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Stocchero, M., Jinno, Y., Toia, M., Ahmad, M., Galli, S., Papia, E., . . . Becktor, J. P. (2023). Effect of Drilling Preparation on Immediately Loaded Implants: An In Vivo Study in Sheep. International Journal of Oral & Maxillofacial Implants, 38(3), 607-618
Open this publication in new window or tab >>Effect of Drilling Preparation on Immediately Loaded Implants: An In Vivo Study in Sheep
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2023 (English)In: International Journal of Oral & Maxillofacial Implants, ISSN 0882-2786, E-ISSN 1942-4434, Vol. 38, no 3, p. 607-618Article in journal (Refereed) Published
Abstract [en]

Purpose: To determine the biologic and biomechanical effects of two implant drilling protocols on the cortical bone around implants subjected to immediate loading. Materials and Methods: A total of 48 implants were inserted into the mandibles of six sheep following one of two drilling protocols: undersized preparation (US; n = 24) and nonundersized preparation (NUS; n = 24). Immediately after implant insertion, an abutment was placed on each implant and 36 implants were subjected to 10 sessions of dynamic vertical loads (1,500 cycles, 1 Hz) of 25 N or 50 N. Insertion torque value (ITV) was recorded at implant installation. Resonance frequency analysis (RFA) was measured at implant insertion and at each loading session. Fluorochrome was administered at day 17, and the animals were euthanized after 5 weeks. The removal torque values (RTVs) were measured, and samples underwent histomorphometric, mu CT (microcomputed tomography), and fluorescence image acquisition analyses. The bone volume density (BV/TV), bone-to-implant contact (BIC), bone area fraction occupancy (BAFO), and fluorochrome stained bone surface (MS) were calculated. A linear mixed model analysis was performed, and Pearson paired correlation was calculated. Results: Five implants from the NUS group failed, with a mean ITV of 8.8 Ncm and an RFA value of 57. The mean ITVs for US group and NUS group were 80.5 (+/- 14) Ncm and 45.9 (+/- 25) Ncm, respectively (P < .001). No differences were noted in the RFA values from the time of implant insertion until the end of the study. No differences in RTV, BV/TV, BAFO, or MS were observed between the groups. Intense new bone formation took place in the NUS group implants that were subjected to load. Conclusions: Undersized preparation of cortical bone ensured a greater BIC compared to a nonundersized preparation. Moreover, this study demonstrated that immediate loading did not interfere with the osseointegration process, but loading induced intense new bone formation in the NUS group. It is not recommended to immediately load the implants when the clinically perceived primary stability is lower than an ITV of 10 Ncm and an RFA value of 60.

Place, publisher, year, edition, pages
Quintessence Publishing, 2023
Keywords
biomechanics, drilling preparation, histomorphometric, immediate loading, primary stability, surgical procedure
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-63565 (URN)10.11607/jomi.9949 (DOI)001069540900025 ()37279224 (PubMedID)2-s2.0-85163368909 (Scopus ID)
Available from: 2023-11-10 Created: 2023-11-10 Last updated: 2023-11-10Bibliographically approved
Bruns, S., Krueger, D., Galli, S., Wieland, D. C., Hammel, J. U., Beckmann, F., . . . Moosmann, J. (2023). On the material dependency of peri-implant morphology and stability in healing bone. Bioactive Materials, 28, 155-166
Open this publication in new window or tab >>On the material dependency of peri-implant morphology and stability in healing bone
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2023 (English)In: Bioactive Materials, E-ISSN 2452-199X, Vol. 28, p. 155-166Article in journal (Refereed) Published
Abstract [en]

The microstructural architecture of remodeled bone in the peri-implant region of screw implants plays a vital role in the distribution of strain energy and implant stability. We present a study in which screw implants made from titanium, polyetheretherketone and biodegradable magnesium-gadolinium alloys were implanted into rat tibia and subjected to a push-out test four, eight and twelve weeks after implantation. Screws were 4 mm in length and with an M2 thread. The loading experiment was accompanied by simultaneous three-dimensional imaging using synchrotron-radiation microcomputed tomography at 5 mu m resolution. Bone deformation and strains were tracked by applying optical flow-based digital volume correlation to the recorded image sequences. Implant stabilities measured for screws of biodegradable alloys were comparable to pins whereas non-degradable biomaterials experienced additional mechanical stabilization. Peri-implant bone morphology and strain transfer from the loaded implant site depended heavily on the biomaterial utilized. Titanium implants stimulated rapid callus formation displaying a consistent monomodal strain profile whereas the bone volume fraction in the vicinity of magnesium-gadolinium alloys exhibited a minimum close to the interface of the implant and less ordered strain transfer. Correlations in our data suggest that implant stability benefits from disparate bone morphological properties depending on the biomaterial utilized. This leaves the choice of biomaterial as situational depending on local tissue properties.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Biodegradable implant materials, Bone mechanical testing, Implant stability, Synchrotron micro-computed tomography im, aging, Digital volume correlation
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-60572 (URN)10.1016/j.bioactmat.2023.05.006 (DOI)000995849400001 ()37250865 (PubMedID)2-s2.0-85159628500 (Scopus ID)
Available from: 2023-06-13 Created: 2023-06-13 Last updated: 2023-09-18Bibliographically approved
Krüger, D., Galli, S., Zeller-Plumhoff, B., Wieland, D. F., Peruzzi, N., Wiese, B., . . . Willumeit-Römer, R. (2022). High-resolution ex vivo analysis of the degradation and osseointegration of Mg-xGd implant screws in 3D. Bioactive Materials, 13, 37-52
Open this publication in new window or tab >>High-resolution ex vivo analysis of the degradation and osseointegration of Mg-xGd implant screws in 3D
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2022 (English)In: Bioactive Materials, ISSN 2452-199X, Vol. 13, p. 37-52Article in journal (Refereed) Published
Abstract [en]

Biodegradable magnesium (Mg) alloys can revolutionize osteosynthesis, because they have mechanical properties similar to those of the bone, and degrade over time, avoiding the need of removal surgery. However, they are not yet routinely applied because their degradation behavior is not fully understood.

In this study we have investigated and quantified the degradation and osseointegration behavior of two biodegradable Mg alloys based on gadolinium (Gd) at high resolution.

Mg-5Gd and Mg-10Gd screws were inserted in rat tibia for 4, 8 and 12 weeks. Afterward, the degradation rate and degradation homogeneity, as well as bone-to-implant interface, were studied with synchrotron radiation micro computed tomography and histology. Titanium (Ti) and polyether ether ketone (PEEK) were used as controls material to evaluate osseointegration.

Our results showed that Mg-5Gd degraded faster and less homogeneously than Mg-10Gd. Both alloys gradually form a stable degradation layer at the interface and were surrounded by new bone tissue. The results were correlated to in vitro data obtained from the same material and shape. The average bone-to-implant contact of the Mg-xGd implants was comparable to that of Ti and higher than for PEEK. The results suggest that both Mg-xGd alloys are suitable as materials for bone implants.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Biomedical Engineering, Biomaterials, Biotechnology
National Category
Biomaterials Science
Research subject
Health and society
Identifiers
urn:nbn:se:mau:diva-46878 (URN)10.1016/j.bioactmat.2021.10.041 (DOI)000766636300004 ()35224290 (PubMedID)2-s2.0-85119009753 (Scopus ID)
Available from: 2021-11-17 Created: 2021-11-17 Last updated: 2024-02-05Bibliographically approved
Reinedahl, D., Johansson, P., Galli, S., Kjellin, P., Albrektsson, T. & Wennerberg, A. (2022). Review of PEEK implants and biomechanical and immunological responses to a zirconium phosphate nano-coated PEEK, a blasted PEEK, and a turned titanium implant surface.. American Journal of Dentistry, 35(2), 152-160
Open this publication in new window or tab >>Review of PEEK implants and biomechanical and immunological responses to a zirconium phosphate nano-coated PEEK, a blasted PEEK, and a turned titanium implant surface.
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2022 (English)In: American Journal of Dentistry, ISSN 0894-8275, Vol. 35, no 2, p. 152-160Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate the biomechanical and immunological reactions to coated and non-coated blasted PEEK implants in vivo after 12 weeks and review the associated literature.

METHODS: Two osteotomy sites were performed in each proximal tibia of 10 lop-eared rabbits (n= 4 per rabbit). Each rabbit received a randomly placed (1) blasted zirconium phosphate nano-coated PEEK- (nano-ZrP), (2) blasted PEEK- (PEEK) and (3) titanium implant (Ti) and an empty sham site. At 12 weeks, removal torque of all implants and biological investigation with qPCR was performed. The implant surfaces were analyzed prior to insertion with interferometry, SEM and XPS.

RESULTS: The interferometry analysis showed that there was no difference in roughness for the uncoated PEEK compared to the ZrP coated PEEK implants. The titanium implants were considerably smoother (Sa= 0.23 µm) than the uncoated Sa= 1.11 µm) and ZrP coated PEEK implants (Sa= 1.12 µm). SEM analysis on the PEEK implants corroborated the interferometry results; no difference in structure between the uncoated vs. the ZrP coated PEEK was visible on the micrometer level. At higher magnifications, the ZrP coating was visible in the SEM as a thin, porous network. All tested implants displayed osseointegration with the highest RTQ for nano-ZrP (18.4 Ncm) followed by PEEK (14.5 Ncm) and Ti (11.5 Ncm). All implants activated the immune system, with elevated macrophage and M2 macrophage qPCR markers at 12 weeks compared to the sham site.

CLINICAL SIGNIFICANCE: Nano-ZrP coating improves osseointegration of blasted PEEK implants at 12 weeks of follow-up. Osseointegration of titanium, PEEK and nano-ZrP PEEK is not a normal bone healing process, but rather a shield-off mechanism that appears to be regulated by the innate immune system.

Place, publisher, year, edition, pages
Mosher & Linder, Inc., 2022
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-56285 (URN)000893228600008 ()35798711 (PubMedID)
Available from: 2022-11-29 Created: 2022-11-29 Last updated: 2023-09-07Bibliographically approved
Willumeit-Roemer, R., Bruns, S., Helmholz, H., Krueger, D., Wiese, B., Galli, S., . . . Zeller-Plumhoff, B. (2022). The Comparability of In Vitro and In Vivo Experiments for Degradable Mg Implants. In: Maier, P Barela, S Miller, VM Neelameggham, NR (Ed.), MAGNESIUM TECHNOLOGY 2022: . Paper presented at 23rd Magnesium Technology Symposium at the 151st TMS Annual Meeting and Exhibition, FEB 27-MAR 03, 2022, Anaheim, CA (pp. 8-15). Springer
Open this publication in new window or tab >>The Comparability of In Vitro and In Vivo Experiments for Degradable Mg Implants
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2022 (English)In: MAGNESIUM TECHNOLOGY 2022 / [ed] Maier, P Barela, S Miller, VM Neelameggham, NR, Springer, 2022, p. 8-15Conference paper, Published paper (Refereed)
Abstract [en]

Mg implants possess a great potential for clinical applications. Thousands of patients are already successfully treated with Mg implants and the number of approved products increases. Despite the fact that the implants generally work, we know that we have not yet reached a full understanding of all processes which occur during the degradation of the material and tissue regeneration. A prerequisite for a comprehensive description is the visualization and analysis of the in vivo processes with high resolution, while avoiding metal artefacts during imaging and taking care of different imaging properties of inorganic and organic matrices. Here, synchrotron radiation-based micro-computed tomography was utilized to determine the degradation rates for two implant materials (Mg-5Gd and Mg-10Gd, wt. %) in vitro and in vivo. The comparison for in vitro and in vivo degradation in terms of degradation rate and pitting factor shows that in vitro experiments predict in vivo results the error. As a second aspect, push-out experiments revealed a better integration into bone for Mg-10Gd and the improvement of implant stability over time. Finally, micro X-ray fluorescence spectrometry was applied to determine the elemental composition of degradation products around the Mg-5Gd specimen in vivo. This technique shows that the Mg content of the degrading specimen is decreasing while the Gd content stays constant.

Place, publisher, year, edition, pages
Springer, 2022
Series
Minerals Metals & Materials Series, ISSN 2367-1181
Keywords
Degradable magnesium, In vivo, Synchrotron tomography
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-51195 (URN)10.1007/978-3-030-92533-8_3 (DOI)000771835800003 ()2-s2.0-85125250154 (Scopus ID)978-3-030-92533-8 (ISBN)978-3-030-92532-1 (ISBN)
Conference
23rd Magnesium Technology Symposium at the 151st TMS Annual Meeting and Exhibition, FEB 27-MAR 03, 2022, Anaheim, CA
Available from: 2022-05-02 Created: 2022-05-02 Last updated: 2024-02-05Bibliographically approved
Toia, M., Stocchero, M., Galli, S., Papia, E., Wennerberg, A. & Becktor, J. P. (2022). The use of implant-level connection in screw-retained fixed partial dentures: A 3-year randomised clinical trial.. Clinical Oral Implants Research (1), 78-93
Open this publication in new window or tab >>The use of implant-level connection in screw-retained fixed partial dentures: A 3-year randomised clinical trial.
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2022 (English)In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, no 1, p. 78-93Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: This randomised controlled trial compares the 3-year outcomes, that is, marginal bone-level (MBL) changes and clinical parameters, between an abutment-level (AL) and implant-level (IL) connection for implants with an internal conical connection (ICC) supporting a screw-retained fixed partial denture.

MATERIAL AND METHODS: Fifty patients with 119 implants were randomly allocated to either the AL or IL group. Radiographic and clinical examinations were performed after one, two, and 3 years. A linear mixed model was used to evaluate the differences between groups.

RESULTS: The MBL change was not significantly different between the groups at any point. The MBL was 0.12 ± 0.31 mm (AL) and 0.23 ± 0.26 mm (IL) after 1 year; 0.15 ± 0.34 mm (AL) and 0.17 ± 0.22 mm (IL) after 2 years; 0.18 ± 0.39 mm (AL) and 0.15 ± 0.21 mm (IL) after 3 years. The bleeding on probing was 43.44 ± 39.24% (AL) and 58.19 ± 41.20% (IL) after 1 year; 35.78 ± 39.22% (AL) and 50.43 ± 41.49% (IL) after 2 years; 51.27 ± 44.63% (AL) and 49.57 ± 37.31% (IL) after 3 years and was significantly different (p = .025) between 1 and 2 years. The probing depth showed a significant difference at each time point while the plaque was not significant between the groups. The overall technical, biological and prosthetic complication rates were 5.04%, 3.36%, and 16.00%, respectively.

CONCLUSIONS: The MBL change was similar in the groups. The slight differences in the soft tissue complications between the groups are likely not of clinical relevance. An IL connection is considered to be a valid alternative to an AL set-up in ICC implants.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
abutment-/implant level, dental implant abutment connection, dental implant-abutment design, osseointegration
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-46347 (URN)10.1111/clr.13867 (DOI)000706144800001 ()34617341 (PubMedID)2-s2.0-85116831496 (Scopus ID)
Available from: 2021-10-15 Created: 2021-10-15 Last updated: 2024-02-05Bibliographically approved
Jinno, Y., Stocchero, M., Galli, S., Toia, M. & Becktor, J. P. (2021). Impact of a hydrophilic dental implant surface on osseointegration: biomechanical results in rabbit. Journal of Oral Implantology, 47(2), 163-168
Open this publication in new window or tab >>Impact of a hydrophilic dental implant surface on osseointegration: biomechanical results in rabbit
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2021 (English)In: Journal of Oral Implantology, ISSN 0160-6972, E-ISSN 1548-1336, Vol. 47, no 2, p. 163-168Article in journal (Refereed) Published
Abstract [en]

This study aimed to evaluate the effect of surface hydrophilicity on the biomechanical aspects of osseointegration of dental implants in the tibia and femur of rabbits. Forty-eight mature female New Zealand White rabbits were included, and 96 commercially pure, Grade 4, titanium dental implants (control group), and 96 implants of same macro geometry with the hydrophilic surface (test group) were used in this study. One osteotomy was performed in each tibia and femur on both sides of the rabbit, and four implants were placed in each rabbit. Control and test groups were randomly allocated on the left and right sides. During surgery, insertion torque (ITQ) value of the complete implant placement was recorded. After healing periods of 0, 2, 4, and 8 weeks after surgery, Implant Stability Quotient (ISQ) value, and removal torque (RTQ) values were measured. No statistical difference was observed for ITQ, for ISQ and for RTQ between the control group and test group in tibia/femur for all time periods. The effect of hydrophilic properties on moderately roughened surfaces has no impact in terms of biomechanical outcomes (ISQ values and RTQ values) after a healing period of 2 to 8 weeks in rabbit tibias /femurs.

Place, publisher, year, edition, pages
Academy of Implant Dentistry, 2021
Keywords
osseointegration, surface topography, hydrophilicity, Removal torque, Implant Stability Quotient
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-18015 (URN)10.1563/aaid-joi-D-19-00217 (DOI)000655004900012 ()32663272 (PubMedID)2-s2.0-85107088556 (Scopus ID)
Available from: 2020-08-18 Created: 2020-08-18 Last updated: 2024-02-05Bibliographically approved
Peruzzi, N., Galli, S., Helmholz, H., Kardjilov, N., Krüger, D., Markötter, H., . . . Bech, M. (2021). Multimodal ex vivo methods reveal that Gd-rich corrosion byproducts remain at the implant site of biodegradable Mg-Gd screws. Acta Biomaterialia, 136, 582-591
Open this publication in new window or tab >>Multimodal ex vivo methods reveal that Gd-rich corrosion byproducts remain at the implant site of biodegradable Mg-Gd screws
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2021 (English)In: Acta Biomaterialia, ISSN 1742-7061, E-ISSN 1878-7568, Vol. 136, p. 582-591Article in journal (Refereed) Published
Abstract [en]

Extensive research is being conducted on magnesium (Mg) alloys for bone implant manufacturing, due to their biocompatibility, biodegradability and mechanical properties. Gadolinium (Gd) is among the most promising alloying elements for property control in Mg alloy implants; however, its toxicity is controversial. Investigating Gd behavior during implant corrosion is thus of utmost importance. In this study, we analyzed the degradation byproducts at the implant site of biodegradable Mg-5Gd and Mg-10Gd implants after 12 weeks healing time, using a combination of different imaging techniques: histology, energy-dispersive x-ray spectroscopy (EDX), x-ray microcomputed tomography (µCT) and neutron µCT. The main finding has been that, at the healing time in exam, the corrosion appears to have involved only the Mg component, which has been substituted by calcium and phosphorus, while the Gd remains localized at the implant site. This was observed in 2D by means of EDX maps and extended to 3D with a novel application of neutron tomography. X-ray fluorescence analysis of the main excretory organs also did not reveal any measurable accumulation of Gd, further reinforcing the conclusion that very limited or no removal at all of Gd-alloy happened during degradation.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
Molecular Biology, Biomedical Engineering, Biochemistry, Biomaterials, General Medicine, Biotechnology
National Category
Biomaterials Science Dentistry Orthopaedics
Research subject
Health and society
Identifiers
urn:nbn:se:mau:diva-46879 (URN)10.1016/j.actbio.2021.09.047 (DOI)000723158500003 ()34601107 (PubMedID)2-s2.0-85116896974 (Scopus ID)
Funder
Swedish Research Council
Available from: 2021-11-17 Created: 2021-11-17 Last updated: 2024-02-05Bibliographically approved
Pihl, M., Galli, S., Jimbo, R. & Andersson, M. (2021). Osseointegration and antibacterial effect of an antimicrobial peptide releasing mesoporous titania implant. Journal of Biomedical Materials Research. Part B - Applied biomaterials, 109(11), 1787-1795
Open this publication in new window or tab >>Osseointegration and antibacterial effect of an antimicrobial peptide releasing mesoporous titania implant
2021 (English)In: Journal of Biomedical Materials Research. Part B - Applied biomaterials, ISSN 1552-4973, E-ISSN 1552-4981, Vol. 109, no 11, p. 1787-1795Article in journal (Refereed) Published
Abstract [en]

Medical devices such as orthopedic and dental implants may get infected by bacteria, which results in treatment using antibiotics. Since antibiotic resistance is increasing in society there is a need of finding alternative strategies for infection control. One potential strategy is the use of antimicrobial peptides, AMPs. In this study, we investigated the antibiofilm effect of the AMP, RRP9W4N, using a local drug-delivery system based on mesoporous titania covered titanium implants. Biofilm formation was studied in vitro using a safranine biofilm assay and LIVE/DEAD staining. Moreover, we investigated what effect the AMP had on osseointegration of commercially available titanium implants in vivo, using a rabbit tibia model. The results showed a sustained release of AMP with equal or even better antibiofilm properties than the traditionally used antibiotic Cloxacillin. In addition, no negative effects on osseointegration in vivo was observed. These combined results demonstrate the potential of using mesoporous titania as an AMP delivery system and the potential use of the AMP RRP9W4N for infection control of osseointegrating implants.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
Staphylococcus epidermidis, biofilm, rabbit tibia model, sustained release
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-41658 (URN)10.1002/jbm.b.34838 (DOI)000632244600001 ()33763981 (PubMedID)2-s2.0-85103050347 (Scopus ID)
Available from: 2021-04-08 Created: 2021-04-08 Last updated: 2024-02-05Bibliographically approved
Zeller-Plumhoff, B., Malich, C., Krüger, D., Campbell, G., Wiese, B., Galli, S., . . . Wieland, D. C. (2020). Analysis of the bone ultrastructure around biodegradable Mg-xGd implants using small angle X-ray scattering and X-ray diffraction. (ed.). Acta Biomaterialia, 101(1), 637-645
Open this publication in new window or tab >>Analysis of the bone ultrastructure around biodegradable Mg-xGd implants using small angle X-ray scattering and X-ray diffraction.
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2020 (English)In: Acta Biomaterialia, ISSN 1742-7061, E-ISSN 1878-7568, Vol. 101, no 1, p. 637-645Article in journal (Refereed) Published
Abstract [en]

Magnesium alloys are increasingly researched as temporary biodegradable metal implants in bone applications due to their mechanical properties which are more similar to bone than conventional implant metals and the fact that Magnesium occurs naturally within the body. However, the degradation processes in vivo and in particular the interaction of the bone with the degrading material need to be further investigated. In this study we are presenting the first quantitative comparison of the bone ultrastructure formed at the interface of biodegradable Mg-5Gd and Mg-10Gd implants and titanium and PEEK implants after 4, 8 and 12 weeks healing time using two-dimensional small angle X-ray scattering and X-ray diffraction. Differences in mineralization, orientation and thickness of the hydroxyapatite are assessed. We find statistically significant (p<0.05) differences for the lattice spacing of the (310)-reflex of hydroxyapatite between titanium and Mg-xGd materials, as well as for the (310) crystal size between titanium and Mg-5Gd, indicating a possible deposition of Mg within the bone matrix. The (310) lattice spacing and crystallite size further differ significantly between implant degradation layer and surrounding bone (p

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Biodegradable magnesium implants, Bone ultrastructure, Bone-implant interface
National Category
Biomaterials Science
Identifiers
urn:nbn:se:mau:diva-6310 (URN)10.1016/j.actbio.2019.11.030 (DOI)000504504300051 ()31734411 (PubMedID)2-s2.0-85075900585 (Scopus ID)30480 (Local ID)30480 (Archive number)30480 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2023-08-24Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-7488-3588

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