 'PEEK, titanium alloy'.
What is the predicted timeline for conductive PEEK translation?
It is predicted that conductive PEEK will accelerate translation in 2026-2027.
What are the main research directions for PEEK in skull repair?
The core directions are 3D printing, surface modification, and intelligent integration, with a shift from passive repair to active bioactivity promotion.
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