With an array of dental implant options and a variety of dental literature indicating different therapeutic protocols, there is no evidence that decision making for the selection of appropriate dental implant products is truly objective. But the underlying science in treatment states that the biomechanical, surgical, and prosthetic guidelines must exist for the success of dental implant procedures.

A lot of the fundamentals were questioned today as all presentations tried to address the challenges in current dental practice. For example, there is an existing perception that using high insertion torques to deliver high primary stability guarantees a higher success and greater predictability in osseointegration. Whether this is based on any clinical or biological validation is in question as manufacturers offer different sizes of dental implant diameters, but often don't recommend different insertion torques for each size. This may be one of the flaws in implant dentistry because insertional torque has a great impact on primary stability. This is especially true since primary stability should be evaluated by not just subjective evaluation, but also the peak insertion torque (PIT), perio-test and resonance frequency analysis measured by implant stability quotient  (ISQ). But today, Dr. Norton illuminated dentists on the fact that the goal in implant dentistry is not primary stability, but rather an early onset secondary stability with optimal bone response. Dr. Norton's talk was convincing to me as the transition from primary to secondary stability is moving the conversation from mechanical to biological reactions of the body, and intuition can tell anyone that the latter is more important.

In addition to this controversial view, there were also presentations that questioned the difference in implant length, height, and diameter as well as the difference in particulate bone grafts. Dr. Zadeh elaborated on how to identify appropriate case selection criteria for the application of reduced dimension implants. His presentation was informative on how the survival rate of a dental implant is not necessarily dependent on the length of a dental implant. Because the occlusal stress associated with a dental implant is only imposed on the crestal portion, the length of the dental implant is negligible in terms of withstanding the associated stress. Consequently, the survival rate of the short and long dental implants was similar. Then what differentiates these two. Case selection. It was found that short implants had a higher failure rate for immediate loading. Meanwhile, Dr. Reynolds gave a evidence-based review and comparison of particulate bone grafts with the emphasis placed on how clinical parameters are important in guiding the selection of regenerative material.

Day 2 at the AO Annual Meeting seems to indicate that there is always science behind every treatment and that the fundamentals can easily be overlooked. However, there is always room for increases in efficiency, even if the evidence for the survival rate of dental implants today is compelling.

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