Bone Graft and Substitutes Associated with Titanium

Dome for Vertical Bone Formation in Osseointegrated

Implants: Histomorphometric Analysis in Dogs
Mario Vinicius Zendron, DDS, PhD1/Matheus Völz Cardoso, DDS, MS2/
Giovana Fuzeto Veronesi, DDS, MS2/Daniel Romeu Benchimol de Resende, DDS, PhD3/
Carla Andreotti Damante, DDS, PhD4/Adriana Campos Passanezi Sant’ana, DDS, PhD4/
Sebastião Luis Aguiar Greghi, DDS, PhD5/Mariana Schutzer Ragghianti Zangrando, DDS, PhD6

Purpose: This animal study investigated vertical bone formation (VBF) around implants and used
histomorphometric analysis to compare different bone-filling materials associated with a massive titanium
dome as a tissue barrier. Materials and Methods: Seven dogs were submitted to surgical procedures
with extraoral access to the lower edge of the mandible, and four implants were semi-inserted in each
animal. Each implant received one treatment: autogenous bone with clot (AB), control clot (C), synthetic
graft (Biogran [BG]), or xenograft (Bio-Oss [BO]). Massive titanium domes were stabilized over the implants.
Histologic analysis was performed after 3 months, and quantitative aspects were evaluated in extraosseous
and intraosseous threads on Image Pro-Plus software. Results: VBF around implants exhibited significant
values in AB compared with other groups. BG and BO presented statistical equivalency to AB and C in the
apposition and filling of extraosseous threads. There was no difference between groups for parameters
evaluated in intraosseous threads. Conclusion: The experimental model was valid for evaluation of VBF
around implants placed in atrophic mandibles. Considering the limitations of this study, histomorphometric
analysis evidenced better outcomes for group AB. Even though groups BG and BO presented worse
outcomes than AB, they were slightly better compared with the control group. Int J Oral Maxillofac Implants
2018;33:311–318. doi: 10.11607/jomi.5762

Keywords: animal experiments, biomaterials, bone-implant interactions, bone regeneration, guided tissue
regeneration

C urrently, treatment with implants is highly indi-

cated with remarkable success and survival rates.1
1 Associate Professor and Dean, Department of Dentistry,
Universidade Federal de Santa Catarina, Santa Catarina, SC,
Brazil.
2PhD Student, Discipline of Periodontics, Department of
Prosthodontics and Periodontics, Bauru School of Dentistry,
University of São Paulo, Bauru, SP, Brazil.
3 Private Practice, Bauru, SP, Brazil.
4 Associate Professor, Discipline of Periodontics, Department of
Prosthodontics and Periodontics, Bauru School of Dentistry,
University of São Paulo, Bauru, SP, Brazil.
5Full Professor, Discipline of Periodontics, Department of
Prosthodontics and Periodontics, Bauru School of Dentistry,
University of São Paulo, Bauru, SP, Brazil.
6 Professor, Discipline of Periodontics, Department of
Prosthodontics and Periodontics, Bauru School of Dentistry,
University of São Paulo, Bauru, SP, Brazil.
Correspondence to: Dr Matheus Völz Cardoso, Al. Octavio
Pinheiro Brisolla 9-75, 17012-901, Bauru-SP, Brazil.
Fax: (14)32358390. Email: matheusvolz@usp.br
©2018 by Quintessence Publishing Co Inc.
However, there are challenges in implant planning
and placement, such as atrophic mandibles, mental
foramen, superficial positioning of the mandibular
alveolar nerve, and muscle attachments altered by
either bone resorption or maxillary sinus pneumati-
zation.2 One option would be the utilization of short
implants; however, minor bone losses would cause
significant impairment of support around the im-
plant.3 Thus, grafting techniques and materials are
necessary to enhance bone support and placement
of long implants. The most-described techniques aim-
ing at vertical bone formation (VBF) are guided bone
regeneration,4,5 block bone grafts,6 and distraction
osteogenesis,7 associated or not with particulate bone
grafts,8 and other chemical inducers (platelet-derived
growth factor BB [PDGF BB], enamel matrix protein de-
rivative [EMD], platelet-rich plasma [PRP], β tricalcium
phosphate).9
VBF has been reproduced in animal models us-
ing dome-shaped tissue barriers associated with ex-
panded polytetrafluoroethylene (e-PTFE) membranes,
achieving significant bone gain.10 Thereafter, these

The International Journal of Oral & Maxillofacial Implants 311

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Zendron et al
b c
membranes were combined with different grafting
materials in mandibles of dogs, demonstrating con-
tact between the newly formed bone tissue and the
implant.11 Another study12 using titanium domes com-
pared with e-PTFE membranes associated or not with
autogenous bone fragments in dogs demonstrated
greater mean bone gain when the domes were used.
Concerning the performance of xenogeneic or allo-
plastic grafts associated with VBF in implants, animal
studies revealed that the association of Bio-Oss and
collagen membrane in immediate implant placement
promoted bone regeneration, similar to the utilization
of autogenous bone.13 Due to its three-dimensional
microparticulate porous configuration, the synthetic
material Biogran allows diffusion of nutrients, blood
vessels, and cell proliferation, with potential of new
bone formation in animal studies.14 Another study
analyzing bioactive glass around implants placed in
rat tibiae and femurs demonstrated better stability of
implants in the newly formed tissue compared with
the hydroxyapatite group.15 However, other studies
observed that, after 1 year, the biomaterials (Bio-Oss
and Biogran) associated with hollow and massive Tef-
lon capsules delayed bone healing in the mandibu-
lar ramus of rats in simulations of periodontal and
peri-implant defects. Fibrous connective tissue was ob-
served between particles, while the control group with
hollow capsules exhibited significant bone filling.16
The critical factors for the success or failure of VBF
associated with implants, as well as the performance
and analysis of biomaterials in these borderline con-
ditions, have not yet been fully elucidated in the lit-
erature. Considering the limitations of experiments
with animal models, this study aimed to evaluate VBF
around implants and compared, by histomorphomet-
ric analysis, different bone filling materials associated
with a titanium device as a tissue barrier.
MATERIALS AND METHODS
This study was performed on seven male healthy mon-
grel dogs with a mean age of 26 months and with a
mean body weight of 21 kg. The selection of this animal
model was based on the requirement of a larger animal
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Fig 1    (a) Exposed threads of implants
in relation to bone crest. (b) Additional
drilling on the bone crest. (c) Massive
titanium dome covering implants and
containing the clot (group C [control])
and filler materials (groups AB, BG, BO).
(mandible dimension) and characteristics of bone re-
generation similar to humans.17 After approval by the
University of São Paulo - USP - Animal Ethics Commit-
tee (USP-026/2016), the animals were kept in standard
individual cages and fed ad libitum. Twenty-four hours
prior to surgery, the chosen dog was then maintained
on a restricted soft diet to prevent any gastrointestinal
intercurrence during the surgical procedure. One day
before surgery, shaving of the lower mandibular area
and intraoral disinfection were performed under seda-
tion by intramuscular injection of dihidrotiazine chlo-
ride (1.5 mL/10 kg). The main surgical procedures were
then conducted under intravenous general anesthesia
with sodium thiopental (1 mL/kg). The anesthesia was
applied through open vein access maintained by the
injection of saline throughout surgery, aiming hydra-
tion at subsequent administration of complementary
anesthetic doses.
The animal was placed in supine position, and
local disinfection was performed by application of
chlorhexidine digluconate (0.2%); a medial incision
was performed, extending from the symphysis to
the level of the mandibular angle. Bilateral periosteal
incisions were performed on the mandibular lower
extension at both the right and left sides.9 The bone
surface at the mandibular body was exposed by a
total-thickness flap. These surfaces were manually
planed using bone files (Hu-Friedy) under constant
irrigation to achieve an even surface with at least 6
mm height and 45 mm extension measured with a
periodontal probe, to represent the atrophic ridge.
In each mandibular body, two areas 25 mm apart
were selected, resulting in four sites per dog. Four
custom-fabricated implants (3.3 × 6.0 mm) (Conexão
Sistemas de Prótese Ltda) were partially inserted af-
ter conventional instrumentation in densely cortical
areas, totaling 28 implants. Thus, three threads per
implant remained exposed and protruding in relation
to the original bone level, and three threads remained
below the bone level (Fig 1a). Four perforations were
performed using a 1.0-mm bur on the cortical bone
around the implants to expose the medullar spaces
of the bone tissue (Fig 1b). These perforations aimed
to increase the availability of regenerative cells in the
experimental wound area.

Each animal received four implants, and each pro-
truding aspect of the implants received one particular
treatment, each one containing 1 mL of peripheral ve-
nous blood filling the internal space of the tissue barri-
ers. The groups were divided as follows:
• C (control group): filled with blood clot
• AB (autogenous bone): cortical bone chips
harvested during planing of bone surfaces in the
mandibular body
• BG (Biogran, Biomet 3i): synthetic graft
(Granule size: 300 to 355 µm)
• BO (Bio-Oss, Geistlich Pharma AG, Division
biomaterials): bovine graft (Granule size: 0.25 to
1.00 mm)
The protruding aspects of the implants were then
covered with custom-fabricated commercially pure
titanium dome-shaped tissue barriers, measuring
4.8 × 5.0 mm of internal space (Conexão Sistemas
de Prótese Ltda) (Fig 1c). Each of the four structures
was filled with material of one experimental group,
randomly assigned by drawing lots. The material was
easily maintained inside the dome due to its massive
structure and with the use of venous peripheral blood
associated or not with filling materials, establishing a
blood clot. Also, the bleeding perforations made in the
bone around the implants further preserved a viable
clot. The barriers were fixated to the cortical bone by
means of 1.2 mm commercially pure titanium minis-
crews (Intermedic Technology).
Sutures were performed in layers using resorbable
sutures (Vicryl 5-0 Ethicon, Johnson & Johnson) for
periosteum and muscular tissue, and nylon sutures
for the skin (Mononylon 2-0 Ethicon, Johnson & John-
son). After the surgical procedures, dogs received in-
tramuscular injections of 30,000 U/kg of antibiotics
(Pentabiótico, Fort Dodge Saúde Animal) for 9 days.
Externally, a topical antibiotic solution containing
rifampicin sodium chloride was applied for 7 days
(Rifocina Hoechst-Marion Roussel S/A). An Elizabethan
collar (Agrosolo, LTDA) was maintained in place for
30 days to protect the surgical area from inadvertent
movements of the animal.
The animals were euthanized by an anesthetic over-
dose with sodium thiopental (4 mL/kg) 3 months af-
ter placement of implants and barriers. The mandibles
were dissected, and the blocks containing the experi-
mental specimens (implant/barrier) were retrieved
and immersed in 4% neutral formalin for fixation.
The decalcified sections (70 to 85 µm) were prepared
from the center of the implant/barrier assembly, corre-
sponding to the longitudinal section (anteroposterior)
of the mandibular base, as previously described.18 The
sections were stained with 1% toluidine blue.18
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Zendron et al
Table 1   Standardized Exposure of
Extraosseous Threads Between
Groups (Mean [mm] and SD)
AB (n = 12) C (n = 12) BG (n = 12) BO (n = 12)
Mean 2.64a 2.64a 2.57a 2.56a
SD 0.3 0.14 0.16 0.12
SD = standard deviation; n = number of observations; AB =
autogenous bone; C = control; BG = Biogran; BO = Bio-Oss.
Different lowercase letters represent statistically significant
differences.
Histomorphometric Measurements
All parameters were analyzed by a single calibrated
examiner (intraclass correlation coefficient = 0.98), as
follows:
• VBF: height of new bone formation, considering
the initially exposed implant threads, taking
as a reference point the original cortical bone
and the implant shoulder. For each slide, the
mesial and distal portions of the implant/barrier
assembly were individually considered (n = 12). For
standardization, all exposed implant surfaces were
measured per experimental group (Table 1). The
percentages of VBF were then calculated in relation
to the measurement of exposed threads.
The other parameters were analyzed by slide
(n = 24) and included the following:
• Filling of extraosseous threads: percentage of
filling of each thread positioned above the original
cortical bone level
• Bone-to-implant contact in extraosseous threads:
percentage of contact between the bone tissue
and implant in each exposed thread
• Filling of intraosseous threads: percentage of
filling of each thread positioned below the original
cortical bone level
• Bone-to-implant contact in intraosseous threads:
percentage of contact between the bone tissue
and implant in each thread positioned below the
original cortical bone level
Histomorphometric analyses, under the previ-
ously exposed limits of threads of each implant (three
threads per implant), were performed on the mesial
and distal sides, using a microscope connected to a
video camera and computer software (Image Pro-Plus,
Media Cybernetics). Software tools to calculate linear
and area measures were used to establish the exten-
sion of the regenerative process, filling with new bone
formation, implant-bone contact fraction, and all the
measurements related to bone formation inside the ti-
tanium dome and the original cortical bone. Data were
The International Journal of Oral & Maxillofacial Implants 313
Zendron et al
A B
A B
A
B
Fig 2   Distinction between the Fig 3  Lamellar bone forma-
newly formed bone (A: darker tion (arrows) near the surface of
blue) and the original cortical the implant (1% toluidine blue)
bone (B: lighter blue) (1% tolu- (100×).
idine blue) (100×).
statistically analyzed by analysis of variance (ANOVA)
for comparison of means of each parameter analyzed,
and by the Bonferroni t test for individual comparisons
(P < .01) between the different groups, to reveal the
significant differences for each proposed treatment.
RESULTS
The histomorphometric analysis demonstrated that,
among seven specimens, one presented infection and
abscess formation and was excluded. The 24 slides mi-
croscopically analyzed demonstrated direct bone ap-
position to titanium surfaces.
Qualitative Analysis
Some general aspects were common to all investigat-
ed groups regarding the pattern of bone formation.
Besides the variable extent of bone formation among
groups, no experimental treatment used to fill the re-
generative space changed the quality of newly formed
bone. The staining technique (1% toluidine blue) al-
lowed distinction between the newly formed bone
(darker blue) and the original cortical bone (lighter
blue) (Fig 2). In all groups exhibiting new bone forma-
tion, a highly stained woven bone type was observed,
covered by a thin layer of lamellar bone less stained than
the previous one (Fig 3). Although the staining method
was not specific to soft connective tissue, condensa-
tions observed above the newly formed bone were
suggestive of bone-forming cells. At the inner part of
the new woven bone, connective tissue and blood ves-
sels were present. All the referred newly formed bone
herein established a close relationship with the re-
maining flat cortical bone surface. Some poorly stained
structures were also observed, adjacent to the titani-
um implant surfaces, resembling the arrangement of
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A
Fig 4   Connective tissue fibers Fig 5    Fibrous connective tis-
(arrows) oriented parallel to the sue (arrows) around the par-
implant surface (1% toluidine ticles of bioactive glass (A) (1%
blue) (100×). toluidine blue) (100×).
osteons, surrounded by connective tissue and blood
vessels. These structures were always found above the
recently formed bone and distant from the flat cortical
bone, suggesting an ongoing process of bone matrix
deposition and mineralization, which was incomplete
at the 90-day healing period.
Nevertheless, some aspects were specifically ob-
served in each group:
• C: Bone formation was minimal in the majority of
analyzed slides. Furthermore, the slides revealed
the presence of a dense connective tissue oriented
parallel to the implant surfaces inside the domes
(Fig 4).
• AB: Some specimens presented vertical bone
formation that surpassed the reference mark used
for morphometry. Autogenous bone particles were
incorporated to the mineralized matrix of newly
formed bone.
• BG: Minimum vertical bone formation and contact
between the newly formed bone and material
particles were observed. The histologic processing
of specimens by abrasion showed that the particles
had a central core of fibrous tissue and several
fractures. The entire regenerative space was
dominated by the presence of fibrous connective
tissue.
• BO: subtle bone formation similar to group BG was
observed. In the majority of specimens, a fibrous
connective tissue layer surrounded the particles
(Fig 5).
Quantitative Analysis
The mean VBF was calculated in percentage, standard
deviation, and number of observations for each exper-
imental group, which are described in Table 2. The per-
centage of bone formation in relation to the extension
 Zendron et al

Table 2   Percentage of VBF Demonstrated by

Mean and SD for Each Group
AB C BG BO
(n = 12) (n = 12) (n = 12) (n = 12)
Mean 36.82a 9.86b 13.32b 14.08b
SD 39.77 22.27 12.25 7.23
VBF = vertical bone formation; SD = standard deviation; n = number of
a
observations; AB = autogenous bone; C = control; BG = Biogran; BO =
Bio-Oss.
Different lowercase letters represent statistically significant differences.

Table 3   Percentage of Filling of Extraosseous

Threads Demonstrated by Mean and
SD for Each Group
AB C BG BO
(n = 24) (n = 24) (n = 24) (n = 24)
b
Mean 30.08a 2.80b 11.77ab 13.92ab
Fig 6   (a) Greater vertical bone formation
SD 29.28 7.82 22.91 23.41 in group AB. (b) lower vertical bone forma-
SD = standard deviation; n = number of observations; AB = autogenous tion in group C (1% toluidine blue) (25×).
bone; C = control; BG = Biogran; BO = Bio-Oss.
Different lowercase letters represent statistically significant differences.

Table 4   Percentage of Bone-to-Implant

Contact in Extraosseous Threads
Demonstrated by Mean and SD for
Each Group
AB C BG BO
(n = 24) (n = 24) (n = 24) (n = 24)
Mean 13.81a 0.92b 7.33ab 7.61ab
SD 15.69 3.13 14.01 15.26
a b
SD = standard deviation; n = number of observations; AB = autogenous
bone; C = control; BG = Biogran; BO = Bio-Oss. Different lowercase
letters represent statistically significant differences.

Table 5   Mean Percentage of Filling and

Bone-to-Implant Contact in
Intraosseous Threads
AB C BG BO
(n = 24) (n = 24) (n = 24) (n = 24)
Filling threads 65.35a 61.21a 63.46a 67.78a
c d
Bone-to-implant 38.08a 35.12a 37.35a 42.46a
contact Fig 7   Bone filling and bone-to-implant contact in extraosseous
n = number of observations; AB = autogenous bone; C = control; threads. (a) group AB; (b) group C; (c) group BG; and (d) group BO
BG = Biogran; BO = Bio-Oss. (1% toluidine blue) (100×).
Different lowercase letters represent statistically significant
differences.

of protruding screws was calculated (Table 2). AB
proved to be significantly better than all groups (Fig 6).
BG and BO groups were demonstrated to be equiva-
lent to the C group.
The percentage of bone apposition on exposed
threads positioned above the original cortical bone
level demonstrated a significantly better outcome
for the AB group compared with the C group. BG and
BO were equivalent to AB and C (Fig 7) (Table 3). The
percentage of bone-to-implant contact at the exposed
threads demonstrated that AB presented a significant-
ly superior outcome compared with C. BG and BO were
equivalent to AB and C (Fig 7) (Table 4).
The analysis of bone apposition on submerged
screws and the submerged bone-to-implant contact
portion revealed that none of the treatments modi-
fied the rate of bone formation and osseointegration
around the implants (Table 5).

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Zendron et al
DISCUSSION
This study analyzed VBF in vivo, using a tissue bar-
rier associated with different filling materials around
implants in areas resembling an atrophic mandible.
Analysis of data demonstrated that the group using
autogenous bone (AB) achieved better outcomes of
VBF, filling, and bone-to-implant contact in extraos-
seous threads compared with the other groups. Con-
cerning the parameters of filling and bone-to-implant
contact in extraosseous threads, the groups using bio-
materials (BG to BO) were equivalent to group AB and
the control. However, the histomorphometric analysis
revealed a difference in the quality of formed tissue,
with the presence of fibrous connective tissue be-
tween the biomaterial particles.
The use of a rigid and nonperforated titanium dome
as a tissue barrier allowed biocompatibility, soft tissue
exclusion, and prevention of tissue collapse, acting
as a three-dimensional framework for cell prolifera-
tion.12,19,20 The utilization of structures for VBF was
demonstrated with a cast dome-shaped titanium
structure in rat calvaria.10 Therefore, potential of bone
formation promoted by these devices11,12 and massive
Teflon capsules associated with different biomaterials
was demonstrated, presenting favorable outcomes in
animal studies.16 However, perforated titanium domes
seem to achieve inferior bone regeneration.12,20 Ren-
vert et al12 compared the use of perforated domes
associated or not with e-PTFE membranes for bone
regeneration in dogs. The results showed that the use
of a perforated dome alone was related to encapsula-
tion of the autogenous graft by soft tissue. Yamada et
al20 compared the effectiveness of the perforated and
massive domes in the calvaria of rats and observed
that massive domes induced greater bone formation
in the osseous defect.
In humans, the use of massive domes as tissue bar-
riers has not been reported. Clinical studies on guided
bone regeneration for implants associated nonresorb-
able e-PTFE membranes with autogenous bone filling
and observed remarkable outcomes.21,22 However,
these procedures were performed in intrabony defects.
In the present study, VBF around implants was great-
er for AB compared with the other groups. The superior
outcomes of autogenous grafts have been previously
observed in animal specimens23 and also clinically.24
This is explained by the biologic characteristics of this
tissue, which allow greater gain in bone volume incor-
porated into native bone.25,26 However, autogenous
grafts are not always well accepted by patients due to
the greater morbidity related to surgical sites (both re-
ceptor and donor).22 Also, depending on the quantity of
bone graft required for reconstruction, extraoral sites (il-
iac crest, cranial vault, etc) may be required. Thus, due to
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these limiting factors and the increasing development
of new biomaterials, the utilization of bone substitutes
should be considered. Therefore, the other experimental
groups in this study included biomaterials (Biogran and
Bio-Oss) to evaluate their performance in relation to the
proposed parameters. Even though the groups BO and
BG presented similar outcomes as the control group, sta-
tistical similarity was also observed in the filling and con-
tact with extraosseous threads compared with group
AB. However, histomorphometric analysis revealed that
the formed tissue and biomaterial particles were inter-
spersed with fibrous connective tissue. Possible lacunae
between dome and bone tissue may have allowed the
invasion of connective tissue during healing in groups C,
BG, and BO. The results suggest the possibility of utiliza-
tion of biomaterials in the proposed scenario. A study in
animal models, using xenogenous grafts and laser pho-
tobiostimulation, achieved similar rates of bone-to-im-
plant contact as the autogenous bone in the evaluation
of different grafts.27 Contact with titanium implants was
also observed after filling of bone defects with bioactive
glass.28 Clinically, the potential of bone regeneration of
bioactive glasses in implant sites should be further ana-
lyzed.29 It should be highlighted that bone tissue gain
in height is challenging, especially around implants, due
to the surface topography and lack of vascularization.2
In other clinical conditions, such as intrabony defects
around teeth or implants, effective bone filling has been
observed with bioactive glass (Biogran)30 and xenog-
enous grafts (Bio-Oss).31–33
All groups received autogenous peripheral venous
blood, which presents osteoinductive biologic proper-
ties.34 In the study of Kumar et al,35 utilization of ve-
nous blood compared with PRP improved the healing
support to the surgical site, without great demands of
treatment time or cost.
Considering the number of surgical procedures,
morbidity, and uncertainty of outcomes, one option
would be the utilization of short implants, especially
in areas with adverse anatomical conditions.3 Sys-
tematic reviews36,37 reported similar survival rates of
short implants and implants associated with vertical
ridge augmentation. However, data should be care-
fully analyzed depending on the number and quality
of randomized controlled clinical trials (RCTs) included
in the review.36,37 In contrast, recent publications dem-
onstrated that short implants present a greater risk of
failures.38,39 Therefore, more RCTs are necessary to con-
tribute in this decision-making process.
Concerning the experimental model employed, the
extraoral approach was selected due to the relatively
high risk of intraoral exposure of the dome.11,40 Hence,
sufficient soft tissue was available due to the osteotomy,
allowing complete flap closure of the wound without
tension. In a clinical scenario, lack of appropriate soft

tissue for closure of the flap represents a limiting factor
of the technique. The tension in the tissue causes expo-
sures of the tissue barriers and graft contamination.41
The time of 3 months for analysis was similar to other
studies, which ranged from 3 to 6 months.12,42,43 Previ-
ous animal studies estimated sufficient study periods of
12 weeks for Bio-Oss44 and 8 weeks for Biogran in critical
defects around implants.45 However, studies with longer
follow-up periods are necessary to observe maintenance
of the newly formed bone after guided bone regenera-
tion and performance after prosthesis placement.
Future studies using the proposed experimental
model and combination of autogenous bone grafts
and biomaterials should be conducted. There are re-
ports of high regeneration potential by the associa-
tion of different biomaterials, especially in intrabony
defects.46 These would reduce the need for extensive
volume of autogenous bone, reducing the morbidity
and surgical time and enhancing the biologic proper-
ties of grafts.47
Within the limitations of this study, data from the histo-
morphometric analysis demonstrated better outcomes of
the parameters analyzed for group AB compared with the
other groups. It is suggested that, even though groups
BG and BO demonstrated inferior outcomes to group AB,
they were slightly superior to group C.
CONCLUSIONS
The experimental model was suitable for evaluation
of VBF around implants placed in atrophic mandibles.
Histomorphometric analysis evidenced better out-
comes for group AB. Even though groups BG and BO
presented worse outcomes than AB, they were slightly
better compared with the control group.
ACKNOWLEDGMENTS
The authors reported no conflicts of interest related to this study.
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