Biomechanical and Biological Behavior of Zirconium-Reinforced Polyether-Ether-Ketone (Biohpp®) Prosthetic Applications: A Systematic Review

Abstract

Background/Objectives: The development of high-performance biocompatible polymers such as zirconium-reinforced polyether ether ketone (BioHPP®) has expanded the range of materials available for implant-supported prostheses, traditionally limited to metal alloys and zirconia. Due to its favorable mechanical properties and elastic modulus similar to cortical bone, BioHPP® has been proposed as a potential alternative in implant prosthodontics. This systematic review aimed to analyze the biomechanical behavior of zirconium-reinforced PEEK and assess its advantages and limitations in implant prosthetic applications. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines, including studies published between 2011 and 2025 that evaluated the performance of BioHPP in implant prosthetic applications. Results: The search strategy identified 34 studies that met the inclusion criteria. The included studies evaluated mechanical properties such as fracture resistance, elastic modulus, stress distribution, and peri-implant tissue response. Zirconium-reinforced PEEK demonstrated fracture resistance values reaching up to 1623.31 N and an elastic modulus of approximately 4 GPa, comparable to cortical bone. Several studies also reported favorable stress distribution patterns and reduced mechanical complications when compared with conventional metallic materials. Conclusions: Zirconium-reinforced PEEK exhibits promising biomechanical characteristics for use in implant-supported prostheses, particularly due to its fracture resistance and bone-like elastic modulus. However, the available evidence is predominantly based on in vitro and finite element studies. Long-term clinical trials are required to confirm its clinical performance and establish definitive recommendations for routine use.