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I opinion _ implantology at the University of Freiburg and was then rebuked by the main speaker, who was from the USA, during the ensuing panel discussion. He asserted that he had “not seen one case of peri-implantitis in twenty years of implantology—this phenomenon does not existand,ifitoccurs,itcanonlybeattributedtoalack inskillonthepartoftheimplantologists.”Howtimes have changed. However, trouble-shooting and com- plications in implantology and even the word “fail- ure” have been mentioned in the themes of many congressesheldbyleadingprofessionalassociations of implantology in the past years. _Patients’ expectations While a consistently positive and at times even euphoric tone prevailed regarding the topic of im- plants for many years, a few critical voices and later increasing criticism emerged at the beginning of the observation period. This was—concurrent with a no- ticeable increase in the number of implants—based ontheconsiderableincreaseinimplantologyfailures andcomplications.Thefollowingimagesdepicttotal implantologicalfailure—thelossofapurelyimplant- supported complete maxillary restoration caused by aninfaustperi-implantitis(Figs.15–17),leavingpro- found osseous defects. However, in line with the consistently positive evaluation of implants and the persisting promise thattheuseofimplantswouldyieldoptimumresults always—and often publicised by the lay press—our patients’expectationshaveincreasedconsiderablyin the past 15 years. Patients assumed that, regardless of the individual situation, he or she would always receive the optimum results. In this regard, it seems reasonable to maintain a self-critical attitude and to concede that we did not always contradict this general assumption vehemently enough. And then what was bound to happen, happened: at times, the result was not what the patient had expected. An awkward situation arises when the dentist, based on the initial diagnosis, considers the result to be successful and the patient considers it a failure. A long-time legal expert sums up this situ- ation accurately by stating that, “Two-thirds of all pending court proceedings were filed by patients whose expectations were disappointed.” Rather un- fortunately,theincreasingnumberofcourtproceed- ings are mostly related to implantology. It cannot be by chance that the premiums for mandatory profes- sionalliabilityinsurancehaveincreasedconsiderably. _Emerging criticism German periodontists Dr Thomas Kocher referred to implantology as “the red light district of dentistry”. Whether this evaluation is justified is a matter to be decidedindividually.Personally,Idonotagreewiththis evaluation, but a grain of truth might be found in its referencetoovertreatment.Inthisregard,theextrac- tion of teeth in favour of implants, even when not in- dicated, is a concern voiced increasingly by periodon- tistsandthoseinfavourofconservativetreatment. We have to address this issue by individual evalu- ation of each patient, as well as through academic 20 I CAD/CAM 1_2013 Fig. 19 Fig. 20Fig. 18 Fig. 22 Fig. 23Fig. 21