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Chapter 8228The formation of viable osseous tissue within the ramal scaffold that was seen during the histological analysis, as well as the ramal integration that was seen during the radiological analysis(16), proved that a good osteoconductive, -inductive and biocompatible environment was achieved. Despite these good ramal results, we found or only a limited amount of osteogenesis within the subcondylar scaffold and an absence of proper osseointegration of the LPM. Several possible reasons can be found as to why a fibrous, rather than osseous reinsertion of the LPM enthesis occurred.In order for osseointegration to occur, not only implant properties have to be considered. The implant environment needs to be both sufficiently osteogenic (i.e. sufficient mesenchymal stem cells, osteoblasts and osteocytes ) and osteoinductive (promoting the differentiation of stem cells).(39,40) Fig. 6: Lateral pterygoid muscle (LPM) insertion. Blue arro LPM fibers Red arro Muscle tendon Green arro Haversian canals within enthesis Considering the periosteum and bone marrow near the enthesis-scaffold junction were removed during the ostectomy, a reduced amount of mesenchymal cells has likely been present in this area. Those cells are essential to differentiate into (pre)osteoblasts(39,40), and therefor Nikolas de Meurechy NW.indd 228 05-06-2024 10:14