|Articles about Biomaterials|
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| Differential gene expression after implantation of biomaterials into rat gastrointestine
Lobler, M., M. Sass, et al. (1999), J Mater Sci Mater Med 10(12): 797-9.
Abstract: Two biodegradable materials, polyglycolide-copoly(L)-lactide/poly-dioxanone composite and poly(3-hydroxybutyrate), have been employed for surgery in the gastrointestine of laboratory rats. The tissue response was analyzed at distinct time intervals up to 2 months by differential mRNA display. Two specific PCR fragments were transiently present 7 and 14 days after contact with poly(3-hydroxybutyrate). Both fragments represent distinct rat lipases which might play a role in poly(3-hydroxybutyrate) degradation.
| Differential growth factor retention by platelet-rich plasma composites
Tsay, R. C., J. Vo, et al. (2005), J Oral Maxillofac Surg 63(4): 521-8.
Abstract: PURPOSE: This study evaluates the temporal sequence and growth factor release from platelet-rich plasma (PRP) combined with different bone substitutes (BS), to identify an optimal substrate for extended growth factor retention. MATERIALS AND METHODS: PRP was clotted with bovine thrombin or thrombin receptor activator peptide-6 (TRAP). In addition, PRP was clotted using Allogro (Ceramed, Lakewood, CO), BioGlass (Mo-Sci, Rolla, MN), or BioOss (Osteohealth, Shirley, NY). The effects of media exchange and BS on platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF beta) release were quantified via enzyme-linked immunosorbent assay. RESULTS: At day 1, the thrombin group released 36% more PDGF than the TRAP group and 80% more than the BS groups. At 7 days, PDGF release was the greatest for the TRAP group. PDGF release was minimal for all groups at day 14, with BS groups retaining 60% more PDGF than thrombin clots. Similarly, the thrombin group released the greatest amount of TGF beta (81.4% of the total), whereas TRAP and BS groups released significantly less TGF beta at day 1. Compared with thrombin, TRAP retained 39.2% more TGF beta, whereas BS groups retained even greater levels (Allogro, 54.3%; BioOss, 45.8%; BioGlass, 67.0%). No significant difference in TGF beta release was observed among the substitutes after day 1. The BS groups continued to retain TGF beta after 14 days, whereas all TGF beta in the thrombin clots was depleted. CONCLUSIONS: PRP preparation with thrombin results in a large, immediate release of growth factors that could be lost into the interstitium in vivo. TRAP-BS may prove more efficacious than thrombin in sustaining growth factor levels critical for the cascade of events leading to bone formation.
| Differential levels of dendritic cell maturation on different biomaterials used in combination products
Babensee, J. E. and A. Paranjpe (2005), J Biomed Mater Res A 74(4): 503-10.
Abstract: Immature dendritic cells (iDCs) were derived from human peripheral blood monocytes, and treated with films of biomaterials commonly used in combination products (e.g., tissue engineered constructs or vaccines) to assess the resultant dendritic cell (DC) maturation compared to positive control of lipopolysaccharide (LPS) treatment for DC maturation or negative control of untreated iDCs. The following biomaterials were tested: alginate, agarose, chitosan, hyaluronic acid, 75:25 poly(lactic-co-glycolic acid) (PLGA). The effect of DC culture on these films was undertaken to identify biomaterials which support DC maturation and those biomaterials that did not. Dendritic cells treated with chitosan or PLGA (agarose to a lesser extent) films increased expression levels of CD86, CD40, and HLA-DQ, compared to control iDCs, similar to LPS-matured DCs, whereas DCs treated with alginate or hyaluronic acid films decreased their expression levels of these same molecules. In summary, a differential effect of the biomaterial on which iDCs were cultured was observed as far as the extent of induced DC maturation. The effect of biomaterials on DC maturation, and the associated adjuvant effect, is a novel biocompatibility selection and design criteria for biomaterials to be used in combination products in which immune consequences are potential complications or outcomes.
| Differential potentiometric titration: development of a methodology for determining the point of zero charge of metal (hydr)oxides by one titration curve
Bourikas, K., C. Kordulis, et al. (2005), Environ Sci Technol 39(11): 4100-8.
Abstract: A new methodology is presented, called differential potentiometric titration (DPT), which allows the determination of the point of zero charge (pzc) of metal (hydr)oxides using only one potentiometric curve. By performing extensive simulations of potentiometric titrations for various model (hydr)oxides, we found that an inflection point in a H+(cons,surf) versus pH potentiometric curve (H+(cons,surf): hydrogen ions consumed on the surface of the (hydr)oxide) and a peak in the corresponding differential curve, dH+(cons,surf)/dpH versus pH, appear at a pH equal to the pzc assumed for a model (hydr)oxide. This distinguishable peak appears at the same position irrespective of the surface ionization and the interfacial model adopted as well as the assumed ionic strength. It was found that the aforementioned peak also appears in the high-resolution differential potentiometric curves experimentally determined for four oxides (SiO2, TiO2, gamma-Al2O3, and MgO) that are widely used in various environmental and other technological applications. The application of DPT to the above-mentioned oxides provided practically the same pzc values as the corresponding ones achieved by using four different techniques as well as the corresponding isoelectric point (iep) values determined by microelectrophoresis. Differences between the pzc and iep values determined using various techniques in the case of MgO were attributed to the increasing dissolution of this oxide as pH decreases and the adsorption of cations (Mg2+, Na+) on the MgO/electrolytic solution interface.
| Differential production of interleukin 1 on the surface of biomaterials
Krause, T. J., F. M. Robertson, et al. (1990), Arch Surg 125(9): 1158-60.
Abstract: The production of cytokines on the surface of surgical biomaterials plays a major role in their biocompatibility. Membrane-associated interleukin 1 (mIL-1) is a cytokine found on the surface of macrophages activated by biomaterials. To better understand the host-foreign body interaction, we quantitated the production of mIL-1 on the surface of two materials commonly used in surgery, expanded polytef (ePTFE) and silicon elastomer (SE). The mean (+/- SD) level of mIL-1 produced by adherent cells to ePTFE significantly decreased from day 2 (13,746 +/- 3630 cpm per disk) compared with day 7 (2828 +/- 1304 cpm per disk). However, the level of mIL-1 produced by ePTFE-adherent cells was still markedly greater than the level of mIL-1 produced by cells adherent to SE (1877 +/- 1028 vs 1595 +/- 822 cpm per disk). These results indicate that ePTFE and SE elicit a differential host response in terms of cytokine production. This study may enhance our understanding of the cellular events on the surface of biomaterials that underlie clinical observations.
| Differentiation ability of rat postnatal dental pulp cells in vitro
Zhang, W., X. F. Walboomers, et al. (2005), Tissue Eng 11(3-4): 357-68.
Abstract: The current rapid progression in stem cell research has enhanced our knowledge of dental tissue regeneration. In this study, rat dental pulp cells were isolated and their differentiation ability was evaluated. First, dental pulp cells were obtained from maxillary incisors of male Wistar rats. Immunochemistry by stem cell marker STRO-1 proved the existence of stem cells or progenitors in the isolated cell population. The dissociated cells were then cultured both on smooth surfaces and on three-dimensional (3-D) scaffold materials in medium supplemented with beta-glycerophosphate, dexamethasone, and L-ascorbic acid. Cultures were analyzed by light and scanning electron microscopy and, on proliferation, alkaline phosphatase activity and calcium content were determined and the polymerase chain reaction was performed for dentin sialophosphoprotein, osteocalcin, and collagen type I. These cells showed the ability to differentiate into odontoblast-like cells and produced calcified nodules, which had components similar to dentin. In addition, we found that the "odontogenic" properties of the isolated cells were supported by three-dimensional calcium phosphate and titanium scaffolds equally well.
| Differentiation from embryonic stem cells to vascular wall cells under in vitro pulsatile flow loading
Huang, H., Y. Nakayama, et al. (2005), J Artif Organs 8(2): 110-8.
Abstract: This study evaluated the possibility of differentiation from embryonic stem (ES) cells to vascular wall cells by physical (mechanical) stress loading in vitro. A cell mixture containing Flk1-positive cells (ca. 30%) derived from murine ES cells was added to a compliant microporous tube made of segmented polyurethane. The compliance of the tube was close to that of the human artery [the stiffness parameter (beta) = 57.2 (n = 5, SD < 5%)]. The luminal surface of the tube was fully covered with the cells by preincubation for two days in the presence of vascular endothelial growth factor (VEGF). After 2 days of additional incubation without VEGF under static conditions, layering of the grown cells, mostly smooth muscle actin (SMA)-positive cells, was observed only on the luminal surface of the tube. The cells were flat, polygonal, and randomly oriented. On the other hand, after a 2-day incubation under a weak pulsatile flow simulating the human venous systems [wall shear stress (WSS) from -0.98 to 2.2 dyn/cm(2); circumferential strain (CS) 4.6-9.6 x 10(4) dyn/cm(2)] without VEGF, cells in the superficial layer were regularly oriented in the direction of the pulsatile flow. The oriented cells exhibited endothelial-like appearance, indicating that they were platelet endothelial cell adhesion molecule 1 (PECAM1)-positive. In addition, the cells growing into the interstices in the deeper layer showed smooth muscle-like appearance, indicating that they were SMA-positive. Differentiation to two different cell types and segregation of incorporated ES cells may be simultaneously encouraged by the combination of WSS and CS. It is expected that the monobloc building of hierarchically structured hybrid vascular prostheses composed of several vascular wall cell types is possible by physically synchronized differentiation of ES cells.
| Differentiation of a mouse submandibular gland-derived cell line (SCA) grown on matrigel
Barka, T., E. S. Gresik, et al. (2005), Exp Cell Res 308(2): 394-406.
Abstract: SCA-9 cell line was developed from an induced tumor of mouse submandibular gland. We have studied some of the phenotypic characteristics of SCA cells cultured on different matrices. On plastic surface, the cells grow as a monolayer; on matrigel, they form branching structures and tubes, a phenomenon termed branching morphogenesis. EGF and HGF promoted cellular growth and branching morphogenesis which was inhibited by anti-EGF antibodies. We have performed RT-PCR and real-time quantitative RT-PCR of cells grown on plastic surface or on matrigel. Grown on plastic, the cells express EGF and renin 2, but no or only trace amounts of NGF. Growth on matrigel for 24 h resulted in a transient 21-fold increase in EGF mRNA and a 3371-fold increase in renin 2 mRNA. There was no change in NGF mRNA level. SCA-9 cells express mRNAs for receptors for the EGF family of ligands. On plastic, mainly ErbB1 and ErbB2 are expressed. Culture on matrigel resulted in 11-fold increase in mRNA levels for ErbB1 and ErbB2, and a 221-fold and 85-fold increase in the mRNA levels for ErbB3 and ErbB4, respectively. Small interfering RNAs siErbB3 and siErbB4 inhibited the growth of the cells grown on plastic or matrigel. Significant growth inhibition was seen also with siErbB1+siErbB3 and siErbB2+siErbB3. siErbB1 and siErbB2 also inhibited branching morphogenesis. Since SCA cells express EGF and receptors for EGF, EGF acts an autocrine regulator in promoting growth and branching morphogenesis. We conclude that SCA cells provide a useful model to analyze the mechanism of branching morphogenesis and the role of matrix in regulating expression of phenotypic characteristics of cultured cells.
| Diffusion in three-dimensionally ordered scaffolds with inverted colloidal crystal geometry
Shanbhag, S., J. Woo Lee, et al. (2005), Biomaterials 26(27): 5581-5.
Abstract: Inverted colloidal crystal geometry has been recently utilized in the design of highly organized 3D cell scaffolds. The regularity of the resulting scaffolds enables computational modeling of scaffold properties. In this work we probe the resistance offered by these scaffolds to nutrient transport, by using Brownian dynamics and Monte Carlo simulations to model the effective nutrient diffusivity. Brownian dynamics simulations indicate that the effective diffusivity for small nutrients in the scaffold, D(eff)=0.3D(0), where D(0) is the free solution diffusivity. Further, results of Monte Carlo simulations for dilute solutions of larger particles show that the D(eff) decreases linearly with the size of the particles.
| Dimensional stability of the alveolar ridge after implantation of a bioabsorbable bone graft substitute: a radiographic and histomorphometric study in rats
Hile, D. D., S. T. Sonis, et al. (2005), J Oral Implantol 31(2): 68-76.
Abstract: This study evaluated reconstruction of the alveolar ridge after molar extraction in rats with bioabsorbable bone repair scaffolds. The material was prepared from the unsaturated polyester poly(propylene glycol-co-fumaric acid) (PPF), which may be cured in situ to form a porous scaffold. The intention is to use this material either as a stand-alone bone graft substitute or as an extender to autograft harvested from mandibular reconstruction sites. The bioactivity of the graft substitute was investigated in a rat residual ridge resorption model. PPF bone repair material was injected into the defect site, where it cross-linked in situ in the presence of a hydroxyapatite (HA) filler and effervescent agents. The PPF-based material develops porosity during an in situ cure by generating carbon dioxide during the effervescent reaction of citric acid and sodium bicarbonate. The incorporation of HA promotes osteoconduction within the bone repair scaffold. In this study, bioactivity of the porous scaffold was evaluated as a function of HA particle size (micrometer-sized vs nanometer-sized particles). The maxillary or mandibular molars on the right side were extracted from 96 adult Sprague-Dawley rats. A 2-mm round bur was used to create a uniform trench defect measuring 2 mm in diameter, 2 mm in depth, and 4 mm in length at each extraction site. The defect site was (1) treated with PPF bone repair material containing nanometer-sized HA, (2) treated with PPF material containing micrometer-sized HA, (3) treated with demineralized freeze-dried bone allograft, or (4) left untreated. Rats were sacrificed at 2, 4, 7, and 12 weeks postoperative. Resorption of the residual alveolar ridge was assessed by radiographic outcomes. Bone ingrowth through the defect site was measured by histomorphometric outcomes. Mandibular and maxillary ridge heights increased for all treatments used in this study. There were no clinical indications that addition of either of the PPF bone repair materials retarded hard- or soft-tissue healing of the extraction sites. Although not statistically significant, the mandibular defects treated with PPF containing nanometer-sized HA healed at a faster rate as determined by ridge height and new bone formation measurements when compared with the other treatments. These findings suggest the feasibility of using PPF bone graft substitutes for oral-maxillofacial applications.
| Direct activation of mast cells by prosthetic biomaterial particles
Al-Saffar, N., H. Iwaki, et al. (1998), J Mater Sci Mater Med 9(12): 849-53.
Abstract: IL-4 is a mast cell and T cell produced immune cytokine that is important in the regulation of macrophage function. IL-4 has also been implicated in the induction of foreign body giant cell formation. In patients with long-term joint prostheses, a localized granulomatous inflammation develops in periarticular tissues and other organs where phagocytosis of particulate material from various prosthetic components takes place. In this study we used the inflammatory lesions of the bone-implant interface as a model to investigate the possible production, the frequency and the cellular source of IL-4. 40 samples of the interface membrane obtained from 25 patients undergoing revision of clinically failed implants were analyzed by immunohistochemistry. Cryostat sections were labeled with specific monoclonal antibodies to mast cell products: IL-4, tryptase and the receptor c-kit (CD117). The study has identified a significant level of production of IL-4 by mast cells in all the cases analyzed. There was an apparent difference in the number of mast cells in relation to the histological variants of the interface. The increase in the number of mast cells and IL-4 production was more pronounced in cases with heavy macrophage infiltrate than those exhibiting a predominance of giant cells. The findings imply that the recruitment of mast cell and IL-4 expression precede the granulomatous reaction and may have a role in the induction of a number of immunopathological changes related to mast cell activation by biomaterial particles.
| Direct comparison of biomaterials and endothelium in an ex vivo shunt
Lindenauer, S. M., J. S. Schultz, et al. (1981), Trans Am Soc Artif Intern Organs 27: 231-5.
| Direct comparisons, new technologies highlight DES symposium
Kahn, J. (2005), J Interv Cardiol 18(4): 295-8.
| Direct correlation between adsorption-induced changes in protein structure and platelet adhesion
Hylton, D. M., S. W. Shalaby, et al. (2005), J Biomed Mater Res A 73(3): 349-58.
Abstract: It is widely recognized that adsorbed proteins on biomaterial surfaces tend to initiate thrombus formation, although the specific mechanisms involved are still not well understood. In attempts to decrease the conformational change of adsorbed proteins, surface treatments that reduce surface hydrophobicity have been considered, such as the sulfonation of low-density polyethylene and isotactic polypropylene. The objectives of this present research were to study how changes in surface chemistry influence the degree of conformational change of adsorbing proteins and to investigate the correlation between the change in adsorbed protein structure and platelet response. Adsorbed porcine serum albumin and porcine fibrinogen were used as the model proteins for determining the effects of sulfonation on protein conformational change. Circular dichroism spectroscopy studies showed that the proteins were less altered structurally on the sulfonated surfaces. Platelet adhesion studies were used to correlate the number of adhered platelets with the amount of conformational change in adsorbed proteins on the polymer surface. The results of these studies show a linear correlation between platelet adhesion and the degree of adsorption-induced protein conformational change. These findings suggest that the degree of protein conformational change after adsorption is a dominant mechanism governing platelet interactions with biomaterial surfaces.
| Direct electrochemistry and electrocatalysis of heme proteins immobilized on gold nanoparticles stabilized by chitosan
Feng, J. J., G. Zhao, et al. (2005), Anal Biochem 342(2): 280-6.
Abstract: Three heme proteins, myoglobin, hemoglobin, and cytochrome c, have been adsorbed onto chitosan-stabilized gold nanoparticles (Chit-Aus) modified Au electrode via a molecule bridge like cysteine. UV-vis spectra indicated that the proteins on Chit-Aus films retained near-native secondary structures. The fabricated procedures and electrochemical behaviors of proteins on such an interface were characterized with electrochemical impedance spectra and cyclic voltammetric techniques. It was demonstrated that Chit-Aus film could not only offer a friendly environment to immobilize protein molecules but also enhance the electron transfer ability between protein molecules and underlying electrode. The effects of scan rate and pH on the electrochemical behaviors of each heme protein are discussed in detail. The resultant electrode displayed an excellent electrocatalytic response to the reduction of H(2)O(2), long-term stability, and good reproducibility.
| Direct electron transfer between copper-containing proteins and electrodes
Shleev, S., J. Tkac, et al. (2005), Biosens Bioelectron 20(12): 2517-54.
Abstract: The electrochemistry of some copper-containing proteins and enzymes, viz. azurin, galactose oxidase, tyrosinase (catechol oxidase), and the "blue" multicopper oxidases (ascorbate oxidase, bilirubin oxidase, ceruloplasmin, laccase) is reviewed and discussed in conjunction with their basic biochemical and structural characteristics. It is shown that long-range electron transfer between these enzymes and electrodes can be established, and the mechanistic schemes of the DET processes are proposed.
| Direct evidence for Sphingomonas sp. A1 periplasmic proteins as macromolecule-binding proteins associated with the ABC transporter: molecular insights into alginate transport in the periplasm
Momma, K., Y. Mishima, et al. (2005), Biochemistry 44(13): 5053-64.
Abstract: A Gram-negative bacterium, Sphingomonas sp. A1, has a macromolecule (alginate) import system consisting of a pit on the cell surface and an alginate-specific ATP-binding cassette importer in the inner membrane. Transport of alginate from the pit to the ABC importer is probably mediated by two periplasmic binding protein homologues (AlgQ1 and AlgQ2). Here we describe characteristics of binding of AlgQ1 and AlgQ2 to alginate and its oligosaccharides through surface plasmon resonance biosensor analysis, UV absorption difference spectroscopy, and X-ray crystallography. Both AlgQ1 and AlgQ2 were inducibly expressed in the periplasm of alginate-grown cells of strain A1. Biosensor analysis indicated that both proteins specifically bind alginate with a high degree of polymerization (>100) and that dissociation constants for alginate with an average molecular mass of 26 kDa are 2.3 x 10(-)(7) M for AlgQ1 and 1.5 x 10(-)(7) M for AlgQ2. An in vitro ATPase assay using the membrane complex, including the alginate ABC importer, suggested that both alginate-bound forms of AlgQ1 and AlgQ2 are closely associated with the importer. X-ray crystallography showed that AlgQ1 consisted of two domains separated by a deep cleft that binds alginate oligosaccharides through a conformational change in the two domains. These results directly show that alginate-binding proteins play an important role in the efficient transport of alginate macromolecules with different degrees of polymerization in the periplasm.
| Direct fabrication and harvesting of monodisperse, shape-specific nanobiomaterials
Rolland, J. P., B. W. Maynor, et al. (2005), J Am Chem Soc 127(28): 10096-100.
Abstract: A versatile "top-down" method for the fabrication of particles, Particle Replication In Nonwetting Templates (PRINT), is described which affords absolute control over particle size, shape, and composition. This technique is versatile and general enough to fabricate particles with a variety of chemical structures, yet delicate enough to be compatible with sophisticated biological agents. Using PRINT, we have fabricated monodisperse particles of poly(ethylene glycol diacrylate), triacrylate resin, poly(lactic acid), and poly(pyrrole). Monodisperse particle populations, ranging from sub-200 nm nanoparticles to complex micron-scale objects, have been fabricated and harvested. PRINT uses low-surface energy, chemically resistant fluoropolymers as molding materials, which eliminates the formation of a residual interconnecting film between molded objects. Until now, the presence of this film has largely prevented particle fabrication using soft lithography. Importantly, we have demonstrated that PRINT affords the simple, straightforward encapsulation of a variety of important bioactive agents, including proteins, DNA, and small-molecule therapeutics, which indicates that PRINT can be used to fabricate next-generation particulate drug-delivery agents.
| Direct fabrication of TiO2 nanoparticles deposited on hydroxyapatite crystals under mild hydrothermal conditions
Sujaridworakun, P., D. Pongkao, et al. (2005), J Nanosci Nanotechnol 5(6): 875-9.
Abstract: TiO2 nanoparticles-deposited on hydroxyapatite (HAp) have been successfully synthesized by direct (single step) hydrothermal treatments of a CaCO3 suspension in a H3PO4 solution with 10 vol% TAS-FINE (titanium amine complex) at 150 degrees C for 6 h or 120 degrees C for 12-24 h under nearly neutral pH conditions. The obtained products were characterized by XRD, SEM-EDX, visible, Raman, and TEM. The XRD and Raman results showed the formation of HAp and TiO2 anatase phases under these hydrothermal conditions. SEM and TEM observations revealed that anatase TiO2 nanoparticles with the size of about 10 nm were deposited on the surfaces of the HAp crystals.
| Direct implant loading in the edentulous maxilla using a bone density-adapted surgical protocol and primary implant stability criteria for inclusion
Ostman, P. O., M. Hellman, et al. (2005), Clin Implant Dent Relat Res 7 Suppl 1: S60-9.
Abstract: BACKGROUND: Long healing periods and submerged implant placement are commonly used in the maxilla. This extends the time of oral handicap and makes the use of immediate loading protocols an attractive option. The current clinical literature on direct loading of dental implants in the maxilla is limited. PURPOSE: The purpose of this prospective clinical study was to evaluate the clinical outcome and stability of directly loaded Branemark System or Replace Select Tapered implants (Nobel Biocare AB, Goteborg, Sweden) after using a modified surgical protocol and inclusion by primary implant stability. In addition, a reference group treated according to a two-stage protocol was used for comparison. MATERIALS AND METHODS: Twenty patients planned for prosthetic rehabilitation with implant-supported bridges in the edentulous maxilla participated in the study group. The final decision on immediate loading was made after implant placement using insertion torque and resonance frequency analysis (RFA) as acceptance criteria. All patients were included, and 123 oxidized implants (TiUnite, Nobel Biocare AB) were placed using a surgical protocol for enhanced primary stability. A screw-retained temporary bridge was delivered within 12 hours and a final bridge within 3 months of implant placement. The patients were monitored through clinical and radiographic follow-up examinations from implant placement to at least 12 months. Marginal bone level was measured at bridge delivery and after 12 months of loading. Additional RFA measurements were made after 6 months of loading. A reference group comprising 20 patients with 120 implants treated according to a two-stage protocol was used for comparison. RESULTS: One (0.8%) of the 123 implants in the study group failed, and no implant was lost in the reference group. The cumulative survival rates after 12 months of loading were thus 99.2% and 100% for immediate and delayed loading protocols, respectively. The marginal bone resorption was 0.78 (SD 0.9) in the study group and 0.91 (SD 1.04) in the reference group. RFA showed a mean value of 62.9 (SD 4.9) implant stability quotient (ISQ) at placement and 64.5 (SD 4.8) ISQ after 6 months for immediately loaded implants (not significant). The corresponding figures for the reference groups were 61.3 (SD 8.8) ISQ and 62.6 (SD 7.0) ISQ (not significant). There were no statistically significant differences between the groups at any time point. CONCLUSION: The use of six to seven implants for immediate loading of a fixed provisional bridge is a viable option for implant treatment of the edentulous maxilla, at least when good primary implant stability can be ensured.
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