## 4 Discussion  
This case-control study experiment showed no statistically significant differences among the DBBM intentionally uncovered in the oral cavity or sealed by the collagen matrix in the change in alveolar bone dimensions, including width and height, from baseline to 4 months post implant placement. Therefore, the null hypothesis of no difference  
\begin{table}
\begin{tabular}{c c c c c c c c c c} \hline \hline
**Bone** & \multicolumn{3}{c}{**B**} & \multicolumn{3}{c}{**BM**} & \multicolumn{3}{c}{**AB-BM**} \\
**Level** & & & & & & & & & \\ \hline \multicolumn{2}{c}{**T1 \(\pm\) SD**} & **T2 \(\pm\) SD** & \(\Delta\)**T1-T2** & \(p\)**-Value** & **T1 \(\pm\) SD** & **T2 \(\pm\) SD** & \(\Delta\)**T1-T2** & \(p\)**-Value** & \(\Delta\)**B-BM** & \(p\)**-Value** \\ \hline \multicolumn{2}{c}{**BUCCAL HBT**} & & & & & & & & \\ \hline
**0** & 2.44 \(\pm\) 0.51 & 1.70 \(\pm\) 0.45 & 0.74 & 0.285 & 2.74 \(\pm\) 0.51 & 1.63 \(\pm\) 0.45 & 1.11 & 0.112 & 0.06 & 0.923 \\ \(-\)**1**  
between healing groups was accepted, which lends positive support to the utilization of the DBBM exposed to the oral environment in clinical practices under specific circumstances as outlined in this study. Immediate implant insertion to fill the gap with grafts resulted in 0.59 mm less horizontal bone loss [10]. The buccal bone wall thickness (>1 mm) [7; 12] and the larger horizontal gap significantly influenced a reduction in hard tissue alteration [12; 17]. In the present study, given that it involves a molar area, the patient profiles have these two characteristics, in which the mean initial thickness on the buccal side, at reference 0, was 2.44 \(\pm\) 0.51 mm for B and 2.74 \(\pm\) 0.51 mm for BM, all exhibiting a thick phenotype, which may contribute to HBT stability. It is important to highlight that in this study, an implant was used to replace the third molar in a single patient. However, this was a specific case, despite being an unusual procedure, where the patient had the presence of the antagonist tooth and expressed a desire for such a treatment. In the present investigation, horizontal buccal bone changes above the RL, in mm, from baseline to 4 months postoperatively in B were 0.74, 0.44, and 0.20; and in BM were 1.11, 0.92, and 0.70; for line 0, \(-\)1, and \(-\)2, respectively. The findings of this study are consistent with the existing literature, and also in molar area and the same implant type in a follow-up from 1 to 5 years, which showed changes above the RL that were 0.84, 0.55, and 0.15 mm [3]. Furthermore, according to another study [22], a notable horizontal bone alteration (0.88 \(\pm\) 0.25; \(p\) < 0.05) was observed at the most cervical level. These disparities could be impacted by the positioning of the reference line and the large implant and cap, reducing the gap and providing little space for the DBBM and socket overfilling. The vertical dimension changes from the most coronal measurement at the buccal side were 0.74 \(\pm\) 0.32 mm [22] and 0.18 \(\pm\) 1.82 mm [3]. In a meta-analysis, buccal bone height changed ranging from 0.1 to 1.3 mm after immediate implant placement with socket grafting [10]. Our results are consistent, with vertical bone levels less than 1.00 mm, with no difference in the treatment group, specific to bone remodeling [23], as no bone loss occurred below the RL. The initial gingival tissue thickness (more than 2 mm) on placed implants is important to maintain crestal bone level [23; 24; 25]. Our results did not show a linear correlation between vertical soft tissue measurement and vertical bone level, possibly due to the average soft tissue height among patients being consistently close (2.25 \(\pm\) 0.48 mm), with a tendency toward a thick phenotype; additionally, the small sample size for this analysis may have influenced the outcome. One of the major concerns regarding leaving the DBBM exposed is the biomaterial becoming contaminated, leading to surgical procedure failure.