Success Rate of Mandible Implants Placed in Vascularized Fibula Bone Graft: A Systematic Review.

This systematic review addressed the implant success rate after mandible reconstruction with vascularized fibula bone graft. Therefore, preferred reporting items for systematic review and meta-analysis guidelines were used to perform the systematic review, and the search included following databases: PubMed, Lilacs, Google Scholar, Open Gray, Science Direct and Cochrane. A search of medical subject headings (MeSH) and related terms (fibula) OR (vascularized) OR (microvascularized) AND (implant) OR (rehabilitation) OR (osseointegrated) AND (mandible) OR (jaw) OR (maxillofacial), without any language or time restrictions until October 2017 was carried out. The eligible studies primarily consisted of clinical cohorts designed to evaluate the feasibility of mandible reconstruction using vascularized fibula bone grafts and implant-supported rehabilitations, with a minimum observation period of 12 months. After screening, 13 eligible cohort studies for this review were selected (3 retrospective and 10 prospective). Of 285 vascularized fibular reconstructions, only 6 failures were reported with a success rate of approximately 98% after a mean follow-up period of 40 months. In total, 910 implants were placed in vascularized fibular grafts with a success rate of 92.6% (range, 82%-100%) after 40 months. Also, similar success rates for primary (95%; range, 93%-100%) and secondary (91%; range, 83%-100%) implant surgeries have been demonstrated. Considering risk factors, implant survival in irradiated patients was usually lower (76%; range, 38%-88%) than nonirradiated patients (90%; range, 83%-94%); however, it was significantly different in only 1 study. Alcohol and tobacco use has shown no significant association with implant failure in any study. Hence, implant placement in vascularized fibula bone graft presented similar success rates relative to native mandible bone rehabilitations.

Technical Strategy of Bone Graft Augmentation in the Anterior Maxilla.

Bone graft augmentation in the anterior maxilla has a high successful rate. However, suture dehiscence and consequent bone graft exposure can compromise and fail this procedure. Therefore, this article presents a new strategy of closure technique to guarantee the bone graft augmentation. The sutures occur in muscular and mucous planes to avoid suture tension, thus decreasing complications of bone graft augmentation in the anterior maxilla.

Bilateral Coronoid Hyperplasia in a 43-Year-Old Patient Treated With Intraoral Coronoidectomy.

The mandibular coronoid hyperplasia can be classified as a congenital or development change of the temporomandibular joint. This condition occurs due to a no-neoplasic growth of the coronoid process to the infratemporal fossa. Thus, this part of the bone impacts in the posterior face of the zygomatic bone causing limitation of the mouth opening. The aim of this paper is to report a clinical case of a 43-year-old male with mouth-opening limitation 28 years ago. After clinical and computed tomographic examinations, he was diagnosed with bilateral mandibular coronoid hyperplasia. The treatment proposed was a bilateral coronoidectomy by intraoral approach. In a 1-month postoperative period, the patient reported improvement of the painful complaints and mouth opening. After 1 year, the patient recovered the mouth opening improving his quality of life and there were no more complaints.

The Effect of Osteotomy Dimension on Implant Insertion Torque, Healing Mode, and Osseointegration Indicators: A Study in Dogs.

PURPOSE: This study investigated the effect of the osteotomy diameter for implant placement torque and its effect on the osseointegration. MATERIALS AND METHODS: Eight male beagle dogs received 48 implants (3.75 mm × 10 mm) in their right and left radius, 3 implants per side and allowed to heal for 3 weeks. Three experimental groups were evaluated. Group 1: implant with an undersized osteotomy of 3.0 mm; group 2: osteotomy of 3.25 mm, and group 3: osteotomy of 3.5 mm. The insertion torque was recorded for all implants. Histological sectioning and histometric analysis were performed evaluating bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). RESULTS: Implants of group 1 presented statistically higher insertion torque than those of groups 2 and 3 (P < 0.01). No differences in BIC or BAFO were observed between the groups. From a morphologic standpoint, substantial deviations in healing mode were observed between groups. CONCLUSION: Based on the present methodology, the experimental alterations of surgical technic can be clinically used with no detrimental effect over the osseointegration process.

Histomorphological and Histomorphometric Analyses of Grade IV Commercially Pure Titanium and Grade V Ti-6Al-4V Titanium Alloy Implant Substrates: An In Vivo Study in Dogs.

PURPOSE: To evaluate the bone response to grade IV commercially pure titanium (G4) relative to Ti-6Al-4V (G5). MATERIALS AND METHODS: Implant surface topography was characterized by optical interferometry and scanning electron microscopy (SEM). Thirty-six implants (Signo Vinces, n = 18 per group) were installed in the radius of 18 dogs. The animals were killed at 1, 3, and 6 weeks, resulting in 6 implants per group and time in vivo for bone morphology, bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO) evaluation. RESULTS: SEM depicted a more uniform topography of G4 than G5. Surfaces were statistically homogeneous for Sa, Sq, and Sdr. At 1 week, new bone formation was observed within the healing connective tissue in contact with the implant surface. At 3 weeks, new bone in direct contact with the implant surface was observed at all bone regions. At 6 weeks, the healing chambers filled with woven bone depicted an onset of replacement by lamellar bone. No significant effect of substrate was detected. Time presented an effect on BIC and BAFO (P < 0.001). CONCLUSION: Both titanium substrates were biocompatible and osseoconductive at the bone tissue level.

Surface characterization and in vivo evaluation of laser sintered and machined implants followed by resorbable-blasting media process: A study in sheep.

BACKGROUND: This study aimed to compare the histomorphometric and histological bone response to laser-sintered implants followed by resorbable-blasting media (RBM) process relative to standard machined/RBM surface treated implants. MATERIAL AND METHODS: Six male sheep (n=6) received 2 Ti-6Al-4V implants (1 per surface) in each side of the mandible for 6 weeks in vivo. The histomorphometric parameters bone-implant contact (BIC) and bone area fraction occupancy (BAFO) were evaluated. RESULTS: Optical interferometry revealed higher Sa and Sq values for the laser-sintered/RBM surface in relation to standard/RBM implants. No significant differences in BIC were observed between the two groups (p>0.2), but significantly higher BAFO was observed for standard/RBM implants (p<0.01). CONCLUSIONS: The present study demonstrated that both surfaces were biocompatible and osseoconductive, and the combination of laser sintering and RBM has no advantage over the standard machined implants with subsequent RBM.

Osseointegration of Plateau Root Form Implants: Unique Healing Pathway Leading to Haversian-Like Long-Term Morphology.

Endosteal dental implants have been utilized as anchors for dental and orthopedic rehabilitations for decades with one of the highest treatment success rates in medicine. Such success is due to the phenomenon of osseointegration where after the implant surgical placement, bone healing results into an intimate contact between bone and implant surface. While osseointegration is an established phenomenon, the route which osseointegration occurs around endosteal implants is related to various implant design factors including surgical instrumentation and implant macro, micro, and nanometer scale geometry. In an implant system where void spaces (healing chambers) are present between the implant and bone immediately after placement, its inherent bone healing pathway results in unique opportunities to accelerate the osseointegration phenomenon at the short-term and its maintenance on the long-term through a haversian-like bone morphology and mechanical properties.

Surface characterization and in vivo evaluation of dual Acid-etched and grit-blasted/acid-etched implants in sheep.

PURPOSE: Dual acid-etching is widely used to modify dental implant topography and enhance early bone healing. This study evaluated the histomorphometric, biomechanical, and histological bone response to acid-etched (AA) in comparison with grit-blasted/acid-etched (GB) and machined control (C) implants within sites of relatively low-bone remodeling rates. MATERIALS AND METHODS: Implant surface topography was evaluated by scanning electron microscopy and optical interferometry (IFM). Six adult male sheep (n = 6) received 72 Ti-6Al-4V implants (n = 24 per surface) in both ilium (n = 12 per bone bilaterally). The implants remained for 3 and 6 weeks in vivo. The histomorphometric parameters bone-implant contact (BIC) and bone area fraction occupancy (BAFO) were evaluated. Biomechanical analysis consisted of torque-to-interface failure. RESULTS: IFM analysis showed the highest average surface roughness for GB and the highest density of summits and developed surface area percentage (P < 0.01) for AA. No difference was observed in BAFO for all groups in 3 and 6 weeks. Increased BIC and torque resistance were observed for AA implants at both time points after implantation. CONCLUSIONS: Overall, improved bone-to-implant response was observed for the AA implant surface.

The effect of implant diameter on osseointegration utilizing simplified drilling protocols.

OBJECTIVES: To observe and to compare histologically and histomorphometrically, the combined effect of drilling sequence and implant diameter in vivo. MATERIAL AND METHODS: A total of 72 alumina-blasted and acid-etched Ti-6Al-4V implants with three different diameters (3.75, 4.2, and 5 mm, n = 24 for each group) were placed in the right and left tibiae of 12 beagle dogs. Within the same diameter group, half of the implants were inserted after a simplified drilling procedure (pilot drill + final diameter drill) on one tibia and the other half were placed using the conventional drilling procedure on the other tibia. After 1 week, half of the animals (n = 6) were sacrificed, and the other half was sacrificed after 5 weeks (n = 6). The retrieved bone-implant samples were subjected to non-decalcified histologic sectioning, and the bone-to-implant contact (BIC) and the bone area fraction occupancy (BAFO) were analyzed. Primary statistical analysis used a mixed model analysis of variance with significance level set at P < 0.05. RESULTS: Histologic observation showed that at 1 week, immature woven bone formed in vicinity of the implant, whereas at 5 weeks, the woven bone was replaced by lamellar bone, which formed in proximity with the implant. Histomorphometrically, the simplified technique was associated with significantly greater BIC and BAFO after 1 week. Differences between techniques were not longer apparent after 5 weeks, but BAFO was inversely and significantly associated with implant diameter at that time. CONCLUSIONS: The simplified technique did not impair either early or late bone formation for any tested implant diameter; however, wider diameters were associated with less bone formation at longer healing times for both techniques.

Amoxicillin administrations and its influence on bone repair around osseointegrated implants.

PURPOSE: The objective of this study was to evaluate the influence of 4 different amoxicillin administration protocols on osseointegration of dental implants. MATERIALS AND METHODS: Thirty-five Wistar rats received an implant in the right tibia and were divided into 5 groups (n = 7): the control group (G1), a group that received a single dose of amoxicillin suspension (40 mg/kg) hour before surgery (G2), a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 3 days (G3), a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 5 days (G4), and a group that received amoxicillin suspension 1 hour before surgery and a 10-mg/kg dose every 12 hours for 7 days (G5). The animals were sacrificed by anesthesia overdose 28 days after implant placement. The samples were retrieved for bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) analyses. RESULTS: BIC analysis indicated 3 different statistical groups: G1 plus G2, G3, and G4 plus G5. There was no statistical difference between G1 and G2 or between G4 and G5. G3 presented lower values, with statistical difference for G1 plus G2 and G4 plus G5. Also, a statistical difference was found between G1 plus G2 and G4 plus G5. For BAFO evaluation, no statistical difference was found for the experimental groups. CONCLUSION: The results of this study suggest that prolonged use of amoxicillin might have a negative effect on bone formation around implants.

Modification of xenogeneic graft materials for improved release of P-15 peptides in a calvarium defect model.

Particulate bone augmentation is an established clinical alternative to regenerate bone. However, in regions of poor bone quality or previously infected sites, the clinical outcomes are more inconsistent. For that purpose, peptides have been added to particulate materials in an attempt to render them with antibacterial properties or to improve their osseoconductivity. For instance, competence-stimulating peptide (CSP) has been studied to decrease the division rate of Streptococcus mutans. Also, the addition of a specific short amino acid sequence peptide derived from type I collagen (P-15) to the bone substitutes has been introduced in an attempt to increase its osseoconductivity. The present study hypothesized that xenogeneic graft materials with and without CSP would present improved host-to-biomaterial response when used in combination with P-15. Particulate graft materials with and without P-15, OsteoGraf with CSP and OsteoGraf, were implanted in an 8-mm rabbit calvarial defect for 4 weeks, and thereafter, histological and histomorphometrical evaluation was performed. The results showed that both OsteoGraf and CSP groups with the addition of P-15 induced bone growth towards the center of the defect. Furthermore, the addition of CSP to Osteograf showed a tendency to increase its osteoconductivity when combined with P-15. The results of the current study suggested that P-15 had some impact on osteogenesis; however, the effect differed between different bone substitute materials. Further investigation is necessary to clarify its effectiveness when used in combination with bone substitutes.

Elucidating the Benefit of Perforated vs Non-Perforated Membranes in Guided Bone Regeneration: An in Vivo Histologic Evaluation and Histomorphometric Analysis.

BACKGROUND: Non-perforated Polytetrafluoroethylene (PTFE) membranes are effectively utilized in guided bone regeneration (GBR) but may hinder cell migration due to limited interaction with the periosteum. This study compared bone regeneration using occlusive or perforated membranes combined with acellular collagen sponge (ACS) and recombinant human bone morphogenic protein-2 (rhBMP-2) in a canine mandibular model. MATERIAL AND METHODS: Male beagle dogs (n=3) received two mandibular defects each to compare ACS/rhBMP-2 with experimental (perforated group) and control (non-perforated group) membranes (n=3 defects/group). Tissue healing was assessed histomorphologically, histomorphometrically and through volumetric reconstruction using microcomputed tomography. RESULTS: The perforated group showed increased bone formation and reduced soft tissue formation compared to the non-perforated group. For the primary outcome, histomorphometric analysis revealed significantly greater total regenerated bone in the perforated group (67.08 ± 6.86%) relative to the nonperforated group (25.18 ± 22.44%) (p = 0.036). Perforated membranes had less soft tissue infiltration (32.91 ± 6.86%) compared to non-perforated membranes (74.82 ± 22.44%) (p = 0.036). CONCLUSION: The increased permeability of membranes in the perforated group potentially enabled periosteal precursor cells greater accessibility to rhBMP-2. The availability may have accelerated their differentiation into mature bone-forming cells, contributing to the stimulation of new bone production, relative to the non-perforated group.

Buccal and lingual bone level alterations after immediate implantation of four implant surfaces: a study in dogs.

OBJECTIVES: Bone formation and maintenance around implants placed immediately after tooth extraction may be affected by implant surface treatment and compromise long-term esthetic results. This study morphometrically evaluated buccal bone loss and bone-to-implant contact (BIC) of four implant systems placed immediately after tooth extraction in a dog model. MATERIAL AND METHODS: The premolars of eight beagle dogs were bilaterally extracted with a full-thickness flap, and root-form dental implants were placed on the root extraction socket. Implants (n = 16 each) with different surface treatments were placed from sites 1 to 4 and alternated between animals to allow evaluation of the same number of implants at sites and evaluation time points. Implant surface treatments were as follows: anodized, discrete crystalline deposition, SLActive, and microblasted. The left and right side provided implants that stayed for 2 and 4 weeks, respectively. Submerged healing was allowed and bone-to-implant contact (BIC) and buccal bone loss were morphometrically measured. Linear mixed models (P < 0.05) were used to assess differences between groups, across time, and their interaction. RESULTS: Buccal bone loss was observed to approximately double between 2 and 4 weeks (P = 0.01). BIC also increased between 2 and 4 weeks, by 20-25% (P = 0.01). These changes were statistically similar for each surface. CONCLUSION: When placed immediately after tooth extraction, the evaluated histomorphometric parameters vary only with time.

Biomechanical evaluation of undersized drilling on implant biomechanical stability at early implantation times.

PURPOSE: The present study evaluated the effect of different drilling dimensions (undersized, regular, and oversized) in the insertion and removal torques of dental implants in a beagle dog model. METHODS: Six beagle dogs were acquired and subjected to bilateral surgeries in the radii 1 and 3 weeks before euthanasia. During surgery, 3 implants, 4 mm in diameter by 10 mm in length, were placed in bone sites drilled to 3.2 mm, 3.5 mm, and 3.8 mm in final diameter. The insertion and removal torque was recorded for all samples. Statistical analysis was performed by paired t tests for repeated measures and by t tests assuming unequal variances (all at the 95% level of significance). RESULTS: Overall, the insertion torque and removal torque levels obtained were inversely proportional to the drilling dimension, with a significant difference detected between the 3.2 mm and 3.5 mm relative to the 3.8 mm groups (P < 0.03). Although insertion torque-removal torque paired observations was statistically maintained for the 3.5 mm and 3.8 mm groups, a significant decrease in removal torque values relative to insertion torque levels was observed for the 3.2 mm group. A different pattern of healing and interfacial remodeling was observed for the different groups. CONCLUSIONS: Different drilling dimensions resulted in variations in insertion torque values (primary stability) and stability maintenance over the first weeks of bone healing.

Histomorphometry and bone mechanical property evolution around different implant systems at early healing stages: an experimental study in dogs.

PURPOSE: Commercial implants differ at macro-, micro-, and nanolevels, which makes it difficult to distinguish their effect on osseointegration. The aim of this study was to evaluate the early integration of 5 commercially available implants (Astra OsseoSpeed, Straumann SLA, Intra-Lock Blossom Ossean, Nobel Active, and OsseoFix) by histomorphometry and nanoindentation. MATERIALS AND METHODS: Implants were installed in the tibiae of 18 beagle dogs. Samples were retrieved at 1, 3, and 6 weeks (n = 6 for each time point) and were histologically and nanomechanically evaluated. RESULTS: The results presented that both time (P < 0.01) and implant system and time interaction (P < 0.02) significantly affected the bone-to-implant contact (BIC). At 1 week, the different groups presented statistically different outcomes. No significant changes in BIC were noted thereafter. There were no significant differences in rank elastic modulus (E) or in rank hardness (H) for time (E: P > 0.80; H: P > 0.75) or implant system (E: P > 0.90; H: P > 0.85). CONCLUSIONS: The effect of different implant designs on osseointegration was evident especially at early stages of bone healing.

Histologic and biomechanical evaluation of 2 resorbable-blasting media implant surfaces at early implantation times.

This study evaluated 3 implant surfaces in a dog model: (1) resorbable-blasting media + acid-etched (RBMa), alumina-blasting + acid-etching (AB/AE), and AB/AE + RBMa (hybrid). All of the surfaces were minimally rough, and Ca and P were present for the RBMa and hybrid surfaces. Following 2 weeks in vivo, no significant differences were observed for torque, bone-to-implant contact, and bone-area fraction occupied measurements. Newly formed woven bone was observed in proximity with all surfaces.

Biomechanical and histologic evaluation of non-washed resorbable blasting media and alumina-blasted/acid-etched surfaces.

OBJECTIVES: To compare the biomechanical fixation and histomorphometric parameters between two implant surfaces: non-washed resorbable blasting media (NWRBM) and alumina-blasted/acid-etched (AB/AE), in a dog model. MATERIAL AND METHODS: The surface topography was assessed by scanning electron microscopy, optical interferometry and chemistry by X-ray photoelectron spectroscopy (XPS). Six beagle dogs of ∼1.5 years of age were utilized and each animal received one implant of each surface per limb (distal radii sites). After a healing period of 3 weeks, the animals were euthanized and half of the implants were biomechanically tested (removal torque) and the other half was referred to nondecalcified histology processing. Histomorphometric analysis considered bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). Following data normality check with the Kolmogorov-Smirnov test, statistical analysis was performed by paired t-tests at 95% level of significance. RESULTS: Surface roughness parameters S(a) (average surface roughness) and S(q) (mean root square of the surface) were significantly lower for the NWRBM compared with AB/AE. The XPS spectra revealed the presence of Ca and P in the NWRBM. While no significant differences were observed for both BIC and BAFO parameters (P>0.35 and P>0.11, respectively), a significantly higher level of torque was observed for the NWRBM group (P=0.01). Bone morphology was similar between groups, which presented newly formed woven bone in proximity with the implant surfaces. CONCLUSION: A significant increase in early biomechanical fixation was observed for implants presenting the NWRBM surface.

Evaluation of a nanometer roughness scale resorbable media-processed surface: a study in dogs.

OBJECTIVES: This study compared the biomechanical fixation and bone-to-implant contact (BIC) of implants with different surfaces treatment (experimental - resorbable blasting media-processed nanometer roughness scale surface, and control - dual acid-etched) in a dog model. MATERIAL AND METHODS: Surface characterization was made in six implants by means of scanning electron microscopic imaging, atomic force microscopy to evaluate roughness parameters, and X-ray photoelectron spectroscopy (XPS) for chemical assessment. The animal model comprised the bilateral placement of control (n=24) and experimental surface (n=24) implants along the proximal tibiae of six mongrel dogs, which remained in place for 2 or 4 weeks. Half of the specimens were biomechanically tested (torque), and the other half was subjected to histomorphologic/morphometric evaluation. BIC and resistance to failure measures were each evaluated as a function of time and surface treatment in a mixed model ANOVA. RESULTS: Surface texturing was significantly higher for the experimental compared with the control surface. The survey XPS spectra detected O, C, Al, and Ti at the control group, and Ca (∼0.2- 0.9%) and P (∼1.7- 4.1%) besides O, C, Al, and Ti at experimental surfaces. While no statistical difference in BIC was found between experimental and control surfaces or between 2 and 4 weeks in vivo, both longer time and use of experimental surface significantly increased resistance to failure. CONCLUSIONS: The experimental surface resulted in enhanced biomechanical fixation but comparable BIC relative to control, suggesting higher bone mechanical properties around the experimental implants.

Effect of Si addition on Ca- and P-impregnated implant surfaces with nanometer-scale roughness: an experimental study in dogs.

OBJECTIVES: To investigate the effect of Si addition on a nanometer-scale roughness Ca and P implant surfaces in a canine tibia model by biomechanical and histomorphometric evaluations. MATERIAL AND METHODS: The implant surfaces comprised a resorbable media CaP microblasted (control) and a CaP resorbable media+silica-boost microblasted (experimental) surfaces. Surfaces were characterized by scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and optical interferometry (IFM) down to the nanometric level. The animal model involved the bilateral placement of control (n=24) and experimental surface (n=24) implants along the proximal tibiae of six dogs, remaining in vivo for 2 or 4 weeks. After euthanization, half of the specimens were torqued-to-interface failure, and the other half was subjected to histomorphologic and bone-to-implant contact (BIC) evaluation. Torque and BIC statistical evaluation was performed by the Friedman test at 95% level of significance, and comparisons between groups was performed by the Dunn test. RESULTS: IFM and SEM observations depicted comparable roughness parameters for both implant surfaces on the micrometer and nanometer scales. XPS analysis revealed similar chemical composition, except for the addition of Si on the experimental group. Torque-to-interface failure and BIC mean values showed no significant differences (P=0.25 and 0.51, respectively) at both 2- and 4-week evaluation points for experimental and control groups. Early bone healing histomorphologic events were similar between groups. CONCLUSIONS: The experimental surface resulted in not significantly different biomechanical fixation and BIC relative to control. Both surfaces were biocompatible and osseoconductive.

Effect of drilling dimension on implant placement torque and early osseointegration stages: an experimental study in dogs.

PURPOSE: Primary stability has been regarded as a key factor to ensure uneventful osseointegration of dental implants. Such stability is often achieved by placing implants in undersized drilled bone. The present study evaluated the effect of drilling dimensions in insertion torque and early implant osseointegration stages in a beagle dog model. MATERIALS AND METHODS: Six beagle dogs were acquired and subjected to bilateral surgeries in the radii 1 and 3 weeks before death. During surgery, 3 implants, 4 mm in diameter by 10 mm in length, were placed in bone sites drilled to 3.2 mm, 3.5 mm, and 3.8 mm in diameter. The insertion torque was recorded for all samples. After death, the implants in bone were nondecalcified processed and morphologically and morphometrically (bone-to-implant contact and bone area fraction occupancy) evaluated. Statistical analyses were performed using the Kruskal-Wallis test followed by Dunn's post hoc test for multiple comparisons at the 95% level of significance. RESULTS: The insertion torque levels obtained were inversely proportional to the drilling dimension, with a significant difference detected between the 3.2-mm and 3.8-mm groups (P = .003). Despite a significant increase in the bone-to-implant contact over time in vivo for all groups (P = .007), no effect for the drilling dimension was observed. Additionally, no effect of the drilling dimension and time was observed for the bone area fraction occupancy parameter (P = .31). The initial healing pathways differed between implants placed in bone drilled to different dimensions. CONCLUSIONS: Although different degrees of torque were observed with different drilling dimensions and these resulted in different healing patterns, no differences in the histometrically evaluated parameters were observed.