“Oops! What Now?” – 6th AID Symposium Discusses Challenging Cases from Everyday Clinical Practice (english version)

Zurich, October 20, 2026 – An implant with unexpected bone loss, an extensive treatment whose necessity is questioned in hindsight, and the realization that one might choose a different therapeutic approach today. Under the motto “Oops! What Now? Challenging Cases from Everyday Clinical Practice,” nearly 100 participants gathered for the 6th AID Symposium at Lake Side Zurich to focus on precisely those clinical situations in which things do not go according to plan. Rather than presenting only successful treatment outcomes, complications, difficult decisions, and alternative treatment approaches were openly discussed. Audience members were also invited to contribute their own perspectives and experiences.

Trust, Responsibility, and the Limits of What Is Possible

Dental technician Marco Camin opened the symposium with his lecture “Medicine at the Intersection of Law, Ethics, and Innovation.” He explored the legal and ethical challenges of everyday dental practice and addressed the question of where the boundaries lie between patients' wishes, professional responsibility, and one's own capabilities.

Using a case involving high patient expectations and unfavorable clinical conditions, Camin demonstrated the importance of realistically assessing one's own competence and clearly explaining risks and treatment alternatives to patients. Among other topics, he addressed the concept of professional negligence arising from undertaking treatment beyond one's competence, which can occur when clinicians perform procedures for which they lack the necessary knowledge or experience. However, excessive reluctance due to fear of liability claims can be equally problematic. In this context, Camin discussed defensive medicine and emphasized the importance of clear patient communication and shared decision-making.

The subsequent discussion also addressed collaboration between dentists and dental technicians. What happens when a laboratory case cannot be carried out responsibly under the given circumstances? Camin made it clear that such situations must be addressed openly. Rather than looking for someone to blame, everyone involved should work together to find solutions.

Preserve or Remove the Implant? Not Always a Clear-Cut Decision

The interactive case discussions demonstrated just how differently complex clinical situations can be assessed. Moderated by Ueli Grunder and Quirin Döbelin, Claude Andreoni, Vivianne Chappuis, Karin Wolleb, Kilian Troxler, Lucia Zaugg, and Luca Vaglio presented challenging cases from their daily practice. The discussions were by no means limited to the expert panel. Participants had the opportunity to ask questions, share their own experiences, and contribute their perspectives on the cases presented.

The very first case sparked a lively exchange: During the uncovering of an implant that had not yet been restored prosthetically, unexpected bone loss was observed around the implant shoulder, leaving parts of the implant threads exposed. What now? Should the implant be removed and a new one placed after an appropriate healing period? Or should an attempt be made to preserve it through decontamination and augmentation procedures?

Opinions differed. While some experts favored implant removal because of the unclear cause and potential risks to the long-term prognosis, others pointed to the additional risks of removing an implant when limited bone remains. However, the discussion went beyond surgical options. Equally important was the question of how to explain an unexpected complication to a patient when the clinician may not fully understand its cause. On this point, the participants agreed: Transparency with the patient and thorough documentation are essential.

When Circumstances Change Over Time

Another case from clinical practice illustrated how even a long-standing, functioning implant-supported prosthetic restoration can present new challenges. A patient whose extensive implant-supported anterior restoration had functioned well for many years developed peri-implant complications with pronounced bone loss around one implant after approximately 20 years. In the meantime, her overall health had deteriorated significantly, and regular follow-up care had become considerably more difficult.

Various treatment options were weighed against one another during the discussion, ranging from nonsurgical and regenerative approaches to implant removal. Additional considerations included the patient's health limitations, her reservations about undergoing further extensive procedures, and the uncertain prognosis of the different treatment options. The treating team had ultimately decided to remove the implant. Following alveolar ridge reconstruction and an appropriate healing period, a tissue-level implant was placed.

However, the case raised a question that went beyond the complication itself: Should existing prosthetic restorations be adapted over time? After all, a restoration that could be cleaned without difficulty for many years may no longer be as manageable for a patient who has grown older or whose health has declined. Opinions among those present also differed on this issue.

Was the Chosen Treatment Approach Really Necessary?

Particularly insightful were the case presentations that focused not on a complication, but on critically reviewing a treatment that had already been performed.

One case involved a young patient with an extensive bone defect in the mandible. Following surgical bone augmentation, the missing tooth had been replaced with a resin-bonded bridge, without implant placement. Among other questions, the discussion focused on whether such extensive augmentation had actually been necessary given the type of restoration ultimately chosen. Alternative, less invasive treatment concepts and autogenous tooth transplantation were also discussed.

Another case presentation involving advanced root resorption in the anterior region prompted a similar discussion. The treating dentist had opted for a staged approach with delayed implant placement and subsequently questioned whether immediate implant placement might also have been possible, potentially shortening the treatment duration for the patient. The presenter also openly reflected on how her training and experience up to that point had influenced her decision to follow the approach chosen at the time.

It was precisely these insights into the reasoning and uncertainties behind treatment decisions that made the exchange particularly interesting. Even when the outcome is satisfactory, it can sometimes be worthwhile revisiting the chosen approach.

Preserve, Correct, or Provide a New Restoration?

Further cases highlighted the extent to which patients' individual circumstances and preferences can influence treatment planning. In one patient with peri-implant complications, the existing prosthetic restoration was difficult to clean. As the patient wished to avoid another implant placement procedure, the treating team opted for an implant-preserving treatment attempt involving decontamination and regenerative procedures. Whether this approach would achieve stable long-term conditions remained uncertain at the time of the presentation.

The management of a complex anterior dental trauma case also prompted an intensive discussion about the appropriate course of action. The experts explicitly cautioned against prematurely extracting traumatized teeth. Instead, options for repositioning, stabilization, and tooth preservation should be carefully evaluated.

Further case presentations addressed esthetic complications following long-standing implant treatment and demonstrated the importance of soft tissue management and the design of provisional restorations for treatment outcomes.

Questioning, Discussing, and Learning Together

Not every question at the 6th AID Symposium had a clear answer. Opinions differed on some cases, while previously completed treatments were critically reassessed in others. The speakers' openness in acknowledging their own uncertainties, together with the audience's questions and contributions from personal experience, made the discussions particularly engaging.

True to the motto “Oops! What Now?” the symposium provided a setting for honest, practice-oriented exchanges of experience. In particular, discussions about unexpected treatment courses and potential solutions opened up new perspectives and offered valuable insights for everyday clinical practice. In doing so, the event underscored one of AID's core goals: fostering collegial exchange, sharing experiences, and learning from one another.

Autor: Loreen Plankensteiner