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24 EDI EDI News group! Systemic diseases have serious repercussions for the prognosis of implant treatments. I keep wondering about results where implant success rates of more than 95 percent are claimed for edentulous patients. I would like to ask the authors of those reports: Were all those edentulous patients 18 years old? Or did you exclude all older patients with concomitant diseases? Of course this effect is particularly pronounced in patients for whom bone augmentation has been planned. Yet in these patients, the best augmentation procedure is the one that is not implemented. What influence does the choice of materials have – the “right” implant or the “right” bone replacement material? An analysis of the patient population and a major study we conducted have shown that, as long as the appropriate protocols are observed, the materials used have no significant influence on success rates. Unfortunately, many oral implantologists have become almost addicted to discussing materials here and properties there. But patient selection, the physiology of wound healing and, most of all, operator skills are much more important. Nerve injuries must be included among the serious treatment errors. Is there any reliable method to avoid them? Many experts have shown us that, while nerve injury may be due to inferior surgical techniques, its main cause will generally be inappropriate treatment planning. Cases abound where the operator deviates from the treatment plan intraoperatively because of unpleasant surprises during implant insertion, such as an insufficient supply of transversal bone. To avoid augmentation, implants are frequently inserted too deeply in these cases. Your department performs sophisticated and demanding procedures such as bone augmentation. At the Expert Symposium, one of the speakers – Prof Khoury – said that there is no augmentation without complication. What will be your focus at the 14 th BDIZ EDI Annual Symposium when it comes to bone augmentation? Complications may occur during any type of augmentation surgery. How frequent they are depends both on the procedure and on the operator. The greater the amount of allogenous material, the higher the infection rate. It is therefore important to do with as little alloplastic material as possible. At this point, the transplantation of autogenous vital bone is still the most valuable procedure from a biological point of view, with the lowest infection rates. What is the relative importance of immediate implant insertion procedures today? The European Consensus Conference 2006 had developed pertinent guidelines. Have we had new insights regarding materials and procedures since? The “fad” of immediate insertion surgery has subsided somewhat as more complications are seen – as many operators have been disappointed to learn. With the exception of the mandibular intraforaminal region, the relevant criteria have not been firmly established. I believe that immediate insertion is rarely indicated for the average patient at this time. I am sure these patients prefer safe, low-risk implant procedures and will opt for the lengthier but more successful treatment once properly informed. Implantation and augmentation procedures often compromise the soft tissues. What possibilities do we have today to avoid complications in this area? Next to augmentation and implantation, the important third element of success is soft-tissue surgery. The operator must determine whether a special soft-tissue technique is required as early as during reentry. If peri-implantitis manifests itself later, vestibuloplasties will often fail to deliver the desired result, and the peri-implantitis and the associated bone loss will proceed. When exposing implants following bone augmentation, special soft-tissue management techniques are required. Apically repositioned flaps play an important role. The flap, when created correctly, will not only create a zone of periimplant attached gingiva 2 to 3 mm in height, but it will allow the operator to shape the vestibulum again. Well, that really arouses our curiosity as to the scientific day in Munich. Professor Zöller, thank you very much for this interview. AWU
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